Thursday, November 25, 2010

Health Care Update News

The Health 2.0 public option - Ano Lobb

Justmeans health writer and RAND researcher Sam Werthheimer recently reported on interesting trends from the Health 2.0 conference in San Francisco.  Just because the conference was dominated by private ventures,  however, doesn't meant that governments aren't also trying to apply web 2.0 to improve health delivery.

US health reform efforts are banking on effective health information technology (IT) as a means for improving the efficiency, quality, and value proposition of health care delivery.

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Facebook triggers asthma -  Ano Lobb

Can Facebook trigger asthma attacks? Apparently so. Italian doctors report in The Lancet on a new and previously unreported health risk associated with the ubiquitous social networking site: Asthma.

Sound crazy? Granted, the headlines are catchy and trying to ride the wave of social-media. But the details actually make sense. The case-report discusses an 18-year old man with asthma who was distraught after his girlfriend un-friended then broke up with him. After gaining access to her facebook page, he saw that she had friended several new young men, then had an asthma attack.

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Health 2.0 Company Launch Review Part 1 - Sam Wertheimer

The term "Health 2.0" describes the interface between web 2.0-inspired technology and health care. The sector is growing rapidly as patients search for ways to navigate the health care system and companies - both large and small - race to serve consumer needs. The annual Health 2.0 Conference in San Francisco (Health 2.0 SF) brings many of the key players under one roof. This year I joined the gathering to learn more about the entrepreneurs, innovators, and consumers doing good work in the Health 2.0 sector.

Among the highlights of the conference were launches of new Health 2.0

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Health 2.0 Company Launch Review Part 2  - Sam Wertheimer

Sharecare is WebMD plus facebook. The site aims to help patients make healthy decisions by interacting through social media applications with registered health care "experts." These experts are vetted by Sharecare and include health care providers, advocacy groups, and corporations. Consumers can search the site by topic, enter particular health care questions, or browse their favorite expert's pet subjects. They can also use the facebook "like" button to endorse helpful health care advice and become friends with the experts who provide the tips.

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Smart health care=Innovation - Ano Lobb

Basic sciences are increasingly being applied in innovative ways to address some fundamental health care problems. Applied chemistry has combined paraffin and dye to potentially double the effectiveness of blood tests used outside the clinic. Improving the accuracy of home-based health tests has benefits beyond the obvious improvements in accuracy: When appropriately used they also reduce demand on health care resources by potentially keeping people away from unnecessary clinical encounters, and by bringing the test to the person they are the embodiment of patient-centered care.

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Friday, October 8, 2010

Health Care Weekly Updates - Justmeans

Commonwealth Games vs. Common Health goals in India - Ano Lobb

Along with the expected fanfare accompanying the opening of the Commonwealth Games in New Delhi, India this weekend there was a generous serving of controversy. While there are many good reasons for skeptics to raise concerns, this post will briefly consider three: Public health, dengue fever, and malaria.

Bluntly stated, health equals wealth. More specifically, greater inequalities in national distribution of wealth are correlated with worse measures of population health. Rapid economic gains in India have not been shared by all; one telling statistics is that the personal wealth of the richest 49 Indians accounts for a whopping 31% of India's entire gross domestic product, according to the newspaper Financial Express.

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Race (still) Matters: Innovation needed to tackle health disparities - Ano Lobb

A recent posting looked at a new study of health technology being overused in breast cancer care.  Another study presented this month at the American Association for Cancer Research Conference sheds light on the importance that race plays in health outcomes, regardless of insurance status.

Assistant Professor Heather Hoffman and colleagues from George Washington University's School of Public Health performed a retrospective analysis of 983 women who underwent breast cancer examinations at six hospitals in Washington D.C. They measured diagnostic delay, the span of time between the detection of a breast abnormality and a definitive diagnosis, for women who were white, African American, or Hispanic, stratified by whether they were insured or not.

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Is questionable medical information technology putting patients at risk? - Ano Lobb

There's been a lot of good news in cancer care lately: The American Cancer society recently reported a decrease in cancer deaths, medical information delivery harnesses technologies such as interactive patient-information kiosks, and nano-technology verges on a breakthrough for more targeted treatments. All of these, combined with more vigorous prevention and detection efforts and more effective standard treatments has helped to make cancer an increasingly survivable journey.

Technology, however, is not a panacea. A striking example is the increasing usage of computer-aided detection (CAD) for both screening and detection mammography. Rather than depending on the seasoned eyes of radiologists, CAD uses a computer program to analyze radiographic images.

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The Evolution of Primary Care: Part 4 - Sam Wertheimer

Delivery of primary health care services in the U.S. used to involve a physician and a patient. The physician would see the patient in a clinic, conduct an examination, enter notes in a paper record, prescribe a follow up appointment, and say goodbye until the next scheduled visit. Usually this process occurred within a 15-minute window arranged by the physician's front office staff. Although this type of health care visit still occurs, it is fast becoming an exception to the new rules of primary care. This column, the fourth in a series on the players changing primary care, focuses on non-physician health care providers.

One of the targets of change in the evolution of primary care is the 15-minute visit. This is because many find visits this short do not allow enough time to provide comprehensive health care.

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Wednesday, May 5, 2010

Health care conundrum: When cancers are harmless

A new paper in the Journal of the National Cancer Institute raises an interesting health care conundrum for cancer care: up to 25% of breast cancers, 50 of lung cancers, and 60% of prostate cancers that are detected by screening may represent overdiagnosis. This is not a radical new finding made in haste, the authors, one of whom was my biostatistics professor in grad school, have in fact been studying this phenomenon for decades. But it is a finding that raises especially interesting challenges in how we perceive, screen for, and treat diseases.

What the paper found was that in those cases and frequencies mentioned above, cancers detected very early would, if left untreated, never develop to cause symptoms or threaten health, and the patient would die of some other, non-cancer related cause. How is this possible? Two forces conspire to create the quandary: The amazing power of our bodies, and the amazing power of technology. On the one hand, screening technologies are getting so good that we are able to locate ever-smaller abnormalities that fit the general definition of being “cancerous.” And yet we are finding that in many cases, the body is able to detect and destroy aberrant cell growth on its own in a not-insignificant percentage of cases. So we are increasingly able to detect and label as cancer abnormalities that the body is often able to neutralize on its own, or that would never grow to a life-threatening stage.

Is there harm in treating something, even if it wouldn’t have turned deadly? In short, yes. Cancer treatment is never a nice experience, and may involve radical surgeries, such as breast removal, and of course powerful chemical and radiation treatments. In some cases the treatments themselves result in death or new cancers. And there’s also the stress, fear and discomfort involved.

The health care conundrum occurs when deciding how to use this information. The authors of this new paper call for more research, as well as carefully informing patients of the possibilities and likelihoods that their cancer’s may not actually be life threatening. The trouble, of course, is that we can’t yet tell the harmful abnormalities from those that might kill us. What fascinates me is, even if informed of the possibilities that a potential cancer is harmless, how would I respond? How would you respond? Would this new knowledge give you some hope, sway you to opt for a less aggressive approach? Would it further confuse you and ad to the stress of the decision making process? We have been raised in a world that wages wars on cancer, and malignancies constantly rate among the most frequent causes of death. Is it possible that we know a lot less about this thing called cancer than we’d lke to admit? It appears so.

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The best diet? Try changing your environment

It’s no mystery that many of us struggle to lose weight on the quest for health. And its not that the knowledge or theory of weight lose is so difficult, it’s factors like discipline and convenience that generally sink our best intentions. For many, unhealthy eating verges on an addiction. After all most of us understand the numbers game of weight lose: Eat more calories than you burn, and you gain. Burn more than you eat, and you lose. Tomatoes: Good. French fries: Bad.

Now new research is putting some evidence behind a possibly more effective approach: Changing your environment. Researchers from the Cornell Food and Brand Lab performed a small study in 200 folks aiming to improve their health through weight loss. Participants were put into three groups and given instruction of either 1. Changing their environment, 2. Changing their eating behavior or 3. Changing their diet. After three months the winners were folks in group 1. In fact, they lost 1 to 2 pounds per month per “environmental change” tip. What kind of tips dropped the pounds? Simple things like using smaller plates, moving or removing candy dishes, rearranging their cupboards, abstaining from watching tv or surfing the internet while eating.

The single biggest key was consistency, and after sticking with a routine for 20 days, people were pretty much on track for the rest of the month. The researchers note that such behavioral changes are easier to follow than advice such as “eat more fruit” or “stop eating fried foods.” And another new study from the same researchers adds further support for our strange food choices we make in the name of health. In a separate study they found that people eating fattening foods such as cookies that were labeled “organic” underestimated their calorie count by 40%. They call this the “health halo,” the perception that a healthy label such as “vegetarian” or “organic” adds intrinsic healthiness to a food. Their advice when it comes to such healthfully labeled treats?

“Take your best guess at its calorie count. Then double it. You’ll end up being more accurate, and you’ll probably eat less.” Calorie counting may not always be the best way to lose weight, but when it comes to sweets and treats, its worth at least pondering how many minutes on the treadmill you’ll need to burn off those empty calories, since they provide no other meaningful benefits to human health.

Photo credit: The author

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Friday, April 30, 2010

Obama Administration Discusses Lessons Learned from Swine Flu

Public health officials did much to alleviate spread of swine flu in 2009, but more needs to be done.

Too many people still mistrust vaccines – health care providers included – and vaccine production technology needs a shot in the arm. That’s the takeaway from the swine flu experience of 2009, U.S. Health and Human Services Secretary Kathleen Sebelius said last week at the 44th National Immunization Conference in Atlanta. And while communication systems were strong during the early days of the swine flu outbreak, more needs to be done to reach out to some communities, especially minority communities, and above all physicians, Sebelius said.

“We shouldn’t have to convince health providers that vaccines are safe and that they work. But, despite the fact that we had more health providers than ever getting vaccinated last year, there was still a sizable number who did not. We need providers on the front lines. We need to make sure that the vulnerable people they work with aren’t at greater risk,” Sebelius said.

Sebelius’ address comes one year after the panic of last April, when public health officials were still puzzling out the new, aggressive strain of flu that had clearly invaded the New York City public school system. Later dubbed swine flu, the virus appeared to hop-scotch over typical influenza victims – the elderly and those with compromised immune systems – and instead was striking down and even killing young, otherwise healthy people and pregnant women with a vengeance.

The unknowns surrounding the swine flu – and the rapidity of its spread – created simultaneous panic over its origins and effects and suspicion over the vaccine that arrived on the scene. The World Health Organization declared an official pandemic in April of 2009, and has since had to defend itself against accusations that the declaration was motivated by a desire to enrich the pharmaceutical companies that were working on the vaccine. Too many people, including those whose medical conditions made them susceptible to swine flu complications, refused to take the vaccine out of fear it had been rushed and had not been properly vetted. Sebelius’ own agency, the HHS, had to admit that original estimates of the country’s ability to produce the vaccine had been overstated. This in particular is troubling to Sebelius, who used the confusion around vaccine production to illustrate the need for better vaccine production methods.

“This flu season has made us even more committed to ensuring that vaccine production—and all of our medical countermeasures—are state-of-the-art. Our experience with the ups and downs of the vaccine manufacturing process has made clear the need to enhance our country’s influenza vaccine manufacturing capability,” Sebelius said, adding the HHS was already working with vaccine companies to move past the “egg-based” technology, in which vaccines are basically grown in eggs, to more advanced and reliable method.
Sebelius is right. We need to learn the lessons provided in 2009 and then do it better next time. Some southern states are already showing swine flu activity, though it’s too soon to know if that will develop into a true outbreak. But if and when swine flu does return in greater numbers, we want there to be plenty of vaccine to give, and plenty of people willing to receive it.

Photo Credit: Justin Hourigan

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Tuesday, April 27, 2010

Patents in health care: Fuel for innovation or secretive black box?

Exclusive patents in the biotech, pharmaceutical and chemical realms of health care can foster collaboration, increasing the speed at which new products come to market. This according to an analysis of 200 exclusive patents by publicly traded firms just published in Strategic Management Journal. But there does appear to be at least one exception to this rule, according to other new research: Genetics.

Evidence supporting patents finds that rather than locking away potential innovations in a black box of exclusivity, such contracts encourage partners to throw their full weight behind projects, since they know that their efforts won’t be undercut by a faster moving competitor. The authors acknowledge that some discoveries can have multiple future applications, and recommend very narrowly crafted agreements that leave open the possibility of taking other product variations to market at a future date, perhaps with other collaborators.

Another new report published in Genetics in Medicine, suggests that the opposite is true for health care applications of genetic discoveries. After reviewing genetic tests for 10 conditions, the authors report that patent holders, who are generally academic entities supported by governmental research grants, were never the first to market with innovative applications of their genetic patents.

Of course, when it comes to genetic testing it might not matter when you consider that not a single genetic test has yet been shown to increase length or quality of life. They have been shown to land health care researchers in shaky political and cultural grounds, however. Academic researchers recently found them on the wrong side of a judge’s order after using genetic material gathered from a Native American tribe to link tribal ancestry to Asian populations. The tribe claims that they were not provided with adequate informed consent, and were outraged that genetics were used to disprove the creation myths that are central to their self-identity and that clearly identify their current tribal land as their place of origin. While the researchers fall back on the argument that they are merely increasing knowledge for the good of all humankind, accidently “disproving” a creation myth in the name of health care is at very least an exercise in poor public relations.

Genetic research unveils at least two fallacies of science: 1. That there is no opportunity cost. In other words, that we couldn’t use the resources being poured into “knowledge for knowledge’s sake” into practices proven to improve health; and 2. That not moving forward means moving backwards. While its argued that halting genetic research could miss chances to cure disease, leaving all of use worse off than we currently are, the fact is genetic research has to date not improved our lives. Then there’s the creepy sensation that you might get from the idea that a corporation can patent something that is naturally created in your body, and is fundamental to your identity as an individual.

Photo credit:
The author

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Monday, April 26, 2010

Volcanic ash cloud poses no health threat

The volcano that has critically injured the airline industry poses no real threat to human health.

We like to celebrate good health news here at Justmeans, so I’m pleased to say that despite the billion or so dollars that pesky Icelandic volcano has caused the airline industry, it apparently isn’t causing a whole lot of health problems for humans. A report from the World Health Organization (WHO) says that because the bulk of the ash is so high in the atmosphere, it isn’t expected to cause a lot of trouble on the ground - unless winds shift and cause localized, regional problems.

According to the WHO, it’s the size of the particulate matter of the ash cloud that counts. The most dangerous particulates are those that are smaller than 10 microns in size, because they can reach deep into the lungs and embed there. That can potentially cause far-reaching health problems. About one-fourth of all the particulate matter of the Icelandic ash cloud is that small, according to Dr Maria Neira, Director of Public Health and Environment Department at WHO.

Still, the WHO is encouraging people, especially those with chronic respiratory conditions like asthma, emphysema or bronchitis, to keep a close eye on the ash cloud and an ear tuned to their local health authorities. "Since the ash concentration may vary from country to country depending on the wind and air temperatures, our advice is to listen to local public health officials for the best guidance for individual situations," says Neira. "If people are outside and notice irritation in their throat and lungs, a runny nose or itchy eyes, they should return indoors and limit their outdoor activities."

The ash cloud was born last week, when a volcano belched a mass of smoke and ash into the air. That cloud drifted over much of Europe and grounded thousands of flights. Analysis has shown that the ash cloud particles consist mostly of quartz and glass. Health authorities have also found aluminium, silica and oxygen, as well as some fluoride.

Officials with the World Health Organization say the concentration of particles that may reach ground level is likely to be low and should not cause serious harm. Most of the ash that might reach the ground is likely to be too big to inhale into the lungs, but could irritate eyes, nose and throat. Remaining indoors will diminish the risk of these symptoms, since closed doors and windows will partly prevent penetration of the larger, irritating particles inside buildings. How has the ash cloud affected you?

Photo Credit: NASA Goddard

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