Tag: Uncategorized

Stay young, keep your brain fit

Oct 23, 2008• 3

By Alvaro Fernandez Alvao

A spate of recent global news coverage on cognitive fitness and "brain training" reflects
a growing interest in innovative interventions to keep our brains sharp as we age. This interest is very timely, given an aging population, the increasing prevalence of Alzheimer’s, and the growing body of research linking a number of clinical conditions with specific cognitive deficits.

US brain fitness market: significant and growing

We estimate the size of the US brain fitness market was $225m in 2007 – more than double what it was in 2005. Consumers were responsible for most of the growth from 2005 to 2007, followed by health care and insurance providers. We estimate that the consumer segment grew from a few million in 2005 to $80m in 2007, and the health care/ insurance one from $35m to $65m, and foresee continued growth in both.

Health 2.0 Liveblog: Consumer Information Aggregators

Oct 22, 2008• 4

By Craig Stoltz

Five companies that are leaders in making consumer data, including personal health records, available.

Web MD: Just did a deal with Wal-Mart, making WebMD
personal health records and tools available to employees. Proof that
health technology adoption is moving “from the salaried workers to the
hourly workers.”

Comment: Includes a PHR for members to use.

HealthVault, Microsoft: Now has developed 90-plus
partners making products for the platform. Seeking to make it easier
for doctors and patients to share information. HealthVault launch is
part of a “long journey” in integrating information for consumers and
with healthcare system. Have created an “industry” around making these
connections happen. New partnership with Kaiser, integrating its own
PHR service with the HV platform. Process to copy Kaiser health record
to HealthVault is multi-step and multi-click box/policy agreement
process–not a smooth demo. Multiple sign-outs and sign-ins.

Comments: The demo failed–yikes. The conference gives him a “do-over”. . .and that fails too. Dude: Smooth it or lose it.

Health 2.0 Liveblog: Clay Shirky

Oct 22, 2008

By Craig Stoltz

Author of “Here Comes Everybody,” NYU Interactive technology/culture prof: Health
2.0 keynote address.

“More is Different”: As groups aggregate, they create not just more
knowledge, but a different, more valuable kind of knowledge….this
affects healthcare innovation in three ways:

Information: Most valuable aspect of the Internet: “people.” Those who think about health information think of individual transactions–but the value is when people share this information.
Yahoo Groups, “the first social software,” illustrates tremendous
public demand for collaboration with others. “Wherever people trust
each other, the information will flow.”

Health 2.0, LLC, Launches Health 2.0 Advisors

Oct 22, 2008• 5

Health 2.0 Advisors is an advisory service formed by four Health 2.0 thought leaders:
Matthew Holt, Brian Klepper, Michael L. Millenson, and Jane Sarasohn-Kahn.

The new service, in close collaboration with Edelman, will integrate data from Edelman’s Health Trust Barometer in its reports to helps clients unlock value of Health 2.0.

Health 2.0 Advisors will offer a package of state-of-the-industry reports, on-site strategic workshops, and advisory services, with a focus on building value for clients. To learn more read the Press Release.

Ethics of the genetic testing marketplace

Oct 22, 2008• 3

By Hsien-Hsien Lei

Dna

Fresh on the heels of the launch of the deCODE BreastCancer genetic test last week, Dr. Arthur Caplan, renowned director of the University of Pennsylvania Center for Bioethics, said in an article for MSNBC.com that breast cancer gene tests are not worth the price.

If you are worried about your risk of getting the disease, or are thinking about getting a genetic test done for any other reason, talk with your doctor or a genetic counselor who can determine whether your family history justifies the expense. You may be surprised to find that you can make changes in lifestyle and monitoring your own health that can reduce your risk without testing.

Dr. Caplan even goes so far as to accuse genetic testing companies of corporate greed which, given the current economic environment in the U.S., is bound to send shivers down their spine.

With respect to deCODE’s breast cancer genetic test, it examines seven single nucleotide polymorphisms* (SNPs) that are purportedly involved in 60 percent of all breast cancers. Results from the test are given as personal lifetime relatively risk compared to the general population (specifically people of European descent). Other risk factors such as family history, pregnancy history, etc. are not taken into consideration when calculating a deCODE BreastCancer genetic test taker’s risk.

deCODE’s Chief Scientific Officer, Dr. Jeff Gulcher, responded to Dr. Caplan on its blog, deCODE You (a member of the DNA Network) and drew analogies between the BreastCancer genetic test and LDL-cholesterol tests. Anyone who is identified to be at higher risk of breast cancer (or in the analogy, high cholesterol leading to cardiovascular disease) would benefit from greater vigilance, more intensive screening, and possibly, preventive therapy.

Another DNA Network member, Dr. Steve Murphy at Gene Sherpas calls the deCODE BreastCancer test “hype.” Cancer Research UK also believes that “it’s too early for a test of this kind to be released to the general public.” Dr. Len Lichtenfeld of the American Cancer Society does not believe the test will “advance our cause in the fight to reduce deaths from cancer in a meaningful, evidence-based and scientifically accurate way.”

Speaking of cost, though,it seems that 23andMe customers get the better deal because six of the seven SNPs (rs4415084 was on the v1 chip but not on the v2 chip) examined in the deCODE BreastCancer genetic test are included on version 2 of the 23andMe gene chip (I checked using SNPedia) not to mention the other nearly 600,000 SNPs included in the 23andMe report. A 23andMe DNA test costs $399 while a deCODE BreastCancer genetic test costs $1,625.

deCODE’s test offers other bits and fancy algorithms for calculating risk to justify the price. But customers should be aware that there is more than one way to get the genetic data they desire. And that data’s worth can be hard to price.

*See the list of SNPs in this sample report (pdf).

Hsien-Hsien Lei (pron. shen-shen lay) is a PhD-trained epidemiologist and biotech consultant. She blogs regularly at Eye on DNA, where this post first appeared. She is a consultant to DNA Direct, a genetic testing company.

Ready or not, it’s time for Health 2.0!

Oct 21, 2008• 2

By Matthew Holt

Tonight the party starts, the beautiful (and not so beautiful) people gather, and the shows under way—and that’s just the Health 2.0 team! There’s also 900 + speakers, guests, media, volunteers and the community is buzzing. Wall Street may be going crazy, the election may be a cakewalk (or not) but in health care interest in combining user-generated content with personalization based on data is growing. Last year around 500 people got together to find out what Health 2.0 was. Really, we only had about 35 decent options from which to choose our eventual 25 demo panelists (and one or two of those were a little of a stretch).

This year we’ll hit about 1,000 in attendance, and Indu & I have chosen from over 250 possible presenters. Attendees will see about 100 of them. Jen McCabe Gorman, Ranger extraordinaire, has sat through 3.2 million demos—making sure that the presenters get it right. And our phalanx of moderators, advisors and presenters have also been burning the midnight oil.

Meanwhile John Pluenneke & Jamie Cao are corralling sponsors & exhibitors, Robin Smiley is about to issue 900 badges, graphics whizzes Patrick Wang & Lauren Golik are putting the final touches to a huge presentation, and head wrangler Joi Hawkins is smiling serenely through the chaos she’s been managing since Sara Walker retired into her confinement. Perry Hallinan is managing the production schedule while making a video on the side, Blake Robin is creating the best soundtrack of any conference you’ll ever hear, and behind the scenes, the staff at Scribe Media, the Marriott and McCune AV are (and will be) working their tails off. Not to mention the 60 volunteers coming to help!

Given that Indu & I thought we’d have a little conversational meeting with 50 people when we started this less than 2 years ago, I’m still amazed every day! Thanks to everyone for their incredible hard work (and of course my love and thanks to Amanda for putting up with me and the hordes of people in her house!)

And yes, there are still a few overflow only tickets left for those true procrastinators! Details about this and much more are on the Health 2.0 Site

An Impending Hanging: Will Health 2.0 Be Compromised By The Economic Downturn?

Oct 21, 2008• 3

By Brian Klepper

Nothing focuses the mind like an impending hanging. — Samuel Johnson

I’ve been preparing for tomorrow’s 3rd Health 2.0 conference in San Francisco, where I’ll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who’s-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.

The meeting is sold out at 950 participants. It’s worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he’d be surprised if 75 people showed up. There were almost 500, many of them with genuine influence.

Overregulating patient safey

Oct 21, 2008• 3

Robert_wachter
By Bob Wachter

In responding to dysfunctional systems, America instinctively turns to “more regulation” (Exhibit A: today’s Wall Street). But regulation can, and often does, go too far, and – in patient safety – I believe that it now has.

Note that this comes from someone who believes that health care was under-regulated
until recently, not a popular viewpoint (just more mavericky behavior,
I guess). But you must admit that it was rather odd that until 5 years
ago, I was more likely to have my order read back when I called my
Chinese takeout restaurant than when I called my hospital ward with a
complex medication order. (Parenthetically, the reason for this
disconnect is that my takeout restaurant has a more powerful business
case to avoid screw-ups – they lose a customer – than does my
hospital). So now there is a Joint Commission requirement to perform
“read-backs” of important verbal communications. And it’s hard to
question the need for regulation when a prescription that said, “Inject
10U Insulin,” could be followed without question, despite the fact that
such orders have been mistaken for “100 Insulin” thousands of times,
leading to scores of patient deaths.

I reviewed the first 5 years of the patient safety field a few years ago. In an article in Health Affairs,
I opined that increased regulatory/accreditation pressure had been the
most potent force for change in the first years of the safety
revolution:

Because physicians remain highly
individualistic (which causes them to resist regulatory solutions and
standardization), and hospitals continue to lack a robust set of
incentives to drive patient safety, regulatory solutions have arguably
been the most important early step, particularly when it comes to
procedural safety (creating safe systems, standardization, and
redundancies) in hospitals.

Researchers question publishing ethics of leading economics journal

Oct 21, 2008• 1

By Sarah Arnquist

Update: The Harvard Health Policy Review site is back up with an apology and disclaimer for not seeking a response from the JHE editors.

A Harvard Health Policy Review article that details two researchers’ account of unethical editing at the Journal of Health Economics (JHE) mysteriously has gone missing from the Internet (but not entirely–here’s the PDF). Actually, the journal’s entire site has been taken down.

The article is full of drama that rivals a John Grisham thriller. It involves the Ivy League, corporate greed, a suggestion of tainted science, and legal threats — which I’m guessing may not be over.

In the "missing" article, University of Pennsylvania sociologist Donald Light and health economist Rebecca N. Warburton, of Canada’s University of Victoria, recount their two-year ordeal to publish a critique of a 2003 study published in JHE, in which Tufts researchers — using confidential data supplied by drug companies — estimated research and development costs for a new drug at $802 million.

Light and Warburton had several criticisms of this article, namely the undisclosed conflicts of interest of the Tufts authors. But they say the JHE editors thwarted their efforts to publish a fair critique.

The "missing" article details the back and forth between the JHE editors (three of whom are Harvard professors) and the original authors. Light and Warburton called it "ultimatum editing," and said the editors "violated almost every ethical standard set for editors."

At one point in the process, Light and Warburton even threatened to sue. Alan Millstein agreed to make a legal case on behalf of the authors and drafted a complaint. “He did not expect much in monetary damages, but expected to win before a jury, revealing to the world how leading economists handled an independent critique of a key article concerning the high costs of drug development form an industry-sponsored research center.”

Merrill Goozner wrote about the conflict in his post, "Where’s Harvard’s Missing Health Policy Journal?" PharmaGossip also writes about the missing journal here.

You can lead a horse to evidenced-based medicine but …

Oct 20, 2008• 7

By Merrill Goozner

Note: This post first appeared at Goozner’s blog, Gooznews.

A new important and depressing study appeared last week in the Journal of the American Medical Association. Researchers who poured over Medicare records found that
less than half of seniors (44.5 percent) with stable coronary artery
disease who complained of symptoms like angina were whisked off to the
catherization lab for percutaneous coronary interventions (PCI) like
balloon angioplasty and stenting without first confirming by a stress
test that they were indeed suffering from reduced blood flow to the
heart (ischemia). Guidelines published by American College of
Cardiology, the American Heart Association and, significantly, the
Society for Cardiology Angiography and Intervention call for the tests.

Previous studies among the commercially-insured population are even
worse. Only a third of patients in the under-65 crowd with stable heart
disease but having symptoms are likely to have gotten a stress test
before getting PCI.

Why is this important? Let us count the ways:

* PCIs have increased 300 percent over the past decade and
accounted for at least 10 percent of the increase in Medicare spending
since the mid-1990s.

* Medicare spends $10,000 to $15,000 per PCI.

* While PCI may reduce ischemia and angina more effectively than
drugs, more than a half dozen studies conducted over the past decade
have established that in terms of reducing deaths or heart attacks, PCI
is no better than drugs alone.

* Patients who fail a stress test and then get PCI do better and have shorter hospital stays; and

* Patients who get PCI with minimal symptoms, with or without the
stress test, are at increased risk of repeat procedures and may
experience a deterioration in their overall quality of life going
forward.