Ano Lobb's blogshttp://www.justmeans.com/editorials/health/210.htmlFri, 25 May 2012 00:19:01 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/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/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/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/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/Walmart-s--4-Generic-Drug-Pricing--Rx-for--6-Billion-in-Savings/47526.htmlWed, 23 Mar 2011 08:26:39 GMTAno Lobb Wal-Mart triggered an industry "race to the bottom" in terms of generic drug pricing when it introduced its program to charge $4 for a 30-day supply of a host of common generic medications, $10 for a 90-day supply. Other large retailers like Target soon followed. The average cost before Wal-Marts discount program was $10.50 for 30-days worth of drugs, $26 for 90-days. What would happen if the entire nation adopted this pricing scheme? For the first time a small study just published in the Archiv Read Full Article ]]> Wal-Mart triggered an industry "race to the bottom" in terms of generic drug pricing when it introduced its program to charge $4 for a 30-day supply of a host of common generic medications, $10 for a 90-day supply. Other large retailers like Target soon followed. The average cost before Wal-Marts discount program was $10.50 for 30-days worth of drugs, $26 for 90-days. What would happen if the entire nation adopted this pricing scheme? For the first time a small study just published in the Archives of Internal Medicine asks this question.The researchers, funded in part by RAND, the University of Pittsburgh and the NIH, reviewed data from some 31,000 participants in the 2007 Medical Expenditures Panel Survey (MEPS). These individuals were aged 18 or older, and used some generic or name-brand drug that was available as a $4 generic in 2007.Extrapolating to the entire US population, the study found that around 80,500,000 American adults could potentially benefit from a $4 generic program, though only about 6% (or 4.4 million) actually did so in 2007. So what would happen if all eligible adults shopped at Wal-Mart, or at least benefited from Wal-Mart pricing?Individual would only save an average of around $64 out of pocket per year, about half of them would only save about $22 per year. But overall societal health care system savings would be more significant:-$5.78 billion in total savings-$3.23 billion saved out of pocket-$1.07 billion in Medicare savingsThese savings may not seem like much in the scope of massive health care spending, but here are at least some questions about this idea:-Economists make a big deal about the impact of rising gas costs based on the argument that every extra dollar put into your fuel tank is one less dollar you are spending on all those other things that stimulate the economy. So conversely, does that mean that consumers who are spending $3.23 billion less on meds would spend that money elsewhere?-Could this shift towards generics represent a boon for the generic pharmaceutical industry, and generic manufacturers such as Watson, Teva, and Sun Pharmaceuticals ? Even if the over all dollar figures are small, relative to the size of the entire industry, wider acceptance of generics could help shift the entire spectrum of prescribing behaviors towards such drugs.- Could an industry shift towards generics lead to an industry shift that lowers the financial profile of pharmaceutical production, leads to specialization, diversification, and more of a mission-driven industry looking to increase health more than profits? Instead of an industry dominated by giants such as Pfizer, Merck, Novartis and Glaxo, would we see more smaller pharmaceutical companies such as the non-profit Institute for One World Health? And how might the branded industry respond?-Most physicians and researchers take for granted that generics are bio-equivalents of branded drugs, the generic pharmaceutical industry certainly does. But some folks point out that generics may not be quite as equivalent as the yare made out to be. In fact some prescriptions come with explicit instructions to provide a brand-named drug and not a pharmacologically equivalent generic. Would this policy have any unintended consequences in these cases, especially if generics gained wider acceptance as the "go-to" option.-Generics by their nature are older, have been on the market longer, have been used by more patients (generally speaking) than equivalent branded medications. Theoretically this means that their safety profile is better understood (if we assume that they are in fact pharmacologically equivalent to branded alternatives). Could a shift towards generics be a boon for patient safety?What interests or concerns come to your mind when you hear of the idea of scaling Wal-Marts drug pricing innovations to a national level?Photo credit: The author]]>http://www.justmeans.com/Despite-Positive-Findings--Uncertainty-around-Evidence-Behind-Electronic-Medical-Records/47407.htmlMon, 21 Mar 2011 10:36:31 GMTAno Lobb A new review of recent literature on the effectiveness of electronic medical records (EMR) from the Office of the National Coordinator for Health Information Technology (part of the Department of Health and Human Services) finds that fully 92% of reviewed papers published since 2007 have positive results. This means that the overall conclusion of the 154 papers they reviewed concluded that EMR and other health information technologies (HIT) tested were associated with improvements in care with n Read Full Article ]]> A new review of recent literature on the effectiveness of electronic medical records (EMR) from the Office of the National Coordinator for Health Information Technology (part of the Department of Health and Human Services) finds that fully 92% of reviewed papers published since 2007 have positive results. This means that the overall conclusion of the 154 papers they reviewed concluded that EMR and other health information technologies (HIT) tested were associated with improvements in care with no drawbacks, or were overall positive despite one or a few negative elements.A recent posting raised the issue of cost and returns on investment for adopting EMR, specifically General Electricic's Centricity EMR system. The point was made that although it can grow tiresome to forever look at dollars and cents, doc do have to find a way to pay for technology investments. Clinicians are likely more interested in how such technologies might improve their outcomes, and the health of their patients. The well-trained clinician would then turn to the literature to see what recent reviews have found.The Authors of this new review, published in Health Affairs, found a laundry list of benefits from individual EMR and HIT studies, including things such as:-48% reduced mortality and 25 % reduced nursing levels over 3 years at a dialysis center-Fewer complications, lower mortality and cost at more "wired" hospitals in Texas, compared to less wired ones.They also found some negative, potentially contradictory findings, such as:-Higher costs at more wired facilities vs. less wired ones-Longer time to fulfill prescriptions at facilities using e-prescribing versus those writing by hand-Implementation characterized by increases in medical errors, medication errors, and procedural errorsWithout fully detailing the individual benefits or drawbacks highlighted in each study, the authors seem to be a bit skeptical, and rightly so. There's certainly some publication bias at work here (the tendency for positive studies to be more likely to be submitted and accepted for publication than negative findings). Study designs and statistical analysis varied extensively. Measuring outcomes from a grab-bag of benefits, ranging from improved efficiency, to lower cost, to fewer medication errors, makes it hard to draw conclusions from a many studies. With so many different systems being tested, its also hard to differentiate between which particular type of program might work better. The interface between clinician and HIT can make a huge difference in how well such technology works in the field. The authors acknowledge as much, writing that "the stronger finding may be that the "human element" is critical to health IT implementation." Further, there seems to be a weakness inherent in publishing so few negative papers, especially about the tough implementation period that accompanies any new technology."The negative findings also highlight the need for studies that document the challenging aspects of implementing health IT more specifically and how these challenges might be addressed," write the authors.How does this help? It illustrates several potential pitfalls in the rush to adopt EMR and HIT more generally: The federal HITECH program has established funding to help doc's go digital, but there seems to be a disconnect between what we are trying to achieve, and whether there's any evidence that it will in fact improve health systemically.Remind me again what the overall public health and societal goals of EMR were? Is there a master list somewhere that we are following?Without fully enunciating what the goals of HIT are, its impossible to choose the right technology, the right measures, or to determine what success might look like, or measure whether we are getting there.Much interest around health reform swirls around the issues of cost, and yet the data about cost-effectiveness, whether it's ROI in dollars or cents, or ROI in terms of health outcomes, is uncertain.Wouldn't it help if we established some ground rules, for example: What are three things that we should expect all EMR to do, and three outcome measures that would tell us whether we are getting there?Photo credit: The author]]>http://www.justmeans.com/Do-Incentives-for-Electronic-Medical-Records-Outweigh-the-Costs/47220.htmlFri, 18 Mar 2011 10:30:57 GMTAno Lobb Electronic Medical Records (EMR) are receiving a lot of attention as well as investment. The federal government has earmarked some $20 billion to get help medical records go digital. The assumption is that EMR will improve quality and lower costs over the long term. But in the short term it requires capital investment and a potentially steep learning curve. A couple of papers in the latest issue of Health Affairs and the Journal of the American Medical Informatics Association (JAMIA) help to qua Read Full Article ]]> Electronic Medical Records (EMR) are receiving a lot of attention as well as investment. The federal government has earmarked some $20 billion to get help medical records go digital. The assumption is that EMR will improve quality and lower costs over the long term. But in the short term it requires capital investment and a potentially steep learning curve. A couple of papers in the latest issue of Health Affairs and the Journal of the American Medical Informatics Association (JAMIA) help to quantify the investments of time and money that your average doctors practice might need to go digital. Currently only 13-17% all physicians report using some form of EMR, only 4% use the type of advanced system that fully meets the governments new standards for "meaningful use." That standard qualifies practitioners for the full suite of financial incentives, described below.Researchers looked at 26 primary care clinics in the HealthTexas Provider Network, all of whom where integrating General Electric's Centricity Electronic Medical Record. In a nutshell they found that it costs an average of:--$32,409 per physician to implement EMR over the first 60 days, $46,659 over the first year.--$162,047 for a 5-doctor practice over the first 60 days, $233,297 for the first year--134 hours of staff time, including doctors and nurses, to prepare to use the systems.A recent paper in JAMIA seems to dispel the myth that EMR will suck up clinicians' time with data entry. This paper, looking at a large academic tertiary facility, looked at backend tracking logs and found that attending and resident docs spent about 90 minutes a day in the EMR authoring or reviewing notes. Past studies have cited much higher figures, often because they relied on self reports and lets face it, each minute spent on "paper work" of any kind can feel like hours.In addition to the need to purchase software and hardware (extra computers, printers, wiring, etc..), the cost of licenses was a significant contributor to costs.An obvious question about the costs of EMR is whether incentives or other benefits make it "worth it" from a financial angle. Or put crudely, if you are a doctor, can you afford it?An estimated 90% of primary care doctors qualify for financial incentives to implement EMR from the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act of 2009 (other specialties are also eligible as well). Practices that see Medicaid patients are eligible for up to $18,000 in the first year, and $44,000 over five years. If 30% of their patients are on Medicaid, the amount rises to $21,250 the first year, and $63,750 over five years. In order to qualify for the highest dollar amounts, physician's need to adopt more advanced systems that meet "meaningful use" guidelines.Do those numbers add up? If you are a five-doc facility looking to spend $233,000 to implement EMR, and you receive a $21,000 financial incentives from CMS, how do you make up the additional $212,000? Obviously this is oversimplified and doesn't account for depreciation and other accounting methods for spreading costs over time, and possible tax benefits for investments in technology. But what do we tell financially strapped primary care offices who are essentially asking us to make the business case for EMR? Where does the financial benefit show up?How would you make the case?Then there're the non-financial benefits that are often touted by advocates of EMR. An upcoming post will look at a new review of the literature supporting the use of EMR to improve quality and safety.Photo credit: GE Healthcare]]>http://www.justmeans.com/Danger-from-Dietary-Supplements--The-Strange-Tale-of-Hydroxycut/47042.htmlWed, 16 Mar 2011 05:07:49 GMTAno Lobb Two years ago the then-best selling weight loss supplement Hydroxycut was pulled from the market after being linked to 23 cases of liver damage and one death. While the recall was voluntary on the part of the manufacturer, the Food and Drug Administration (FDA) issued consumer and clinician warnings, and you might think the story would end there. But it doesn't.The active ingredients suspected of causing harm included an extract of the Garcinia cambogia fruit, called hydroxycitric acid (in a pro Read Full Article ]]> Two years ago the then-best selling weight loss supplement Hydroxycut was pulled from the market after being linked to 23 cases of liver damage and one death. While the recall was voluntary on the part of the manufacturer, the Food and Drug Administration (FDA) issued consumer and clinician warnings, and you might think the story would end there. But it doesn't.The active ingredients suspected of causing harm included an extract of the Garcinia cambogia fruit, called hydroxycitric acid (in a proprietary formula called SuperCitrimax), green tea, and chromium. Were those substances really effective, and did they really cause the harm? We don't know for sure. The few studies of hydroxycitric acid in humans that have been published tend to be very small, of shirt duration, and many of the positive studies did not disclose financial conflicts of interest. The manufacturer never-the-less cited those studies in advertisements for their products, making it seem as though their product was clinically tested. After the recall, Hydroxycut returned to the market, with those suspected ingredients removed from its primary formulation.Amazingly, you can still find products that contain that triad of ingredients, including a sub-formulation of Hydroxycut, for sale on the internet. What was once dangerous enough to be withdrawn by the manufacturer has quietly returned to the market now that the fuss has died down. Perhaps this is an argument for ingredient-based regulation efforts, rather than just product based ones? That is, after all, the approach that finally removed ephedra from the market.The new formulation of Hydroxycut contains Cissus quadrangularis. What exactly is that, and does it work? No clue (about whether it works). It's a botanical extract, but evidence about its safety and effectiveness is hard to pin down. To begin with there are very few studies of the substance in humans. Those that were conducted were very small and only lasted for a few weeks. On closer scrutiny, many of the human trials that are supportive of the substances effectiveness were conducted by researchers with financial relationships to the manufacturer (in some cases they were patent holders for gimmicky supplements containing the substance under study). These relationships were not disclosed in many of their published studies. Hmmm, sounds familiar.Interestingly enough, even with the original formulation of Hydroxycut no longer being widely marketed, case reports continue to be published, including in Medical Journal of Australia, and the Hawaii Medical Journal.So why should we care about any of this we don't use this particular brand of supplement? Several reasons, including:-Dietary supplements are often considered "natural and therefore safe," even though their labels often claim, and their ingredients often provide, potent pharmacological effects.-Since they do not undergo anywhere near the pre-marketregulatory scrutiny of pharmaceuticals, we have no way of knowing if they are safe and effective before they go to market.-Post-market regulation is so lax that only an estimated 1% of adverse events are ever reported to FDA. This means the 23 reported cases might actually reflect something like 2300 cases of liver damage.-When industry-related researchers publish findings that are strangely supportive of products that they stand to earn money from, and they fail to disclose their conflicts of interest, we should all be concerned. The scientific evidence-base isn't perfect, but it's the closest thing we have to objective truth about what works and what doesn't in health. If industry is subverting this objectivity, we all stand to lose.While many people like to scowl at the seemingly poor job that the FDA does in keeping the supplement-taking public safe, its important to remember that they are limited by the enforcement powers granted them by congress, and hamstrung by underfunding. The result is a very short-staffed agency with limited powers and an almost unenforceable mandate to keep the public safe.That's another reason why its unfortunate that manufacturers of dietary supplements appear to be willing to profit with potentially dangerous products of dubious effectiveness.Finally, while one might assume that engaged and educated consumers might also be an answer, a new study found that even among doctors, there's appears to be a lot of misconceptions about supplement safety and effectiveness: 20% of doctors surveyed in a new study reported using botanical supplements, with green tea being the most commonly taken. There just isn't enough evidence supporting safe effective use of that many botanicals to suggest that all those doctors are taking those substances for evidenced-based reasons.Photo credit: The author]]>http://www.justmeans.com/Public-Health-Melt-Down--Nuclear-Lessons-from-Japan/47013.htmlMon, 14 Mar 2011 11:52:59 GMTAno Lobb 9/11 showed the strength and weaknesses of skyscrapers: incredible resilience capable of withstanding the impact of a direct hit by an airplane, but vulnerable to extreme heat.Japan's nuclear reactors show similarly unexpected strengths and vulnerabilities worth pondering not only from an energy policy perspective, but also public health. When we consider how risky a behavior is, three general criteria come to mind: How likely is it to happen to me, how bad will it be if it does happen, and what Read Full Article ]]> 9/11 showed the strength and weaknesses of skyscrapers: incredible resilience capable of withstanding the impact of a direct hit by an airplane, but vulnerable to extreme heat.Japan's nuclear reactors show similarly unexpected strengths and vulnerabilities worth pondering not only from an energy policy perspective, but also public health. When we consider how risky a behavior is, three general criteria come to mind: How likely is it to happen to me, how bad will it be if it does happen, and what are the trade offs? Keeping these two factors in mind, even events as unlikely as recent Somali piracy have health lessons.Japan's current nuclear saga is far from done or even fully understood. But two points seem fairly certain: The reactors actually withstood the 9.0 earthquake, and the subsequent tsunami. What they were not able to recover from was the ultimate failure of the power grid and backup generators necessary to maintain cooling systems. This was exacerbated by poor emergency planning that placed backup generators in a low laying location susceptible to flooding.This paints a far more scary picture from a generalizable public health perspective, because it potentially makes the "Japan Syndrome" (explosion and radioactive release secondary to a cooling failure) a real possibility practically anywhere. Rather than a tale of what can happen to the infrastructure when a once-in-a-generation natural disaster occurs, this becomes a possibility under much more mundane circumstances that might threaten electricity supply and backup plans, in much more geologically stable areas far above sea level.Risks, Perceptions and Trade OffsSerious nuclear accidents are rare, and in the US no one has ever died from a nuclear power accident. But the consequences are tremendous: radiation contamination of large areas of land for literally hundreds of thousands of years. Ground waters and atmospheric forces spreading the danger. You can't see or smell radiation, so the public is left to trust government and industry to tell them who is at risk of what. Situations that don't engender confidence include evacuation notices that clear populations in neatly concentric circles with a radius of a dozen or so miles, then experts tell us that the danger actually extends more in a pencil shaped plume potentially hundreds of miles that will wander based on weather conditions.Then there's the strange trade-off that nuclear energy offers: Ideally, in an accident free environment they offer lots of (relatively) cheap electricity in the short term that doesn't contribute to climate change. More reliable than generation dependent on the sun or wind, cleaner than coal. Long term they of course create wastes that remain deadly for thousands of years. There're huge capitol expenses to build plants. And accidents can be horrifying.Perhaps reactor age and design doesn't matter, but it certainly doesn't make the public relations any easier when news spreads that plants of the same design and age as Japan's exploded Fukushima Daiishi Unit 1 are operating elsewhere. 40-year old Vermont Yankee, the oldest nuclear power plant in the US, is apparently an identical reactor.In addition to being plagued with numerous safety problems and (comparatively mild) radiation leakages, Vermont Yankee faces regulatory challenges. Although the federal Nuclear Regulatory Commission granted a license for Yankee to continue operating for another 20 years, the Vermont legislature voted against re-licensure. It's unclear whose authority will ultimately prevail, so the issue will likely fester in federal court before reaching an eventual resolution.Will events in Japan diminish the Obama administration's previous support for building more nuclear power plants in the US? Will it influence the fate of Vermont Yankee? Should it? Could the Northeast be endangered by failures of the power grid and backup generation caused by weather or man-made conditions? Are these rare risks worth taking, even though their potential health impact could last for hundreds of generations?Photo credit: Vermont Yankee.com]]>http://www.justmeans.com/Japan-Earthquake-on-Twitter--Social-Media-Trends-During-Disaster/46835.htmlFri, 11 Mar 2011 11:30:35 GMTAno Lobb The tragic magnitude 8.9 earthquake that struck Japan at 12:46 a.m. EST this morning has not only left its mark on the people, infrastructure, society and economy of Japan. It also created a cresting wave in the social media space. Twitter has a long history of being used to track earthquakes. The US Geological Survey maintains the "World Earthquakes" feed (@earthquake), and their @USGSted is an official site tracking earthquake responses (Twitter Earthquake Detector). The USGS has found that sp Read Full Article ]]> The tragic magnitude 8.9 earthquake that struck Japan at 12:46 a.m. EST this morning has not only left its mark on the people, infrastructure, society and economy of Japan. It also created a cresting wave in the social media space. Twitter has a long history of being used to track earthquakes. The US Geological Survey maintains the "World Earthquakes" feed (@earthquake), and their @USGSted is an official site tracking earthquake responses (Twitter Earthquake Detector). The USGS has found that spikes in twitter traffic from affected populations occurs within seconds of a quake, compared to the typical 2 to 20 minutes that it takes for scientific alerts to be issued.Data from Trendistic.com shows that within about 75 minutes of the largest jolt, Twitter traffic related to Japan jumped dramatically. Typically about 0.05% of all Twitter traffic relates to Japan, but at 2:00 a.m. EST, it accounted for nearly 12% of all twitter traffic. Here's the graph from Trendistic. Perhaps coincidentally, Twitter traffic about Haiti also jumped from practically nothing to 10% following their massive quake in January 2010.A retrospective analysis of Twitter traffic has also found that traffic correlates well with the incidence of infectious disease. The trick, of course, is interpreting what this means. Obviously people will tweet about news items, or if the ground around them is shaking. The trick may be in how to monitor the 25 billion tweets that are sent each year to pick up such emergent trends. Do they tell us anything new? In the case of earthquakes they appear to be quicker than scientific alerts, though by a time margin that likely doesn't affect response.Its also fascinating that even when major disaster hits, people are reaching for their phones to tweet about it, rather than heading for higher ground or assessing their surroundings or the well being of their family and neighbors. Is social media truly entering our social DNA to the point that for a significant number of people it is part of their reflex response to emergency? Or are we finally empowering citizens the world over with a tool that allows them to fulfill a very basic human need: The need to let others know when tragedy strikes.Photo credit: USGS]]>http://www.justmeans.com/Comedy-of-Social-Media-Errors--Pharma-s-Lame-Take-on-Glee/46831.htmlFri, 11 Mar 2011 10:52:43 GMTAno Lobb With nearly 600 million people on Facebook, 175 million on Twitter, and 75 percent of the worlds 2 billion internet users accessing social media of some sort, you might not think that the internet's social spaces are that difficult to navigate. Businesses like Wellness Layers have further honed the marketing potential of the social media space by creating "social media ecosystems" that allow customers to build relationships with a brand that translate into higher sales figures, and engaged consu Read Full Article ]]> With nearly 600 million people on Facebook, 175 million on Twitter, and 75 percent of the worlds 2 billion internet users accessing social media of some sort, you might not think that the internet's social spaces are that difficult to navigate. Businesses like Wellness Layers have further honed the marketing potential of the social media space by creating "social media ecosystems" that allow customers to build relationships with a brand that translate into higher sales figures, and engaged consumers.The pharmaceutical industry, however, has not been able to figure out what the 6 million 'tweens following Justin Bieber on Twitter have already absorbed into their DNA: How to work this thing called social media.A wonderfully cringe-inducing example are the efforts to market Allergan's acne medicine Aczone. This prescription product contains dapsone, originally used to treat leprosy. Seeing the traction that shows such as Glee and High School Musical have had among their pimple-prone target market, Allergan employed the marketing firm Indelible to create an online musical promoting their product. The result is a freakish high-school themed musical production featuring one of the stars of the Twilight series, and song-and-dance routines such as "Cheerleader in Love." Youngsters suffering from acne, or who jut want to see their drug-pusher shake pom-poms, are introduced to cast members including the fetching blond Amber, "your classic bubble-headed cheerleader who has always gotten what she wants by letting her poms poms do the talking." Err, yeah, that's just the character I want my daughter singing with.To make matters worse, when this author accessed the site, links to potentially helpful sites such as "Find a Dermatologist," "Get a Prescription," "Skin Care Zone" and of course the "Parent's Zone" didn't work. I couldn't even claim my free sample because of the dead links. Darn.In an interview, an Indelible exec says that "ACZONE: THE MUSICAL was an exceptional mix of originally produced glam rock with dazzling motion graphics and first-class choreography."But is it a good way to market medicines to kids, or even build a relationship? Is this the way that pharma should be using applying social media or the internet? Or should they pack up, regroup and talk with real experts like the folks at Wellness Layers who seem to have a much more authentic approach.Check it out (if you dare) by going to Aczone the Musical, and let me know what you think.Photo credit: Aczone the Musical]]>http://www.justmeans.com/Personal-Health-Records-In-Action--Google-Health-and-Microsoft-HealthVault/46745.htmlWed, 09 Mar 2011 13:11:50 GMTAno Lobb Personal Health Records (PHRs) offer an interesting way for patients to access an electronic health record, or at least selected portions of it. While there are many to choose from, tech giants Google and Microsoft each have PHR offerings, and the Journal of the American Medical Informatics Association recently published a study that trialed both these systems. The authors pull 4 main learning points from their experience.But first some backgroundPHRs generally fall into two categories: Tethered Read Full Article ]]> Personal Health Records (PHRs) offer an interesting way for patients to access an electronic health record, or at least selected portions of it. While there are many to choose from, tech giants Google and Microsoft each have PHR offerings, and the Journal of the American Medical Informatics Association recently published a study that trialed both these systems. The authors pull 4 main learning points from their experience.But first some backgroundPHRs generally fall into two categories: Tethered or stand alone. Roughly speaking a stand alone variety can be separate from any other paper or electronic record and filled with patient-entered data, or have some varying level of interconnectedness with a clinical EMR (electronic medical record). As its name suggests, a tethered system is fed by an electronic medical record and is essentially a patient portal into clinical data gathered by a provider or payer.In 2008 researchers at the Military Health System launched MiCare, a one year pilot project aimed at giving service personnel greater access to their EHRs. The clinicians were practicing out of a major 400-bed tertiary care center in Washington State. They enrolled 250 participants, and gave them option of choosing Google Health or Microsoft's HealthVault PHR system, tethered to their military EHR. 169 chose HealthVault, and 81 opted for Google Health.The PHRs provided data on: Lab results, allergies, medications, radiology reports, appointments, medical procedures medical problems, consultation reports, inpatient notes, outpatient encounter notes.Lessons LearnedAfter extensive surveying, debriefing and analysis, including the table of comments from users shown below (Table 4), the researchers extrapolated four key learning points. There were technical findings as well, which you can read about in the paper itself.1. Speed (and therefore data) Matters. Since most participants wanted all possible data to show up in their PHR, the initial default was to transfer all possible data to the PHR. Problem: The amount of data transferred was such that it slowed the system to a point that was unacceptable to many users. Solution: Let patents decide what data they wanted to transfer to their own PHR.2. Immediacy versus Perspective. Patients wanted access to information such as lab test results as soon as they were available, yet clinicians wanted a 7-day lag time between when results were ready and when they appeared in the PHR. This would give them time to interpret results, and have a chance to communicate directly with the patient. Solution (sort of): Test results related to sensitive issues such as sexually transmitted disease or pregnancy would be communicated by the clinician to the patient, and only appear in the PHR if the patient requested it.This raises a couple of interesting issues tied to the perceived purpose of the PHR. If it is supposed to allow a patient access to their medical information, does it make sense to have them receive it after their clinician? On the other hand, should I learn that I've tested positive from a dread disease from a new entry in my PHR? Is the PHR supposed to provide a reasonably complete view of my health, or an edited one that allows me to pick and choose what is listed: Diabetes, yes, gonorrhea, no. For an 'out of network' provider that may be using a PHR to get a glimpse at a patient history, this could lead to problems (more on that in #4).3. Workflow matters. Providers complained that the interface between EMR and PHR was not fully automated, which necessitated an additional step for them. This seems like a no brainer: A tethered PHR has to automatically feed from an EMR without additional inputs from the clinician if it expects to live a long, healthy, functional life. Another interesting point: If patients choose what information is appears in their PHR, then it may be of limited utility as a communication tool for clinicians, who may not be sure exactly what information each patient has access to via the PHR. "Results of your blood panel look fine, and are available in your PHR. If you have enabled 'view my test results.'"Maybe that'd work.4. Giving control to patients can have unintended consequences. When patients can choose what information is shared via their PHR, it may not provide a holistic view of their health. What if you don't mention your mental health condition to your cardiologist who prescribes a drug contra-indicated for patients with your condition? In addition to these possible scenarios, could giving patients ultimate power over their health information ultimately degrade provider trust and acceptance of such systems? The answer to that likely depends on who you ask.Photo Credit: Google Health, HealthVault.]]>http://www.justmeans.com/Weathering-the-Health-Impact-of-Climate-Change-With-Social-Media-Technology/46566.htmlMon, 07 Mar 2011 10:10:53 GMTAno Lobb Two new papers point to the pressing need for public and clinical health efforts to pay attention to the effects of climate change when working to prevent and manage chronic conditions. While climate change and its impact on the weather may seem beyond the control of a patients and doctors, services such as Mediclim that provide advance warning of potentially disease-triggering weather events can inform individuals and allow them to take risk-mitigating steps such as staying indoors or taking pr Read Full Article ]]> Two new papers point to the pressing need for public and clinical health efforts to pay attention to the effects of climate change when working to prevent and manage chronic conditions. While climate change and its impact on the weather may seem beyond the control of a patients and doctors, services such as Mediclim that provide advance warning of potentially disease-triggering weather events can inform individuals and allow them to take risk-mitigating steps such as staying indoors or taking prophylactic drugs.In fact, Mediclim has recently unveiled a service for companies that allows them to help protect their employees from the effects of weather and climate change, and save $700 per employee per year at the same time. More on that in a moment, first, here's what the new studies found:Air Pollution More Potent than Cocaine?Researchers from Belgium published a new analysis in The Lancet this week showing that air pollution (defined as high particulate matter count) is responsible for triggering the same number of heart attacks as more commonly controlled risk factors such as physical exertion, alcohol, coffee, infections or even cocaine use.How is this possible? Part of it is a numbers game: While few folks use cocaine, for example, scads of us are exposed to air pollution. By combining data from 36 previously published studies, the authors calculated the population attributable fraction (PAF) of each of a dozen of exposures. PAF is the proportion of all events that were caused by any given trigger. The top PAFs:--Traffic exposure (7.4%)--Physical exertion (6.2%)--Alcohol and coffee (5.0% each)--Air pollution (4.8%)--Negative emotions (3.9%)--Anger (3.1%)--Cocaine, well down on the list, contributed to 0.9% of events.Climate Change and Children's HealthAnother paper just published in Environmental Health Perspectives, meanwhile, estimates the increased burden of disease on children around the world that is likely to be caused by climate change. They calculate that in 2000 there were 150,000 additional deaths worldwide caused by climate change, 80% of which occurred in children. Conditions contributing to this include the types of floods, famines and political conflicts typically associated with lower resource settings. But they also point to a host of weather-related effects that increase the severity of conditions such as respiratory disease.The authors conclude by pointing out that need for "enhanced monitoring of current children's environmental health status, better incorporation of climate change adaptation into existing programs, and new climate-sensitive disease prevention programs that have short- and long-term health co-benefits"Protecting Health and FinancesAt least one thing that both of these papers have in common is that they point to health risks that are exacerbated by weather. Climate change, meanwhile, has the potential to enhance weather conditions that exacerbate chronic disease. Conditions such as asthma or other respiratory conditions, or heart disease can be triggered by changes in weather. The effects of air pollution are also magnified by weather, a slow moving, moist warm weather system may concentrate particulate matter, for example, increasing the risk to heart patients.Mediclim has long provided weather-warning service that is free to patients. You sign up, let them know what conditions you suffer from, and begin to receive emailed warnings when risky weather is in the forecast. They continue to expand their geographic coverage, as well the types of media they use to send warnings (such as text messaging).Mediclim has now rolled out a service where they work with employers to provide their weather warnings as part of a company's health and wellness offerings. For example, warnings can be delivered to work inboxes, and be customizable to plant locations and specific employer needs.Now imagine the impact that such a program could have if tied to companies listed in Justmeans' Global 1000. That's a CSR ranking of publically traded companies with annual revenues of $1 billion or more. That in turn translates into a lot of employees, a lot of chronic conditions such as asthma and heart disease, and a lot of potentially reduced disease and associated health care costs. It would seem like a no-brainer for corporations in the health sector such as Merck (who also enjoys a #1 CSR rating) or Baxter International (ranked #4), or technology companies such as Hewlett-Packard or Intell (ranked #7 and #8 respectively) to incorporate Mediclim's pragmatic health-technology solution. Mediclim estimates that using their warnings can reduce absenteeism costs by around $700 per employee per year. Merck alone has 60,000 employees, so that could equal a potential savings of $42 million, not to mention the potential savings to their health plan.What other hands-on, practical systems are available today that immediately help reduce the health effects of climate change? Please share your examples!Photo credit: Mediclim.org]]>http://www.justmeans.com/Drug-Development-Cost--Does-the--1-Billion-Pill-Actually-Cost--50-Million/46450.htmlSat, 05 Mar 2011 20:31:40 GMTAno Lobb While surveys find that the public generally holds pharmaceutical manufacturers in low esteem--trusting them about as much as the oil and tobacco industries--Justmeans' Global 1000 CSR rankings for 2009 seem to paint a different picture: Merck leads all companies and industries with its #1 CSR rating, Novartis is just below it at #3, GlaxoSmithKline and Astrazeneca are a few rungs down the ladder at #10 and #13 respectively.While the Global 1000 rankings are based on 200 criteria, the public's l Read Full Article ]]> While surveys find that the public generally holds pharmaceutical manufacturers in low esteem--trusting them about as much as the oil and tobacco industries--Justmeans' Global 1000 CSR rankings for 2009 seem to paint a different picture: Merck leads all companies and industries with its #1 CSR rating, Novartis is just below it at #3, GlaxoSmithKline and Astrazeneca are a few rungs down the ladder at #10 and #13 respectively.While the Global 1000 rankings are based on 200 criteria, the public's lack of trust may have just received a prescription-strength boost in the form of a new paper in the publication BioSocieties, published by the London School of Economics. This paper takes an axe to one of the hallowed pillars supporting freakishly high drug costs: Namely the cost of developing new drugs. (See the link to the full text of the paper below.)Pharma has long claimed that the cost to bring a new drug to market is $800 million. The only source for this figure, however, was a single paper published many years ago that used unverifiable, confidential data from two dozen unnamed manufacturers to reach their conclusion. This new paper has done it's best to recreate the analysis using what appear to be more reliable assumptions and calculations. Though hampered by pharma's refusal to share realistic figures on R&D, the authors of this new paper calculate that the real cost of bringing a new drug to market is actually closer to between $44 and about $60 million.Why the huge difference? Among the troubles with the older, pharma-friendly figure is that it over-estimated the costs of required trials, in some cases doubling the average number of participants used in studies, and assuming they are much longer than they actually are. And there are a host of other accounting 'tricks' that appear to have been used to reach the inflated and poetically well-rounded figure of nearly $1 billion.Why should we believe this new figure any more than we should believe the older figure? The authors rightly point out the windfall profits that pharmaceutical manufacturers harvest, which may support the contention that the R&D costs per drug that they are recouping are only about 10% what they are claimed. Then there's the unwillingness of any pharmaceutical manufacturer to come clean on what they are really spending on R&D. They claim it's a trade secret, but why not release real data from some product that has lost patent? Total lack of transparency breeds distrust.A final bitter garnish to these new findings: Most of the major pharmaceutical companies are becoming glorified marketing, manufacturing and distribution machines. Rather than pursue the costly, creative and difficult science of finding new cures for human disease, they are increasingly fearing their pipeline by purchasing discoveries made by smaller start up companies.Click here to download a copy of the paper, "Demythologizing the high cost of pharmaceutical research."Photo credit: The author]]>