Justmeans's blogshttp://www.justmeans.com/editorials/health/210.htmlThu, 09 Feb 2012 22:39:25 GMThttp://www.justmeans.com en hourly 1http://www.justmeans.com/Information-Technology-for-Health-Advocacy--American-Cancer-Society-s-Social-Media-Strategy/48848.htmlSun, 01 May 2011 15:42:46 GMTAno Lobb One constantly voiced theme for marketing or advocacy in social media: Listen, don't just talk. (Also, perhaps not coincidently, good advice in effective leadership circles as well.)So one crude rule of thumb for assessing whether an organization "gets it" is how much their social media strategy emphasizes listening. Interactivity naturally implies responding to what is heard, and advocacy requires some degree of broadcasting information. But listeningwhile arguably the most importantis often th Read Full Article ]]> One constantly voiced theme for marketing or advocacy in social media: Listen, don't just talk. (Also, perhaps not coincidently, good advice in effective leadership circles as well.)So one crude rule of thumb for assessing whether an organization "gets it" is how much their social media strategy emphasizes listening. Interactivity naturally implies responding to what is heard, and advocacy requires some degree of broadcasting information. But listeningwhile arguably the most importantis often the least intuitive.To get a sense of how the American Cancer Society (ACS) approaches information technology and social media for anti-cancer advocacy, Justmeans asked them several questions on the matter. David Balcom, Managing Director of Digital Activation, provided the following answers:Justmeans: What is ACS' view of social media as an advocacy or awareness tool?A: "Social media is one channel of many to reach our audience, but it's an effective one for both advocacy and awareness. We maintain a presence on several social media networks, primarily Facebook and Twitter, and use these concentrated networks to listen and to talk. We talk about our programs and our initiatives, we ask our audience to take action, and we listen to what our patients say to us. Since our mission is delivered in a highly distributed way geographically, we employ both local and national social media outlets to deliver and monitor content."Justmeans: What Role does ACS see for cancer patient-focused information technologies, such as social media, advocacy and support, informed patient decision making? A: "Our goal is to serve our patients at their point of need, wherever that point of need is. We're hard at work building and designing digital tools and services to extend our ability to care for our patients. An example includes the creation of a new diagnostic social network that puts cancer patients in touch with others who've shared their experiences. We're also extending our cancer information services to mobile devices, to better deliver where our patients need cancer information. We've aggressively delivered our advocacy calls to action via social media outlets, again to reach our audience where they live and act. All of these examples illustrate an approach that takes advantage of the available channels -- web, social, mobile -- to deliver our core mission."Talk, Ask, Listen.Deliver, monitor. Sort of like a socially engaged conversation.They are using tools for what they are good for, for the value it provides to their core mission, rather than just "because its there." Clearly their strategy seeks to harness digital technology's ability to bring social support and information support to where the patient is, in terms of geographic location, preferred device or favorite social media platform (twitter vs. facebook).As you might expect, ACS has a large social media following: 235,400 Facebook likes, 142,000 followers on Twitter (@americancancer). Does that translate into effectiveness? Lacking reliable objective metrics for social media effectiveness, or whether such efforts result in better health, that's likely open to interpretation. ACS has a klout score of 62, if you value that metric, which is in the ballpark of some other large advocacy organizations such as the American Heart Association, American Diabetes Association, and AARP-as well as Justmeans.Among health journalists, ACS is a go-to organization for cancer information, and their publications are some of the most common sources for data on cancer incidence, prevalence, as well as screening strategies.Technology, including information technology, also has the potential to produces unintended consequence and challenges for health advocates, but more on that in the next installment of this story.(Furthering public health mission, ACS' upcoming Corporate Impact Conference will explore workplace solutions for building a healthy workforce.)Photo credit: Facebook, Twitter, ACS]]>http://www.justmeans.com/Women-s-Health--Tsunamis--Natural-Disasters--Resilience-and-Coping-Revisited---A-Little-Help-is-Good/48703.htmlTue, 26 Apr 2011 21:08:14 GMTJohn Pospisil A few weeks ago, I posted an article that largely agreed with a researcher's findings that people are naturally resilient and many coping interventions are minimally useful or potentially harmful. A reader responded, and I promised to go back and look at my sources. This article summarizes some positive aspects of coping interventions following natural disasters.Psychosocial support and professional care can be a strong, effective intervention after disasters. In the case of natural disasters, s Read Full Article ]]> A few weeks ago, I posted an article that largely agreed with a researcher's findings that people are naturally resilient and many coping interventions are minimally useful or potentially harmful. A reader responded, and I promised to go back and look at my sources. This article summarizes some positive aspects of coping interventions following natural disasters.Psychosocial support and professional care can be a strong, effective intervention after disasters. In the case of natural disasters, such as the Orissa cyclone of 1999 and the 2004 tsunami that affected many areas including India, psychological support after the event was crucial in recovery and constitutes a meaningful public health intervention in the final stage of disaster response.Cyclone 05B, the Orissa supercyclone, struck many areas in the North Indian basin. It made landfall in India on October 29, 1999. Approximately 16,000 human deaths were directly attributed to the cyclone. Of course, millions were affected in ways ranging from homes destroyed, critical livestock killed and the sanitation and supply problems as aftermath of such events. One positive (and resilient) event to come from the disaster was a training program to assist in providing psychosocial support to survivors of natural disasters. Individuals were taught how to provide support, but also how to train others as well. For better or worse, that program was useful in 2004, when the so-named Indonesian Tsunami struck many places, including India. The presence of trained workers skilled in rebuilding social support allowed for scientific testing of the hypothesis regarding the usefulness of support programs as public health interventions.What does effective psychosocial care in disasters involve? The treatment paradigm revolves around not labeling emotional reactions as mental diseases. Rather than focusing on the potential for depression, anxiety and post-traumatic stress syndrome, a strong treatment program views such emotional reactions as normal responses to the worst-case abnormal events possible.Humans are social beings, and accordingly a focus on social relations after disaster is important. A primary aspect is reliance on community, especially trained community workers skilled in providing emotional support and helping survivors who may have lost many important connections re-establish social connections that are accessible and available. The next most important aspect, according to Dr. Susan Becker, is providing skills to mitigate the potential for adverse, long-term psychological damage. Relaxation techniques might sound impossible to somebody mired in loss and destruction, but they apparently work and are recommended.How does one know this works? Dr. Susan Becker's peer-reviewed article in the American Journal of Public Health (April 2009, Vol. 99, No. 4) compared a control group of 100 Indian women who did not receive psychosocial care after the 2004 tsunami with 100 women who did receive such care. All women were recruited volunteers. Women were chosen as opposed to a cohort consisting of both men and women as previous research indicates that women are approximately three times as likely to report more depression, anxiety and post-traumatic stress responses in response to negative life events than men. This does not mean men are unaffected. For any public health intervention, one has to target individuals most likely to be affected by a given condition whether that is influenza or psychological responses.The intervention by mental health teams lasted three months. Based on self-report scores on a valid and reliable scale (the Impact of Events scale), women who received the psychosocial treatment showed statistically meaningful less emotional distress than women who did not receive such trained support. Subscale measures included hypervigilance, avoidant behavior and intrusive thoughts relative to the disaster, and women receiving treatment had lower scores on the respective subscales than their control group counterparts.Research shows that up to one-third of individuals can show negative psychological symptoms up to one year after a disastrous event. While there may be equivocal research surrounding long-term coping, it is clear that whether through their own means or with skilled assistance, people have the capability to recover from disasters. By itself, that is both impressive and admirable.Image courtesy of U.S. National Oceanic and Atmospheric Administration]]>http://www.justmeans.com/Pharmaceutical-Data-Mining--Health-Care-Privacy-and--Free--Speech--Sorrell-vs--IMS-Health/48673.htmlTue, 26 Apr 2011 08:12:07 GMTAno Lobb Today the US Supreme Court is due to hear arguments in Sorrell vs. IMS Health, a pharmaceutical data-mining case that has potentially far reaching implications for health care privacy, as well as how pharmaceutical companies detail (or market to) doctors.A previous blog post outlines the crux of the practice at the center of the lawsuit, sometimes called "prescriber identifiable prescription tracking." And here's an abstract from a presentation at the American Public Health Association meeting a Read Full Article ]]> Today the US Supreme Court is due to hear arguments in Sorrell vs. IMS Health, a pharmaceutical data-mining case that has potentially far reaching implications for health care privacy, as well as how pharmaceutical companies detail (or market to) doctors.A previous blog post outlines the crux of the practice at the center of the lawsuit, sometimes called "prescriber identifiable prescription tracking." And here's an abstract from a presentation at the American Public Health Association meeting about the potential impacts of the practice.The legal case hinges on a Vermont law ("Sorrell" in the Supreme's case refers to Bill Sorrell, the Vermont State Attorney General) that sought to ban the practice. More details on the case itself can be read and heard here, and a very informative interview with AG Sorrell that includes some of the wider implications of the suit can be heard here. Interested in amicus briefs and more legal details? Try the NLARx website.Predicting how the Supreme Court might rule is of course a bit like reading tea-leaves, which is why most wise folks refrain from making such predictions. But this writer lacks such wisdom, so here goes. Supreme Court Likely to Side With IndustryThe industry's case is based on free speech. It is notable that they do not make any claims that what they are doing has positive health or social value, only that it is protected by their first amendment rights. The current Supreme Court's attitude that corporations should have similar constitutional protections as individuals might hint towards their support for IMS Health and the coterie of pharmaceutical industry heavy weights that support them. But their support is likely to be much more fundamental than even that.Here's how the majority might read the case: The privacy at stake here is not patient privacy, which we all hold to be sacrosanct and worthy of protection, but the privacy of your doctor's prescribing records. These records are currently not private in that regulators such as the DEA and state Medicaid officials and private insurance have access to them for compliance and quality reasons. Plus, doctors are highly trained professionals, so they are capable of hearing a sales pitch and ignoring it if the information they are presented with is not in the best interests of their patients.Here're Three Reasons why They are Wrong1. Drug marketing is about selling more higher-priced drugs. It is not about improving health. That's why the drugs that are most commonly advertised are the most expensive, and the newest, not the most effective. In fact, by being so new, we know the least about their safety so they often end up being some of the most dangerous in real world settings. Direct-to-consumer drug advertising is currently allowed in large part because of the "learned intermediary" principle: I can't simply see an ad for a potent atypical antipsychotic, then go out and buy it. I have to go to a doctor first, a learned intermediary who will determine whether it is appropriate for me based on her clinical knowledge, experience and training.Unfortunately the type of targeted physician profiling that occurs with the data in question allows pharmaceutical marketers to corrupt the learned intermediary who is supposed to bring rational, evidenced-based analysis to my desire to buy that potent drug. And all evidence suggests that marketing to doctors, which is closely tied to marketing to consumers so that both parties are "educated" about the same drug, increases prescription of marketed drugs, increases prescription costs, but doesn't improve health.2. Because of the above effect, prescriber-identifiable prescription tracking does infringe on patient health and patient privacy. Anything that adversely affects my doctor's judgment when she reaches for a prescription pad influences my health. Its as if a drug rep were allowed to sit in the exam room, minding his own business (even wiggling his fingers in his ear when my name is mentioned) until he hears that I have high cholesterol, at which point he hands glossy informational brochures and a few minor gifts to my doctor to help make the prescribing decision. This s not a free speech issue, it is a patient health issue.3. Despite the industry's claims of free speech there is the persistent irony that once they've compiled the data on specific identified prescribers, that information is no longer free. To begin with, it is priced so prohibitively high that it is generally well-beyond the reach of even the most well-funded academic, objective researchers. Secondly, in at least one instance a company such as IMS Health would not allow researchers from a very prestigious institution to purchase their data for a research project that essentially was aimed at exposing some of the negative public health risks associated with the industry practice. Finally, the fact that everyone in the chain of information stands to potentially benefit EXCEPT the patient is reprehensible: Pharmacies get paid to provide raw data, health information organizations like IMS Health get paid by pharma for their reports, pharma gets more money from increased drug sales, and doctors get sometimes significant gifts. The patient get prescribed a higher priced drug whose safety and effectiveness amy not be as well known as a competitor drug.So what to do? First, lets hope this prediction is dead wrong. Second, lets hope that the Global 1000 pharmaceutical industry heavy weights such as Pfizer, Merck, and Glaxosmithkline extend CSR to their marketing practice and reform their behavior. Without their financial support, this practice would wither and die. Finally, there's a clear need for regulators and advocates for evidence-based medicine, patient care, and health care privacy to be as innovative as industry is wealthy to fight back against the overwhelmingly negative patient health effects of prescriber-identifiable prescription tracking. This is an information struggle, and perhaps social media and information technology can give health-concerned Davids some ammunition to battle drug slinging Goliaths?Photo credit: The Author]]>http://www.justmeans.com/Who-Can-Fix-Health-Care-TEDx-Talk--Dartmouth/48573.htmlThu, 21 Apr 2011 10:11:24 GMTAno Lobb Who Can Fix Health Care? - That's the question posed by Dr. Al Mulley. director of the Center for Health Care Delivery Science at Dartmouth College. Its also the title of the TEDx Talk he just gave, and its the kind of talk that you can't help but want everyone to see.For those of you who have followed this column, Al Mulley, the Center and Dartmouth are familiar. This author works for the masters degree program associated with the center, the Master of Health Care Delivery Science Program.Al's Read Full Article ]]> Who Can Fix Health Care? - That's the question posed by Dr. Al Mulley. director of the Center for Health Care Delivery Science at Dartmouth College. Its also the title of the TEDx Talk he just gave, and its the kind of talk that you can't help but want everyone to see.For those of you who have followed this column, Al Mulley, the Center and Dartmouth are familiar. This author works for the masters degree program associated with the center, the Master of Health Care Delivery Science Program.Al's talk is worth watching for a number of reasons. To begin with he has had a distinguished clinical career, most recently heading the internal medicine department at Massachusetts General Hospital. Currently he leads the Dartmouth Center for Health Care Delivery Science, a new department in a new discipline that will soon be emulated at institutions around the globe. He's a great speaker. And he's also a smart guy who really cares; a consummate intellectual in the best sense of the word.Among the concepts covered are what might be called Mulley's Four Goals For Quality Healthcare:1. Provide patients with the care they need and no less and the care they want and no more2.No decision about health and health careshould be made in the face of avoidable ignorance3.Every decision about health and health careshould be informed by both professional and personal knowledge4.Patients must shape the capacity of the health caresystem by revealing their preferencesIt wouldn't be an overstatement to pronounce the talk a must-see for those interested in healthcare reform, or who believe that healthcare needs some, well, caring-for. And also for those wondering what the heck they can do to help. The audience was Dartmouth College students, but it might as well have been the entire country. With that in mind, do yourself a favor and watch it. Here' I've made it easy:]]>http://www.justmeans.com/Modern-Drug-Marketing--An-Unsustainable-Model/48518.htmlWed, 20 Apr 2011 18:24:03 GMTJohn Pospisil Cymbalta. Abilify. Lunesta, Chantix and that drug for "when the time might be right." As a consumer and especially as a psychologist, it unsettles me when I see television ads exhorting potential clients to ask a doctor about a specific drug. Even if I do not believe general practitioners or specialists know best, I do not believe consumers should ask for specific drugs. To me, without any science behind my opinion, that seems like patients are being turned into marketing agents for pharmaceutic Read Full Article ]]> Cymbalta. Abilify. Lunesta, Chantix and that drug for "when the time might be right." As a consumer and especially as a psychologist, it unsettles me when I see television ads exhorting potential clients to ask a doctor about a specific drug. Even if I do not believe general practitioners or specialists know best, I do not believe consumers should ask for specific drugs. To me, without any science behind my opinion, that seems like patients are being turned into marketing agents for pharmaceutical companies. The next observation is based solely on my television viewing habits: it seems the number of diseases treatable by drugs, even if used off-label, has grown.According to an article published in the American Journal of Public Health, my unscientific beliefs may really have a scientific basis. Howard Brody, MD, PhD and his colleague, Donald W. Light, PhD identified several trends and cite examples supporting the idea that physicians are pressured to prescribe drugs to a larger population than they were originally intended to treat. As an experimental psychologist, it especially disturbed me to read that 60% of prescriptions for antipsychotics - not trivial drugs with potentially severe and permanent side effect - are for off-label use. Meaning, they are being prescribed for conditions they were not originally meant to treat. The article claims that in 75% of those cases, there was not strong evidence of a positive effect to warrant exposing patients to harm.The authors do cite drug demand being driven by marketing towards consumers as a factor. They also cite "disease-mongering", or reducing the threshold for an existing condition to being diagnosed as a disease as a contributing factor as well. They call the process "the inverse benefit law." According to Brody and Light, the way to look at the "law" is that the more heavily a drug is marketed, the greater chance of harm to the patient rather than good occurs.As thrilled as I was to discover I was not merely paranoid, I had to look up the inverse benefit law. There is dissenting opinion. Not dissenting, exactly, but more complications. Naturally, in the form of how regulatory bodies handle the entire process. Specifically, the dynamic between marketing and the benefit-to-harm ratio may also be affected by a combination of regulation of the pharmaceutical companies and the difference in knowledge about drugs between the manufacturers on one hand and the doctors and their patients on the other.This implies that the effect of the "inverse benefit law" is modified by a combination of regulation designed to prevent abusive marketing and exaggerated claims about product efficacy and safety with increased public awareness of the problem in the first place. This is a classic modern model of a public health approach to solving health problems, for better or worse.If there really is a health problem associated with fabrication of disease states, convincing both the public and physicians to use drugs in unsafe ways, then it constitutes a menace to the public health. Personally, I am quite aware of the financial and scientific difficulties with drug development, clinical trials and getting drugs approved for use and sale. I know a large number of people involved in drug development, and I truly believe not a one of them sets out to create a drug that will be misused or do more harm than good. To me, it is another example of a process that has become so complex with tension created at so many points it may be impossible to ever control.Image provided by a U.S. Army soldier or employee.]]>http://www.justmeans.com/What-the-Budget-Cuts-Mean-for-Health-Care/48554.htmlWed, 20 Apr 2011 06:08:00 GMTEricka Foster If you have trouble managing a few thousand dollars in your bank account, you may be sympathetic to Congressional politicians who finally reached an agreement on the budget minutes (not even hours) before the federal government would have shut down. Congress and the White House agreed to trim $38 billion off of a trillion-plus budget. It may sound like a lot, but there are twelve zeroes in a trillion and nine zeroes in a billion. That puts the percentage of cuts in the single digits. That includ Read Full Article ]]> If you have trouble managing a few thousand dollars in your bank account, you may be sympathetic to Congressional politicians who finally reached an agreement on the budget minutes (not even hours) before the federal government would have shut down. Congress and the White House agreed to trim $38 billion off of a trillion-plus budget. It may sound like a lot, but there are twelve zeroes in a trillion and nine zeroes in a billion. That puts the percentage of cuts in the single digits. That includes $13 billion in funding for education, health and labor programs.Women's Health dodged a bulletAt the center of this budget fight was the nonprofit Planned Parenthood. The organization provides sexual health counseling, contraception services, STI's education and prevention and abortion services. Although abortion services constitute 3% of the organization's services, (according to the organization's records) some politicians wanted to eradicate $317 million of funding to any organization that offers any sort of family planning services (covered by Title X). It is already illegal to fund abortions with federal dollars. While other organizations would be affected by the cut, Planned Parenthood is most well-known organization in the legislation. In addition, House Republicans proposed to eradicate all funding for Planned Parenthood, and instead Congress will send a block grant to individual states for divvy up. Planned Parenthood and other women's health organizations were saved in the final budget. Because Washington D.C. is not a state and is governed by Congress, they were able to maintain a law already on the books that prevents the District of Columbia from using locally generated taxes to provide financial help to poor women for abortions (the law already prohibits the federal funding of abortions).Medicare and MedicaidMedicare is the government program design to assist senior citizens over the age of 65 with health care costs. Congressman Paul Ryan (R-Wis.) proposed to subsidize program, giving patients the option to choose from insurance plans, and the government will foot the bill for the difference. That proposal is still up for debate, as politicians seek to come to an agreement regarding the debt ceiling. Medicare is a sensitive subject as the baby boomer generation gets older and will require more medical care. Medicaid is the health care program designed to assist America's poorest citizens with health care costs. The proposed plan would cut more than $700 billion dollars from the program over 10 years. Similar to the Planned Parenthood bill, the organization would send block grants to the states to late them determine how the money is spent. Those block grants would be less than the current funds.Universal health care and community health centersThe legislation proposed by Senator Ryan would also eliminate funding for the health care plan championed by President Obama which has yet to fully take effect. Additionally, the amended budget will cut $600 million from community health centers. Low-income Americans take advantage of community health centers for illness as well as managing chronic diseases such as heart disease and diabetes.As politicians continue to hammer out the final details of the proposed budget, programs for education, health and labor are cut in a recovering economy. While people are are still trying to get back on their feet, the very programs designed to help them get axed.Photo by At.morey.tota]]>http://www.justmeans.com/Sustainable-Health-IT--A-Plan-for-Healthcare-Generated-e-Waste/48532.htmlTue, 19 Apr 2011 14:19:36 GMTAno Lobb As American and world health care systems move towards increased reliance on health information technology, there's a corresponding need arising for responsible, sustainable and safe methods of managing the growing tide of e-waste that inevitably follows. Paying attention to the twilight period of IT's life cycle also provide opportunities for innovation. While Global 1000 companies such as GE churn out high value, yet toxin-rich hardware, innovators such as Redemtech find responsible ways of re Read Full Article ]]> As American and world health care systems move towards increased reliance on health information technology, there's a corresponding need arising for responsible, sustainable and safe methods of managing the growing tide of e-waste that inevitably follows. Paying attention to the twilight period of IT's life cycle also provide opportunities for innovation. While Global 1000 companies such as GE churn out high value, yet toxin-rich hardware, innovators such as Redemtech find responsible ways of recycling such equipment.A new paper in the online journal Environmental Health Perspectives, meanwhile, spells out the growing health concerns from e-waste, specifically around the potent neurotoxicants often associated.The primary producers of e-waste are the US and China (each produce around 2.5 million tons per year), the EU (9 million tons). While high tech recycling plants produce little environmental or associated human dangers, large scale primitive recycling practices release vast amounts of toxins. Such recycling occurs primarily in China, India, Nigeria and Vietnam, with smaller operations in Morroco, Senegal, Peru, South Africa and Uganda. This produces a noxious flow of neurotixns from the developed to less developed world, with the possible exception of China who are both large producers of waste, and large contaminators through unsustainable recycling practices.Menu of MenaceThe primary pollutants of concerns released from e-waste include the following:Lead from monitors and old circuit boards is a potent, well studied neurotoxin. Children aged 1-6 who live in communities engaging in primitive e-waste recycling have blood lead levels 50% higher on average than neighboring communities. Poisoned children face a number of developmental challenges.Mercury is found in tiny amounts in monitors, circuit boards, cell phone and various types of lamp bulbs. But when combined in mass recycling sites, the amounts released can reach troublesome levels. Inorganic mercury is transformed into organic mercury, which then accumulates in the food chain, with fish being the primary source of exposure in humans. While mercury toxicity has developmental effects in children, little research has looked at the effects of e-waste on children's blood levels.Cadmium from batteries and chips results in substantially increased exposure among children living nearby, though the precise health effects are not known. Numerous studies have linked higher cadmium levels to increased neurological deficits in children.Hexavalent hromium is a metal coating used to prevent corrosion in many components. While a known human carcinogen, effects on children from environmental exposure is unclear.A veritable salad of other chemicals including PBDE flame retardants, PCBs and polycyclic aromatic hydrocarbons round out the rogues lists. Some of these are the result not only of the components being recycled, but also the process: Using heat that creates toxic smoke, for example.Challenges of e-WasteIn addition to the large amounts, and currently dubious business model for competitively addressing the problem, several other challenges exist. These include the fact that e-waste enters the waste stream as a completely mixed source of toxicants that varies in toxicity, may contaminate for long periods of time and through multiple media: air pollution, water contamination and the food stream, for example. Further conflating the challenge: A general lack of scholarship regarding the true extent of the hazard, how much harm it is causing and how best to mitigate that harm.First Do No HarmWill the irony that health information technology meant to save lives in the developed world might end up poisoning children elsewhere compel resourceful social innovators to develop large scale sustainability efforts to manage health care related e-waste?Should health IT plans on the organizational, as well as state and national level also be tied to sustainable management practices over the complete lifecycle of the technologies?Should "meaningful use" also be linked to "responsible reuse & recycling?"Photo credit: The author, and EHP: Chen A, Dietrich KN, Huo X, Ho S]]>http://www.justmeans.com/How-Much-Does-Your-Insurance-Pay-Your-Doctor--Do-You-Care/48423.htmlWed, 13 Apr 2011 18:55:16 GMTAno Lobb There are a few cost comparisons we are familiar with when comparing health insurance options, while choosing an insurance option from your employer's benefits package, for example. Generally you'll see the different plan options laid out, with column showing what's covered and at what percentage, out-of-pocket costs such as your portion of the premium costs, deductibles and co-pays.As healthcare costs grow, there's been a commensurate growth in interest about increasing patient/ consumer cost a Read Full Article ]]> There are a few cost comparisons we are familiar with when comparing health insurance options, while choosing an insurance option from your employer's benefits package, for example. Generally you'll see the different plan options laid out, with column showing what's covered and at what percentage, out-of-pocket costs such as your portion of the premium costs, deductibles and co-pays.As healthcare costs grow, there's been a commensurate growth in interest about increasing patient/ consumer cost awareness. In some cases by 'cost sharing'- shifting more costs to the consumer- and in other cases providing actual prices for medical services. The great moral hazard of health finance generally arises from the fact that neither the provider nor the patient (if insured) bears the brunt of costs, and in many cases neither of those parties is even aware of how much a service will cost.Now imagine if two other columns where added to that table you were using to compare health plans. One of the new columns has quality information, either some measure of how in-plan providers rate compared to all doctors in the state, or some indication of what type of quality data might be available to help you choose a primary care provider, specialist or if you are lucky enough to have a choice, a hospital for non-emergency procedures. Those types of measures have long been hoped for, but are not the main focus of this discussion.The next column provides information I've not heard widely discussed. This would be some ballpark measure of the average or median amount that the plan in question pays providers relative to other public and private payees and the cost of providing services. Why would you want to know this? A couple of possibilities come to mind:--Are plans charging more in premiums, etc.. paying providers better?--Maybe I feel that I'll get better care and more time with providers who are getting reimbursed more for the care they provide me.One arena where this might come into play: State such as Vermont that are looking to provide some form of single -payer plan to cover all their citizens will be tempted to essentially expand Medicaid to cover everyone. The trouble is that Medicaid pays providers far less than it costs to provide care, rendering the program somewhat unsustainable. Private payers and uninsured persons not covered by Medicaid essentially subsidize the state program.So what might happen if consumers able to opt into Medicaid were empowered with knowledge about how much their insurance was paying providers relative to the costs of providing services? If choosing between a free state plan and more costly private one, would patients avoid an expanded Medicaid-like insurer who reimburses at low rates, for fear it would impact the care their doctor provides? Do consumers covered by such a plan have a right to know how much their doctor is being paid to provide care for them?All other things being equal, would knowledge of how much your doctor will be paid on your behalf influence your health insurance choice? Why?And while we are on the path towards cost transparency, let's add a third new column that tells us what percentage of premiums are spent on administrative overhead. Perhaps I'd like to reward a more efficient company with my business.What about you?Photo credit: The author]]>http://www.justmeans.com/Feds-Aren-t-the-Only-One-Struggling-with-Budgets/48420.htmlWed, 13 Apr 2011 15:29:37 GMTEricka Foster As the Congress and the President hammer out the final details of the budget, states are facing their own difficulties. Leaders struggle to find a way to fund transportation, health and education programs (among others) with limited funds. Health care programs that depend on government funding face cuts that limit the quality and quantity of care for patients requiring health care services such as prenatal care, mental health care, and regular care for chronic diseases, including seniors on Medi Read Full Article ]]> As the Congress and the President hammer out the final details of the budget, states are facing their own difficulties. Leaders struggle to find a way to fund transportation, health and education programs (among others) with limited funds. Health care programs that depend on government funding face cuts that limit the quality and quantity of care for patients requiring health care services such as prenatal care, mental health care, and regular care for chronic diseases, including seniors on Medicare, and poor people on Medicaid. With unemployment still at a high rate, the very programs designed to assist people who cannot afford health care are seeing their budgets slashed.Earlier this year, New Jersey Governor Chris Christie announced a budget that would restructure Medicaid and cut $250 from the state budget. He also proposed a 15 percent cut to the state's Department of Health and Senior Services.In February, low-income residents in Pennsylvania learned that their health insurance under adultBasic insurance would be canceled. The program that was previously totally funded by the state ran out of money. As a result, close to 42,000 people will move to subsidized insurance, or lose coverage altogether until 2014 when the health care reform law takes effect.In Wisconsin, Governor Scott Walker proposed a 4.2 million dollar budget cut. Amidst the protests from union workers, the budget proposed $500 million in Medicaid, primarily by requiring some participants to pay a portion of their premiums and medical services.In Texas, tempers flare as legislators cut $23 billion from the state budget. Officials say that the governor's proposed budget will create a $4 billion shortfall, force nursing homes out of business, hitting rural communities the hardest. The governor has proposed a budget that cuts expenses without raising tax revenues. According to the Austin Statesman budget cuts would cause 4000 adults and 320 children to lose mental health care services including counseling, diagnosis, medication monitoring and family assistance.Most organizations receive funding from a variety of sources, some federal, some state and some local. In addition, organizations may also receive funding from private donors. Private organizations that receive funding from donors and other sources will face an additional strain as they try to meet public health demands as government funding dries up. Patients may see longer times in hospital emergency rooms as preventative care and facilities are closed.Some governors have raised taxes or reallocated funds to protect healthcare funds, while others including have slashed budgets without raising taxes.Photo by Heidi Elliott]]>http://www.justmeans.com/Leveraging-EMR-to-Embed-Comparative-Effectiveness-Research-into-Clinical-Practice/48399.htmlWed, 13 Apr 2011 08:30:33 GMTAno Lobb A new approach to health care delivery may well provide a first taste of the value that can be realized when health IT is integrated into systems for delivering care and improving quality. The hope that simply plugging an electronic medical record (EMR) system into existing medical practices is worth the costs and will on its own improve health outcomes has yet to prove itself. But a paper just published inClinical Trials provides a more enlightened vision for implementing EMR.A cooperative agre Read Full Article ]]> A new approach to health care delivery may well provide a first taste of the value that can be realized when health IT is integrated into systems for delivering care and improving quality. The hope that simply plugging an electronic medical record (EMR) system into existing medical practices is worth the costs and will on its own improve health outcomes has yet to prove itself. But a paper just published inClinical Trials provides a more enlightened vision for implementing EMR.A cooperative agreement between the Veterans Affairs Cooperative Studies Program Coordinating Center in Boston and the schools for Medicine and Public Health at Boston University, guided in part by a Stanford biostatistician, has resulted in the development of the "Point-of-care clinical trial." This approach uses a programmable EMR to essentially run a persistent clinical trial, and allows the clinical knowledge gained by the growing data to be fed back into clinical practice.In a nutshell here's how it works:Let's say you are interested in seeing which of two (or three) treatments was most effective at controlling blood sugar. Your EMR is adaptable enough that after programming in your variables it identifies the type of patient that'd be a candidate (in this case a diabetic). When a patient is seen that meets the criteria, the clinician can choose which treatment protocol is preferred. If there's no preferred treatment, the clinician can indicate that, and the EMR randomizes the patient to one of the testing arms of the study. Data is gathered going forward, and your trial is underway and constantly growing.This approach has numerous advantages over the traditional Randomized Clinical Trial (RCT), considered the gold standard of medical research. These include:--It's an RCT of the specific patient population that you serve. Typically RCT findings require that you apply the generalized knowledge of an often-idealized study population that may not resemble your patients to the realities of your local context.--It's quick and economical. Rather than waiting for a long and costly trial to be performed, you begin gathering data practically from day one. Naturally it'll take time for your data to become robust, since it takes time for our study population to grow. Plus, you have a feedback loop to respond to findings very quickly. What if you begin to notice a trend in side effects? Rather than wait for a trial to be performed you could take corrective action to see if you can reduce those harms.--It infuses data collection and quality improvement into the everyday practice of clinical medicine. This promotes a culture of quality, and also removes the barrier between researchers and clinicians. The value of this speaks for itself.--It's a great example of how the redesign of health care processes and systems is a value-added proposition: Not only improving systems by reducing unwarranted variation, inefficiency and waste, but also providing additional benefits, such as high value health outcomes and comparative effectiveness data and ability to develop and test hypothesis in clinical practice, as a byproduct of what is already done everyday. Another term for this: Health care delivery science.This approach essentially melds the best parts of observational research (relatively quick and inexpensive) with the RCT (randomized design), and could breath new life into the hope that adopting EMR will not only result in digitized health information, but also an investment into clinical research and better care.Finally, an innovative use of EMR that actually has the potential to improve clinical outcomes. As an aside, this partnership may also provide a glimpse of what "Government Healthcare" is really all about: Using self-contained health systems such as the VA (the only system in the nation where the "government" could actually be said to provide patient care) as proving grounds for innovative new methods of delivering care, improving performance, and gathering comparative-effectiveness data for rational clinical and policy decision making.Photo credit: Boston University & the Veterans Administration]]>http://www.justmeans.com/Wisdom-of-the-Crowd--What-Health-Reform-Might-Look-Like-If-Voters-Had-Their-Say/48277.htmlThu, 07 Apr 2011 19:56:33 GMTAno Lobb As legislators torture health reform to a slow and painful death with ideological wrangling, a new survey just released by the Commonwealth Fund offers an optimistic look at what American voters might propose if their voice could be heard.The big headline that's been generated from the survey is that 72% of Americans believe that the American health care system needs "fundamental change or complete rebuilding." That's not surprising, but short on details.So lets pretend for a moment that the res Read Full Article ]]> As legislators torture health reform to a slow and painful death with ideological wrangling, a new survey just released by the Commonwealth Fund offers an optimistic look at what American voters might propose if their voice could be heard.The big headline that's been generated from the survey is that 72% of Americans believe that the American health care system needs "fundamental change or complete rebuilding." That's not surprising, but short on details.So lets pretend for a moment that the results of this representative sample of 1,011 adults was used to guide decisions on some specifics. Here's some of the solutions that we might see:Robust and community integrated electronic medical records (EMR):96% believe that all of their doctors should be able to access all of their medical records, something that's only truly feasible with some serious IT. When asked specifically about doctor's use of EMR, 88% supported it. 92% say its important for doctors to be able to share information electronically.Meaningful and transparent outcome measures:96% wanted quality information about their doctors and hospitals.Medical homes:93% said its important or very important to hove one primary doctor coordinate their care.Cost transparency:89% say they want to know the cost (to them) of the care they are about to receive before they receive it.Availability of Personal Health Records:Only 20% of Americans with internet access currently use it to communicate with their doctor and 14% to access their records, but 50% would like to.Negotiated payments, rewards for high quality outcomes:85% believe that private and public payers should negotiate costs with providers, and he same percentage believe that high performing providers should be financially rewarded for high performance.This survey seems to offer some hope that voters are perhaps intuitively aware of what types of solutions might really improve health care. Sure the questions may have led them their somewhat, but the fact that the survey results are in agreement with what may knowledgeable researchers and health care innovators say are effective solutions is heartening.Will the legislators we entrust to implement such solutions listen? That remains to be seen.Photo credit:http://www.commonwealthfund.org/]]>http://www.justmeans.com/Hi-Tech-Radiation-Risks--part-1---Airport-Backscatter-X-Rays/48242.htmlWed, 06 Apr 2011 13:06:52 GMTAno Lobb A newly published report related to cancer risks posed by modern technology may well lower growing concerns about the safety of the 486 "backscatter x-ray" scanners introduced by Homeland Security for enhanced airport screening (another 500 are planned). Will they also allay your fears or concerns?First, Through Airport SecurityNew airport scanners that provide TSA's a sneak peak under your clothing to check for bombs, weapons and other contraband have raised travelers hackles on two accounts. T Read Full Article ]]> A newly published report related to cancer risks posed by modern technology may well lower growing concerns about the safety of the 486 "backscatter x-ray" scanners introduced by Homeland Security for enhanced airport screening (another 500 are planned). Will they also allay your fears or concerns?First, Through Airport SecurityNew airport scanners that provide TSA's a sneak peak under your clothing to check for bombs, weapons and other contraband have raised travelers hackles on two accounts. The first being privacy issues: We just don't like being technologically disrobed by strange men and women in the airport wearing funny badges and rubber gloves. The second is probably more serious: Concerns about increased cancer risk related to the additional radiation dosage that the scanners provide.A new write up in the Archives of Internal Medicine appears to allay the cancer fears. The authors, from departments of public health, radiology and biomedical imaging, and obstetrics and gynecology at the University of California ran estimates of cancer risk based on the purported dosages the machines provide. What they report:-The radiation dosage equals 3-9 minutes of radiation received from "daily living," seeing as the sun is constantly deluging us with the stuff.-You receive about 100 times more radiation from a ride at altitude in a plane (depending on the length of the flight naturally)-50 airport scans equals one dental x-ray, 1000 equal a chest x-ray and 4000 equal a mammogram.-If 100 million people flew 750 million times in a year, you could expect to see 6 additional cancers from the x-ray machines.-If 1 million frequent flyer embarked on 10 six-hour trips a week, you'd see 4 additional cancers from the x-rays, plus 600 additional cancers related to flying at high altitude.-Since cancer risk may be higher among children, for whom the dose is relatively higher, they calculated it for a five-year-old girl's risk of developing breast cancer. For every 2 million five-year old who flew one trip a week, you could expect to see one additional case of breast cancer over their lifetime.Sounds assuring, right? These figures of course assume that the machines are in good working order, and appropriate run, maintained and use the proper settings. Is it possible that relatively low-paid, modestly trained TSA's might accidently up the juice on a scanner and significantly raise the radiation dose? Could the federal government potential try to save money by relaxing maintenance schedules or going with the lowest bidder?Even in healthcare settings that are overrun with doctors and advanced degrees radiation accidents from scanners occur. The potential that it might happen at a busy airport is certainly a possibility.The comparison with the radiation dangers of flying is also interesting. Should we be comforted by the fact that the x-ray machines only expose us to 1% of the radiation of a high altitude flight, or concerned that flying exposes us to 100 times the radiation of the x-ray?Do any of these figures allay your concerns with airport scanners?Photo credit: TSA.gov]]>http://www.justmeans.com/Mental-Resilience---How-People-Overcome-Tsunamis--Meltdowns-and-other-Disasters/47813.htmlSun, 03 Apr 2011 18:42:12 GMTJohn Pospisil The world is full of people suffering. Tsunamis, earthquakes, epidemics and other natural disasters are obvious stressors. Acts of war and terrorism can be traumatic for the perpetrators, victims, medical personnel and bystanders. On a family level, divorce, loss of a spouse, disease, loss of a child and even loss of a pet can be overbearing.Stress by itself can make one sick. Hans Selye was one of the first to report that as awful as these events are, it is actually the number of minor stressor Read Full Article ]]> The world is full of people suffering. Tsunamis, earthquakes, epidemics and other natural disasters are obvious stressors. Acts of war and terrorism can be traumatic for the perpetrators, victims, medical personnel and bystanders. On a family level, divorce, loss of a spouse, disease, loss of a child and even loss of a pet can be overbearing.Stress by itself can make one sick. Hans Selye was one of the first to report that as awful as these events are, it is actually the number of minor stressors (how often you lose your keys and cell phone when you need to go to work immediately) that correlate most highly with rates of illness.Conventional thinking mandates that "survivors" of traumatic events are inherently at risk of stress-related illness, including mental illnesses such as post-traumatic stress syndrome, anxiety and depressive disorders. Grief and trauma counseling are industries, and it's practitioners are called in after events almost as a knee-jerk reflex. Public policy in some cases dictates that such professionals arrive at disaster and other catastrophic scenes as soon as possible to speed "the healing process."But is it necessary? Or even a good idea? In other words, is this belief about the inherent frailty of humans scientifically valid?George Bonanno, a leading researcher at Columbia University who studies grief, bereavement and resilience, thinks not. Quite the opposite, Bonanno's research indicates that the grief counselors and near-mandatory traumatic crisis interventions can do more harm than good. Published in "Weighing the Costs of Disaster: Consequences, Risks and Resilience in Individuals, Families and Communities", there is evidence across multiple studies that psychological resilience is common. This is not meant to ignore the negative consequences people can experience following traumatic incidents. Post-traumatic stress syndrome, depression, substance abuse as a maladaptive coping strategy and damaged social relationships do happen. The more psychological and social resources available reduce the likelihood, severity and duration of adverse consequences such that only a minority of individuals are extremely affected. In other words, the majority of people are inherently resilient and thus resistant through potentially traumatic events.Some individuals even show little or no grief after significant losses. Bonanno's work shows that these people are not cold sociopaths, but are essentially "immunized" by virtue of their psychological resilience. So, if resiliency can provide resistance, can people be trained in becoming resilient? Given that awful things do happen to everybody at some point in time, resilience training might be a wonderful psychological and physical investment. The U.S. Army believes there is a significant payoff in assessing positive coping traits and teaching resilience skills to it's soldiers. Among other events, war veterans are at greater risk of homelessness than other members of society. The organization launched a five-year, $125 million program involving 800,000 troops. Soldiers participate in psychological assessments and each months 150 participate in a University of Pennsylvania program to learn how to teach resiliency to others. The long-term hope is that a significant database will exist that can be tapped by civilian researchers to better understand factors that cultivate and impede the development of psychological resilience.Bonanno, however, remains skeptical. Given that most intervention programs either do no good or actually do harm, what will the Army program accomplish? Will resilience improve across the board, or would otherwise normal, healthy, resilient soldiers be rendered more susceptible to negative outcomes? Will this become $125 million well-spent, or $125 million worth of harm? Without even meaningful pilot data, there is no current scientifically valid answer.Image courtesy of U.S. National Oceanic and Atmospheric Administration]]>http://www.justmeans.com/Guess-How-Many-Calories-Are-In-This-Meal/48000.htmlThu, 31 Mar 2011 20:00:47 GMTEricka Foster Last year's American health care reform bill has faced controversy over providing medical care to uninsured and underinsured patients, but one of the lesser discussed items of the bill is a mandate for restaurant chains with more than 20 locations to post their calorie count on their menu items. The FDA has postponed issuing guideline citing the "complexity" of the situation, so for now, you will continue to have to guess how many calories are in the meal you purchased.The FDA issued a statement Read Full Article ]]> Last year's American health care reform bill has faced controversy over providing medical care to uninsured and underinsured patients, but one of the lesser discussed items of the bill is a mandate for restaurant chains with more than 20 locations to post their calorie count on their menu items. The FDA has postponed issuing guideline citing the "complexity" of the situation, so for now, you will continue to have to guess how many calories are in the meal you purchased.The FDA issued a statement saying, "We expect only a short delay in getting these documents out, and it is a reflection of the complexity of this issue, but most important an indication that the FDA is willing to work with all interested parties to ensure the best policy is presented," the FDA said. "We are committed to helping the public get clear and simple information about the food they buy and using a common sense approach to implement this law."Although the FDA cites "complexity", some chains have already been able to make the change, including Panera Bread. Furthermore, in New York City, restaurants are already required to post their calorie count on their menus. If you visit the websites of most of your favorite restaurants the calorie counts are already available, which begs the question, what exactly is so complicated?The law also includes convenience stores, movie theaters, bakeries, cafeterias, airlines and trains, food carts, and vending machines, which certainly adds a wrinkle to the plan. Obtaining accurate calorie count, and overhauling printed materials can be a cost burden to the guy selling hot dogs outside of your office. Grocery stores will now have to post calorie counts for those hot foods that we smell when we go in to pick up a box of cereal.Although the FDA is supposed to be an independent government body, movie theaters have hired lobbyists to fight the mandate. The underlying fear is that if moviegoers know that a large popcorn can be upwards of 1000 calories, they may just opt for the movie. Theater owners could then lose between 35% and 40% of their profits. However, the jury is still out as to whether consumers are changing their habits based on calorie counts being posted. Results released from a study by NPD found that customers continued to order high-calorie items, resulting in only a small calorie difference (approx. 200 calories). In addition, customers ordered the same amount of items as they had without knowing the calorie count. A study at Ohio State University, had different results: although students at a university dining hall chose lower calorie options, the bottom line didn't decrease.Photo by Jon Sullivan]]>http://www.justmeans.com/Bariatric-Surgery-is-Cost-Effective-for-Diabetes-Patients/47996.htmlThu, 31 Mar 2011 14:52:22 GMTEricka Foster Approximately 285 million people around the world suffer from type 2 diabetes. Type 2 diabetes (formerly known as adult onset diabetes) occurs when the body becomes resistant to insulin. Type 1 diabetes is occurs when the body does not produce insulin and patients, starting from a very young age, must participate in insulin therapy in order to stay healthy. Type 1 diabetes is also known as juvenile diabetes, although more and more children are getting type 2 diabetes as the rate of obesity incre Read Full Article ]]> Approximately 285 million people around the world suffer from type 2 diabetes. Type 2 diabetes (formerly known as adult onset diabetes) occurs when the body becomes resistant to insulin. Type 1 diabetes is occurs when the body does not produce insulin and patients, starting from a very young age, must participate in insulin therapy in order to stay healthy. Type 1 diabetes is also known as juvenile diabetes, although more and more children are getting type 2 diabetes as the rate of obesity increases among children.A study presented earlier this month at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes indicated that bariatric surgery is a viable and cost-saving option for people who suffer from type 2 diabetes. Bariatric surgery reduces the size of the stomach, and reduces absorption in the small intestine. Bariatric surgery includes gastric bypass, biliopancreatic diversion, and gastric banding. In the United States, bariatric surgery can cost between $15,000 and $24,000. This cost is less than the ongoing treatments relating to managing type 2 diabetes and treating complications relating to type 2 diabetes - including glaucoma, kidney failure and frequent hospital visits.The researchers looked at the data of 16 studies already done, comparing the cost effectiveness of morbidly obese patients who have received the surgery. They also found a greater benefit of performing the procedure on newly diagnosed patients. "Targeting recently diagnosed diabetes is likely to be more cost effective because diabetes remission rates achieved are higher in this group than in those with established Type 2 diabetes," says Catherine Keating, a senior research fellow from the Health Economics Unit at Deakin University in Melbourne, Australia. "Some of the studies I analyzed, particularly those targeting therapy for patients with recently diagnosed Type 2 diabetes, have found that the costs of surgery may be fully recouped through prevention of future health care costs. This excellent result is fairly rare."The news may be beneficial to patients found in the "Diabetes Belt". After detailed research of 644 U.S. counties, researchers have found the highest prevalence in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia, creating a "belt" within the U.S. The Diabetes Belt has similar characteristics to the Stroke Belt, which is also concentrated in the southern U.S. Similarities among these counties include poor diet, sedentary lifestyle, lower education levels and higher concentration of African-Americans. This implies that local jurisdictions need to focus community efforts on improving lifestyle habits such as diet and exercise.Photo courtesy of the Walter Pories, M.D. FACS. , U.S. National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health (NIH)]]>http://www.justmeans.com/Do-High-Deductible-Health-Plans-Reduce-Cost/47952.htmlWed, 30 Mar 2011 15:21:25 GMTAno Lobb Health reform and health care redesign inevitably fixates on reducing costs. Yes, there's always the idea that we might improve quality and safety, but in the end costs become a major driver for change.In some cases its unclear whether certain approaches that look good on paper will really work in practice. Some $20 billion and a lot of hope has been placed on the promise of electronic medical records (EMR) to reduce costs and improve quality of care, for example. But its still not clear if they Read Full Article ]]> Health reform and health care redesign inevitably fixates on reducing costs. Yes, there's always the idea that we might improve quality and safety, but in the end costs become a major driver for change.In some cases its unclear whether certain approaches that look good on paper will really work in practice. Some $20 billion and a lot of hope has been placed on the promise of electronic medical records (EMR) to reduce costs and improve quality of care, for example. But its still not clear if they will improve quality, and they are associated with significant implementation costs. And despite government incentives, implementation is still costly.Some have argued for high deductible health insurance plans as a way of "sharing" costs with consumers, as well as discouraging unnecessary utilization of costly care.So do high deductible plans really reduce costs? The short 80 second video blog below summarizes a new study from RAND that tried to answer this question.Photo credit:The author]]>http://www.justmeans.com/Health-Care-Delivery-Science--Management-is-Key-to-Affordable-Quality/47841.htmlMon, 28 Mar 2011 13:32:31 GMTAno Lobb One of the most exciting advancements in today's health industry is the growing field of health care delivery science. Granted, not everyone is aware of what this field is, and there's debate about whether it's a true science. But few doubt that it has great potential for improving the quality, value and potentially the financial solvency of American health care. A growing body of research support these hopes.But first a disclaimer: This author is an instructional designer for the Master of Heal Read Full Article ]]> One of the most exciting advancements in today's health industry is the growing field of health care delivery science. Granted, not everyone is aware of what this field is, and there's debate about whether it's a true science. But few doubt that it has great potential for improving the quality, value and potentially the financial solvency of American health care. A growing body of research support these hopes.But first a disclaimer: This author is an instructional designer for the Master of Health Care Delivery Science Program at Dartmouth College (On twitter at @DartmouthMHCDS). This 18-month program represents several firsts, including: Dartmouth's first foray into online education (it's a hybrid program: Mixed online and residential), it's the first official "health care delivery science" program in the nation (and probably the world). It also represents a collaborative effort between two storied professional schools: The Tuck School of Business, and The Dartmouth Institute of Health Care Policy and Clinical Practice (formerly known as the Center for the Evaluative Clinical Sciences). The idea is to combine business strategy and leadership from a world-class MBA program, with the clinical and health policy know-how of a leading health care think tank to tool today's health care leaders with the skills to redesign care.There are many reasons to suspect that better management is the prescription for improving health care, including a small but thought provoking new study in the Annals of Internal Medicine that sought to highlight the distinguishing characteristics of hospitals that were top performers in providing heart attack (AMI, or acute myocardial infarction) care. The researchers Interviewing 158 staff members at 11 hospitals whose risk-standardized mortality rates for AMI were either in the best 5% or the worst 5%.Performance in six principle domains appeared to separate the industry leaders from laggards:--"organizational values and goals--senior management involvement--broad staff presence and expertise in AMI care--communication and coordination among groups, and--problem solving and learning."Management makes a difference.Its interesting to note the dominating role that management, leadership and institutional culture plays in the list above, rather than technical ability. Creating a learning-organization, potentially utilizing health information technology to systematically improve communication and coordination, having buy-in from top management, and a sense of common goals, values and purpose. Those "basics" of leadership and management may well trump the adoption of the newest drugs and medical devices, at least when it comes to saving lives in heart attack patients.Implementing such values naturally sounds good, but can be difficult: Cultures have inertia that can be hard to overcome. Clinicians and administrators are busy and may not have time to ponder redesign. Leadership may not be informed by data, because staff may not be inculcated with a culture that expects everyone to contribute to quality improvement, and to be dedicated to measurement. And is there really a business model to support the implementation of such feel-good principles? Turns out yes, but more on that in upcoming posts.Photo credit: The author]]>http://www.justmeans.com/New-Drug-Could-Help-Alzheimer-s-Patients/47805.htmlSat, 26 Mar 2011 19:55:06 GMTEricka Foster Zileuton, a drug that has been approved by the U.S. Food and Drug Administration (FDA) to treat asthma has been shown to help reduce the formation of amyloid beta, a peptide in the brain associated with the development of Alzheimer's disease.According to the American Health Assistance Foundation, an estimated 36.5 million people suffer from Alzheimer's around the world. Alzheimer's is a brain disease that usually effects people over the age of 65. Memory loss, dementia, loss of concentration, an Read Full Article ]]> Zileuton, a drug that has been approved by the U.S. Food and Drug Administration (FDA) to treat asthma has been shown to help reduce the formation of amyloid beta, a peptide in the brain associated with the development of Alzheimer's disease.According to the American Health Assistance Foundation, an estimated 36.5 million people suffer from Alzheimer's around the world. Alzheimer's is a brain disease that usually effects people over the age of 65. Memory loss, dementia, loss of concentration, and a decline in judgment are all symptoms of the disease. The disease is degenerative and symptoms get worse as patients get older. Patients with Alzheimer's often need round-the-clock care and a family member with Alzheimer's can take a physical, emotional and possibly financial tool on the family. Although there is no cure for Alzheimer's, there are drugs on the market that slow down the progression of the disease in some patients.Cholinesterase inhibitors such as Aricept are used to treat mild to moderate Alzheimer's disease. Namenda is prescribed to treat moderate to severe cases of the disease. Alternative therapies include hormone replacement therapy, and sensory therapies like art and music therapy. Doctors also recommend a healthy lifestyle that includes exercise and a diet rich in produce and whole grains, and low in saturated fat.Zileuton inhibits 5-lipoxygenase -- an enzyme long known to exist in the brain - which controls the activation state of gamma secretase which is responsible for the final production of amyloid beta. Researchers at Temple University's School of Medicine found that Zileuton blocks the 5-lipoxygenase, reduces gamma secretase's production of amyloid beta and the subsequent build up of amyloid plaques in the brain by more than 50 percent.Gamma secretase is present throughout the body and plays a significant role in many essential bodily functions. But blocking the enzyme completely may cause cancer. Zileuton only modulates the protein expression levels, keeping some of its vital functions in tact while blocking adverse effects like the development of the amyloid plaques.Zileuton is already FDA approved, so the new drug use might be expected to advance to clinical trials relatively easily. "This drug is already on the market and, most importantly, is already FDA-approved, so you don't need to go through an intense drug discovery process," said Domenico Pratic, an associate professor of pharmacology in Temple's School of Medicine. "So we could quickly begin a clinical trial to determine if there is a new application for this drug against a disease where there is currently nothing."Because the brain is one of our most complicated organs, scientists know some things about Alzheimer's. There are genetic markers that indicate the likelihood that someone my get the disease.Photo courtesy of the National Institution on Aging.]]>http://www.justmeans.com/Human-Trafficking-as-a-Public-Health-Crisis-Part-3---What-One-Person-Can-Accomplish/47698.htmlFri, 25 Mar 2011 19:38:13 GMTJohn Pospisil What can one person accomplish? Dr. Paula Heron is a a postdoctoral fellow at the University of Kentucky. Born in Zimbabwe, she's lived most of her life in South Africa. Ten years ago, Ms. Heron came to the US to complete her Ph.D. in neuroscience and has remained here. She decided to combine her triathlon experience with a passionate stand against human trafficking. The following is a verbatim record of my interview with Dr. Heron. For her, it began with a movie...1.. What is Tri4Freedom and wh Read Full Article ]]> What can one person accomplish? Dr. Paula Heron is a a postdoctoral fellow at the University of Kentucky. Born in Zimbabwe, she's lived most of her life in South Africa. Ten years ago, Ms. Heron came to the US to complete her Ph.D. in neuroscience and has remained here. She decided to combine her triathlon experience with a passionate stand against human trafficking. The following is a verbatim record of my interview with Dr. Heron. For her, it began with a movie...1.. What is Tri4Freedom and when did you start it?"Tri4freedom is something I conceptualized less than a year ago with the intention of using the sport of triathlon as a platform to raise public awareness about human trafficking. The success and effectiveness of this mission hinges upon the support and commitment of fellow triathletes and community at large willing to take a stand against human trafficking."2. What motivated you to take such an interest in human trafficking?"Initially my own awareness about human trafficking stemmed from a movie about a young woman from an eastern European country who thought she was coming to the United States to pursue a dream job as a model but once she arrived she was forced into sex slavery. What struck me was the relative ease with which this travesty was committed by the trafficker and the finality of what had occurred from the victim's perspective. The excitement associated with arriving in a new country - something I can well relate to - is abruptly replaced with an indescribable fear. This I find terrifying and the realization that human slavery occurs within our communities and areas we deem safe to live, haunts me."3. How surprised are people to learn the extent of human trafficking, both in sheer numbers and global extent?"I have found that the majority of people I speak to either have no idea what human trafficking is or they have heard of it but fail to recognize how prevalent it is in the United States. Most people see it as a third-world issue. People's responses have varied greatly when they hear that human trafficking occurs in their own cities. Some people prefer to continue ignoring the issue, while some are alarmed and take a genuine interest in what they can do to help the situation."4. It's literally an ancient crime. In terms of modern solutions, do you feel governments willfully ignore human trafficking or is it just so difficult to solve that it slips below the radar?"Governments are certainly aware of the issue. Many states have anti- human trafficking laws; however law enforcement alone is not sufficient to combat the problem. The Not For Sale Campaign, a non-profit organization committed to the fight against human trafficking, maintains that abolishing slavery can only be achieved by creating a community task force. I think the fact that human trafficking occurs unnoticed to the general public has contributed to its escalation into the 32 billion dollar industry it is now. If people knew the extent of human trafficking it should prompt public outrage which would force governments into finding effective ways to combat it."5. How doe Tri4Freedom help the problem?"As an individual deeply disturbed by the issue of human trafficking I created tri4freedom in an attempt to merge my passion for triathlon with my desire to see an end to human slavery. Firstly, Tri4freedom can raise substantial awareness about human trafficking within the triathlon community, including spectators of major races such as Ironman. Secondly, Tri4freedom aims to support The Not for Sale Campaign by raising funds and highlighting the efforts this organization is doing to combat the issue."6. Why the link between triathlon and the cause?"Triathlon by definition is comprised of three sports presenting a challenge that only the most dedicated and zealous individuals find appealing. Not surprisingly, demographics have indicated that the majority of triathletes are highly successful and educated professionals. For this reason I am hopeful that tri4freedom will spark enthusiasm from fellow triathletes who are entrepreneurs, lawyers, healthcare workers, teachers and community leaders. Collectively triathletes are in professional positions most likely to have an influential impact on finding effective solutions to combat human trafficking."7. How much support are you receiving through the Tri4Freedom website? Domestically, internationally?"The support I have received so far has stemmed from letters I have written requesting sponsorship or from individuals that know me. The purpose of the website is to provide interested people with information and resources to help in the fight against slavery. As I promote my site more in the coming months I hope to achieve greater support from the general public and fellow triathletes."8. Who are some of the "good actors" organizations that either partner w/Tri 4 Freedom or provide support in some way?"First and foremost the Not For Sale Campaign has demonstrated continuous support for Tri4freedom, which is raising funds for their Free2play initiative. In collaboration with this organization, we are working on promoting fair trade athletic apparel and increasing media awareness about Tri4freedom's contribution to their efforts in abolishing human slavery.Local businesses have been very supportive. Most notably, Green's Toyota of Lexington has provided financial assistance to help promote the Tri4freedom event in June. This event would not have been possible without the support of SpindleTop Hall who kindly offered to host the event and help with local promotion. Ad-Venture Promotions, and In His Image Designs have also shown enthusiastic support for Tri4freedom. HFP racing has been very supportive in helping promote Tri4freedom at two of their race weekends this summer which will reach almost 1500 athletes. Newton Running has generously donated a free pair of their running shoes for me to wear during my 27 hour triathlon."9. What is this 27-hour event you are planning this summer?June 18th-19th I will do a solo triathlon lasting 27 hours, which I named "Free2tri" after Free2play, which is the sole recipient of all funds we raise. 27 hours has significance- 27 million people are currently enslaved around the world. The event will be hosted by Spindletop Hall and will begin at 6am starting with a 2.5 hour swim, followed by a bike ride until sunset and ending with an overnight run until 9am the following morning. In collaboration with Not For Sale and our sponsors, planning is underway to encourage public attendance and donation incentives. As the date approaches we will release updates on the website. The purpose of "Free2tri" is to showcase Tri4freedom in the hopes of gaining athlete support, to raise funds for the Not For Sale Campaign and most importantly to highlight the widespread travesty of human trafficking.10. How can individuals help draw attention to and combat the problem of human trafficking?Talk about it. Get angry. Acknowledge that human trafficking exists and accept the reality that an end to human trafficking is going to require a change in behavior. For example one way to help is by only purchasing fair trade products. This ensures that employee's lives are enhanced. The current reality is that fair trade is expensive because there is no overwhelming consumer demand to drive the price down. We need to demand that companies and their supply chains adhere to a slave-free workforce. The success of this approach has been demonstrated in the chocolate industry where a few companies have been pressured by the public to make their chocolate fair trade.People could further this issue by being vigilant in identifying potential victims of human trafficking and contacting local authorities or dialing the National Human Trafficking hotline 1888-3737-888. There are numerous resources available on the web that describes human trafficking cases and how the public can help. I good place to start is http://www.notforsalecampaign.org and my site http://www.tri4freedom.com Image courtesy of Paula Heron at Tri4Freedom.com]]>http://www.justmeans.com/Human-Trafficking-as-a-Public-Health-Crisis--Part-2/47497.htmlWed, 23 Mar 2011 21:24:31 GMTJohn Pospisil This is the second part of a three-part series focusing on human trafficking from a public health perspective.Malaria affects over six million people per year. Worldwide, more than two million individuals are infected with tuberculosis. Each year, there are about two - three million new people who are newly infected with HIV. Each disease is considered a public health problem and is preventable. The World Health Organization estimates that up to four million people are direct victims (captives) Read Full Article ]]> This is the second part of a three-part series focusing on human trafficking from a public health perspective.Malaria affects over six million people per year. Worldwide, more than two million individuals are infected with tuberculosis. Each year, there are about two - three million new people who are newly infected with HIV. Each disease is considered a public health problem and is preventable. The World Health Organization estimates that up to four million people are direct victims (captives) or indirect victims (for example, affected by disease or family member loss) of human trafficking. If 16,000 US citizens died from an epidemic, there might reasonably be national outrage. However, 14,500 - 17,500 individuals, including children, are estimated to be illegally brought into the United States per year for the purposes forced labor, among other crimes. It is even more difficult to estimate how many people once within US borders are moved between states and communities without leaving the country. Worldwide, hundreds of thousands of men, women and children are direct victims.The standard governmental model for handling criminal behavior includes punishment for offenders, protection for victims and despite best intentions, preventive measures come last. Human trafficking is a complex social and economic problem, much like the war on drugs. Similarly, it cannot be stopped by single, law-enforcement focused approach. Criminal law tends to address events after they have occurred rather than through encouraging attitudinal and behavioral change. To abate human trafficking, it might be time to change tactics to put a premium on prevention.Even if one does not view human trafficking as a public health problem, there are aspects of the model that fit well in this fight. Public health is a unique field among the health professions. There is a focus on populations rather than individuals and prevention rather than cure. It is a scientific, evidence-based endeavor with a firm link to government and politics. Additionally, outcomes of violence prevention initiatives benefit from a public health model, so it seems reasonable to extend this methodology to human trafficking.Following the model proposed by the Center for Disease Control for preventing violence, there are four steps that must be fulfilled. The root cause of trafficking must be understood. This means a scientific analysis that evaluates individual risk factors, social relationships that increase personal risk, the role of the local environment and community and finally sociocultural standards.Public health campaigns must bring the problem to a level of social consciousness. According to the report "U.S. Awareness of Human Trafficking: Executive Summary of Survey Findings", most Americans are quite unaware that the United States is affected. Individuals, communities and non-governmental organizations can, if motivated, provide government officials with feedback about what efforts work well for the local population, what resources are necessary and generally guide lawmakers on how government can effectively intervene rather than government blindly and unwisely throwing resources at the problem.Finally, at the level of personal responsibility, each person should be able to see how even small actions can help ameliorate the issue of human trafficking. Just in the same way that people learn how diligent hand-washing and how to properly "cover and cough" can help prevent the spread of colds and the flu, small efforts can make a difference. The next posting in this series examines one person's efforts to raise awareness about the problem of human trafficking and how to combat it.Image courtesy of Antonu]]>