June 21, 2011

US doctors braced for deep cuts in spending

Matt Kennard:

Doctors treating the poor in the US are braced for significant reductions to their services amid increased pressure from both the Obama administration and Republicans for deep cuts in health spending.

Twenty-nine Republican governors have called for greater flexibility in how states administer Medicaid programmes for the poor, a move which coincides with the Obama administration's withdrawal of stimulus funds used to pay for treatment.

Nearly 49m people in the US, or one in six Americans, were covered by Medicaid in 2009. The figure is thought to be higher today.

The federal government increased its subsidies to the states under the stimulus programme, spending $2.68 for every dollar a state spent on Medicaid, nearly twice as much as before the stimulus.

Posted by jez at 9:20 PM

June 11, 2011

Invasion of the body hackers

April Dembosky:

Michael Galpert rolls over in bed in his New York apartment, the alarm clock still chiming. The 28-year-old internet entrepreneur slips off the headband that's been recording his brainwaves all night and studies the bar graph of his deep sleep, light sleep and REM. He strides to the bathroom and steps on his digital scale, the one that shoots his weight and body mass to an online data file. Before he eats his scrambled egg whites with spinach, he takes a picture of his plate with his mobile phone, which then logs the calories. He sets his mileage tracker before he hops on his bike and rides to the office, where a different set of data spreadsheets awaits.

"Running a start-up, I'm always looking at numbers, always tracking how business is going," he says. Page views, clicks and downloads, he tallies it all. "That's under-the-hood information that you can only garner from analysing different data points. So I started doing that with myself."

His weight, exercise habits, caloric intake, sleep patterns - they're all quantified and graphed like a quarterly revenue statement. And just as a business trims costs when profits dip, Galpert makes decisions about his day based on his personal analytics: too many calories coming from carbs? Say no to rice and bread at lunchtime. Not enough REM sleep? Reschedule that important business meeting for tomorrow.

The founder of his own online company, Galpert is one of a growing number of "self-quantifiers". Moving in the technology circles of New York and Silicon Valley, engineers and entrepreneurs have begun applying a tenet of the computer business to their personal health: "One cannot change or control that which one cannot measure."

Posted by jez at 4:46 PM

June 3, 2011

Stupid IT Tricks: Medical Records, or Why a Federal Subsidy Makes No Sense (I Agree)


A reader asked me to write tonight about the Health Information Technology for Economic and Clinical Health Act, which is about as far from something I would like to write about as I can imagine, but this is a full service blog so what the heck. The idea behind the law is laudable -- standardized and accessible electronic health records to allow any doctor to know what they need to know in order to treat you. There's even money to pay for it -- $30 billion from the 2009 economic stimulus that you'd think would have been spent back in 2009, right? Silly us. Now here's the problem: we're going to go through that $30 billion and end up with nothing useful. There has to be a better way. And I'm going to tell you what it is.
But first a word from my reader:

Posted by jez at 9:31 AM

March 21, 2011

Dynamist Blog: The Chart Every Journalist Covering the Fukushima Plant Should Read

Virginia Postrel:

For the past week, I've been complaining that journalists covering possible radiation dangers from Fukushima plant have abandoned the old convention of putting radiation exposures in context (usually by comparing them to chest x-rays). The result is that all "radiation" sounds equally dangerous, and people in Plano, Texas, start stocking up on potassium iodine.

Posted by jez at 9:11 AM

March 8, 2011

A sugared pill

Andrew Jack:

When Daniel Carlat, a psychiatrist in Massachusetts, was flown to New York with his wife by Wyeth, the "training" weekend he attended in a luxury hotel was topped off with a Broadway show. It was early 2001 and he had just agreed to the US pharmaceuticals company's proposal that he give talks to doctors about its antidepressant Effexor.

During the following year, he was regularly paid fees of $750 a time to drive to "lunch and learn" sessions where he would speak for 10 minutes to emphasise the drug's advantages to fellow doctors, using slides prepared by the company. "It seemed like a win-win," he recalls. "I was prescribing it, educating doctors and making some money."

But within a few months, he became disillusioned with his co-option as a marketing representative. He was selectively presenting clinical data that put the drug in a positive light to physicians who had been targeted by the company through "data mining" techniques that identified their individual prescription patterns.

Posted by jez at 6:06 PM

October 8, 2010

Teddy, J.P. and Henry

Ed Wallace
The last seven years have had much in common with the period of 1893 to 1900. But the turmoil this country experienced during the first few years of the 20th century also seems to be mirrored in the events of today.

Certainly the nation once witnessed the rise of the more radical elements, whether they were far-left anarchist movements or center-left progressives. Those movements attested to a very real battle being waged for the heart and soul of what the American Century would become. Its apex was marked by one president's assassination and by the dreams of an inventor who wanted to revolutionize our mobility.

Given what has transpired over the last two years, it is haunting to read Teddy Roosevelt's letter to Congress and his personal thoughts on companies whose sole reason for existence is to make their owners wealthy without regard to the damage they were doing to society. One wonders what would have happened if today's Wall Street Masters of the Universe had been confronted in a White House with the same resolve that Roosevelt showed to J.P. Morgan.
Posted by James Zellmer at 10:15 PM

August 8, 2010

Community Yoga

Posted by James Zellmer at 5:10 PM

July 27, 2010

What should medicine do when it can’t save your life?

Atul Gawande:
Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left.

Sara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die. It started with a cough and a pain in her back. Then a chest X-ray showed that her left lung had collapsed, and her chest was filled with fluid. A sample of the fluid was drawn off with a long needle and sent for testing. Instead of an infection, as everyone had expected, it was lung cancer, and it had already spread to the lining of her chest. Her pregnancy was thirty-nine weeks along, and the obstetrician who had ordered the test broke the news to her as she sat with her husband and her parents. The obstetrician didn’t get into the prognosis—she would bring in an oncologist for that—but Sara was stunned. Her mother, who had lost her best friend to lung cancer, began crying.

The doctors wanted to start treatment right away, and that meant inducing labor to get the baby out. For the moment, though, Sara and her husband, Rich, sat by themselves on a quiet terrace off the labor floor. It was a warm Monday in June, 2007. She took Rich’s hands, and they tried to absorb what they had heard. Monopoli was thirty-four. She had never smoked, or lived with anyone who had. She exercised. She ate well. The diagnosis was bewildering. “This is going to be O.K.,” Rich told her. “We’re going to work through this. It’s going to be hard, yes. But we’ll figure it out. We can find the right treatment.” For the moment, though, they had a baby to think about.
Posted by James Zellmer at 11:07 AM

February 25, 2010

Fabulous: Health Care Video Stream with Campaign Contributions...

The Sunlight Foundation provides a great service here.
Posted by James Zellmer at 1:42 PM

February 12, 2010

The Legacy of Billy Tauzin: The White House-PhRMA Deal

Paul Blumenthal:
More than a million spectators gathered before the Capitol on a frosty January afternoon to witness the inauguration of Barack Obama, who promised in his campaign to change Washington’s mercenary culture of lobbyists, special interest influence and backroom deals. But within a few months of being sworn in, the President and his top aides were sitting down with leaders from the pharmaceutical industry to hash out a deal that they thought would make health care reform possible.

Over the following months, pharmaceutical industry lobbyists and executives met with top White House aides dozens of times to hammer out a deal that would secure industry support for the administration’s health care reform agenda in exchange for the White House abandoning key elements of the president’s promises to reform the pharmaceutical industry. They flooded Congress with campaign contributions, and hired dozens of former Capitol Hill insiders to push their case. How they did it—pieced together from news accounts, disclosure forms including lobbying reports and Federal Election Commission records, White House visitor logs and the schedule Sen. Max Baucus releases voluntarily—is a testament to how ingrained the grip of special interests remains in Washington.
Posted by James Zellmer at 3:30 PM

December 1, 2009

Throwing Computers At Healthcare

Nicholas Carr:
Computerworld reports on an extensive new Harvard Medical School study, appearing in the American Journal of Medicine, that paints a stark and troubling picture of the essential worthlessness of many of the computer systems that hospitals have invested in over the last few years. The researchers, led by Harvard's David Himmelstein, begin their report by sketching out the hype that now surrounds health care automation:
Enthusiasm for health information technology spans the political spectrum, from Barack Obama to Newt Gingrich. Congress is pouring $19 billion into it. Health reformers of many stripes see computerization as a painless solution to the most vexing health policy problems, allowing simultaneous quality improvement and cost reduction ...

In 2005, one team of analysts projected annual savings of $77.8 billion, whereas another foresaw more than $81 billion in savings plus substantial health gains from the nationwide adoption of optimal computerization. Today, the federal government’s health information technology website states (without reference) that “Broad use of health IT will: improve health care quality; prevent medical errors; reduce health care costs; increase administrative efficiencies; decrease paperwork; and expand access to affordable care.
Posted by James Zellmer at 8:22 PM

September 6, 2009

Medical Tourism Takes Flight

Leslie Norton:
A growing number of U.S. insurers are paying for patients to have medical procedures performed more cheaply overseas. And that's raising the profile of a few companies you've probably never heard of. Video: Bangkok Bypass Surgery

IN THE PAST THREE MONTHS, THE CREAKY Barron's staff has replaced a hip, two knees and undergone various nips and tucks. Based on average prices, these cost a total of at least $100,000. But abroad, say in Singapore, the tab would have been about $50,000, including stays in a private room, airfare and a vacation for the patients and their companions. Elsewhere in Asia, medical care is even cheaper. That's why more U.S. insurers are considering financing treatment for Americans willing to travel abroad. In fact, "medical tourism" could help rein in the health-care costs that devour 16% of America's gross domestic product.

That possibility is raising the profile of a few publicly traded companies you've probably never heard of: Thailand's Bumrungrad Hospital (ticker: BH.Thailand) and Bangkok Dusit Medical Services (BGH.Thailand), Singapore's Parkway Holdings (PWAY.Singapore) and Raffles Medical (RFMD.Singapore), and India's Apollo Hospitals (APHS.India). Says Prathap Reddy, the U.S.-trained cardiologist who founded Apollo in 1983 and is its chairman: "We bring excellent care at a cost benefit. If the U.S. were to cover all its people, there would be a demand/supply gap. India can step in with equivalent care at one-fifth the cost."
Posted by James Zellmer at 8:27 PM

August 21, 2009

Britain's National Medical Records Project - "No money spent on training"...

Nicholas Timmins:
“If you live in Birmingham,” declared Tony Blair when he was UK prime minister, “and you have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you.”

Not any more. Or not, at least, if the Conservatives win the next general election. For the Tories have pledged to scrap the country-wide version of the National Health Service’s electronic patient record.

Back in 2002, the idea of a full patient record, available anywhere in an emergency, was the principal political selling point for what was billed as “the biggest civilian computer project in the world”: the drive to give all 50m or so patients in England (the rest of the UK has its own arrangements) an all-singing, all-dancing electronic record. Roll-out was meant to start in 2005 and be completed by 2010.

Under a Conservative government, development of the local record – exchangeable between primary care physicians and their local hospitals – would continue. Nationally, clinicians would still be able to seek access to it when needed from the doctors who would hold it locally. But the idea of a national database of patients’ records, instantly available in an emergency from anywhere in the country, would disappear.

This may or may not matter, depending on your point of view. For many clinicians, the idea of an instantly available national record was always something of a diversion. It is access to a comprehensive record locally that is crucial for day-to-day care.

Nonetheless, the Conservatives’ decision to scrap the central database is a symbolic moment for a £12bn ($20bn, €14bn) programme that has struggled to deliver from day one. It is currently running at least four years late – and there looks to be no chance in the foreseeable future of its delivering quite what was promised.


On top of that, while there was a £6bn budget for the 10-year central contracts, no money was earmarked for training, in spite of the lesson, from the relatively few successful installations of electronic records in US hospitals, that at least as much has to be spent on changing the way staff work as is spent on the systems themselves.
Posted by James Zellmer at 9:33 AM

May 16, 2009

The Machinery Behind Health-Care Reform How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records

Robert O'Harrow, Jr:
When President Obama won approval for his $787 billion stimulus package in February, large sections of the 407-page bill focused on a push for new technology that would not stimulate the economy for years.

The inclusion of as much as $36.5 billion in spending to create a nationwide network of electronic health records fulfilled one of Obama's key campaign promises -- to launch the reform of America's costly health-care system.

But it was more than a political victory for the new administration. It also represented a triumph for an influential trade group whose members now stand to gain billions in taxpayer dollars.

A Washington Post review found that the trade group, the Healthcare Information and Management Systems Society, had worked closely with technology vendors, researchers and other allies in a sophisticated, decade-long campaign to shape public opinion and win over Washington's political machinery.
Automation certainly makes sense, but we taxpayers should not be subsidizing it....
Posted by James Zellmer at 6:58 AM

April 27, 2009


"Global Disease Alert Map".
Posted by James Zellmer at 7:11 AM

March 3, 2009

Uwe Reinhardt on the health of the economy and the economics of health

Willem Buiter:
My friend professor Uwe E. Reinhardt of Princeton University presented ECONOMIC TRENDS IN U.S HEALTH CARE: Implications for Investors, at J.P. Morgan's annual healthcare conference on Tuesday, January 13 2009. The first half of the presentation (46 slides!) deals with macroeconomic and financial issues in Uwe's inimitable style - equal portions of wit and insight. The second half deals with the embarrassing mess known as health care in the US.
Posted by James Zellmer at 9:27 PM

January 11, 2009

Doctor Side Pay from Drug Companies

John Fauber:
Barry Fox is in big demand. The UW infectious disease specialist had lucrative side jobs working for seven different drug companies in just one year, including one that paid an undisclosed sum of $20,000 or more, records show.

Fox is one of dozens of University of Wisconsin-Madison physicians who also work for drug companies. Some sit on advisory boards; others do promotional or educational work. Fox, for example, did promotional work involving an antibiotic for one company in 2007, working five days for what appears to be at least $2,000 a day, his disclosure form says.

Doctors' moonlighting for drug companies - though legal - is coming under increased scrutiny, both at UW and across the country. This month, the trade group Pharmaceutical Research and Manufacturers of America enacted a voluntary ban on company gifts of branded pens, sticky notes and other items and dinners for doctors. Also of special concern are university physicians who are sought by drug companies because of the influence and respect they wield with colleagues practicing in communities.

Most patients have no knowledge of the side work. Even the university is not aware of exactly how much its doctors earn from drug and medical device companies; they are required to disclose only ranges of income received, and no range beyond $20,000.

More than 30 UW physicians exceeded the $20,000 threshold in 2006 and 2007, records show. At least one of those doctors made at least 20 times that amount in previous years - more than $400,000, paid by a maker of orthopedic implants. But that became known in 2006 only because of records filed in a lawsuit.

Last week, for the first time, signs went up in a handful of UW Health clinics alerting patients about doctors' drug company ties. In addition, the dean of the medical school said the university's policies need to be shored up. Among other things, the medical school might begin requiring doctors to specify how much they are paid, said Robert Golden, head of the UW School of Medicine and Public Health.

Further, U.S. Sens. Herb Kohl (D-Wis.) and Chuck Grassley (R-Iowa) have introduced a bill that would require drug and medical device companies to disclose payments made to physicians. Kohl said it would be best to ban the practice, noting that the medical industry spends $20 billion a year in payments and gifts to doctors.

"The relationship between the doctor and patient is frayed," Kohl said.
Posted by James Zellmer at 1:32 PM

December 27, 2008

The Marshfield Clinic's Electronic Medical Records System in the News

Steve Lohr:
Joseph Calderaro, 67, is one of health care’s quiet success stories. Over the last four years, he has carefully managed his diabetes by lowering his blood sugar, blood pressure and cholesterol with diet, exercise and medication.

To keep on track, Mr. Calderaro visits his doctor, attends meetings for diabetes patients and gets frequent calls from a health counselor. It is a team effort, orchestrated by the Marshfield Clinic here. And it is animated by technology, starting with Mr. Calderaro’s computerized patient record — a continuously updated document that includes his health history, medications, lab tests, treatment guidelines and doctors’ and nurses’ notes.

To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine’s digital future. Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, the way Marshfield and some other health systems have already done, is essential to improving care and curbing costs.
There has been some loose talk about the Obama administration providing "incentives" for health care automation. These investments should be made on their merits, rather than funded by yet another taxpayer give-away.

Marshfield apparently built their own system, a competitor to Verona based Epic Systems.

Might this article be part of their initial marketing efforts to other health care organizations?
Posted by James Zellmer at 7:45 AM

December 5, 2008

The Checklist

Atul Gawande:
he damage that the human body can survive these days is as awesome as it is horrible: crushing, burning, bombing, a burst blood vessel in the brain, a ruptured colon, a massive heart attack, rampaging infection. These conditions had once been uniformly fatal. Now survival is commonplace, and a large part of the credit goes to the irreplaceable component of medicine known as intensive care. It’s an opaque term. Specialists in the field prefer to call what they do “critical care,” but that doesn’t exactly clarify matters. The non-medical term “life support” gets us closer. Intensive-care units take artificial control of failing bodies.

Typically, this involves a panoply of technology—a mechanical ventilator and perhaps a tracheostomy tube if the lungs have failed, an aortic balloon pump if the heart has given out, a dialysis machine if the kidneys don’t work. When you are unconscious and can’t eat, silicone tubing can be surgically inserted into the stomach or intestines for formula feeding. If the intestines are too damaged, solutions of amino acids, fatty acids, and glucose can be infused directly into the bloodstream.

The difficulties of life support are considerable. Reviving a drowning victim, for example, is rarely as easy as it looks on television, where a few chest compressions and some mouth-to-mouth resuscitation always seem to bring someone with waterlogged lungs and a stilled heart coughing and sputtering back to life. Consider a case report in The Annals of Thoracic Surgery of a three-year-old girl who fell into an icy fishpond in a small Austrian town in the Alps. She was lost beneath the surface for thirty minutes before her parents found her on the pond bottom and pulled her up. Following instructions from an emergency physician on the phone, they began cardiopulmonary resuscitation. A rescue team arrived eight minutes later. The girl had a body temperature of sixty-six degrees, and no pulse. Her pupils were dilated and did not react to light, indicating that her brain was no longer working.
Posted by James Zellmer at 1:19 PM

September 15, 2008

Personality Variation by USA Region

US personalities vary by region, say researchers. It's pretty thin on the details, but luckily the original paper can be found online in full, A Theory of the Emergence, Persistence, and Expression of Geographic Variation in Psychological Characteristics. I haven't read the whole thing, nor do I know much about personality, so I have put the maps which illustrate regional variation in traits below the fold. But I do want to note the correlations between Openness and the following metrics on the state level:

Posted by jez at 7:14 PM

August 18, 2008

The Coming Boom in Medical Travel

The Economist:

HEALTH care has long seemed one of the most local of all industries. Yet beneath the bandages, globalisation is thriving. The outsourcing of record keeping and the reading of X-rays is already a multi-billion-dollar business. The recruitment of doctors and nurses from the developing world by rich countries is also common, if controversial. The next growth area for the industry is the flow of patients in the other direction--known as "medical tourism"--which is on the threshold of a dramatic boom.

Tens of millions of middle-class Americans are uninsured or underinsured and soaring health costs are pushing them and cost-conscious employers and insurers to look abroad for savings (see article). At the same time the best hospitals in Asia and Latin America now rival or surpass many hospitals in the rich world for safety and quality. On one estimate, Americans can save 85% by shopping around and the number who will travel for care is due to rocket from under 1m last year to 10m by 2012--by which time it will deprive American hospitals of some $160 billion of annual business.

Posted by jez at 10:36 AM

December 24, 2007

The Rise of Medical Tourism

Martha Lagace:

What used to be rare is now commonplace: traveling abroad to receive medical treatment, and to a developing country at that.

So-called medical tourism is on the rise for everything from cardiac care to plastic surgery to hip and knee replacements. As a recent Harvard Business School case study describes, the globalization of health care also provides a fascinating angle on globalization generally and is of great interest to corporate strategists.

"Apollo Hospitals—First-World Health Care at Emerging-Market Prices" explores how Dr. Prathap C. Reddy, a cardiologist, opened India's first for-profit hospital in the southern city of Chennai in 1983. Today the Apollo Hospitals Group manages more than 30 hospitals and treats patients from many different countries, according to the case. Tarun Khanna, a Harvard Business School professor specializing in global strategy, coauthored the case with professor Felix Oberholzer-Gee and Carin-Isabel Knoop, executive director of the HBS Global Research Group.

The medical services industry hasn't been global historically but is becoming so now, says Khanna. There are several reasons that globalization can manifest itself in this industry:

Posted by James Zellmer at 10:28 AM

December 8, 2007

Everyone's Poop

Nate Blakeslee:

“Down the drain, off the brain” is how most people think about it, but human waste—or effluent, as the professionals call it—has a lot to tell us about how we live, what we eat, and who we are.

They say that shit runs downhill. This is commonly understood to mean that the world is an unfair place, except among those few people who actually work with the substance, for whom it is considered something of an article of faith. This is because municipal sewerage systems are powered almost entirely by gravity, which means that when working properly, they move millions of gallons of sewage a day across considerable distances with only a minimum expenditure of energy, a feat of efficiency virtually unparalleled in the annals of engineering. When sewage stops running downhill, as it inevitably does from time to time, very bad things indeed can happen, as they did on Pecan Springs Road, in the Austin neighborhood known as Windsor Park, one morning last September.

I was spending the day with an Austin Water Utility emergency-response crew when dispatch got a call from a woman reporting that two rooms of her house were flooded with sewage. Our crew consisted of a TV truck, piloted by a twenty-year line-maintenance veteran named David Eller, and a flusher truck, driven by another longtime utility employee, named Dale Crocker. At the house, Eller, who wears wraparound sunglasses and looks a little like the country singer Dwight Yoakam, unspooled a thick red cable from the back of his truck. On the end of the cable was a camera about the size of a roll of quarters, which Crocker shoved down into a PVC clean-out pipe near the curb in the front yard. The woman leaned on a walker in her driveway, looking worried.

Excellent Article.

Posted by James Zellmer at 9:35 PM

October 19, 2007

A profession is born to help people navigate the health care maze

Victoria Colliver:

Margalit Mathan and Peter August found themselves caught in a maze of medical appointments and conflicting professional opinions when their 7-year-old daughter developed serious eye problems related to her juvenile rheumatoid arthritis.

The Berkeley family decided to consult yet another professional. They turned to a health care advocate, an adviser who specializes in helping patients and their families cut through the health care bureaucracy to find the help they need.

"It's been this huge roller coaster with the medical system and negotiating her different needs and the different information we're getting from different doctors," said Mathan, a high school psychologist. Her daughter, Siona, was diagnosed two years ago with arthritis, a condition that can cause eye inflammation and, in Siona's case, led to glaucoma.

Private health care advocacy is a new and growing field emerging at a time when an increasing number of Americans find themselves dealing with a chronic disease, aging family members or the bureaucracy of health insurance.

A professional advocate might have some background in health care, such as nursing or medical social work. But the business of health advocacy is unregulated, and people who call themselves a health advocate might have no training other than helping a family member through a difficult illness.

Posted by James Zellmer at 1:25 PM

September 4, 2007

Your DNA, Please

The Economist:
Rapid advances in genetic testing promise to transform medicine, but they may up-end the insurance business in the process “IF YOU can make a good soufflé, you can sequence DNA.” That assertion sounds preposterous, but Hugh Rienhoff should know. When his daughter was born about three years ago, she suffered from a mysterious disability that stunted her muscle development. After many frustrated visits to specialists, Dr Rienhoff, a clinical geneticist and former venture capitalist, decided to sequence a specific part of her genome himself. He discovered that her condition, which most resembled a rare genetic disorder known as Beals's syndrome, was probably due to a new genetic mutation. “Without a lab and for just a few hundred dollars, you can contract or outsource almost all the steps,” he explains. What a well-connected and highly motivated scientist in California can do today the rest of the world will be able to do tomorrow. Indeed, a number of firms are already offering tests for specific ailments (or predispositions to ailments) directly to the public, cutting out the medical middle-man. Dr Rienhoff, for his part, will soon launch MyDaughtersDNA.org, a not-for-profit venture intended to help others to unravel the mysteries of their family's genes in the way that he unravelled those of his own.
Posted by James Zellmer at 9:21 PM

July 29, 2007

American Family Children's Hospital Grand Opening Photos

A tremendous asset for the Madison Area. Many more photos here.

American Family Children's Hospital website.

Posted by James Zellmer at 4:42 PM

June 13, 2007

Jack LaLanne Interview

An interesting video chat with the "godfather of fitness".
Posted by James Zellmer at 9:12 PM

June 11, 2007

The Dartmouth Atlas of Health Care

Jon Udell:

For each mapped variable, mousing over the displayed hospital referral regions yields the local, state, and national values for that variable.

It’s nicely done. There’s no question that, as of mid-2007, this is cutting-edge data interactivity for the mainstream. But times are changing fast. The Times sourced this data from the Dartmouth Atlas of Health Care.

Posted by James Zellmer at 10:43 AM

June 3, 2007

Time is All We Have: 3 Ways to Increase Return on Investment

John Wesley:

Do not squander time for that is the stuff life is made of.
- Benjamin Franklin

Return on investment (ROI) is a term you hear frequently, usually in relation to business and finance. The goal (obviously) is to maximize return on the money you invest. The implications of this concept go much deeper when you start to think of time as your primary investment rather than money. Everything you do is an investment of time. When you watch television, you’re making an investment in entertainment. If you watch a show that sucks, you’ve made a bad investment and receive a poor return for your time.

In many ways time is more valuable than money. You’ll always have the opportunity to make more money, but once time has been spent it’s gone forever. When you think of time as a commodity, and all of your actions as investments, it changes the way you approach every day decisions.

Posted by James Zellmer at 10:05 PM

June 2, 2007

Sinus Congestion & Travel

Dave mentioned that he arrived in Rome "clogged up". During a recent trip to Southeast Asia, I found the following items essential to long distance, dry air travel (I've had allergies over the years):

  • Sinucleanse twice daily. Works better, for me, than any of the allergy meds.
  • A bottle of nasal saline solution. I used this at least hourly on the long flights and found that it made a big difference.
  • I drank a great deal of water (and made sure that I purchased a large bottle at the airport prior to departure). Airlines can sometimes (often?) skimp on water.
  • I also carried some aspirin.
  • I did not pack all that well for the long dry air, but fortunately found some Hall's drops in Tokyo
Quantas airlines has a useful page on long distance flight health tips.

Posted by James Zellmer at 12:24 PM

April 17, 2007

Bedbugs Bounce Back

Meredith May:
Walter has stopped hugging his friends. He is throwing out his clothes and furniture, and he rarely comes out of his Tenderloin hotel room anymore.

He's not suicidal, but darn near. He has bedbugs.

Nearly eradicated in the United States 50 years ago, resistant strains of "super" bedbugs are infesting mattresses at an alarming rate. In what's being touted as the biggest mystery in entomology, all 50 states are reporting outbreaks of the blood-sucking nocturnal critters.

Pest control companies nationwide reported a 71 percent increase in bedbug calls between 2000 and 2005. Left alone, a few bedbugs can create a colony of thousands within weeks.

"We never treated bedbugs until 2002. Now we have a dedicated bedbug crew working on this every day," said Luis Agurto, president of Pestec in San Francisco.

Agurto's arsenal includes a vacuum, steam heat to cook the bedbug eggs and targeted spraying of insecticides. It takes three, eight-hour visits and about $500 to $750 to exterminate one room. A whole house would cost closer to $5,000.
Posted by James Zellmer at 9:56 AM

February 27, 2007

Garlic Does Not Lower Cholesterol in Study

Carl Hall:
Garlic may be good for a lot of things -- spicing up your diet, for sure -- but it seems to be no good at all at lowering your cholesterol.

After conducting one of the most elaborate studies yet on garlic's effect on cardiovascular health, scientists at the Stanford University School of Medicine said Monday that they could find no benefit in terms of reduced levels of LDL cholesterol, the "bad" form linked to heart disease.

Christopher Gardner, a Stanford assistant research professor and lead author of the six-month study, said he was disappointed by the results, describing himself as a garlic lover whose office is an hour's drive from Gilroy, the generally acknowledged "garlic capital of the world."

"We really thought this was going to work," he said. "I was going to get the key to the city of Gilroy. I was going to get 'Dr. Garlic' license plates."
Another balloon pops. Perhaps the garlic farmers will need a subsidy of some sort to recover?
Posted by James Zellmer at 4:45 PM

January 22, 2007

Requiem for Magic Bullets

Steve Silberman:
The golden age of antibiotics began in 1944 with the widespread use of penicillin in Europe, which saved many thousands of lives during World War II. But the first sign that this new era of easily treatable bacterial infections would not last appeared just a couple of years later, with the emergence of penicillin-resistant strains of Staphylococcus aureus, a bacterium responsible for a wide variety of ailments, from skin infections to fatal pneumonia.

By 1950, 40 percent of the staph strains in hospitals had already become immune to the drug. Now a form of staph known as methicillin-resistant Staph aureus, or MRSA, which is resistant to nearly every known antibiotic, is responsible for the majority of tens of thousands of deaths a year from infections picked up in U.S. hospitals alone.

Bacteria develop immunity to antibiotics by rapidly evolving genetic defenses against the drugs or by acquiring pieces of DNA and RNA from organisms that are already resistant -- even from other bacterial species. Bacterial pathogens that have learned how to survive in hospitals have an evolutionary advantage, because there are plenty of other resistant organisms in the environment from which they can borrow resistance factors.
Posted by James Zellmer at 7:55 AM

December 25, 2006

The Surgeon Undergoes Surgery

Lawrence Altman:
Dr. DeBakey, one of the most influential heart surgeons in history, assumed his heart would stop in a few seconds.

“It never occurred to me to call 911 or my physician,” Dr. DeBakey said, adding: “As foolish as it may appear, you are, in a sense, a prisoner of the pain, which was intolerable. You’re thinking, What could I do to relieve myself of it. If it becomes intense enough, you’re perfectly willing to accept cardiac arrest as a possible way of getting rid of the pain.”

But when his heart kept beating, Dr. DeBakey suspected that he was not having a heart attack. As he sat alone, he decided that a ballooning had probably weakened the aorta, the main artery leading from the heart, and that the inner lining of the artery had torn, known as a dissecting aortic aneurysm.
Posted by James Zellmer at 10:20 PM

December 22, 2006

A Health Information Exchange Conversation

Jon Udell:
Dr. John Halamka joins me for this week’s podcast. He’s a renaissance guy: a physician, a CIO, and a healthcare IT innovator whose work I mentioned in a pair of InfoWorld columns. Lots of people are talking about secure exchange of medical records and portable continuity of care documents. John Halamka is on the front lines actually making this these visions real. Among other activities he chairs the New England Health Electronic Data Interchange Network (NEHEN), which began exchanging financial and insurance data almost a decade ago and is now handling clinical data as well in the form of e-prescriptions. The technical, legal, and operational issues are daunting, but you’ll enjoy his pragmatic style and infectious enthusiasm.
Posted by James Zellmer at 4:15 PM

October 18, 2006

A Lesson from Europe on Healthcare

David Leonhardt:
A few weeks ago, I wrote a column arguing that this country’s increased medical spending over the last half-century has, on the whole, been overwhelmingly worth it. Thanks to new treatments for everything from premature births to heart attacks, human life has continued to lengthen — defying expectations — even without major improvements in public health. Yet, strangely, we talk about medical spending as if it were nothing more than a drag on the economy, rather than an investment in the most important thing of all: our well-being.

I received about 500 e-mail responses from readers, and the most common reaction was a version of a simple question. “Why do Americans spend so much more than folks in most other developed countries while getting worse results?” as Sumati Eberstadt of East Greenwich, R.I., wrote.

In Greece, the government and individuals combine to spend about $2,300 per capita on health care each year, and the average life expectancy is 79 years. Canada, where the hospitals are probably cleaner, spends about $3,300, and people live to about 80. Here in the United States, we spend more than $6,000, yet life expectancy is just below 78.
Posted by James Zellmer at 9:52 AM

August 8, 2006

Sharing Resources Worldwide

It is our mission to make surplus and recycled medical supplies, durable medical equipment and related items/activities available to needy populations around the world in order to improve the health and quality of life of the recipients and to empower the recipients to live with increased dignity, independence, and hope.

This is how we Recycle Resources and Restore Hope... Around the world.....
Great local group.
Posted by James Zellmer at 3:43 PM

July 27, 2006

Hackers Clone Human-implanted RFID Chip

This is the first time someone has cloned an human-implanted RFID chip The pair demonstrated the cloning process: Westhues held a standard RFID reader against an arm to register the chip ’s unique identification number. It actually has no security devices what-so-ever - VeriChip’s claims that its RFID chips can not be counterfited
Former Wisconsin Governor Tommy Thompson is (was) a director of Applied Digital Solutions, a firm that is promoting this technology.
Posted by James Zellmer at 8:15 AM

July 4, 2006

Mute 19 Years, He Helps Reveal Brain's Mysteries

Benedict Carey:
Mr. Wallis, 42, wears an open, curious expression and speaks in a slurred but coherent voice. He volleys a visitor's pleased-to-meet-you with, "Glad to be met," and can speak haltingly of his family's plans to light fireworks at his brother's house nearby.

For his family, each word is a miracle. For 19 years — until June 11, 2003 — Mr. Wallis lay mute and virtually unresponsive in a state of minimal consciousness, the result of a head injury suffered in a traffic accident. Since his abrupt recovery — his first word was "Mom," uttered at the sight of his mother — he has continued to improve, speaking more, remembering more.

But Mr. Wallis' return to the world, and the progress he has made, have also been a kind of miracle for scientists: an unprecedented opportunity to study, using advanced scanning technology, how the human brain can suddenly recover from such severe, long-lasting injury.
Posted by James Zellmer at 10:24 PM

June 19, 2006

If It's Good for Philip Morris, Can It Also Be Good for Public Health?

Joe Nocera:
"We don't make widgets," Steve Parrish likes to say, and that acknowledgment strikes me as a good place to start this story. Parrish, whose title is senior vice president for corporate affairs, is a highly paid executive at Altria Group, a New York-based holding company that is the 10th-most-profitable corporation in America. If the name of the company doesn't strike you as terribly familiar, that's because a few years ago the company changed its name. It used to be called Philip Morris, a name that still attaches to two of its holdings, Philip Morris USA and Philip Morris International. (Altria also owns Kraft Foods.) So, yes, let's stipulate right up front: Steve Parrish represents the country's leading tobacco company, whose best-known brand, Marlboro, is so dominant it accounts for 4 out of every 10 cigarettes smoked in the United States. Last year, Philip Morris USA alone made $4.6 billion in profits. What was it that Warren Buffett once said? "You make a product for a penny, you sell it for a dollar and you sell it to addicts." They most certainly don't make widgets.
Kraft is parent of Madison based Oscar Meyer Foods.
Posted by James Zellmer at 9:34 AM

June 8, 2006

Clostridium difficile: Stalking the World

The Economist:
Ordinarily, the human colon harbours very few of the rod-shaped bacteria that cause Clostridium difficile associated disease or CDAD. But the guts of those people who are given antibiotics to prevent or treat infection during a stay in hospital are different. Antibiotics may rid the colon not only of harmful bacteria, but also of the beneficial ones that normally live there. This, in turn, can give C. difficile the chance to take hold.

Rates of the disease among patients in, or recently discharged from, American short-stay hospitals seem to have doubled between 2000 and 2003 and risen another 25% in 2004, the most recent year for which estimates are available. That translates into at least 225,000 new cases a year, according to the Centres for Disease Control, a government agency based in Atlanta, Georgia. As this number does not capture all of America's hospitals and ignores its nursing homes, the real figure is probably at least 500,000 cases a year.

The full extent of the illness is unclear because American hospitals are not required to report it. Even when someone with the disease dies, his death certificate may not say he had it. Whatever the true numbers, about 20% of people infected have repeated bouts of the illness and some 1-2% of the stricken die; chiefly, but not exclusively, the victims are elderly people who are already in frail health.
Posted by James Zellmer at 10:14 AM

Greenleaf: A Local Food Exchange

Rick Barrett:
When a farmer walked into Whole Foods wanting to sell a huge sack of morels, store employee Heather Hilleren watched a futile effort unfold.

The farmer didn't have vendor credentials, and it would have taken two weeks to get them. By then, the freshly picked morels would have spoiled.

Posted by James Zellmer at 9:18 AM

June 5, 2006

Using Competition to Reform Healthcare

Michael E. Porter and Elizabeth Olmsted Teisberg:
The starting point for developing strategy in any field is to define the relevant business or businesses in which an organization competes. Health care delivery is no different. Health care providers do not think of themselves as businesses, but they are in the business of providing services to patients. (Those who are uncomfortable with the notion of businesses in health care can substitute the term service lines.)

The question "What business are we in?" is an important one because it guides an organization's thinking about who its customer is, what needs it is trying to meet, and how it should organize. Implicit in every business definition is a view of how value is created. Aligning an organization's view of value with actual value is a precondition for excellent performance.

In some fields, defining the relevant business is straightforward. In health care this is not the case, in part because of the way medicine has traditionally been structured and organized. Many hospitals, for example, see themselves in the "hospital" business or the "health care delivery" business, competing with other hospitals based on their overall service offering. An even broader definition of the business, "health care," is common among experts in health policy. This leads them to favor large health systems, believing that health care is best organized by combining insurance and health care delivery into one vertically integrated, full-line system.
Posted by James Zellmer at 4:01 PM

June 3, 2006

Race for the Cure Photos

More photos here. Madison Race for the Cure website.
Posted by James Zellmer at 5:02 PM

May 30, 2006

Mammograms: Digital vs Film

David Armstrong:
For the 23 million U.S. women who get mammograms each year, there is an increasingly urgent question: digital or film?

Interest is growing in the digital version of the breast-cancer screening test, driven in part by a study last fall in the New England Journal of Medicine that said digital was better for some women. The findings quickly became a marketing tool for makers of digital-mammography machines and hospitals that have them. Sales of the machines have been rising, with one major manufacturer citing digital equipment as the driving force behind record second-quarter revenue.

But some hospitals and doctors are concerned that the advantages of digital are being overestimated and may be causing women to delay getting a mammogram until digital machines arrive in their area. Still only about 11% of the 8,800 U.S. mammography facilities are estimated to have digital.

The advice from doctors: Don't wait, especially if you are in one of the groups for whom digital has no demonstrated advantages. The study found that digital was better at detecting cancer only for premenopausal women, those under 50 years old, or those who have dense breasts. The majority of women who get mammograms are over 50, and looking at the 40,000 women in the study as a whole, the new technology was found to be no better than film overall.
Posted by James Zellmer at 9:54 PM

March 19, 2006

New Rand Healthcare Study

Tyler Cowen:
1. We get only 55 percent of recommended medical attention [TC: hey, didn't an earlier Rand study show us that more care doesn't translate into better health care outcomes?]

2. "Those with annual family incomes over $50,000 had quality scores that were just 3.5 percentage points higher than those with incomes less than $15,000....insurance status had no real effect on quality."

This should make everyone uncomfortable, but most of all those who think that access to health insurance is a panacea. Here is the press release, the piece is in The New England Journal of Medicine. Am I supposed to believe the following?:
Posted by James Zellmer at 8:47 AM

March 18, 2006

A Delightful Few Days Skiing at Wisconsin's Whitecap Mountains

A March visit to Whitecap Mountain

Spring break 2006 presented an opportunity to check out a ski area that was within a reasonable distance (avoid flights) and promised a decent amount of snow. I surfed the web last week seeking such a destination and found Whitecap, a resort that Ski Magazine has posted favorable words on the years. Those reviews, along with a very attractive package ($199 per person for 3 nights, 3 day lift tickets, 2 dinners, 3 breakfast meals, rentals and a one hour daily group lesson) sealed the deal.

Whitecap is an easy four hour drive north from Madison. We arrived just as crews were clearing snow from last weekend's 20 to 30" storm - creating great midwest conditions for our visit. Whitecap's founder: Dave (an amazingly active guy), mentioned in between bulldozing snow, grooming trails, cleaning rooms, helping with the lifts and feeding wood to lodge fireplaces that a number of cars were stuck during the storm (see photo) and the resort lost power for a short period of time.

Our package include a room in the Whitecap Lodge. This facility provides very convenient ski in/ski out access, nearby parking, a large hot tub and indoor heated pool. The only downside to the lodging was the smoking rooms nearby (be sure to request non-smoking if that is important to you). Perhaps living in Madison has made it far too uncommon to encounter a smoking facility. I was surprised at the number of smoker skiers. The rooms had plenty of hot water for a decent shower. Some include a kitchenette while others feature a microwave and small refrigerator.

Whitecap's 43 trails provide a great deal of variety, from wide, well groomed slopes for beginners to some quite challenging (viewed from a chair lift) double black diamonds. The requisite bunny hill is available for newby's. They also offer a tiny slope with a "magic carpet" for those just starting out. The other extreme, at least from a view perspective is the double chairlift that goes up Eagles Nest Mountain and continues, if you'd like, over a valley to the top of Thunder Mountain.

There was never a wait at the chairlifts and whitecap provides plenty of terrain to keep one busy for several days.

Links & Commentary
Go Ski's discussion board has some useful comments.

Bill Semion took a look at Whitecap's new trails a few months ago.

I've posted some additional photos below.

Dave takes pride in his family oriented destination, as well he should. There's also a golf course for summer fun.

Posted by James Zellmer at 11:50 AM

March 5, 2006

A Pleasant Saturday Morning at Tyrol Basin

I've been avoiding trips to local ski areas from many years. The AA tag on my ski bag tells the story. The last time the bag was used was a flight from Albuquerque to Dallas - our last pre-children ski trip. The ski bag, along with my boot bag made the journey from Dallas to Madison in 1993.

Living in a four season climate, my recreation thoughts have generally drifted toward warm weather vacations. However, and perhaps giving in to the inevitable, I put my fun but evidently outmoded skis (purchased at Denver's Gart Brothers during my days there) in the car and made the short drive to Tyrol Basin early Saturday morning.

A glorious, sunny day, there were perhaps 15 cars in the lot as we walked toward the ticket office. The temperature and conditions were quite good, with only a bit of ice detected here and there.

Moments later, standing on top of the basin, I enjoyed the view and thought that it was quite pleasant to be within an hour's drive of this place.

While checking out the basin's runs - all except the moguls, my thoughts turned to:

  • Training:
    I saw two (surprising) examples of skiers evidently losing control and requiring ski patrol assistance. Years ago, when I learned to ski in a more serious way (via a Swiss instructor at Loveland), he advised that I take a lesson at the beginning of each ski season. I think this is correct - and I spent a bit of time on Tyrol's bunny hill last weekend, regaining my alpine perspective.
  • The Road Not Taken:
    Like Frost, I prefer the less travelled and popular routes. Tyrol makes it easy to turn right off the main lift and ski down toward another lift, where very few people where skiing (moguls - not for me, but the black and blue runs were enjoyable). I chose this route quite a few times and very much enjoyed the views, serenity and a rather quiet late morning outing.
  • Safety:
    There's quite a bit more safety enhancements than I recall. A large, orange plastic fence now greets the skier as she turns off the triple chair. An out of control skier will be caught in this, rather than careening down the hill.
  • The rise of snowboarding:
    Just starting to take off when I last skied, snowboarding is big time, today. I can see the friction between traditional alpine downhillers and snowboarders.
  • Variety:
    Snowboarders, downhillers and telemark skiers mingled reasonably well at Tyrol. It's great to see a few telemark folks sliding downhill.
Finally, my eldest added these notes:
You are weird skiing is odd and my lower back is sore!!!!! Overall it was a fun experience, and I would love to go more often next year!!! Thank you Nora for teaching me!!
Posted by James Zellmer at 4:01 PM

January 19, 2006

Adults Can Take Steps to Delay Alzheimer's

Christine Dell'amore:
Older adults who exercise at least three times a week keep their minds sharper as they age, a new study shows.

Researchers at Group Health Cooperative in Seattle found that regular exercise, in as little as 15 minute intervals, can delay the onset of dementia and Alzheimer's disease in adults over 65. Their study offers the most conclusive evidence to date that physical activity can help stem the degenerative diseases.
Posted by James Zellmer at 8:09 AM

iPod Personal Trainer

Catherine St. Louis:
But that was before she tried MP3 workouts. Taking advantage of sale prices last January at www.cardiocoach.com, she downloaded the first three volumes of a five-part series. Cardio Coach audios are designed to be used during any kind of cardiovascular exercise: running, stair climbing, even walking. For 30 to 60 minutes Sean O'Malley, the personal trainer who created the programs, offers encouragement as he guides the listener through a series of sprints - and for those exercising on machines, hills - that alternate with easier periods. Original music accompanies the ebb and flow of the intervals.
Posted by James Zellmer at 8:02 AM

January 8, 2006

Genetic Testing for the Rest of Us - over the Internet

Katherine Seligman:
DNA Direct offers genetics tests that can reveal a predisposition to a half dozen diseases or conditions, among them breast and ovarian cancer, cystic fibrosis, clotting disorders and infertility. Phelan obtained her chromosomal analysis the same way any client could. She spoke with the company's genetic counselor and then went for a blood test. The counselor reviewed the findings to help her interpret what they meant. In Phelan's case, the results provided a surprise -- what looked like partial Turner's syndrome. It was a possible clue to her past struggle with infertility, although she's never had any other symptoms.

"When I realized this I was thrilled," she said. "There may have been an underlying genetic factor. ... I thought, wow, women could go through this and have this help. It can work backward and help diagnose the past."
Posted by James Zellmer at 10:35 AM

January 6, 2006

White Noise

Jonathan Duffy:
While veteran rocker Pete Townshend blames his hearing loss on a lifetime spent using headphones, experts say today's iPod Generation is storing up trouble for the future by listening to music at high volumes. Is this a crisis in the making?
Posted by James Zellmer at 10:51 AM

December 13, 2005

What employees think about consumer-directed health plans

Vishal Agrawal, Paul D. Mango, and Kimberly O. Packard:
Eager to curb the rising cost of health care, many US insurers and employers are considering consumer-directed health plans (CDHPs), which are designed to lower costs by giving consumers more responsibility for managing their own health care spending.1 Indeed, a survey indicates that this interest is more than justified. We found that the plans encourage value-conscious behavior, increase the consumers' level of engagement with their well-being, and may even promote behavior that leads to better long-term health.

In March 2005 we surveyed 2,500 consumers, 1,000 of whom had been enrolled in a CDHP for at least one year.2 We also conducted extensive interviews with 25 of these CDHP consumers and with seven benefits managers who administer the plans.3 Our goal was to learn how consumers' behavior changes when they become responsible for a greater share of their health care costs.
Posted by James Zellmer at 11:41 AM

November 13, 2005

Seniors Embrace Blogs

There's Dad's Tomato Garden Journal, Dogwalk Musings, and, of course, the Oldest Living Blogger.

"It's too easy to sit in your own cave and let the world go by, eh?" said Ray Sutton, the 73-year-old Oldest Living Blogger and a retired electrician who lives in Vancouver, British Columbia. "It keeps the old head working a little bit so you're not just sitting there gawking at TV."
Posted by James Zellmer at 6:00 PM

Madison's Martens on the Medicare Prescription Drug Benefit

Wall Street Journal:

Bill and Barbara Marten of Madison, Wisc., buy medications from Canada and New Zealand to save money. Bill, 68, and Barbara, 69, are skeptical a Medicare drug plan can beat what they're paying now for their prescription drugs.
Bill Marten has marked his calendar. This Saturday, he plans to take another stab at the Medicare Prescription Drug Plan Finder.

Posted by James Zellmer at 12:01 AM

October 20, 2005

Health Savings Accounts and the Future of American Health Care

Richard L. Kaplan:This article examines the recent enactment of Health Savings Accounts (HSA) as they might affect how Americans obtain coverage for their health care expenses and the role that personal responsibility will play in that process. It explains the historical development of this country's tying health insurance to current employment status and especially the role of tax policy in that phenomenon. After considering the advantages and disadvantages of this approach, the article analyzes the key elements of the 2003 legislation that created HSAs. This part examines the high deductible insurance plan that must accompany an HSA, including its limit on out-of-pocket expenditures and the scope of additional insurance permitted.

Posted by James Zellmer at 8:15 AM

August 30, 2005

Interesting Susan G. Komen Breast Cancer Foundation Fund Raiser

9 Million Miles for the Ultimate Drive, an interesting annual BMW test drive promotion that supports the Susan G. Komen Breast Cancer Foundation. This initiative, which raises at least $1M annually, passed through Madison today.
Posted by James Zellmer at 8:00 PM

August 24, 2005

Costco Selling Health Insurance in California

Wendy Kaufman:
Costco, the members-only discount retailer, is testing sales of individual health insurance policies. The pilot program launched last month in California. It targets mom-and-pop business owners, and those without a job or without job-provided health insurance.
Posted by James Zellmer at 12:01 PM

August 23, 2005

Gladwell on our Healthcare System

Malcolm Gladwell:
One of the great mysteries of political life i the United States is why Americans are s devoted to their health-care system. Six times i the past century—during the First World War during the Depression, during the Truman an Johnson Administrations, in the Senate in th nineteen-seventies, and during the Clinton years—efforts have been made to introduce som kind of universal health insurance, and eac time the efforts have been rejected. Instead, th United States has opted for a makeshift syste of increasing complexity and dysfunction Americans spend $5,267 per capita on healt care every year, almost two and half times th industrialized world’s median of $2,193; th extra spending comes to hundreds of billions o dollars a year.
Tyler Cowen offers a number of counterpoints, links really, to Gladwell's words.
Posted by James Zellmer at 9:04 AM

August 2, 2005

Atkins Goes Belly-Up

Michael Noer:
Atkins Nutritionals, the New York company founded in 1989 by the late Dr. Robert Atkins to cash in on his low-carb diet, filed for Chapter 11 bankruptcy protection yesterday. The company cited weakening demand for its products. Ironically, the Atkins diet–affectionately known by some as the “cheeseburger-hold-the-bun” diet–had been blamed in recent years for earnings shortfalls in companies ranging from Krispy Kreme Doughnuts (nyse: KKD - news - people ) to Kraft Foods (nyse: KFT - news - people ) to Interstate Bakeries (the maker of Wonder Bread and Twinkies).
Posted by James Zellmer at 6:57 AM

July 26, 2005

Cheaper Health Insurance?

Wall Street Journal:
The idea behind the legislation, sponsored by GOP Representative John Shadegg of Arizona, is disarmingly simple: Allow Americans to buy health insurance from vendors in any one of the 50 states.

Right now Americans who aren't lucky enough to get insurance from large employers or poor enough to qualify for Medicaid find themselves at the mercy of the legislators and insurance commissioners of the state in which they happen to live. This can be OK in states that exercise this regulatory function judiciously. But in others, the young and working poor find themselves effectively priced out of the market by special-interest regulations dressed up as consumer protections.
Posted by James Zellmer at 9:37 AM

July 25, 2005

Bad Practices Net Hospitals More Money: The Waste in Medicare Spending

Gilbert M. Gaul:
Medicare's handling of Palm Beach Gardens is an extreme example of a pervasive problem that costs the federal insurance program billions of dollars a year while rewarding doctors, hospitals and health plans for bad medicine. In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine.
Posted by James Zellmer at 8:17 AM

July 14, 2005

Health Benefits of Working For a Lifetime

Morning Edition:
Many Americans are working well past the age of retirement. Dr. Robert Butler, founding director of the National Institute on Aging and CEO of the International Longevity Center, talks about why people choose to keep working. Butler says work gives older people's lives meaning, control and an income.
Posted by James Zellmer at 7:52 AM

July 13, 2005

Consumer Directed Health Care Eclipsing Managed Care?

Holman W. Jenkins, Jr.:

Managed care, whatever its prospects for running Medicare better, is facing gradual eclipse in the private sector by the new strategy of consumer-directed health care, based on tax-free health savings accounts, enacted in the same 2003 Bush-promoted law that gave us giant subsidies for the managed-care business. In a new report, McKinsey likens the arrival of HSAs to the creation of 401(k)s in the 1980s, an opportunity that largely bypassed traditional banks and pension managers and was captured by mutual fund firms like Fidelity and Vanguard.

Posted by James Zellmer at 6:25 AM

June 16, 2005

International Volkssport Association

Evidently, a group from The International Volkssport Association was recently in Madison. This group has organized walking tours of US Capitol Areas. Interesting stuff. I remember running across these sort of opportunities in Europe.

Posted by James Zellmer at 5:32 PM

June 13, 2005

The Illiterate Surgeon

Kristof posts a moving story from Addis Ababa. Check out the photos & video.

Posted by James Zellmer at 12:20 AM

May 6, 2005

Herbert's Reawakening

Robert Siegel:

Firefighter Donald Herbert suddenly became lucid Saturday after living in an unresponsive state for 10 years.

Posted by James Zellmer at 12:01 AM

May 5, 2005

Pre-Surgery Safety Checks

All Things Considered:

patients awaiting surgery are subjects of various questions and checklists. The queries get redundant, but the procedure is akin to the aviation industry's safety precautions.

Posted by James Zellmer at 12:00 AM

April 29, 2005

The Economist: Health Care & Information Technology

Fascinating and timely article from the Economist on health care & IT

The inability, and reluctance, of doctors and hospitals to use information technology more widely is killing thousands of people
IT is strategic - when used wisely.

Apr 28th 2005

The inability, and reluctance, of doctors and hospitals to use
information technology more widely is killing thousands of people

"WHETHER or not a treating doctor has Alex's full medical record
available can literally mean life or death," says Cynthia Solomon of
Sonoma, California. Her son Alex, now in his 20s, grew up with
hydrocephalus, a rare and life-threatening condition in which fluid
accumulates in the brain and needs to be drained through special
shunts. So Ms Solomon had no choice but to become a walking filing
cabinet of records on allergies, pituitary-gland problems, brain scans
and "every piece of paper a doctor ever wrote about Alex's case." She
worried constantly. There were close calls, such as the time that Alex
went on a trip and ended up, unconscious, in some distant hospital. Ms
Solomon could not get his paper records to the new doctor and had to
pray that Alex would not get the wrong antibiotics or be laid on his
back, which might have killed him.

To Ms Solomon the information problem with health care today is so
glaring that she eventually took matters into her own hands, as best
she could. She took out a second mortgage, hired software programmers
and developed a computer system, called FollowMe, for online medical
records that any doctor can, in theory, access anywhere and anytime.
FollowMe will not fix the world's health-care industry--only about 400
families now use it--but Ms Solomon has correctly identified the
woeful, even scandalous, failure of the health-care industry worldwide
to adopt modern information technology (IT).

The solution seems obvious: to get all the information about patients
out of paper files and into electronic databases that--and this is the
crucial point--can connect to one another so that any doctor can access
all the information that he needs to help any given patient at any time
in any place. In other words, the solution is not merely to use
computers, but to link the systems of doctors, hospitals, laboratories,
pharmacies and insurers, thus making them, in the jargon,

This may be obvious, but today it is also a very distant goal.
According to David Bates, the head of general medicine at Boston's
Brigham and Women's Hospital and an expert on the use of IT in health
care, the industry invests only about 2% of its revenues in IT,
compared with 10% for other information-intensive industries.
Superficially, there are big differences between countries. In Britain,
98% of general practitioners have computers somewhere in their offices,
and 30% claim to be "paperless", whereas in America 95% of small
practices use only pen and paper. But, says Mr Bates, this obscures the
larger point, which is that even the IT systems that do exist cannot
talk to those of other providers, and so are not all that useful.

It shows. People on the right side of the digital divide increasingly
take for granted that they can go online to track their FedEx package,
to trade shares, file taxes and renew drivers' licences, and to do
almost anything else--unless, of course, it involves their own health.
That information, crumpled and yellowing, is spread among any number of
hanging folders at all the clinics they have ever visited, and probably
long since forgotten about. The most intimate information is, in
effect, locked away from its owners in a black box.

Many IT bosses find this baffling. John Chambers, the chief executive
of Cisco Systems, the world's largest computer-networking company, says
that health care is down there with mining as the most technophobic
industry. Jeff Miller, a manager at Hewlett-Packard, a large
computer-maker, calls health care "one of the slowest-adopting
industries", which is especially surreal because hospitals often
splurge on the latest CAT-scan or MRI equipment, but are stingy with
their back-office systems. It is, he says, like "Detroit putting out
futuristic hydrogen cars but using paper processing and manual labour
for the manufacturing."

This has perverse consequences. According to the Institute of Medicine,
a non-governmental organisation in Washington, DC, preventable medical
errors--from unplanned drug interactions, say--kill between 44,000 and
98,000 people each year in America alone. This makes medical snafus the
eighth leading cause of death, ahead of car accidents, breast cancer
and AIDS. "It's like crashing two 747s a day," says Mark Blatt, who was
a family doctor for 20 years before he joined Intel, the world's
largest semiconductor-maker, to manage its health-care strategy. There
should, he says, be more outrage.

Improving computer systems, of course, would not eliminate all medical
errors. But most researchers believe that they would reduce them
dramatically. One study in America estimates that IT could prevent 2m
adverse drug interactions and 190,000 hospitalisations a year. Another
study reckons that electronic ordering of drugs can reduce medication
errors by 86%. By contrast, research published in March in the JOURNAL
OF THE AMERICAN MEDICAL ASSOCIATION warns that IT, if the software is
badly designed, could actually increase errors. But almost everybody
agrees that well-designed IT is essential to improving quality in
health care.

The same goes for its cost, an increasing burden to ageing societies in
the rich world and even in poor countries such as China. HP's Mr Miller
reckons that redundancy and inefficiency account for between 25% and
40% of the $3.3 trillion the world spends on health care every year,
and could be eliminated with proper IT. A study from a clinical
research centre at Dartmouth College in New Hampshire reaches a similar
conclusion, estimating that a third of America's $1.6 trillion in
annual health-care spending (as of 2003) goes to procedures that
duplicate one another or are inappropriate.

Estimating how much IT could save, after taking account of the
considerable cost of applying it widely, is not easy. Writing in HEALTH
AFFAIRS, an American journal, in January, Jan Walker and five
colleagues (including Mr Bates) at the Centre for Information
Technology Leadership in Boston concluded that a fully interoperable
network of electronic health records would yield $77.8 billion a year
in net benefits, or 5% of America's annual health-care spending. This
includes savings from faster referrals between doctors, fewer delays in
ordering tests and getting results, fewer errors in oral or
hand-written reporting, fewer redundant tests, and automatic ordering
and re-fills of drugs. It does not include, however, perhaps the
biggest potential benefit: better statistics that would allow faster
recognition of disease outbreaks (such as SARS or avian flu).

The key word in all such estimates is always "interoperable", says Mr
Bates, pointing to the differences between two pilot programmes in
America. In one, the Californian city of Santa Barbara set up a
city-wide peer-to-peer network (in which the computers of different
practices and clinics can talk directly to one another). This allows
doctors, say, to pull up portable-document-format (PDF) files from one
another. But the information in them--text, with numbers buried in
it--is "unstructured" and so not very useful. It is the equivalent of
faster faxing, and not what people mean by interoperability.

The other American pilot, located in Indianapolis and managed by the
Regenstrief Institute, a non-profit medical-research organisation,
comes closer. It has created a city-wide network in which physicians
can, with the patient's permission, log on to a complete medical
history that includes all previous care at the 11 participating
hospitals. Already, the database contains 3m patient records, 35m
radiology images, 1.5 gigabytes of diagnoses, 20m order-entries by
physicians, and so forth. The key difference is that, wherever
possible, the data is entered in a structured and formatted form. Test
results are in neat rows and columns and tagged in a way that every
other computer can recognise and compare against other appropriate
numbers. This is the sort of IT solution that not only cuts waste and
errors, but also helps physicians to make better decisions.

What, then, would the ideal IT architecture of health care in future
look like? It would start, says Intel's Mr Blatt, with wireless data
entry by nurses and doctors. Practices and clinics would have secure
"Wi-Fi hotspots"--using a radio technology called 802.11--and staff
would walk around with small handheld devices that transmit all inputs
to the database in the back office. Another source of input might be
tiny radio-frequency identification (RFID) chips that are attached to
patients and send basic information when they come in range of a radio
field. Patients could also add inputs themselves. A firm called Health
Hero, for instance, makes a cute little device called a Health Buddy
that patients take home and plug into their telephone lines. A couple
of times a day, it asks them basic questions or takes their heart rate,
and sends the data to the doctor.

Behind the scenes, all this data would be formatted and stored
according to recognised standards. Contrary to widespread concerns,
this does not require a single central repository or any other
particular hardware architecture. Instead, it relies on common software
protocols and formats so that individual computer applications can find
and talk to one another across the internet. Most of these standards,
such as XML, SOAP and WSDL, already exist and are used by many
industries. Others, such as HL7, LOINC or NCPDP (spelling them out
makes them sound no less obscure) are unique to the health-care
industry and govern data interchange between hospitals, laboratories
and pharmacies. On top of these, there need to be hacker-proof layers
of authentication and password protection so that only the right people
get access.

There is still some work to do to refine these technologies. In
January, eight of the world's largest IT companies--Microsoft, Oracle,
IBM, HP, Intel, Cisco, Accenture, and Computer Sciences--teamed up to
form an "interoperability consortium" for that very purpose. In
general, however, "the technology is very, very ready," says Robert
Suh, the technology boss at Accenture, a consultancy that is helping
Britain's National Health Service (NHS) and regional governments in
Australia and Spain to implement electronic health records.

In fact, Britain's--or rather England's--NHS is among the pioneers
worldwide. This year, it will begin rolling out a GBP6.2 billion ($12
billion) project in which five regions in England will form networked
IT"clusters" so that 18,000 NHS sites, including all family doctors and
acute-care hospitals, can share standardised information on patients.
These clusters will eventually be linked through a "spine" (called the
N3 and run by BT) with huge bandwidth to create, in effect, one
national network. Scheduled to be completed by 2010, the plan, like
most IT projects, has had some early hiccoughs and has been greeted
with cynicism by some doctors. But other countries will be looking to
it as a model.

Another pioneer is Denmark, which began rolling out a similar network
for the region around Copenhagen in 2001 and expects to complete it by
2007, before covering the rest of Denmark. Torben Stentoft, the boss of
Hvidovre Hospital in Copenhagen and the head of the city's network,
says that his main concern is the nitty-gritty of dealing with all of
his legacy computers which need to be tweaked or replaced. But he feels
that he has his society's full support. "Nobody is against this.
Everybody is asking for it," he says. In particular, the Danes find
nothing terribly controversial in the idea of a national health
identification number, which they already have, and spend little time
worrying about how to fund the new systems, since their tax kroner are
doing that.

Mr Stentoft is in an enviable situation, especially if viewed from
America, which has the world's largest and costliest health-care
system. America is as enthusiastic as any country about electronic
health records. President George Bush has embraced the idea, and he
spoke about it publicly some 50 times last year. He has even appointed
a "national co-ordinator for health information technology" to create a
fully interoperable, nationwide network within ten years. But America's
health-care system is so different from others that it faces some
special complications.

The first big difference is that, whereas most other rich countries
have "single-payer" (ie, government-run) health-care systems, America
has a highly fragmented industry with many private providers and
insurers doing business alongside large government programmes (such as
Medicare, for old people). This means that in funding a new IT
infrastructure "the financial incentives are not exactly aligned," says
Mr Bates. In single-payer systems, the expenditures come out of the
same pocket--the taxpayer's--that the savings go into. But in America,
he estimates, the practices and hospitals that pay for the IT only get
11% of the cost savings, with the rest going to insurers and employers
(who buy the insurance). The resulting mismatched incentives, says Mr
Bates, could derail the entire project: "It's a situation where America
could end up far behind."

This calls for some combination of government subsidies and
private-sector financial incentives, argues the Markle Foundation, a
charity in New York that is dedicated to the proper use of IT in health
care and national security. Over half of all doctors in America work in
small practices. And, say Markle's researchers, a typical practice
(defined as five doctors handling 4,000 patient-visits a year) would
make losses if it had to pay the estimated $15,000 a year for three
years that it costs to install an interoperable IT system and to learn
how to use it.

The practices, Markle concludes, therefore need incentives of $3 to $6
per patient-visit, or $12,000 to $24,000 a year, which comes to $7
billion-14 billion a year for three years, or between 1.2% and 2.4% of
total ambulatory-care revenues. The trickier question is how to
administer this largesse, whether it is provided by insurers and
employers or the government. The money could be disbursed directly and
specifically for the IT systems. Or it could be given indirectly in
some sort of pay-for-performance arrangement.

The other big difference between America and countries such as Denmark
is public perception of the robustness of privacy laws. The European
Union has stricter privacy laws than America, and Europeans have
relatively more confidence in them. For information sharing, "ours is a
much more porous environment," says Alan Westin, a professor at
Columbia University who has written several books on privacy issues.
This is not primarily an IT issue, although the internet does seem to
raise the stakes. In February, one database broker, ChoicePoint, had to
inform some 140,000 people that it had accidentally sold sensitive
information about them. Also in February, a statistician of the health
department in Palm Beach County, Florida, inadvertently e-mailed a list
of more than 6,000 HIV carriers to all employees of the department.

This makes many Americans suspicious of plans that involve sharing
sensitive health information. Although opinion polls in Europe show
overwhelming support for interoperable medical databases as long as
these are properly regulated, a February poll by Harris Interactive
found that Americans are currently evenly split, with 48% saying that
the benefits outweigh the privacy risks, and 47% saying the opposite.
Some 70% of Americans in the poll worried that sensitive data (on
sexually transmitted diseases, say) might leak.

This is unfortunate, says Michael Callahan, a health-care lawyer at
Katten Muchin Zavis Rosenman, a law firm in Chicago, since a weighty
tome of legislation was passed in 1996 precisely to prevent such leaks.
Called HIPAA (short for "health insurance portability and
accountability act"), the law defines strict codes for sharing medical
data and takes effect in stages, with a large chunk of compliance
falling due this month. HIPAA creates a national "floor", says Mr
Callahan, with some states following even stricter statutes, and
involves the federal government in enforcement and prosecution. HIPAA
is not quite as strong as equivalent laws in Europe, he thinks, but
strong enough.

Mr Westin disagrees. The HIPAA rules are "not at all adequate" for
shared medical records, he says. So the only way to sell such records
to the American public, he says, is to design the whole system with
privacy as a priority. This rules out any form of medical
identification card, to which Americans would be hostile (even though
they think little of giving their social-security numbers, a de facto
ID, when renting DVDs). It also means avoiding a central database that
could be hacked. The best approach, says Mr Westin, is to emulate the
"locators" used by American police. Cops in California who arrest a New
Yorker cannot access information about that person directly, but can
view a directory of such information and request it from the
authorities in New York. Finally, rather than allowing sceptics to opt
out of the new system, says Mr Westin, the system should from the start
require patients actively to opt in.

As the Markle Foundation puts it, the technology must be designed in
such a way that "decisions about linking and sharing are made at the
edges of the network" by patients in consultation with their doctors,
and never inside the network. This goes to the very heart of the
matter. For even though it is fine to start hoping for the day when
interoperable electronic health records create vast pools of medical
information that could be used to find new cures and battle epidemics
in real time, their ultimate purpose is to make one simple and
shockingly overdue change: to enable individuals, at last, to have
access to, and possession of, information about their own health.

See this article with graphics and related items at http://www.economist.com/printedition/displayStory.cfm?Story_ID=3909439

Posted by James Zellmer at 10:16 AM

April 23, 2005

Fetal Cell Therapy for Humans

University of Wisconsin-Madison researcher said he would ask federal regulators Friday to approve the first clinical trial injecting special stem cells into the spinal cords of people with the degenerative nerve ailment called Lou Gehrig's disease.

The trial would test whether a technique anatomy professor Clive Svendsen has pioneered on rats afflicted with the disease is safe to use on people. If successful, Svendsen said a much larger clinical trial aimed at treating the disease could be under way in two or three years. ..... The research does not involve human embryonic stem cells, the blank-slate cells derived from human embryos that can be molded into any type of tissue cell in the body.
Posted by James Zellmer at 7:21 PM

Losing Patience, Not Weight

Great article by Bruce Weber on the President of the Cooper Institute, a non-profit organization in Dallas dedicated to research on the relationship between living habits and health:
"I'm a short, fat guy who runs every day," Dr. Blair said in a recent phone interview. "I've run tens of thousands of miles over the past 40 years, and in that time I've gained 30 pounds."

This doesn't exactly please Dr. Blair. (People who are skinny and never exercise "are going straight to hell," he said, "because they're living in paradise now.") But he was using himself, he said, to illustrate why the federal government's new physical activity recommendations, which are clearly aimed at the alarming rise in obesity in America, are misleading. Even though he has been doing what the guidelines advise for decades, it hasn't controlled his weight.
Posted by James Zellmer at 10:35 AM

April 12, 2005

50 Years Ago: Jonas Salk Conquers Polio

Joe Palca:
Fifty years ago, on April 12, 1955, the world heard one of the most eagerly anticipated announcements in medical history: Dr. Jonas Salk's polio vaccine worked. The vaccine turned a disease that once horrified America into a memory.
Posted by James Zellmer at 12:00 AM

April 11, 2005

Physicians & Drug Abuse

Cheryl W. Thompson:
"Medicine tolerates behavior that in any other industry would be unacceptable," said Lucian Leape, a physician and expert on patient safety who teaches at the Harvard School of Public Health. "There are patients' lives at stake . . . and that's more important than a doctor's career."
Part 2
Posted by James Zellmer at 7:54 AM

April 6, 2005

Why is Tommy Thompson Sad?

Michael F. Cannon:
Finally, Thompson voiced his regret just one day after Medicare's trustees announced that the drug benefit by itself has an unfunded liability 60 percent larger than that of the entire Social Security program. (The unfunded liability for all of Medicare is nearly six times that of Social Security.) Medicare's financial outlook has grown so dire that its two public trustees broke with the trustees who are members of Bush's Cabinet to say that it is in far worse shape that Social Security.
Posted by James Zellmer at 8:19 AM

March 27, 2005

A Passage to India for Medical Treatment

Miranda Kennedy:

Growing numbers of foreign patients, including uninsured Americans, are going to India for medical treatment. Proponents say the health care is comparable to much that is available in the United States, and at a far lower cost.

Posted by James Zellmer at 12:00 AM

March 19, 2005

Employees Who Smoke Face Health Care Surcharge

Paul Gores:
That's why she is troubled by a rule that will go into effect at her company next January. Trapp-Dietz and other smokers who work at Northwestern Mutual - regardless of whether they light up at home or outside the building at work - will pay an extra $25 a month for health insurance coverage.

Trapp-Dietz said considers the fee an invasion of her private life.

"I know I have to quit, and I really want to. But I don't like being told to by my employer," she said.
These type of disincentives are already in play if one purchases other benefit type products such as life insurance.
Posted by James Zellmer at 6:20 AM

March 13, 2005

Culture Crash

Jerry Brown on Oakland's Sideshows (a new term for me). Brown also posts a useful quote from Clint Eastwood. (read the comments)
Posted by James Zellmer at 8:24 AM

March 9, 2005

US Asthma Capitals: Madison is 26th

The Asthma & Allergy Foundation released their second annual "US Asthma Capitals". Madison is 26th.

Posted by James Zellmer at 12:01 AM

March 8, 2005

Health Exchange

Victoria Colliver:
One of the main stumbling blocks in the American health care system, many experts say, is the inefficient use of computer technology to manage medical records.

Now, in Santa Barbara County, a network of hospitals, laboratories, pharmacies and doctors is pioneering new technology that will allow medical professionals with different computer systems to share clinical information. The initiative may well be a first step toward the creation of a national patient-care data bank.
Posted by James Zellmer at 11:26 AM

March 3, 2005

How Marketing Drives Pharmaceutical Sales

I've always wondered about the utility of drug advertising. Every now and then, I'll drive by a billboard that says "Ask your doctor about Bextra". Having no idea what Bextra (insert name of drug here) is, I'm amazed that these efforts pay off at all. Bernadette Tansey digs into the drug industry's marketing practices. Jim
Posted by James Zellmer at 8:51 AM

February 26, 2005

Buy your health insurance at Costco?

Victoria Colliver:
Retailers and health care may seem like an unusual pairing, but an increasing number of stores -- especially big-box discounters -- have been getting into the business of offering health coverage or care. With health care costs on the rise, these retailers want to offer their customers a value on a needed service and increase their profile as a store that offers everything under one roof.

"It makes sense to offer health care in places where people already have to go -- whether to buy food or other household goods," said Linda Sherry, spokeswoman for Consumers Union, a watchdog group.
Posted by James Zellmer at 7:09 AM

February 17, 2005

New Madison Parks?

Aubre Andrus on the Park Commission's plans.
Posted by James Zellmer at 7:29 AM

February 10, 2005

BU: 50% of medical expenses are wasted....

Victoria Colliver:
About 50 percent of health care spending is eaten up by waste, excessive prices and fraud, according to a report set for release today by Boston University researchers.

Major sources of unnecessary spending include administrative costs and profit in the insurance industry, high prices of prescription drugs and health services and, to a smaller extent, theft and fraud, according to the study.
Posted by James Zellmer at 7:48 AM

February 8, 2005

Internet Evangelism: The Interview with God

Gorgeous photography & an interesting approach, by La Jolla, CA based Get Inspired Now.
Posted by James Zellmer at 10:15 PM

January 19, 2005

Why Do Women Live Longer than Men?

The Economist:

That question can be answered at two levels. An evolutionary biologist would tell you that it is because women get evolutionary bonus points from living long enough to help bring up the grandchildren. Men, by contrast, wear themselves out competing for the right to procreate in the first place. That is probably true, but not much help to the medical profession. However, a group of researchers at John Moores University, in Liverpool, England, has just come up with a medically useful answer. It is that while 70-year-old men have the hearts of 70-year-olds, those of their female peers resemble the hearts of 20-year-olds.

Posted by James Zellmer at 12:08 AM

December 30, 2004

Cleveland Clinic Cardiologist Eric J. Topol Criticizes Drug Ads

The heart-attack risks of arthritis painkillers Vioxx, Bextra and Celebrex have exposed a regulatory "house of cards" at the Food and Drug Administration, wrote Dr. Eric J. Topol, chairman of cardiovascular medicine at the Cleveland Clinic.

"Unbridled promotion exacerbated the public health problem," Topol concluded. "The combination of mass promotion of a medicine with an unknown and suspect safety profile cannot be tolerated in the future." Read more here. Topol's Journal of American Medicine article: Arthritis Medicines and Cardiovascular Events"House of Coxibs"
Background Links: alltheweb | Clusty | Google News | MSN Search | Teoma | Yahoo Search

Drug advertising has truly gone off the deep end. Driving down the beltline and seeing a nonsensical name on a billboard makes no sense.

Posted by James Zellmer at 12:03 AM

December 29, 2004

High Prices: How to Think About Prescription Drugs

Malcolm Gladwell pens a very useful look at prescription drug costs:

In the political uproar over prescription-drug costs, Nexium has become a symbol of everything that is wrong with the pharmaceutical industry. The big drug companies justify the high prices they charge--and the extraordinary profits they enjoy--by arguing that the search for innovative, life-saving medicines is risky and expensive. But Nexium is little more than a repackaged version of an old medicine. And the hundred and twenty dollars a month that AstraZeneca charges isn't to recoup the costs of risky research and development; the costs were for a series of clinical trials that told us nothing we needed to know, and a half-billion-dollar marketing campaign selling the solution to a problem we'd already solved. "The Prilosec pattern, repeated across the pharmaceutical industry, goes a long way to explain why the nation's prescription drug bill is rising an estimated 17 % a year even as general inflation is quiescent," the Wall Street Journal concluded, in a front-page article that first revealed the Shark Fin Project.

Posted by James Zellmer at 12:02 AM

November 25, 2004

Brett Favre on Life's Challenges

Brett Farve on his wife Deanna's view of life during a personally challenging time (breast cancer):

My wife said one time, See life through the front windshield, not the rearview mirror, said Favre. I thought that was a great comment. You deal with things that are in front of you, and you cant really worry about whats happening behind you. So thats kind of what we do.

Posted by James Zellmer at 6:01 PM

November 18, 2004

Michael Porter: Solving the Health Care Conundrum

Harvard Strategy Guru Michael Porter on Solving the Health Care Conundrum. He summarized some key learnings here:

  • The U.S. health care system is a paradox in that it has competition yet fails to deliver improving value.

  • The root cause of these problems is that the competition taking place has been the wrong kind.

  • The key to addressing these problems is moving to value-based, positive-sum competition.

  • Moving to value-based competition has important strategic implications for providers as well as health plans and employers.

Posted by James Zellmer at 12:01 AM

30 Teeth Pulled A Day

I had a wisdom tooth pulled last week - unplanned, after a painful few days. The professionals who did the job quickly told me that they do this 30 times per day.... Much, much better now.

Posted by James Zellmer at 12:00 AM

October 26, 2004


Thinking about sinus relief?

I've been (happily) using Madison based Sinucleanse for several months. The process seems rather strange, at first, but the results have been excellent. I no longer take any prescription allergy medications! Check it out (they have a very nicely done video that explains the process).

Well worth checking out.

Posted by James Zellmer at 12:48 AM

October 14, 2004

FDA Approves Use of Chip in Patients

Diedtra Henderson:

Medical milestone or privacy invasion? A tiny computer chip approved Wednesday for implantation in a patient's arm can speed vital information about a patient's medical history to doctors and hospitals. But critics warn that it could open new ways to imperil the confidentiality of medical records.

The Food and Drug Administration (news - web sites) said Wednesday that Applied Digital Solutions of Delray Beach, Fla., could market the VeriChip, an implantable computer chip about the size of a grain of rice, for medical purposes.

With the pinch of a syringe, the microchip is inserted under the skin in a procedure that takes less than 20 minutes and leaves no stitches. Silently and invisibly, the dormant chip stores a code that releases patient-specific information when a scanner passes over it.

Barnaby Feder & Tom Zellmer

Posted by James Zellmer at 12:01 AM

October 8, 2004

Ray Kurzweil on slowing down the aging process

Leslie Walker:

Inventor Ray Kurzweil takes 250 nutritional supplements a day in his quest to live long enough to reap the benefits he expects from biotechnology. He says he's trying to reprogram his body, as he would his computer.

"I really do believe it is feasible to slow down the aging process," Kurzweil told Technology Review magazine's Emerging Technologies Conference at the Massachusetts Institute of Technology here last week. "We call that a bridge to a bridge to a bridge -- to the full flowering of the biotechnology revolution."

Posted by James Zellmer at 12:23 AM

September 26, 2004

Bonuses for Good Doctors

1. Over the last year, six California health plans have been monitoring the performance of 45,000 doctors. The top performers will split a bonus pool of $40 to $60 million

2. 35 health plans, covering some 30 million patients, now tie doctor bonuses to performance. Preventive care and measure to encourage "patient follow-up" receive special rewards.

3. Bonus-based coverage is expected to double in size over the next year.

4. Some experts predict that pay-for-performance eventually will account for 20% to 30% of what the federal government pays health care providers.

The insurance companies feel that better doctor performance will lower their long-run costs. Many doctors don't like these incentives. Their financial risk is increased, and they cannot always control how well the patient sticks to the prescribed regimen. Still, if greater medical skill does not show up in the numbers, over a reasonably large sample of patients, why do we spend so much time and money educating doctors?

I predict that as information technology progresses, and performance becomes easier to measure, the American economy will resort to many more bonuses of this type, across many professions.

Here is the story, WSJ subscription and password required.

By the way, regular MR readers will not be surprised to learn who first wrote up the idea of rewarding doctors for superior performance: our ever-inventive colleague Robin Hanson. More recently Harvard economist David Cutler has promoted the idea as well.

For those who care: Here is a thorough AEI estimate of the cost impacts of the Kerry and Bush health care plans. If you are concerned about our fiscal future, this makes for scary reading.

Tyler Cowan
Posted by James Zellmer at 12:22 PM

September 24, 2004

The Longevity Gene

Lisa Scanlon:

n his laptop computer, biology professor Leonard Guarente plays a video clip of 29-month-old mice hobbling around a cedar-chip-filled cage. Theyre scruffy, fat, slow moving, and over the hill by rodent standards. Then he plays a clip of another group of 29-month-old mice. Theyre svelte, frisky, and scrambling around like adolescents. Whats their secret? These mice have eaten about two-thirds as many calories as their portly peers. Not only does the meager diet seem to keep them light in the limbs, but they tend to live 30 percent longer than their well-fed friends and are less likely to contract age-related diseases, such as diabetes and cancer.

Posted by James Zellmer at 12:09 AM

September 10, 2004

Yin & Yang of Ginseng

Elizabeth Thompson:

In work that emphasizes the need for stronger regulation of herbal drugs, an international team of MIT scientists and colleagues has unraveled the yin and the yang of ginseng, or why the popular alternative medicine can have two entirely different, opposing effects on the body.

Conflicting scientific articles report that ginseng can both promote the growth of blood vessels (key to wound healing) and stymie that process. The latter is important because preventing the formation of blood vessels can be enlisted against cancer. Tumors are fed by blood vessels; cutting off their supply can kill them

Psst: Want some Wisconsin Ginseng?

Posted by James Zellmer at 12:01 AM

September 4, 2004

Bill Clinton's Bypass & Good Drugs

Dave Winer recalls his own bypass surgery as former President Bill Clinton faces the same procedure.

Thank heaven for good drugs.

Bill Clinton called into the special Larry King roundup on his bypass surgery. He sounded great. Of course I projected my own experience onto his. I sounded great too, at that point in the process. They're pumping relaxing drugs into your system. I don't think you could feel anxious, no matter what. Good drugs.

Richard Knox:
About half a million Americans undergo coronary bypass surgery each year. Vice President Dick Cheney has had the surgery. It's a low risk procedure, with as little as 1 to 2 percent mortality and chances for full recovery. It is done urgently sometimes, as in the case of former President Clinton, when blockages are found.

Posted by James Zellmer at 7:17 AM

September 2, 2004

Health Care & Windows Risks

I recently observed a health care diagnostic system (made by Milwaukee based GE/Marquette electronics) that used Microsoft's Windows software. While the system collected data, somehow, another network user took over the screen (!), likely via a terminal sharing tool (PC Anywhere or similar). I wonder what the virus/work risks are?

It sure seems like firms have put a very large tool - windows - into places that it may not make sense, such as atm's, cash registers and medical devices among many others.

Network world has been looking into this.

Posted by James Zellmer at 7:42 AM

August 24, 2004

Passing on a Kidney Transplant

Michael Fraase:

I thought it would be more difficult, or maybe more complicated, but it was neither. A transplant surgeon called from the University of Minnesota this morning to tell me they had a cadaver kidney for me (Ive been on the transplant list for four-and-a-half years). Ill pass, I said in a quiet but steady voice. Call the next person on the list. The physician wanted a reason. Im still working out some ethical issues with the whole transplant business. There. It was out before I had a chance to even think about censoring myself.

Posted by James Zellmer at 12:26 AM

August 19, 2004

Healthcare Pricing Transparency

Adam Hanft has some useful suggestions that would help all of us evaluate health care costs.

The industry could address this by employing this very notion of pricing transparency. How much of its premium income gets passed through to its members and their doctors and hospitals, versus how much is overhead and profit? Imagine how much better consumers would feel if they understood that HMOs exist to collect premiums from everyone in order to redistribute the money to those who need it. Essentially, it's a major re-education campaign.

This is a model that the non-profit world has adopted, as scandals such as the United Way mess focused attention on what percent of a contribution finds its way to those who need it. Indeed, these metrics have become part of their messaging strategy.

Posted by James Zellmer at 10:20 PM

August 11, 2004

Using the Tax Code to Fix Health Care

Interesting ideas, certainly worth discussion:

We propose a simple change that will fundamentally alter the way people buy health care. All individually purchased insurance and out-of-pocket expenses would become tax deductible for persons who have at least catastrophic insurance coverage. The tax deduction could be taken by persons who claim the standard deduction on their tax returns and those who itemize deductions. All purchases of health care would receive the same income tax treatment.

With a level playing field, workers will no longer have a tax incentive to take their compensation in the form of expensive health insurance with low copayments and will shift to health plans with higher deductibles and higher coinsurance rates. Market forces will ensure that the insurance premium savings will be passed on to workers in the form of higher money wages. Just as workers have borne the burden of rising health care costs, so will they reap the benefits when costs are brought under control.

Posted by James Zellmer at 12:43 AM

July 29, 2004

Interesting Battle - Oconomowoc Hospitals

Aurora Healthcare, the state's largest private employer with 25,000 employees is attempting to build a new hospital in the Town of Summit. The Oconomowoc Memorial Hospital is minutes away from Aurora's proposed site. Over 1,000 people attended a public hearing on the required land use changes before the Town's Plan Commission. The proposed hospital would be built on 53 acres at the southwest corner of Interstate 94 and Hwy 67 in Waukesha County.

I remember someone saying (I wish I could recall the name) that when Madison approves new developments it's "planned growth" while when nearby towns approve them it's "urban sprawl".

Meanwhile, Detroit automakers are fighting the proposed construction of two new hospitals in suburban Detroit, according to an article by Lee Hawkins, Jr.:

The auto makers worry that the hospitals would add unneeded costs and lead to overcapacity in Detroit's Oakland County suburbs. Many hospitals see increasing their presence in fast-growing, upper-income suburban areas as a way to subsidize care to uninsured and indigent patients' in urban and rural areas.

The concept of the Big Three urging hospitals to resist overcapacity is ironic, since U.S. auto makers for years have been unable to conquer chronic overcapacity in their own industry.

The auto makers complain that in their business, overcapacity drives prices down. But they argue that in the hospital business, overcapacity drives medical costs up, because it encourages doctors to put more patients -- particularly those with rich health plans who pay little out of pocket -- into empty hospital beds.

Lots of interesting points in these articles. Clearly, today's medical technology provides an increasing amount of out-patient services. As an employer facing annual double digit health care cost increases, I do believe that the costs of these new facilities will indeed be paid.

Interesting counterpoint here.

Posted by James Zellmer at 7:30 AM

July 27, 2004

Shrimp Bandages

It was a couple of years ago, at least, that we first heard about bandages being developed out of chitosan and now it seems they've been put into service in the wars in Iraq and Afghanistan. Chitosan, derived from shrimp shells, carries a positive charge and bonds with a wound's red blood cells (which are negatively charged) to form a clot in as short as 30 seconds. Made exclusively by HemCon, the bandages use shrimp shells from Iceland, are processed and freeze-dried in New Hampshire, assembled and packaged in Oregon, and sterilized in California. No word on when shrimp bandages will be available to consumers.
Via Gizmodo.
Posted by James Zellmer at 11:03 AM

July 19, 2004

GE will see you now

Reed Abelson and Milt Freudenheim take a look at GE's latest moves in the health care business. Their new services include

  • Consulting
  • Lending
  • Software - via acquisitions
The article mentions several GE competitors, but does not include Madison based Epic Systems, a very successful health care software firm (and Madison's tech star).

Posted by James Zellmer at 3:46 AM

April 25, 2004

Phy Ed Cuts?

Activity levels of students drops from years ago according to Nicole Sweeney:

"We want the kids to be smart academically," said Otha Frazier, a physical education teacher at Racine's Case High School. "Well, it's not showing too much intelligence if you're going to destroy the body to prepare the mind."

Posted by James Zellmer at 7:23 AM

April 21, 2004

Is American Healthcare more Productive?

Tyler Cowen writes a useful summary of our healthcare system's costs & productivity vs other nations:

The relevant measures were either life expectancy after treatment or measures of the quality of life. And how about the results:

The United States is more productive in all these diseases except for diabetes in the United Kingdom. [emphasis added] The reasons for this result can be traced directly to the huge differences in the way the health care sector is organized and governed across these three countries. The UK health care system is almost entirely government owned and run...The result has been that the United Kingdom has no invested as quickly in technologies that have dramatically improved the diagnostic capabilities of medicine and significantly reduced recovery time...Germany, on the other hand, has a system more like the United States had twenty years ago. In Germany, medical expenses are paid for on a task-by-task basis for services of doctors and hospitals. As a result, hospitals in Germany have no financial incentive to reduce length of stay.

Posted by James Zellmer at 8:33 AM

April 9, 2004

Antidepressant Use Questioned

"Pediatricians and family physicians should not prescribe antidepressants for depressed children and adolescents because the drugs barely work and their side effects are often significant, Australian researchers have concluded", Gardiner Harris writes.

Posted by James Zellmer at 7:47 AM

March 21, 2004

Thinking different about opening arteries

Gina Kolata writes about some different thinking with respect to opening arteries (using stents & bypass surgery) vis a vis heart attack risks:

But the new model of heart disease shows that the vast majority of heart attacks do not originate with obstructions that narrow arteries.

Instead, recent and continuing studies show that a more powerful way to prevent heart attacks in patients at high risk is to adhere rigorously to what can seem like boring old advice giving up smoking, for example, and taking drugs to get blood pressure under control, drive cholesterol levels down and prevent blood clotting.

Researchers estimate that just one of those tactics, lowering cholesterol to what guidelines suggest, can reduce the risk of heart attack by a third but is followed by only 20 percent of heart patients.

Posted by James Zellmer at 10:20 PM

Health Care Cost Saving Idea

Clayton Christensen, a Harvard professor who studies disruptive innovations recently discussed an idea to reduce health care costs for many typical patient requests:

"Christensen nailed it on the head when he said this is an industry in desperate need of disruption. In its current state, a gross amount of overhead costs prepare hospitals and doctors to treat the most complex illnesses known to mankind.

In reality, most people need a quick look and a prescription. Christensen talked about a new business model coming out of Minnesota as the perfect disruptor for medicine.

Because Minnesota allows nurses to write prescriptions, the idea would be to create medical drop-in sites that treat 14 primary illnesses. Everything from strep throat to "burn your warts off."

The flat rate for a checkup and 'scrip is $29. If it takes more than 15 minutes, it's free.

This is what you and I want, right? No long wait on the phone. No huge bills for a simple checkup. Quick and easy, in and out.

This would provide an alternate product to consumers and make going to a big ol' HMO with a sore throat an unacceptable hassle for most consumers.

Christensen is suggesting this model to the Johns Hopkins hospitals in Maryland as a way for them to build their brand, embrace a disruptive force to come and give their patients what they want.

The Baltimore medical giant is reticent, he says, which is a typical response from an existing business reluctant to embrace disruption. "

Posted by James Zellmer at 6:55 PM

March 10, 2004

VT's Bernie Sanders on US Drug Prices

"Say what you want about Bernie Sanders, but heis using the Web correctly. He has a great Web site dedicated to drug price reform. Here is a comparison between US and Canadian prices on 50 commonly used drugs. The upshot of a study his team put together is:"
... that the average prices that senior citizens in Vermont must pay are 81% higher than the average prices that Canadian consumers must pay and 112% higher than the average prices that Mexican consumers must pay.
From John Robb
Posted by James Zellmer at 7:58 AM

March 2, 2004

Health Savings Accounts

Avram Lank writes about health savings accounts (similar to IRA's), and the success a Wisconsin Bank has had promoting them.

Posted by James Zellmer at 7:39 AM

February 29, 2004

"My Telltale Heart"

The Washington Post's associate editor tells the tale of his brush with death

Posted by James Zellmer at 10:59 AM