Tag: Reader Mail


Futurist Jeff Goldsmith’s analysis of issues that could cause problems for any health reform effort that eventually emerges from the foodfight in Washington this summer provoked a wide range of reader replies.   (“No Country For Old Men“)  Goldsmith wrote in response:

“The fun part of this blog is how much you learn about an issue when you post something.  Several learning points: 1) How big a deal this is.  $1.6 trillion sounds like a lot of money, but over ten years, it’s less than 1% of the cumulative GDP over those ten years (which I grew to $16.8 trillion from its present $14t in 2019).  In other words, it’s peanuts.   Cumulative health spending over this time looks like over $40 trillion, so  even $600 billion in Medicare cuts looks like peanuts.   These are small numbers made to look big because of the ten years.  Plus ten year numbers are BS anyway because you never get a linear increase over that type of time span.  $1.6 trillion actually sounds like  Dr. Evil’s ransom demands in Austin Powers. . .”

THCB Reader Margalit offered this response to Dr. Rick Weinhaus’s open letter to former Harvard professor Dr. David Blumenthal, the man charged with masterminding the Obama administration’s ambitious health IT push (“An Open Letter to Dr. David Blumenthal“), urging the administration to rethink support for the current EMR certification process …

“Maybe Dr. Blumenthal should come up with two separate “certification” suggestions similar to the auto industry.

1) A minimal set of standard security and safety items. Nothing too fancy and complicated. Something like car emissions and inspection that products have to pass every year in order to “stay on the road”.  Once the criteria are set, the inspection and certification body should be distributed, just like the inspection centers for cars, and multiple private bodies should be able to apply for the status of “Certification Center”.

2) This should be in the form of funding a Consumer Reports like entity, that is completely and totally unbiased, for evaluating EMRs and other health care applications. The Healthcare Consumer Reports should have very strict regulations regarding who it can receive funding from. Maybe the folks at the real Consumer Reports would like to take this one on. I would be inclined to trust them more than anything else that comes to my mind right now.”

Reader Candida also chimed in on the thread on usability prompted by Weinhaus’s proposed EMR design (“The EHR TimeBar: A New Visual Interface Design“), but posed a slightly more provocative question.

“The HIT and CPOE devices out there are an ergonomic failures and that alone renders them unsafe and not efficacious. But that is not the only defect harbored in these CCHIT “cerified” devices that causes injury and death to patients. There are many that are worse and they are covered up. The magnitude of patient injury and endagerment is hidden. The fact is that these are medical devices and as such, none have been assessed for safety and efficacy. CCHIT leadership, when asked about what it does if they get a report that a “cerified” device malfunctions in the after market and results in death, stated that they do not consider after market surveillance in their domain. One can take this a step further. How is it that medical devices are being sold without FDA approval?”

Dr. Evan Dossia wrote in to challenge critics who blame rising malpractice rates on physician attitudes and – in some cases – their ties to the insurance industry, in the thread on Dr. Rahul Parikh’s post looking at how the American American Medical Association is viewed one hundred and fifty years after the organization’s founding. (“How Relevant is the American Medical Association?“),

“Physicians began to be abandoned by big name insurance companies in the mid-1970’s so instead of “going bare” we started our own companies. As we continued to have ups and downs in the malpractice insurance market, more physician oriented companies appeared. Doctors now prefer companies started by other doctors and run by other doctors because these companies fight for their share holders rather than settle with plantiffs attorneys in order to avoid court room battles.”

Fellow reader Tcoyote agreed with industry analyst Robert Laszewki’s criticism of the rumored exemption that the Obama administration may give to labor unions, exempting them from any tax on health benefits for a period of five years. (“Unions May Get a Pass on Health Benefits Tax.”)

“Of course, this is politics, and the Democrats must throw the unions, whom they are stiffing on the “Employee Free Choice Act”, some kind of bone to get health reform financed. True enough, unionized workers’ after tax income isn’t protected by collective bargaining, but if unions knew it could fall by 5-7% because of a benefits tax, they would have asked for more in wages to cover the cost. I completely agree with the Chrysler/GM analogy. Those gold plated benefits are a major reason why our manufacturing sector is in trouble …”

Sarah Greene of the Group Health Center for Health Studies had this to say in response to Weinhaus’s take on a new and more usable electronic medical record design …

“It’s curious to me that human-computer interaction does not seem to have much traction in the EHR world, and yet in the consumer-centered Personal Health Record community, it is a guiding principle. While some might wonder if this suggests that doctors are super-human compared with patients (grin), it strikes me that the EHR developers of the world could take their cues from patient-focused efforts such as Project Health Design (”

Readers respond to the primary care crisis

Two recent posts by Matthew and Bob Wachter on the crisis in primary care sparked great debates in the comment sections.

Matthew’s inference that Medicare’s bankruptcy will be fast upon us if everyone with brain cancer received an experimental surgery like Sen. Ted Kennedy recently had evoked this response from Bev. M.D.Tedkennedy

Kennedy’s case is an excellent example of why evidence-based medicine
will never translate into a "cookbook" of completely standardized
practice. As a pathologist who has looked at this nasty tumor under the
microscope too many times, glioblastoma is almost uniformly fatal
within, at most, a few years. But each patient’s tumor, and each
patient’s age and medical background, and each patient’s will to fight,
is different. Also, many medical advances are made by doctors
courageous enough to defy standard opinion who achieve good results and
then over time develop a track record to make their treatment an
accepted and evidence-based one. Therefore, one cannot apply a uniform
and permanent EBM rubric of – gonna die anyway, don’t operate – to all
glioblastoma patients for MEDICAL reasons. However, one COULD apply it
for social/political/economic reasons, and therein lies the basic
conundrum before us.

Deeper in the comments, Peter wrote:

Bev, I agree to a point, but why should there be only two people
involved in the decision – the doctor, who gets paid when he/she
operates using someone else’s money, and the patient, using someone
else’s money, and therefore has nothing to loose. If we went with this
thinking then who stops all the Mickey Mantle decisions? Is every Terri
Schiavo worth keeping on life support waiting for God to perform a
miracle? Would a Medicaid patient get to go to Duke and obtain the same
try? I know this discussion goes around in circles forever but there
must be a better way if we are going to avoid bankrupting the "system."

Continue reading…

Readers respond to Google Health launch

By Google’s recent launch of its Health Beta personalized health records provoked great commentary from THCB’s expert contributors and thoughtful comments from readers. Generally, readers acknowledge Google’s system is not flawless, they are enthusiastic something tangible finally exists.

But the privacy concerns persist.

In response to Matthew’s "Serious test drive," E-patient Dave wrote,"The privacy issue is simply huge. I don’t know why the advocates don’t get it. The lay people I talk to *all* express concern about it; some flat-out say "No WAY I’m giving them my data."

He continued,"I’d feel a lot better if all the enterprises that want to get into this great opportunity (and it is one) would work to get HIPAA updated to cover their case."

Keith Schorsch’s post on whether consumers care about Google Health also generated a lot of comments — mostly from people who shared his skepticism.

"While I agree that there certainly is and can be value in a PHR for
consumers, I think this is the right discussion. Do consumers even know
what a PHR is and that it is an option for them? I think Forrester’s
data shows that something like 75% of consumers don’t," George Van Antwerp wrote

Continue reading…

THCB Reader

The Omnimedix Institute’s JD Kleinke wrote in to comment on the thread triggered by last week’s news on the dossia project, a story that came out when Wal-Mart CEO Lee Scott revealed new details of the retail giant’s plans to work with major employers to help them cut healthcare costs in his annual January address to the company’s managers and other employees in Kansas City. Scott’s plan provoked the usual skeptical response from critics in the blogosphere and the media, but JD had this to say:    

"Omnimedix is currently in the process of resolving a legal dispute with Wal-Mart and the other Dossia corporations regarding the development and operation of the Dossia PHR system. And while this dispute has been an annoyance for us and no doubt for Wal-Mart, I’d like to make it clear that we support Wal-Mart’s overall health care ambitions, which involve not only PHRs for their own employees, but an expansion of health benefits for those employees, and the creation of a modern, affordable, accessible health care delivery system.  Think whatever you want about this oft-vilified mega-retailer; Wal-Mart has the singular ability to bring a low-cost, low-friction, high-value, high-access alternative to health care delivery in the U.S., one we have desperately needed for decades." 

Continue reading…

THCB Reader Mail (from Maggie Mahar & Jeff Goldsmith)

Frequent THCB contributor Maggie Mahar responds to Matthew’s post last week on decision aids:

"Too often, "patient satisfaction" is based on trivial things that have little or nothing to do with the quality of care. For example, a patient may have to wait two hours to a see a doctor because the doctor was called into surgery, because earlier in the day what he thought would be a routine 20 minute visit turned into an emergency. Or maybe he just spent 10 or 15 minutes longer with each of 5 patients because they had questions.

I once spent five hours listening in while the head of cardiology at a major medical center saw patients. All of these things happened except being called into surgery. One patient showed up, without an appointment, who had begun losing his vision in one eye that morning. A very bad sign. He needed immediate attention.

Another patient’s test showed that his carotid artery was totally blocked. In other words, he shouldn’t be alive. (The doctor was completely shocked). But there he was, sitting there, 85 years old, with a flock of his octogenarian relatives. It took a while to explain to all of them what was going on and why he needed immediate surgery.

Then there was the CEO scheduled for a bypass in four weeks who wanted to put it off because he wanted to wait three months until the end of the golf season. (He had already collapsed on the golf course, which was when he was diagnosed.) He also wondered why he couldn’t have the surgery at a hospital near his home in the surburbs rather than at the medical center in NYC. "It’s so hard to park here," he explained. "And it’s expensive." I wanted to stand up and scream: "You’re having open-heart surgery! Hire a car!"   

Continue reading…

THCB Reader Mail: Maggie Mahar On That Checklist Decision

Frequent THCB contributor Maggie Mahar did a little detective work on the Office of Human Research Protection’s (OHRP) mysterious decision to suspend a trial designed to reduce medical errors by requiring that hospitals follow standardized safety and infection control procedures, a story that Atul Gawande wrote about over the weekend in an op-ed piece for the New York Times.

The logic behind the ruling – namely that patients should have been required to provide their express written consent before participating in a clinical trial, even one involving hospital staff and not some radical new experimental drug or treatment – struck Maggie as slightly, shall we say, strained. Particularly for an administration which boldly ran for office on a campaign platform of vanquishing bureaucratic incompetence and embracing scientific innovation.  Maggie writes:

I read the letters that OHRP sent to Johns Hopkins and Michigan. They are dense with bureaucratic language, but make no sense whatsoever. So then I looked into OHRP and who runs it.Continue reading…

THCB Reader mail

The news that former Bush administration Health IT czar David Brailer will head a private equity fund
backed by $700 million from the California Public Employees Retirement System (CalPers) drew a  cynical response from a number
of readers.  Vijay Goel MD writes:

enough, Dr. Brailer will be getting 5 times as much to invest in Health
IT from the state of California as he did as Bush’s Health IT czar …
I’ve been somewhat puzzled why certain health IT applications haven’t
been marketed more toward consumers. Things like emailing providers,
access to electronic records (for things like vaccine records), and for
simple questions seems like it would be of significant benefit. Why do
these services also waiting for the big payers to push forward? "

Bev MD had this to say about Sermo’s recently announced partnership with the American Medical Association:

I belong to Sermo, although I don’t use it much since there are few
posts in my esoteric area, pathology. My first reaction to Sermo’s
partnership with AMA was that they’ve sold out the docs to the
Establishment. However, I admit I’m attracted by the free access to
JAMA, a journal which i’d like to read, and by the advertised ability
of the members to have access to senior AMA leadership for constructive
criticism. There has already been posted an open letter to AMA
leadership criticizing their, well, leadership. We’ll see where this

Marlon Williams chimes in Thomas Goetz’s op-ed in the New York Times
encouraging physicians to adopt VistA, the open source electronic
medical record considered by some to be the leading competitor to
proprietary systems. Safe to say he doesn’t concur with Mr. Goetz’s prescription.

"The introduction of WorldVistA was a
terrible decision," he writes, "that is only confusing the market. A lot of people
are wasting their time and efforts on a system that is as antiquated as
the first PC. The laggards are finally catching up to the fact that
transformation is necessary. Unfortunately, they are stuck on 20-year
old technology."

Continue reading…