Author Archives

Matthew Holt

Confessions of a Cultural Anthropologist: The Cause and Cure of High Health Costs

Jan 13, 2009• 15

By RICHARD REECE

Today’s medical students are being inducted into a culture in which their profession is seen increasingly in financial terms. Add in such pressures as the need to pay off enormous debts, and it is not surprising that students’ choices are dictated by the desire to maximize income and minimize work time.

Pamela Hartzband, MD, and Jerome Goodman, MD
“Money and the Changing Culture of Medicine”
New England Journal of Medicine, 1/08/09

I have a confession to make. I think the cause of high American health costs is straightforward, but it is not simple. It is American culture in general and the physician culture in particular. There is nothing wrong with this, and I point no fingers.

The Way We Are
It is our culture. It is the way we are, the way we’ve been for 232 years. It is our distrust of government and high taxes. It is our want to be free to choose. It is our belief in for equality of opportunity for access to the latest and best of care.

It is the notion, stemming from frontier days and conquering of the West, that action speaks louder than words, that if you do something specifically, it is better than doing nothing generically. “Don’t do nothing, do something,” as the saying goes.Continue reading…

The anti-Dimitriy!

Jan 13, 2009• 15

By Matthew Holt

Certain people have accused Health 2.0 of being a bubble. Others of us have responded that it’s not. I don’t think either side in that argument has claimed that health care needs a bubble. But Forbes columnist Sramana Mitra thinks that a tech bubble in health care would be a great thing. In particular it would produce many more AthenaHealths and PatientsLikeMes

Certainly a provocative read!

New NRC Report Finds “Health Care IT Chasm,” Seeks New Course Toward Quality Improvement and Cost Savings

Jan 12, 2009• 20

By DAVID C. KIBBE

Like the Institute of Medicine’s (IOM) 2001 counterpart report, “Crossing the Quality Chasm,” a new report from the National Research Council of the National Academies is complex, full of new ideas assembled from multiple disciplines, and is likely to have seminal importance in framing public policy from now on. “Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions” was released last Friday, January 9, 2009 in draft, but there is so much to comment on that I think it’s wise to begin with a quote from the committee that sums up the central conclusion:

In short, the nation faces a health care IT chasm that is analogous to the quality chasm highlighted by the IOM over the past decade. In the quality domain, various improvement efforts have failed to improve health care outcomes, and sometimes even done more harm than good. Similarly, based on an examination of the multiple sources of evidence described above and viewing them through the lens of the committee’s judgment, the committee believes that the nation faces the same risk with health care IT—that current efforts aimed at the nationwide deployment of health care IT will not be sufficient to achieve the vision of 21st century health care, and may even set back the cause if these efforts continue wholly without change from their present course. Success in this regard will require greater emphasis on the goal of improving health care by providing cognitive support for health care providers and even for patients and family caregivers on the part of computer science and health/biomedical informatics researchers. Vendors, health care organizations, and government, too, will also have to pay greater attention to cognitive support. This point is the central conclusion articulated in this report. (emphasis added)

It would be difficult to find a more sober indictment of US health care IT policy and implementation over the past decade than what is contained here.

Commentology

Jan 12, 2009• 1

Dr. Rodney Hornblake of Boston wrote us an email wondering if the Obama administration’s much- ballyhooed plans for Health IT investment may actually be slowing technology investment over the short term.

"My partners and I have put on hold our planned implementation of e Clinical Works. Scheduled for February the project is now on hold. The reason? Obama’s emphasis on healthcare IT as an “economic stimulus”. If we invest now we are likely to miss tax credits or other incentives."

Michael Millenson had this to say in response to David Kibbe’s posting this morning on last Friday’s Health IT report from the National Research Council of the National Academies.

"The tunnel vision of the IT community is unintentionally shown by the comparison of the IT gap to the "quality chasm." That demonstrates a fundamental misunderstanding. The quality chasm is a gap between the care we have and the care we should have. Health IT, by contrast, is a critical tool in closing that gap — but it is only that, a tool. Just like telephones or, for that matter, file folders."

Rick was among the readers who commented on Dr. Val’s posting on Sanjay Gupta’s potential nomnination as Surgeon General …

"Dr. Gupta, while serving as a war correspondent for CNN in Iraq,
performed five emergency brain surgeries in the field. I don’t know if
that counts for military experience, but anyone at the Pentagon who
overlooks it ought to be reminded — though I expect Dr. Gupta would be
too polite to do so.

Frankly, it sounds like Dr. Jones’ anonymous source has a case of
the sour grapes, resentful at getting passed over by someone with more
star power, or at least, is close to people who are."

Meanwhile, skeptic writes:

"The director of public health for Los Angeles County (Jonathan Fielding
MD) or his New York City counterpart would be far better candidates for
Surgeon General. Both have experience running large organizations and
noteworthy accomplishments, along with excellent PR skills."

Free Trade and Free Antibiotics

Jan 12, 2009• 3

By MICHAEL MILLENSON

The next time you visit your doctor with a case of the sniffles, he may want to inquire about your position on the North American Free Trade Agreement before deciding whether to reach for his prescription pad.

A recent article by the Charlemagne columnist of The Economist points out a strong correlation among those European nations whose populations believe that globalization offers an opportunity for economic growth and the data on consumption of antibiotics. The article notes:

Rather like trade protection, the popping of an antibiotic offers false comfort to individuals. In an anonymous 2008 survey, Greek pediatricians said that 85 percent of patients demanded antibiotics for children with the common cold virus. As with political debates over free trade, some people appear to suffer from a corrosive lack of trust when the authorities tell them that they are demanding the wrong thing. Even when told that antibiotics cannot fight viruses, 65 percent of Greek parents in the survey insisted they did until their doctors gave in.

Meet the New (Acting) Boss, Same as the Old Boss

Jan 12, 2009• 4

It didn’t make a Wall Street Journal story on changes at the Department of Health and Human Services , and a brief mention in a pharmaceutical industry blog was a bit vague , but THCB has confirmed that the Agency for Healthcare Research and Quality now has an acting director who will be in charge after Jan. 20: it’s Carolyn Clancy, the current full-time director.

As the Journal reported, the outgoing Bush administration has named acting heads to lead a number of HHS agencies until the Obama administration can pick permanent new leaders. As part of that process, replacements have been named for some current chiefs who clearly won’t be staying on (e.g., Julie Gerberding, head of the Centers for Disease Control and Prevention). At the Centers for Medicare & Medicaid Services, it will be a case of a new Acting Administrator replacing an old Acting Administrator, since Kerry Weems, the Acting Administrator since September, 2007, was never given a permanent appointment subject to Senate approval.

Eric Novack has a few questions….

Jan 12, 2009• 13

By Eric Novack

1. In California, where the SEIU is attempting to forcefully merge with the United Healthcare Workers, I can’t seem to find the focus on, you know, health care. “What it does is allows them to have the strongest voice possible in Sacramento,” said Mary Kay Henry, SEIU executive vice president.

2. Should the new administration be looking at Massachusetts as model to follow for health reform, or as a model of what must, at all costs (and they are extremely high), be avoided?3. How can we reconcile the fact that on Thursday the President-elect spoke about the importance of spending more on healthcare while on Sunday explaining that he intends to recommend spending less?4. In 2005, the association health plan bill (aka small business health plan) was killed, in large part, because advocates for specific disease conditions believed that state mandates and state lobbying efforts would be hampered if more people were covered under ERISA (i.e. national mandates—which are much harder to pass)— how will the administration propose to address this issue of state mandates in sweeping health care reform? 5. If health and health care are ultimately the most personal part of our lives, is it possible that more nationalization of health care will result in a greater role of lobbying bureaucrats and elected officials to seek and obtain care?6. How much would Medicare taxes be, and Part B and D premiums be, if the system actually needed to be self supporting, and the government had to keep adequate financial reserves like private insurers?

The Year in Research according to RWJF

Jan 12, 2009

By Matthew Holt

A while back we suggested that people went to look at RWJF’s Pioneering blog to rate its posts for the year and see what they liked. Well it appears that RWJF fans like articles about obesity and Massachusetts (and not much else). It’s all in the new post 2008: The Year in Research.

Welcome To Health Wonk Review – 1/09/09

Jan 9, 2009• 14

By BRIAN KLEPPER

Well, here we are at the beginning of 2009. On TV we’ve learned that the unlimited spending and brilliant, if socially pathological, heroics of Dr. Gregory House, unfailingly saves his patients from unknowable complexity and the abyss of death.

Meanwhile, the rest of health care, aided largely by really excellent lobbying, continues to be buoyed, defying the relentlessly corrosive gravitational pull of waste, corruption, and a tanking economy.

Still, health care’s troops are beginning to feel, in Tom Lehrer’s words, like a Christian Scientist with an appendicitis. Things definitely are not going well, and this longstanding run of great good fortune could be on the downswing. Is it possible that exorbitant pricing and massive waste are NOT entitlements!

Which brings us to the far-ranging insights, jabs, diatribes, rants and enthusiasms of this edition of Health Wonk Review, which features analysis and exegesis as entertainment.

Should the FDA relax in the search for new cures?

Jan 9, 2009• 1

By Matthew Holt

Over at DiabetesMine #1 health blogger Amy Tenderich has very important post. She and several fellow travelers are appealing to the FDA to strike a balance between safety and progress in allowing new diabetes treatments.

The FDA of course has been beaten to a pulp these last few years because it’s played footsie with the drug industry and ignored several potentially damning studies, with the result that the number of drugs withdrawn from the market has been much higher than in previous years.(Vioxx, Phen-Fen, Baycol, et al).

I’ve always felt that the FDA’s role should not to be a black/white (dangerous/safe) stamp of approval, but instead it should be the honest broker of getting all the data out there. As Amy and her crew point out, some diabetics may be prepared to take a risk of higher long-term cardiac complications in return for a medium term gain from a new medication. Something similar is certainly true in terms of hormone replacement therapy.