Tag: Michael Millenson

Medicine’s Missing Foundation for Health Care Reform

Apr 28, 2009• 15

By LAWRENCE L. WEED & LINCOLN WEED

Preface by Michael Millenson: Lawrence L. Weed published a seminal article in the Archives of Internal Medicine on using the medical record to improve patient care back in January, 1971.

To give you an idea of how glacially the health care system changes, that same issue contained an article entitled, “Universal Health Insurance is the Wave of the Future,” by New York Gov. Nelson Rockefeller, and another, “What Possible Use Can Computers Be to Medicine?” by a Duke University physician that began this way: “The physician's attitude toward computing machinery has changed greatly in the last ten years. A bright future is predicted for its application within medicine.”

In an era when the autonomy of the individual physicians was nearly unchallenged, Weed boldly asserted that “modern data acquisition and retrieval systems” could help doctors make more accurate diagnoses and provide “proper care” more effectively. Weed has continued that same fight ever since, later joined by his son, attorney Lincoln Weed. In the process he has acquired neither fame, popularity or riches — merely become legendary to a small segment of us familiar with his work.

ABSTRACT: Medical practice lacks a foundation in scientific behavior corresponding to its foundation in scientific knowledge. The missing foundation involves standards of care to govern how practitioners manage clinical information. These standards of care, roughly analogous to accounting standards for managing financial information, are essential to exploit the enormous potential of health information technology. Moreover, without these standards and corresponding information tools, evidence-based medicine in its current form is unworkable. Medical practice has failed to adopt the necessary standards and tools, because its historical development has diverged from the paths taken in the domains of science and commerce. The culture of medicine tolerates unnecessary dependence on the personal intellects of practitioners. This dependence has blocked the use of potent information tools, and isolated medicine from forces of feedback and accountability, that operate in the domains of science and commerce. If the necessary standards and tools are adopted, health care cost and quality could become an arena of continuous improvement, rather than a quagmire of intractable dilemmas.

Health 2.0 vs. Ix Therapy

Apr 26, 2009

By MICHAEL MILLENSON

I was staring at the program cover for the special joint conference between Health 2.0 and the Center for Information Therapy going on here in Boston when a sudden realization jumped out at me: both of these movements talks about the consumer, yet both are disconnected from the consumer in an important way any consumer would notice but none of us wonks have commented upon.Before we get to the basis for this flash of insight, allow me to provide some context. One of the themes of this conference is exploring where Information Therapy and Health 2.0 converge and diverge. One area of convergence is that both Information Therapy founder Don Kemper and Health 2.0’s Matthew Holt are widely recognized within the health care community as extraordinary individuals. In addition, their respective missions are aggressively “pro-consumer.” And yet, there is a disconnect.

Like Us, Personalized Medicine is More than Its Genes

Apr 20, 2009• 4

By MICHAEL MILLENSON

For those familiar with the famous Gartner Hype Cycle, the page one New York Times headline, “Genes Show Limited Value in Predicting Diseases” spawned an uncontrollable urge to mark an “x” by the spot where the
Peak of Inflated Expectations starts its plunge into the Trough of
Disillusionment.

The Times’s curtain call for DNA cure-alls reported on a critical examination by the New England Journal of Medicine
related to the strategy of comparing genomes of patients and healthy
people. So-called genomewide association studies, it turns out, have
not fulfilled their goal of discovering DNA changes responsible for
common ills. Instead, they “explain surprisingly little of the genetic
links to most diseases,” wrote the Times. “The era of personal genomic medicine may have to wait.”
Note that the Times
carefully avoided the term “personalized medicine.” Despite the
tendency of drug and diagnostic firms to lay sole claim to that label,
molecular medicine comprises just one part of the personalized medicine
triad. Sickness and health are complex, and, like us, personalized
medicine is more than its genes.

An Economics Lesson From Erectile Drugs

Apr 19, 2009• 4

By MICHAEL MILLENSON

The Wall Street Journal reported Wednesday that hospital and pharmaceutical companies have been pushing through large price increases in the first quarter of 2009 even as most businesses struggle just to
stay above water. (And later Wednesday, the CPI recorded its first
actual decrease since 1955.)

As an example of drug company tactics, the newspaper reported a recent
20.7 percent price increase by Pfizer for Viagra and a 14.2 percent
price increase by Eli Lilly for Cialis, two popular erectile
dysfunction (ED) drugs. Sadly, neither the Journal nor
the drug makers took the opportunity explain the concept of “inelastic
demand” for treatments of a condition where elasticity is the problem.
Pfizer and Lilly are betting that very few of their customers will say,
“Honey, I was in the mood for love tonight for $15, but for for
$18…let’s go see a movie.”

Of course, I shouldn’t be surprised by the lack of economic clarity
because the drug companies clearly don’t understand some basic economic
concepts. For example, a Pfizer spokesman, asked to defend the
aggressive price increases, responded that “the vast majority of our
customers receive some type of legislated or negotiated discount off
our announced list prices.” Gosh, I guess he never thought about the
fact that if you get a 10 percent discount off list price, and the list
price goes up 20 percent, the price you pay also goes up 20 percent!

Dennis Quaid Overlooks Too Much

Apr 6, 2009• 3

By Michael Millenson

Anyone who cares about patient safety has to be grateful to Dennis Quaid
for the way he and his wife Kimberly reacted to the near-death from a
medication error of their twin baby girls. Using his celebrity and his
contacts as an award-winning actor, Quaid launched a crusade to stop
similar errors from ever happening again. He has appeared on 60 minutes , testified before Congress and, Sunday, came to HIMSS to tell his story once again.

At HIMSS, Quaid was amusing (“I am not a doctor [and] I have never
played a doctor on television or in the movies”) and moving, as he
detailed how two massive heparin overdoses turned his newborn twins’
blood to the consistency of water and left them bleeding inside and
out. He was also generous and humble, repeatedly thanking the HIMSS
membership for the work they did in developing the technology that can
prevent inevitable human error from causing harm.

Those Goody Goody Canadians Not So Good

Mar 19, 2009• 12

By MICHAEL MILLENSON

C’mon admit it: you’re sick of hearing how those goody-goody Canadians provide comprehensive health care to all, while we let an estimated 22,000 Americans die each year (http://www.urban.org/publications/411588.html ) because they don’t have coverage. Or the way their cost of prescription medications is so much lower than ours that Congress finally threw up its hands and legalized the equivalent of small-scale (prescription) drug smuggling. Heck, Canadian provinces even do comparative effectiveness research without anyone calling them Nazis.

Now comes word from the Fraser Institute in Toronto that Canadians are not so goody-goody after all. The institute puts out a peer-reviewed and risk-adjusted report card comparing hospitals in Ontario, the nation’s largest province. Last year, the first for the report, just 43 of 136 acute-care hospitals agreed to participate. This year, though, the number of participants plunged 60 percent, to just 17 hospitals, according to a story in Healthcare IT News.

Commentology

Feb 24, 2009• 1

Michael Millenson had this response to a commenter in the thread on his recent post looking at web sites that offer the public data about provider performance. (' Just OK Quality or the Best? ')

"Why does HealthGrades get so many more visitors than HospitalCompare? I think you're correct that it's because of promotion, but the context is the magnitude. HealthGrades constantly promotes, via Google-sense ads, via press releases to the trade and mainstream media, via the ads taken out by hospitals touting their ratings and via search engine maximization. And they've done this for many years, acting as if their economic future depends on it (which it does). The government promotes its site kind of the way you see those "stop smoking" public service announcements.

An Open Response To HHS Secretary Mike Leavitt – Brian Klepper and Michael Millenson

Apr 22, 2008• 1

By Brian Klepper and Michael Millenson

A few months ago, the two of us – both long-time advocates for
transparency and accountability – posted separate comments on Secretary
Mike Leavitt’s blog. Brian asked Secretary Leavitt to square his
support of "Chartered Value Exchanges” with the attempt to block
release of physician-specific Medicare claims data to Consumers’
Checkbook, which wants to rate doctors. After a court ruled that the
data should be provided to the group, HHS appealed. Michael urged the
secretary to go beyond supporting Consumers’ Checkbook and use his
“bully pulpit” to promote sophisticated data analysis that could be
used to create national quality comparisons.
Secretary Leavitt graciously asked us to consider and comment on the
department’s proposed "Medicare trigger legislation" calling for the
release of physician performance measures. We are delighted to continue
the conversation.

First, let’s give credit where credit is due. We agree that the proposed legislation is a major step in the right direction.

Health Care’s Cold Truth: An Iowa Perspective – Michael Millenson

Jan 4, 2008• 13

Obama_web I am writing this blog from Cedar Rapids, Iowa, grateful that the
temperature has warmed from brutally
cold to pleasantly sub-freezing.
Fortunately, the warm feelings left by the extraordinary victory of
Sen. Barack Obama, the candidate for whom I was knocking on doors and
making phone calls these last few days, has trumped the temperatures.

Talking to real voters in the suburbs and rural areas surrounding this
small city provides a nice change from the insular health care policy
world. For one thing, it reminds you that most people don’t care about
“policy,” per se, of any kind. Successful candidates connect first with
the heart and then the head. We instinctively believe that if we trust
a candidate’s values and broad beliefs, we will trust that candidate’s
detailed policy decisions.

Yet the sad reality is that a vast number of citizens won’t even make
that small emotional investment, and they don’t hesitate to proclaim
their apathy when you knock on the door or call. As much as you may
have heard about voters disenfranchised from the Iowa caucuses,
many more simply didn’t care enough to participate. That, alas, makes
Iowa quite representative of the nation as a whole. While Democratic
turnout at this year’s caucuses was double that of four years ago, that
merely turned a “tiny” slice of registered voters into a “small” one.

Fire Burns Away the Fog of Ideology: Can Humane Health Care Reform Rise from the Ashes? – Michael Millenson

Oct 24, 2007• 13

THCB welcomes back our solid pal, the erudite Michael Millenson, for whom the sun doesn’t shine if there’s no wisecrack in the wings. Now leading a consulting firm specializing in health care quality projects, Michael is a former Chicago Trib reporter with 3 Pulitzer nominations to his credit. Michael’s groundbreaking 1997 book Demanding Medical Excellence was one of the first to call attention to the problems addressed by the Quality and Safety movements. Enjoy.

As wildfires sweep Southern California, I have been surprised that homeowners in some of the most affluent and staunchly Republican enclaves in the state have not protested the widespread deployment of government workers bearing fire hoses and driving ambulances. The pain of watching one’s life possessions burn to a crisp must almost be matched by the pain of watching tax dollars wasted on a task that private, for-profit firefighters could surely perform more cheaply and more effectively. Yet not even the richest of the fire-torn refugees has expressed regret over government intervention in their rescue.