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PHYSICIANS/HEALTH2.0: Sermo AMA interview

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This is the transcript of my interview last month with Sermo’s Daniel Palestrant on the announcement of the deal between Sermo and the AMA

Matthew Holt:  This is Matthew Holt with The Health Care Blog and a quick impromptu podcast today, because I have on the line with me Daniel Palestrant. Daniel’s the CEO of Sermo, and we’ve had Daniel on the blog before a couple of times. Those of you reading the blog know that Sermo is one of the leading online physician communities, and Daniel of course will be at the Health 2.0 Conference coming up in September. Daniel, how are you today? And after you’re done with that, you have some interesting news. So tell us.

Daniel Palestrant:  That’s right, Matthew. Thank you for having me. I really always appreciate the opportunity to speak with you and the many readers of the Health Care Blog. As you mentioned, we’re very much looking forward to the conference later in the year; it sounds like it’s going to be quite a show. As far as the news that we’re talking about on this particular interview, it’s a strategic announcement being announced between Sermo and the American Medical Association.

Matthew:  So tell us a little bit about what that’s going to mean for Sermo, for the AMA, and for the future of doctors in communities online.

Daniel:  Well, this is a relationship that’s actually been in the works for several months now; I’d almost say going on a year. There’s many different ways to look at the relationship. Sermo, of course, is the largest online physician community. Now, with almost 16,000 physicians, growing at anywhere between 500 and 1000 physicians a week. The AMA, as I’m sure most of your readers know, is the premier physician advocacy organization in this country. Indeed, it probably has the exclusive franchise as being the voice to represent all physicians in the United States. So, as Sermo gained more and more momentum, it became more and more logical for us to look to have some sort of a partnership with the American Medical Association. Indeed, it was the members of the Sermo community who started putting more and more clarity around what that relationship would look like.

So it is multi-faceted, but to touch on some of the key points, I’d say first off that this is a powerful way for the American Medical Association to tap into the voice of Sermo. If you think about it, there’s an interesting dynamic: You have the American Medical Association, which is among the oldest of the associations in this country, well over 150 years old and the essence of establishment institutions. Then you have Sermo, which is this grassroots – what some people might describe as Web 2.0 – phenomenon. Physicians in all walks of life and all phases of their career coming together and having a voice. So what Sermo does very effectively is create a place for those people to come together and for those voices to be heard – and then, within the unique Sermo architecture, for specific messages to come out. What the AMA does very well is to advocate for the messages of the physicians. That was the first cornerstone of this relationship: Sermo being a mechanism of allowing physicians to have their voices heard, and the AMA being an organization that’s uniquely suited to act on that voice.The second aspect of the relationship is a new paradigm in information and publishing. As many people might know, the American Medical Association is a publisher of several of the top medical journals, including the "Journal of the American Medical Association," or "JAMA." And then the "Archive" series, including the "Archives of General Medicine" and the "Archives of Surgery." Through the Sermo relationship, for the first time ever, Sermo members will be able to gain free full-text access of those journal articles, both current and archived versions, through Sermo. This will be free of charge; it will be part of being a Sermo member.The hope is that this will herald a new era in physicians’ being able to contribute to the academic literature and being able to comment in real time on the academic literature.The third component of the relationship is what you might call a co-development, where Sermo and the American Medical Association will be endeavoring to develop certain technologies for facilitating group discussion and group communication among AMA groups and AMA subgroups.

Continue reading…

PHARMA/POLICY: Crackpots at Hoover

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The NY Times gives an op-ed to a crackpot called Henry Miller who used to be a minor official at FDA and is now with the other loonies at Hoover. It’s called Crackpot Legislation in which he goes after those states allowing smoked medical marijuana as medicine. In this op-ed he apparently with a straight face can say this:

When presented with a cannabinoid development program that comports with modern scientific principles, both the F.D.A. and the D.E.A. have demonstrated their willingness to allow it to proceed.

This is complete and utter bullshit. The FDA has with the rest of the US government (including the crackheads at NIDA) in preventing the use of marijuana in clinical trials and medical testing for decades, despite the IOM study. Here’s a statement from a DEA judge (!) on the topic in March.

"NIDA’s system for evaluating requests for marijuana for research has resulted in some researchers who hold DEA registrations and requisite approval from the Dept. of Health and Human Services being unable to conduct their research because NIDA has refused to provide them with marijuana"

Two tiny smoked marijuana studies (including the Abrams one he cites) have been finally allowed after decades of pressure from academics, and now Sativex is being allowed into clinical trials because a) it has a pharmaceutical company behind it which is going to make money off it, and b) because the Brits and Canadians have already allowed it on the market. That action, after thirty years of preventing research into the medical usefulness of marijuana for purely political reasons, does not suggest anything like what Miller calls “willingness.”

Miller thinks that the FDA should be allowed to regulate marijuana. But of course the US government already does regulate marijuana. It’s been a schedule 1 drug, banned since 1937 by Congress incidentally against the then wishes of the AMA with no debate. So what is the FDA’s likely vote on the matter now? To continue the ban of course. Which is why medical marijuana proponents are opposing the amendment to allow the FDA to regulate them, as it’s a back door way of outlawing the progress made at the state level.

The NY Times should be asking itself why it’s allowing such a bunch of half-truths to be published when somewhere between 60 and 80% of Americans are in favor of legalizing medical marijuana, and it’s abundantly clear to anyone that the reasons for the continued ban is the politically and economically-inspired persecution of people who want to use marijuana—whether for medicine or pleasure.

And if Miller really thinks that the current drug-policy powers that be will allow Sativex to get past the FDA and be openly sold in the US, then he really is a crackpot.

HEALTH PLANS/POLICY: Quinn rips Weintraub

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Dan Weintraub who’s an interesting (and rare) right-wing journalist working in health care wrote a pretty dumb opinion piece in the Sacramento Bee last week saying that regulating health insurers was the wrong idea and wouldn’t work—because of course most of the money they get in goes out the door to the health care system—so it’s the wrong place to look. In the specific instance of rate regulation only, he may be somewhat right—but of course there’s a whole lot of regulation of insurers that could make a huge difference to that underlying health care system.

I was going to rip him a new one, but THCB regular Matt Quinn did it for me and the Bee printed his letter on it on Sunday.

"Regulating insurers won’t cut health costs," June 10: Daniel Weintraub correctly argues that current proposals to regulate health plan profitability will not materially impact overall health care costs. Imposing rules mandating spending on medical care or requiring permission to raise rates could perversely impact the quality and affordability of care. However, he misses a couple of key ways that regulators could impact the affordability and access challenges plaguing health coverage.

Mandating both guaranteed issue (requiring insurers to cover all comers) and community rating (prohibiting insurers from factoring in age, sex, previous medical conditions, or other factors in setting rates) sets a level playing field for insurers to compete on delivering value to their customers. Guaranteed issue and community rating require each other and are both necessary for reform efforts to work. Since the managed care backlash in the 1990s, insurers have largely given up on holding down health care costs and today compete primarily on underwriting — skimming healthy people and shedding sick or otherwise unprofitable ones. Some have even been caught underwriting retroactively or canceling coverage for members who incur medical bills. Mandating both guaranteed issue and community rating forces insurers to compete on their ability to deliver quality, cost-effective care for a population — and not on their skill in underwriting.

Although Matt misses one extra thing need to make guaranteed issue and community rating work—compulsory participation in the system by all (universal coverage) and cross-subsidization to those who can’t afford to buy in from the wealthier taxpayers. The good news is that the Democrats running Arnie’s reform efforts know about that.

Health 2.0: Priming the pump- Jump starting health care consumerism By Scott Shreeve MD

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Scott Shreeve co-founded MedSphere, the Southern Californian open source distributor of the VistA EHR. His latest effort is Crossover Healthcare. Scott has been tracking recent developments in the consumer driven health plan sector. Today he shares his take on a series of reports that suggest the CDHP movement may be faltering. The following piece was originally published on his blog, which can be found here.   

Jumpstart (jŭmp stärt) v.

1. Starting an automobile engine that has a weak battery by means of jumper cables 2. Start or re-start in a vigorous manner3. Start something by tapping into another source of power

A recent report by the Wall Street Journal casts some concern over the vitality and validity of the entire consumer driven health movement. The critique provides some hard numbers regarding the actual uptake in numbers which is significantly less than some other reports indicate. Worse still, a recent report by Towers Perrin indicated that many people with HDHP plans are dissatisfied with their consumer experience to date.

Continue reading…

HEALTH2.0/CONSUMERS/TECH: Patient groups online are a source and a force

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We know that patients have been organizing online and Laura Landro (who’s been there herself) confirms it in a fascinating article. Go read it. Of course this is making some people nervous.

Of course, the rush to link communities and researchers and the move by patient groups to conduct their own research raises some thorny new issues. While the nonprofit, patient-run online groups have no financial interest in research or recruiting for trials, some for-profit health Web sites see their online communities as a way to make money. Such sites, supported by drug-company advertising, may seek to recruit patients for drug-company clinical trials, often without going through physicians who may advise patients about the pros and cons of such trials. Also, the research organized by online patient communities makes some scientists nervous because such efforts don’t use the gold standard of randomized controlled clinical trials.

So you might argue that the for-profit status of Yahoo or DailyStrength raise that thorny issue. But of course the non-profit groups are starting to use for-profit start-ups like Clinicahealth and Solos to supply their online services. And the mix between patient groups, disease groups and big Pharma continues to be a matter of controversy. Meanwhile there’s plenty of evidence that clinical trials per se are not that helpful, and all the data generated online will be very important no matter what the nervous scientists think.

We are on the cusp of a big change here, and everyone’s roles are changing in uncertain ways.

POLICY/HEALTH PLANS: More communism at the Wall Street Journal

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More radical Bolshevism at the Wall Street Journal. Venessa Furhmans is now saying that Health Savings Plans (are) Start(ing) to Falter. How dare she!  She’s going to get it when Rupert takes over!

On the other hand, just dumping people into HSA and CDHPs was always going to raise dissatisfaction, and people, in general, do not want to shop at the point of care for medical treatment because it’s really, really hard.

In a survey published last month by Towers Perrin, an employee-benefits firm, employees enrolled in them said they felt less capable of finding a quality doctor or hospital, though they often were in the same network as colleagues in other plans. Only 29% said they tried to save money in their accounts for future medical expenses. Though the consulting firm says consumer-directed plans have much potential, its executives were surprised consumer responses were so negative. "If I were a product manager in any other industry and saw scores this low in customer satisfaction and understanding, I’d be thinking of pulling that product from the shelves or retooling it," says David Guilmette, managing director of Towers Perrin’s health-care consulting practice.

Still it’s a little ironic that a benefits guy is knocking CDHPs. After all, who the hell has been pushing them all this time?  And (to quote myself), remember kids, the CDHP is the bastard child of a one night stand between a benefits consultant with nothing to sell and a right-wing think tank that can’t do basic math.

THCB: Tech section with UPDATE

Over the next few weeks or so you’ll see some changes at
THCB. Most importantly, we’ll be launching the Tech Section, a new area of the site specifically focused on
healthcare and technology. Stories on healthcare, technology and IT subjects
will live here, as will archived podcasts and our rapidly expanding collection
of Health 2.0 focused content.
You’ll also find guest posts by special guest contributors working in the field,
ranging from execs at top hospital and health plan systems, to experts at the forefront of the industry.

Meanwhile, if you want to reach a monthly audience of tens of thousands
of healthcare industry observers interested in the intersection of technology
and healthcare and related stories, you may want to consider  sponsoring THCB or one of our sections. We’re read “religiously” throughout the
industry, by readers who like our “irreverent’ and “influential” coverage of trends and issues (Wall Street Journal.)  Monthly and longer term corporate sponsorships are available.  A limited number of Health 2.0 sponsorships remain
as well. Contact jo**@***************og.com
for rates, availability and other details.

PODCAST/TECH: HEALTH2.0/TECH/PODCAST: Interview with Venky Harinarayan, Founder Kosmix

Here’s this week’s interview is with Venky Harinarayan, Founder and (unofficial) CEO at Kosmix. Kosmix wants its new RightHealth site to be the "unofficial home page for health". He’ll tell you about categories and "broad" searching, the intricacies of the search ecosystem, and how Powerset will beat out Google. (OK he may not have said that, but it should get this entry lots of hits!).

This was the first interview when I could see my interviewee over Skype and I found it very unnerving, even though he couldn’t see me!  But you’ll only have to listen. You might well want to play with RightHealth while he’s describing it.

My take is that search is just starting in health care…and that in 2-3 years we won’t recognize it!

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