AU Blogspot

                   Thanks to Bethany for permission to use this Photo.

Last week, I appeared on a four-person health care panel that was televised in New Hampshire.  The panel included a conservative who surprised me by arguing that the difference between the progressive candidates’ proposals for health care reform and the conservatives’ position on health care just isn’t that great. Looking at the candidates’ proposals, I disagreed.  Put simply, the conservatives would like to make government smaller. They want to “outsource” many of government’s jobs to the private sector. They tried to privatize Social Security, and they have partially succeeded in privatizing Medicare by paying private insurers a steep premium to take care of seniors under Medicare Advantage. (See my post about the high cost of the program here).

Finally, the vote on SCHIP split along conservative/ progressive lines, with conservatives voting against expanding SCHIP. As President Bush explained, more funding for SCHIP would expand the government’s role in our health care system. The progressives who voted for SCHIP believed that government should expand, as needed, to provide a safety net for its citizens. If the market cannot provide affordable, high quality health care for all Americans, then the government must step in. (more…)

 
                    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.”

(more…)

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 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 Natalie for permission to use this Photo.

We Americans are proud of our work ethic. We work longer hours, and more productively, than any other nation. Our industriousness has long been cited as a source of strength of our economy—but it just might be a source of some of our health care woes as well. 

According to a just-released study from Wake Forest University, professional flexibility is an important contributor to better health. Employees at all levels who have, or feel they have, more job flexibility (e.g. the ability to work from home, choose their hours, etc.) engage in healthier behavior than those that don’t. The study found that employees with flexible schedules exercised more, attended more employer-sponsored health classes, were more likely to describe themselves as living a healthy lifestyle, and reported getting more sleep. When the researchers checked in a year later, they found that as job flexibility improved, so did healthy habits: more flexibility meant more sleep, more health classes, and a healthier lifestyle.

This study deserves attention. Changing behavior is the single most powerful way to prevent health problems. As experts from the Robert Wood Johnson Foundation noted in a Health Affairs article earlier this year, “behavioral issues represent the greatest single domain of influence on the health of the U.S. population,” with 40 percent of early deaths in the U.S. due to behavioral patterns. Anything that promotes health behavior needs to be seriously considered as a strategy for making America healthier—and by extension, health care costs lower. 

Obviously, somehow ensuring that everyone in America had more flexible hours wouldn’t cut early deaths by 40 percent. And there’s no guarantee that more flexible hours will translate into better sleep, more exercise, or more education on a national scale. Any movement for universal job flexibility would have to be coupled with a concerted effort to translate free time into healthy time. (more…)

             Thanks to sidewalkstory for permission to use this Photo.

Should people be worried about the security of their health information?  In the past, I used to believe that perhaps the issues of security and privacy (an issue that is related to but NOT identical to security) were overblown.  I would go so far as to suggest that those with vested interests used these two issues to maintain control and prevent sharing of information (that was the cynic in me).  Around the same time, I also held a similar idea that patients didn’t really concern themselves with privacy so much.  Most patients assume that health providers share information as needed and that explicit consent to share information between providers was the strangest (if not the dumbest) thing.  I also believed that health care organizations seemed relatively secure, based on the measures they take which include triple identity verification and limiting remote access.

Today, I’m not so sure if I feel as confident about the security of my health information.  Recently, a family member of mine was almost a victim of fraud (a stranger tried to withdraw a few thousand dollars from a personal account).  This incident is my personal connection with the issue of security.

I’m not trying to sound like I’m paranoid or some cynic about ehealth and maintaining electronic records of our information.  I actually believe that we need to make more of our health information available in electronic format.  But, we need to be more vigilant about securing our health information. (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 Luke Johnson for permission to use this Photo.

I’ve been very impressed with the Nintendo Wii. The game system is simple to use and very fun. Even though I have a Sony Playstation 2, I hardly ever play it any more. When I do try to play it, I find the games to be far too complicated to play (especially trying to learn the complex controls for sports games). Personally, I think Nintendo has a great business plan that is taking advantage of the theory of disruptive innovations as described by Clayton Christensen.

Basically, Nintendo is expanding the market of game players and not competing for the same “hard-core” gamers that Sony and Microsoft target. Instead, Nintendo focuses on fun, easy to learn games that seem more family and group oriented. Okay, the graphics aren’t great, but after playing a Nintendo Wii, all I remember was how fun it was.

Nintendo’s fitness product called the “Wii Fit”: it consists of “a flat, board-like object that rests on the floor and is touch-sensitive.” The purpose is to use the game system to get into shape by engaging in fitness activities like yoga, aerobics, and other activities that get your heart pumping. With obesity a public health risk, maybe this product can get kids more physically active. (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 Thomas for permission to use this Photo.

One of the key unanswered questions about health information infrastructure over the past several years has been, “Do we have enough trained people to build it?” Over the past year, I’ve been privileged to have the opportunity to serve as the principal investigator of a research project sponsored by the U.S. Department of Health and Human Services (Office of the Assistant Secretary for Planning and Evaluation) to begin to address this question. This work represents the first attempt to quantify the workforce requirements for building the health information infrastructure in the U.S.A presentation summarizing the final results was given to the American Health Information Community (AHIC) Electronic Health Record work group in late September, and the complete final report has recently been posted.  Here is the Executive Summary: (more…)