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Healthcare: Not just another business
Health |
Ano Lobb |
Friday 20th November 2009
A reader comment on a posting about electronic medical records (EMR) suggests that medicine needs to follow other industries into the digital age. This is likely inevitable: Medical record keeping is bound to become more digitized over time. The primary reasons are monetary: It facilitates the generation of bills to send to patients and payers, the jury is still out on whether it increases quali Read More |
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Going for Gold! India Buys 200 tons of IMF BlingSustainable Finance | Johanna Hoopes | Monday 9th November 2009 Last week, the Reserve Bank of India (RBI) purchased 200 tons of gold from the International Monetary Fund (IMF) for $6.7 billion. The transaction increases India's gold holding to the tenth largest among central banks, and brings India's holding from 4 to 6 percent. This is significantly less than the majority of the developed world, but quadruple China's amount. The IMF has agreed to sell 403.3 tons total, or one eighth of its stockpile.One reason for the purchase may be India's push for greater clout in world economic affairs. As a $1.2 trillion emerging economy, India seeks larger representation in the IMF and has made promises to help shore up its resources for lending to developing countries. Proceeds from the sale will help pay for discounted interest rates on loans to low-income countries, said the IMB in July. The Washington-based institution plans to grant as much as $17 billion in extra loans to developing nations through 2014. Another motivation behind buying gold may be to diversify its foreign exchange reserves which are closely linked to the U.S. dollar. As the dollar drops against other currencies, many emerging economies are showing increased interest in diversifying out of U.S. assets. But India's Finance Minister Pranab Mukherjee argued that the purchase doesn't signify any loss of confidence in the dollar, or that the precious metal's appeal is increasing. Read More |
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Darkside of health dataHealth | Ano Lobb | Monday 9th November 2009 You may take it for granted that you have some level of medical privacy: That a company couldn't, for example, buy a list of all the medications your doctor has prescribed you, the better to entice your doc to change to newer, more expensive drugs that are riskier but no better than the old generics you currently take. You might think you have that privacy, but you don't.That's thanks to prescriber-identifiable prescription tracking, a marketing practice that sells your health information to commercial interests, spreading handsome profits to everyone but you the patient. To be fair many doctors aren't aware of this practice, and most see very little if any gain from it. Commonly used throughout the US, it is growing in Europe and other markets with computerized prescription drug fulfillment. Each year approximately $20 billion is spent marketing drugs to physicians in the US, and evidence indicates that it is a worthy investment, providing returns on investment of anywhere from $1.23 to nearly $12 for every $1 spent. This is how it works: When you fill a prescription, the pharmacy's computer system records every detail: The doctor and drug name, your age, sex, any other health conditions on record. Everything but your name. The pharmacy collects this data for every prescription, selling it to Health Information Organizations (HIO) such as IMS Health, Verispan or Wolters Kluwer. HIOs combine it with detailed doctor information gleaned from sources such as the American Medical Association's "master file" of physician members. The AMA sells this database, which includes such information as physician's specialty and contact information. After analyzing the aggregated data, HIOs sell it to drug marketers, who utilize it for targeted sales campaigns. The maker of a new diabetes drug, for example, can identify a doctor with scads of diabetic patients taking a competitor's product, and lavish that physician with attention and gifts in an effort to get them to switch drugs. Gifts amount to far more then pens and coffee mugs: In many cases they amount to $50,000 a year or more. Studies show that marketing works: Prompting physicians to write prescriptions for more expensive, newer drugs that are no-more effective and generally less safe than older, established choices. Bad for health, but good for business. Read More |
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A Glimpse into This Gypsy's SoulSustainable Finance | Johanna Hoopes | Monday 9th November 2009 Johanna here. Very hyped to be bringing you the latest in sustainable finance, global trends, and economic musings. I hope to use this space to inform, inspire, and engage. Please send your thoughts, jokes, stories, and ideas.A bit about myself: I have been bopping around the world ever since I can remember; meeting fascinating people, seeing incredible places and rocking out in general. I first realized development and economics were my passion while working for a community micro-bank in Ayacucho, Peru, and haven't turned back since. From Washington D.C., Cape Town, Madrid, Bangalore and soon Shanghai, I've been living, loving and learning along the way. Having worked for start-ups, consulting firms, and financial institutions, I am driven by the belief that we can manifest mountains of positive change throughout our world by simply connecting with one another. Justmeans is a community where we can exchange best practices and make business better for us all. Now, as an MBA student and freelance consultant, I hope to use my voice to shed some light on the challenges and opportunities of these tumultuous times. In such a dynamic and rapidly growing field, I'll explore the boundaries of this shifting financial paradigm as well as feature new and old players changing the landscape. I am excited to join Justmeans as Editor of Sustainable Finance and look forward to sharing this virtual journey with you all. It's bound to be a bumpy road, so hold on tight and we'll see what cool work we can discover. Read More |
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Build It Green-Part 1Sustainable Development | Kendra Pierre-Louis | Monday 9th November 2009 LEED certification has rapidly spread as the standard of green building. It provides third-party verification that a building or community was designed and built using sustainability strategies including: reduced energy use, water efficiency, CO2 emissions reduction, improved indoor environmental quality, and environmental stewardship of resources. LEED certified buildings often incorporate recycled materials, solar panels, low VOC paint and other modern sustainable sensibilities to help reduce the building's environmental footprint. When one considers that buildings are responsible for 48% of global greenhouse gas emissions, any attempts to reduce the negative environmental impact of buildings is a laudable step forward.When it comes to green building design, however, LEED is not the only sustainable design on the block. LEED represents the cutting edge of sustainable building design - perfect for larger developers or individuals with deep pockets. For the rest of us, however, our options are not merely go super green or go toxic. There are other equally sustainable and gentler on the pocket building options. I am going to spend today and Wednesday profiling some of these other green (or greener) ways of building including taking a peek at building techniques such as rammed earth and cob construction. Next week we'll take a look at some of the laws and policies that hamper the development of these sustainable building techniques, and ways of changing, bending, and altogether circumventing these restrictions. Read More |
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How good is your healthcare?Health | Ano Lobb | Friday 6th November 2009 Or doctor? Or hospital? Chances are, if you are satisfied with the outcome, you'd say the care was good. If you've had bad experiences then your review would be less positive. Regardless, you probably have little information to evaluate the quality of the healthcare you receive, the doctors providing it, or the hospitals housing them.How is the quality of healthcare evaluated? On the national level, you can look at key health indicators like life expectancy and under-5 infant mortality. Live in Switzerland or Costa Rica? Life expectancy is around 82 or 79 years, and the under-5 infant mortality rate is 5 and 11 per 1000, respectively. Live in Somalia or South Africa, however, and life expectancy drops to about 53 years, and infant mortality climbs to 154 and 49 per 1000, respectively. Lots of factors contribute to those figures, in themselves they don't tell us what is causing people to thrive or die, and besides moving from Somalia to Costa Rica, they don't help you make health decisions. National health insurance coverage figures tell us something about ability to pay bills: Only 1% of Taiwanese lack health insurance compared to 20% of Americans under the age of 65. But that doesn't tell us about health or care. Process measures are a good start, and at least in the US these are readily available for hospitals, less so for doctors. These report how often hospitals are doing important things: Giving aspirin to heart attack patients, for example. They are the types of things that have been shown to improve health outcomes, but they are not outcomes themselves. Read More |
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Chickens In the City and Goats on the Roof: Keeping Livestock in Urban EnvironmentsSustainable Food | Tricia Edgar | Friday 6th November 2009 I want chickens. However, given that my yard space is no more than six meters long, I think that this may be an unrealistic goal. Seriously, though, urban agriculture has branched out in recent years, and one of its more prominent branches is the idea of keeping farm animals in urban environments, mostly for eggs and milk, sometimes for meat. While backyard vegetable gardens and community garden plots are considered to be relatively innocuous in many urban areas, the idea of livestock in cities can be a little more difficult to sell.Different cultures have different ideas about the social acceptability of urban livestock. In Asia, animals have been a socially-acceptable part of cities for centuries because they are used to turn waste into food. In Africa, early colonial powers resisted the idea of urban livestock as backward, yet the practice prevailed. In Europe and the United States, the keeping of urban livestock has historically been a fringe activity that is rarely discussed. Many of the world's urban farmers are landless and rely on restaurant scraps and the leavings of urban horticulture to feed their animals. While urban livestock provide a valuable source of food and income, these animals are often feared as a source of noise and disease. In urban areas where rats roam the sewers and cars zoom busily around the streets, fears about the potential disease and noise from urban chickens seem a little extreme, but these fears are there. While all animals bring the potential for disease, access to veterinary services and good public health codes can moderate potential problems. Some argue that keeping small flocks of urban chickens may actually be a solution to controlling disease outbreaks like avian flu, since birds in urban, free-range flocks have smaller populations than those in factory farms, and therefore there is a smaller chance that the virus will spread and mutate. Read More |
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American Policy: Three Reasons Politicians Wrong to Slowly Mitigate Climate ChangeClimate Change | Juan Carlo Pascua | Thursday 5th November 2009 A majority of American policy makers believe waiting 6 - 20 years and gradually mitigating climate change is the best way for America to act. Self proclaimed pragmatists, their argument goes something like this: to sign on with current climate change mitigation plans would require replacing functioning equipment prematurely at an ineffective cost. We should instead wait until equipment needs replacement- because emitting a ton of carbon in the atmosphere now is the same as emitting it 20 years later- we should wait to act. Unfortunately, they are dead wrong.Reason #1 To Act Sooner: A ton of carbon in the atmosphere now is not the same as a ton of carbon later on. Currently, the atmosphere has 380ppm of CO2e in the atmosphere; we will reach 550ppm by 2050 (IPCC, 2007). An increase of 380ppm to 381ppm isn't alarming. An increase from 550ppm to 551 and you start to play dice with the planet. Many American politicians don't address this "fat tail" problem: events that are low probability, highly catastrophic. Even if we become carbon neutral at 550ppm, there's a 4.2% probability of reaching an 8°C rise in temperature (Stern, 2008); to date, no politician has mentioned such probabilities in the States. Read More |
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The Indelible AutomobileSustainable Development | Kendra Pierre-Louis | Thursday 5th November 2009 Ever since Henry Ford rolled the first model T off of the assembly line, the automobile has shaped how countries have moved people and things. Items and people that were once moved by horse and buggy, and then later railway have increasingly been moved by cars and trucks. The highway systems of the US and Western Europe have become the model by which many developing nations shape their own transportation policies with cars and their necessary roads symbolizing progress. Even China is losing its status as the world's "bicycle kingdom" as the emerging middle class increasingly forgoes clean and energy efficient bicycle transport in favor of the car and Chinese government policy follows suit.But the automobile as the primary form of transport is a highly unsustainable pursuit. The contribution that cars make to climate change are well documented, but even if cars did not have a negative effect on the climate they are still not the ideal form of transport. There is sadly, a high human cost associated with driving. According to the NHTSA Fatality Analysis Reporting System roughly 35,000 Americans are killed annually in automobile accidents. Worldwide auto accidents take 1.2 million lives a year, a number that rises to 2 million per year when the effects of car related air pollution are taken into consideration. It is not only those riding in vehicles for whom cars pose a risk; pedestrians and bicyclists are often the unwitting victims of auto accidents. Read More |
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Hedgerows: Secret Gardens That Support Sustainable AgricultureSustainable Food | Tricia Edgar | Thursday 5th November 2009 The lofty hedge - it's both a victim of topiary madness and the alternative to a fence for those who farm. It's also a secret garden that supports sustainable agriculture across Britain. There are nearly two million hedgerows in Britain. Many of them sit beside farm fields and delineate the boundaries of these fields. They also create a boundary that sheep and other livestock find difficult to cross. The hedgerow plays another, more subtle role in British agriculture. In an area with open fields, hedgerows are a refuge for wildlife and help support a sustainable farm ecosystem.Many hedges have been safeguarding farms for hundreds of years. Ancient hedges can date back to Saxon times, making them a thousand years old. Plants like hawthorn are common in hedgerows, and these planted areas also support more than two hundred species of non-hedge plants like ferns and flowers. These diverse and thriving rows of plants prevent soil erosion and create wildlife habitat and wildlife corridors, a last refuge of wildness in a human-dominated landscape. How can a shrub be so important in the ecological life of a farm? On a farm that strives to connect with its local ecosystems, refuges for wildlife are important. Bees are critical pollinators of farm crops, as are butterflies. Hedgerows are a place where wildflowers still grow, so they are important food sources for these pollinating insects. Most hedgerow plants are deciduous, which means that they lose their leaves in the fall. This layer of leaves is an important place for beneficial insects to survive the winter and replenish their populations in the spring. For larger animals, hedgerows are also sanctuaries. Birds eat the insects that can eat farm crops, and they hide their nests in nearby hedgerows. Larger predators like foxes use hedgerows as roadways to hunt mice and rats, animals that eat food crops. Read More |
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