One of my favorite topics is back in the news. Apparently ACL repairs may be unnecessary. Here’s the WSJ Health Blog write up about the NEJM study. Two groups of active young people with torn ACLs were split. Half got immediate ACL repair, half got rehab and later repair if they needed it. Of the second group around 39% needed surgery but when the two groups (surg vs surg when rehab wasn’t enough) were assessed there was no difference.
Mostly this is a big duh! A simple ACL tear doesn’t need fixing unless you are going to go skiing, play soccer, volleyball or some other sport that needs it. I had a left knee simple ACL tear in my early 30s, had it fixed after 6 months wait & rehab and went back to all those sports. (Although I never seriously tested it in a twisting sport before repair).
Then several years later I had both a right knee ACL tear and a few weeks later multiple trauma to my left knee—3 ligament tears and other damage. (Advice to you all; snowboard around the tree not into it). My left knee has never recovered (nor will it) to take part in those twisting sports so I never had the right one fixed (I did get a new ACL & PCL in left knee as I need to be able to walk again!). But the right knee with no ACL is fine for walking, running, biking and even controlled pivoting for snowboarding—where the leg is locked in place vis a vis the other one.
But if I try to twist in a gentle soccer kickabout on my right knee I fall on my ass. So for my earlier ACL repair I suspect that I would have been in the group that needed surgery anyway (the 39%). So if you don’t want to or don’t need to play those sports OR if you do the rehab and are fine, you don’t need a repair, But if you do need to play those sports and rehab alone doesn’t work, then you do.
The question is how many people are getting the ACL repair but never gave rehab a try? Probably quite a few, and for them rehab with the option of surgery is a good idea.
But the real question is how many people are getting ACL repairs when they’re not participants in those sports? Anyone know?
At the AHIP conference in Las Vegas in June 2010, Matthew Holt sat down with two leaders in Microsoft’s health plan practice: Dennis Schmuland, Director οf U.S. Health Plans Industry Solutions and Hector Rodriguez, Industry Technology Strategist for Health Plans. They talked about health plans and the consumer market, where health plans are today and the future technological development of health plans. Oh…and how Microsoft can help.
SUBTEXT: In this technology showcase from the Health 2.0 Goes to Washington conference on June 7, 2010, the participants in the Data Drives Decisions panel showcased and discussed how data collected from and by users can be used to develop powerful insights into healthcare.
Moderated by Health 2.0 co-founder Indu Subaiya, the panel featured Jamie Heywood, PatientsLikeMe, David Hale, National Library of Medicine and National Institutes of Health, Hugo Stephenson, iGuard, Mark Walinske, Boundary Medical and Daniel Palestrant, Sermo.
In this interview captured at the Health 2.0 Goes to Washington on June 10, 2010 David Hale, project manager at the National Library of Medicine and National Institutes of Health talks about his vision for the future of Health IT and their upcoming Hackathon focused on challenges related to drugs and lactation in nursing mothers.
Ever since the “build your own network” company Ning moved to a pay model for its networks, there’s been some browbeating on the blogosphere about what to do with those communities which had created traction on Ning, but didn’t have a way to pay.
For the next year at least that little problem is over. The sugar daddy here is WEGOhealth, which has positioned itself in an unusual niche—the place where people leading online patient communities can go to learn from each other. WEGOHealth is run by former Yahoo Health leader (from a few years back) Jack Barrette. Jack is a hell of a nice guy but I suspect that this deal wasn’t just about being nice. The WEGOhealth business model is about convincing advertisers that they can get in front of influential patients, and anyone running a Ning network for a health condition is likely to be (as Edelman call it) a health infoential.
So if you have a NING network that might qualify, here’s how to apply. And I suspect that Jack would appreciate it if you also paid a visit or two to WEGOhealth as well.
There has been much progress in the understanding of the biology of Alzheimer’s disease. Chemicals detected in the blood and spinal fluid of patients with Alzheimer’s and findings with new brain imaging techniques are the long sought after “biomarkers” of the disease. They are clues to its cause that are already targets for drug development. But there is a great public health danger in jumping the gun and prematurely using biomarkers in clinical practice for diagnosis or prognosis. It is for this reason that I have serious reservations about the new diagnostic guidelines proposed for the diagnosis of Alzheimer’s disease.
The current guidelines, which have served as well as possible for 26 years are based entirely on the patient’s narrative. The diagnostic label is applied when there is no better explanation for a severe and global compromise in cognition that developed insidiously. The diagnosis of Alzheimer’s when it is full blown is not a challenge. The challenge is in making the diagnosis when it is less obvious, when it is but “Possible” or “Probable.” These categories are confronted in the old criteria by considering the degree to which elements of cognition are compromised. The application of these qualified diagnostic labels provokes as much anxiety in the clinician as it does angst in the patient and foreboding in the patient’s intimate community. Maybe the fact that grandpa occasionally forgets his keys or his neighbor’s name is all there is to it; “grandpa’s losing it” or has a touch of “senility”. That would call for a supportive community, and not the specter of a slide to a dreadful fate denoted by Alzheimer’s.
I went to a patient’s funeral this past weekend. I generally don’t do that for people whose relationship I’ve built in the exam room. It’s a complex set of emotions, but invariably some family member will start telling others what a nice doctor I am and how much the person had liked me as a doctor. It’s awkward getting a eulogy (literally: good words) spoken about me at someone else’s funeral. This patient I had known prior to them becoming my patient, and his wife had been very nice to us when we first moved here from up north.
But that’s not why I am writing this. As I was sitting in the service, the thought occurred to me that a patient’s funeral would be considered by many to be a failure for a doctor. Certainly there are times when that is the case – when the doctor could have intervened and didn’t, or intervened incorrectly, causing the person to die earlier than they could have. Every doctor has some moments where regrets over missed or incorrect diagnosis take their toll. We are imperfect humans, we have bad days, and we don’t always give our patients our best. We have limits.
Over the weekend I caught up with Dan Palestrant, the CEO of Sermo–still the largest US based physician online community. Sermo opted not to raise new VC recently (unlike say Phreesia and ZocDoc) and actually reduced headcount in early 2009. Meanwhile during 2009 Daniel got his 15 minutes of fame debating the likes of Howard Dean on cable news and the site became a haven for lots of (grumpy) political talk, But while that may have captured the headlines, Sermo has done a major technology upgrade and redesigned both its user and its client interface. That re-design went live last week and Daniel spoke to me about what they did, what the discussion on the site is about (think clinical and business, less politics than last year), which clients they’re working with (think big Pharma) and how they’re doing financially and business-wise (better than you might have heard).
On June 7, 2010 senior advisor at the Office of the National Coordinator, Farzad Mosashari, gave an interview at the Health 2.0 Goes to Washington conference. These are his thoughts on the conference, meaningful use and the focus his office has on watching out for the little guy.
With the passage of HITECH in 2009, we’ve seen a series of coordinated grant programs from HHS – and if you’re not confused with all of the acronyms, you’re probably not paying attention. But never fear, in the latest of our series of FREE webinars, Health 2.0 has teamed up with the Health 2.0 Accelerator to bring you a conversation with Aaron McKethan, Program Director for the Beacon Communities Program in ONC to explain what the Beacon communities are, give some details about the types of programs and opportunities that they are providing, and to help answer all of your questions!