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                    Thanks to Ali J for permission to use this Photo.

Health 2.0, like its’ older cousin Web 2.0 and uncle Web 3.0, is getting more and more attention. My colleague Bonnie Andersen pointed out the December 11 Modern Healthcare article, in which the magazine describes the three most important principles of what a Health 2.0 company or application is. 
 
The first principle is the software of a Web 2.0 company has to be Web-based, has to provide a service and that service has to be structured  so that the more people use it, the better it becomes. An example is eBay; as more and more buyers and sellers participate, the broader the eBay  market becomes, which creates more value to the customer. 
 
The second key principle is “harnessing collective intelligence,” which  also is referred to by others as “the wisdom of crowds.” To avail  themselves of this wisdom, Web 2.0 developers must create applications that  are dynamic, with user participation designed into the systems, so that  participation itself becomes an integral part of making the underlying  database more valuable. 
 
The third principle, “Data is the next ‘Intel inside,’  notes that  specialized data, enhanced through analysis performed by the service  provider as well as by the contributions of service users, becomes the core  asset of a Web 2.0 company. Amazon wish lists, for example, are aggregated by Amazon and used as buyer’s guides.
 
Matthew Holt of the Healthcare Blog and co-founder of the Health 2.0 conference is looser in his definition, placing the qualifying emphasis on whether the service or application promotes the healthcare experience as an “ongoing process” rather than a “series of episodic events.”

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Many parents have said yes. David Healy, a Scottish psychiatrist, prompted by those stories, did a small experiment in which undepressed persons took anti-depressants. About 10% of them started having suicidal thoughts. Drug companies and the University of Toronto (where Healy had been offered a job) reacted very badly to this information, as Healy describes in Let Them Eat Prozac. An article in the latest issue of the American Journal of Psychiatry by David Leon, a biostatistician on the FDA oversight panel, describes why he voted to extend a warning about this from children (< 18 years old) to young adults (18-24 years old). This was the main data:

What’s shown is the odds ratio for a report of suicide ideation or behavior, comparing those who got anti-depressants with those who got placebos. (more…)

              Thanks to Gwen Harlow for permission to use this Photo.

Oxidative stress has been identified and proven to be the root cause of more than 70 chronic degenerative diseases such as heart disease, cancer, stroke, diabetes, Alzheimer’s dementia, Parkinson’s disease, macular degeneration and other serious ailments, according to Dr Ray D. Strand, an expert on nutritional medicine.

Oxidative stress occurs when free radicals, which are not neutralized by antioxidants, go on to create more volatile free radicals and damage cell walls, vessel walls, proteins, fats and even the DNA nucleus of our cells.

The part of the body which receives the most free radical damage will be the first to wear out and potentially cause a degenerative disease. The type of disease will depend on which part of the body is affected.

“Imagine yourself in front a crackling fireplace. The fire burns safely and beautifully most of the time, but on occasion, out pops a hot cinder that lands on your carpet and burns a little hole in it. One cinder by itself doesn’t pose much of a threat, but if this sparking and popping continues month after month, year after year, you will have a pretty ‘ratty’ carpet in front of your fireplace,” Dr Strand explains.

Referring to his analogy, Strand says that the fireplace represents the furnace of the cell (mitochondria), the cinder is the charged ‘free radical’ and the carpet is one’s body.

The part of the body which receives the most free radical damage will be the first to wear out and potentially cause one of these degenerative diseases. If it is our arteries, one could develop a heart attack or stroke. If it is our brain, one could develop Alzheimer’s dementia or Parkinson’s disease. If it is our joints, one could develop arthritis. (more…)

                 Thanks to Gianni for permission to use this Photo.

Daniel Carlat, of the Carlat Report, has an article in the New York Times Magazine.  It’s six pages long, and decidedly anti-Pharma.  But Daniel Carlat isn’t from New York– so why would he have an article published there?

You say: well, where he’s from has nothing to do with it, the New York Times is publishing it because of what he says.

Exactly.

His article, well written and persuasive, stands as is, undisputed because there is no forum in which to dispute it.  I guess it would be nice if the Times would allow me to write an op-ed– you know, in op to the ed– but I guess this blog will have to do.

Carlat is wrong, very wrong, not because he is factually incorrect about his target, but because his target is a straw man.  The problem isn’t Pharma.  It’s doctors.

The article, called Dr. Drug Rep, chronicles his introduction into the world of lecturing for drug companies– a company hires you to give a talk about a topic or drug to a bunch of doctors– and the effects of the lecturing on doctors and himself, and then his pulling out.  For context, Carlat is a fairly famous psychiatrist blogger who is both a sort of watchdog of Pharma, as well as a source of information about psychiatric drugs. 

The general message is that Pharma softly manipulates doctors to act as proxy drug reps, which in turn lends credibility/celebrity endorsement to the Pharma message, and thus influences other doctors to prescribe the medicine.  Ok, I hear you.  I have no beef with Carlat, his point is not unique.

But break it down:

So we don’t want doctors lecturing about the drugs.  Okay.  Well, who do we want?  More reps?  Here’s where it all falls apart, and I defy anyone to contradict me: doctors aren’t studying these drugs on their own. (more…)

 
                Thanks to Timo for permission to use this Photo.

Two years ago I guest-blogged at the Freakonomics blog about diet and acne. I wrote that the claim of dermatologists that there is no link between diet and acne was absurd, not only because I had seen for myself such a link but also because it was an impossibly broad generalization.

In an article in the Boston Globe, Cynthia Graber, a science journalist, describes quite a bit of evidence that yes, diet affects acne. The research on which the no-link claim was based tested only two foods (chocolate and sugar)! From which committees of dermatologists generalized to all foods.

SO WHY HAVE DOCTORS been taught for so long that there’s no link? The anti-diet hypothesis . . . arose solely from two studies from the late 1960s and early 1970s. . . . One compares real chocolate bars with fake ones and was conducted at the University of Pennsylvania School of Medicine with funding from the Chocolate Manufacturers Association. . . . The other study examines sugar in the diet of a small group. (more…)

 
              Thanks to Jack Lyons for permission to use this Photo.

Not being a clinician myself, I often rely on my students and readers to make sure I don’t miss important developments. Pete Quily, an adult ADD coach, brought the issue of mental health parity to my attention. Thanks for the heads up, Pete!

What is mental health parity? This is an effort to make health insurance coverage of mental health conditions more in line with coverage of medical and surgical services.The Senate passed S. 558 unanimously on September 18, and now the House is considering H.R. 1424 . I encourage you to read about these bills. Click here for another useful description of mental health parity from the US Department of Health and Human Services. There are a number of tables that show the current status of mental health parity in the US.  This pie chart is from the SAMHSA site as well. (more…)

 
                Thanks to supergiball for permission to use this Photo.

On the surface, it seems that American voters have made their will clear.  Poll after poll shows that they are calling for a major overhaul of our health care system.  But when you look closer, their responses bristle with contradictions, contradictions that I think the reform-minded presidential candidates will have to consider when deciding how to approach health care reform. 

In a poll reported in Health Affairs at the end of last year, sixty-nine percent of respondents rated the US system as “fair” or “poor.” Yet in the same survey, when asked about their own experience with receiving medical services or with their own physician, 80 percent who had received care in the last year ranked their care as “excellent” or ”good.”  Other polls reveal the same pattern.

According to a survey released by Greenberg Quinlan Rosner in July, voters express doubts about the quality of the American health care system (with 49 percent dissatisfied), while 74 percent were dissatisfied with the cost.   Yet, “at another, more personal level,” the pollsters note, “a slightly different picture emerges. Fully eight in ten (82 percent) describe themselves as satisfied with the quality of the health care they receive personally. This number jumps to 90 percent among seniors (64 percent very satisfied), but includes impressive majorities of nearly all groups…”

Nevertheless, when the pollsters asked the same group about health care reform, three-quarters called for “major changes” or “completely rebuilding” the system.  If they are satisfied with the care they are receiving, why would they want radical change? Because they don’t feel secure that they will be able to keep what they have:  “There’s a precariousness to Americans’ contentment with their own health insurance coverage,” the Kaiser Family Foundation reported after looking at a number of polls at the end of last year.  “Among the insured, six in ten are at least somewhat worried about being able to afford the cost of their health insurance over the next few years, and nearly as many (56 percent) said they worry that by losing a job, they or their family might be left without coverage.”

This, then, is why so many Americans want universal health care: it would guarantee that they and their families would always be covered. (more…)

            Thanks to 416style for permission to use this Photo.

It’s been widely reported that oncologists are still trying to find ways to profit from treating their patients with expensive drugs, even though Medicare has cracked down on such profits two years ago (by limiting the markups docs can charge to 6% above the cost of the drug).

Doctors can get around the limitations in reimbursement by simply offering drugs to more patients, whether or not they’ll benefit from them. (more…)

Here’s a nice essay about the Women’s Health Initiative, a nine-year mega-million-dollar experiment to measure the effect of “healthy eating” especially a low-fat diet.  The results are quite interesting. (more…)

 
           Thanks to Megan Walton for permission to use this Photo.

For the past year, progressives have begun to talk about health care reform as if it is inevitable. Listen to the Democratic Party’s presidential candidates, and it seems just a question of what form the health care revolution will take, how quickly it will happen, and how we’ll finance it. After all, the polls show that the majority of taxpayers, employers and even most doctors want to see a major change.  Moreover, health care research shows that if we cut the waste in our system, we could fund universal coverage. What, then, is stopping us? (more…)