The Health Care Blog – Page 265 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Medical Care in Rural India

Jul 16, 2018• 4

By SAURABH JHA

I’ve humbly realized that doctors aren’t always indispensable. When I was three, a compounder – a doctor’s assistant – allegedly saved my life. Dehydrated from severe dysentery, I was ashen and lifeless. My blood pressure was falling and I would soon lose my pulse. I needed fluids urgently. An experienced pediatrician could not get a line into my collapsed veins. When hope seemed lost, his compounder gingerly offered to try, and got fluids inside my veins on the first attempt. My pulse and color returned and I lived to hear the tale from my mother.

So, on a recent trip to India, I was intrigued by Birju, a compounder in my ancestral village in Bihar, who the villagers revere like a doctor. After assisting a city physician for ten years, Birju had started his own practice. He has no formal training in healthcare. Even his education was partial – he left school at fourteen to help his father, who also was a compounder.

I wanted to see Birju practice his craft. So, I visited his clinic which is actually a shop. Birju sells stationery, conveniences such as shaving foam, and medications, which was just as well, as I needed Imodium to calm my angry Americanized bowel.

CBD (Cannabidiol) 101

Jul 12, 2018• 4

By DONNA SHIELDS MS, RDN

I’ve been a proponent of marijuana legalization since I heard about it in high school. I lived in the UK in the 1970s when it was not easily available! So I was a legalization proponent before I’d ever touched the stuff. Nearly four decades later, it’s legal in many states, Canada and Uruguay and most — but by no means all — of the drug war hysteria is recognized for the idiocy it is. But while anyone who’s got stone and had the munchies knows that pot is a good appetite enhancer and antiemetic, there are now a bunch of claims being made about cannabidiol (CBD). So I thought we’d explore them. We’re including a video from ZdoggMD which gives a balanced view of the (appalling lack of) data so far, and an article from Donna Shields, co-founder of the Holistic Cannabis Academy. Donna, as you may guess, thinks it’s pretty useful. And while you think this may still be on the edge, a CBD company called Sagely Naturals won the recent G4A contest held by old world big Pharma company Bayer—Matthew Holt

Understanding CBD

It’s come onto the healthcare scene like a rocket yet most people don’t really understand what cannabidiol (CBD) is, how to use it and the results one can expect. Here’s a primer on the basics you need to know.

Do you know about the endocannabinoid system

We all have an endocannabinoid system; a network of receptors throughout the body whose job is to maintain homeostasis and well-being for all our organs. Like a master control system. And while our bodies make their own cannabinoids, life, through stress, toxins, poor diet and illness, has a way of depleting the in-house supply or making those receptors “less receptive”. This is when adding cannabinoids, such as CBD, can be a helpful boost.

Marijuana vs Hemp

The mother plant, called Cannabis sativa, can be cultivated to grow marijuana (the plant containing THC, CBD, and other cannabinoid compounds) or hemp, a crop with many uses from food products to building materials. Hemp also contains CBD (cannabidiol), but less than 0.3% THC. CBD is just one of over 80 different cannabinoid compounds found in both marijuana and hemp. Hemp-derived CBD products are available at retail stores and online; while marijuana-derived CBD products are available cannabis dispensary stores.

Health in 2 Point 00, Episode 38

Jul 12, 2018

Somewhere in this long and rambling in-mourning edition of #HealthIn2Point00 Jessica DaMassa gets past my depression about England’s World Cup semi-final exit & asks me about NuRx’s funding round, and Verily’s move into sleep. But it’s mostly soccer depression! — Matthew Holt

My Triple Aim of Medication Assisted Treatment for Opioid Addicted Patients

Jul 11, 2018• 1

by HANS DUVEFELT, MD

My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound:

Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my MAT patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma and various infectious diseases.

Years ago, working in a mental health clinic, we had strict rules to defer everything to each patient’s primary care provider that wasn’t strictly related to Suboxone treatment. One problem was that many of our patients there didn’t have a medical home or had difficulty accessing services. Another problem was that primary care providers unfamiliar with opioid addiction treatment were uncomfortable prescribing almost anything to patients on Suboxone.

Medicare Holds Out Promise of Health Record Access Revolution

Jul 10, 2018• 8

By MICHAEL MILLENSON

This is the second of two posts from the Society of Participatory Medicine about the important policy issue regarding portability of our medical records. The first provided background, with link to a PDF of the comments SPM submitted, largely authored by Michael Millenson, who provides this essay for context.

The Trump administration is proposing to use a powerful financial lever to push hospitals into making the patient’s electronic medical record interoperable – that is, readable by other care providers – and easily available to patients to download and organize via an app.

The possible new mandates, buried in a 479-page Federal Register “Notice of Proposed Rule Making” from the Centers for Medicare & Medicaid Services (CMS), could become part of hospital “conditions of participation” in Medicare. That means if you don’t do it, Medicare, which accounts for about a third of an average hospital’s revenues, can drop you from the program.

In a comment period that closed June 25, we at the Society for Participatory Medicine registered our strong support for taking the administration rhetoric heard earlier this year, when White House senior advisor Jared Kushner promised a “technological health care revolution centered on patients,” and putting it into practice. The American Hospital Association (AHA), on the other hand, while professing its support for the ultimate goals of interoperability and patient electronic access, was equally strong in telling CMS it was going too far, too fast and with too punitive an approach.

Health in 2 Point 00, Episode 37

Jul 10, 2018

Jessica DaMassa asks me about the American Well mega funding round, Cerner investing in Lumeris, and the new NHS England app. Which naturally descends into a conversation about England’s chances in the world cup semi-final tomorrow!–Matthew Holt

SPM’s comments on important proposed CMS interoperability rules

Jul 9, 2018• 1

By E-PATIENT DAVE DEBRONKART

This is the first of two posts from the Society of Participatory Medicine about an important policy issue regarding portability of our medical records. The second part will be published tomorrow and is written by Michael Millenson, who did the lion’s share of this work, as noted below.

Our Society’s Advocacy and Policy chair Vera Rulon @VRulon has submitted our comments on the proposed rules that have been discussed at great length on social media.

These regulations are a big deal for participatory medicine – they’re the successor to the Meaningful Use rules that have governed patient access to their chart, among other things. The regulations do this by altering how a hospital gets paid based on how well their data moves out of their computers. We want this; we believe it is essential in enabling patients and families to achieve the best possible care. (More on this in Millenson’s companion post.)

Not surprisingly, some hospitals don’t like new rules that affect how they get paid, and have lobbied heavily to NOT be required to give us our data. Some observers say there are ulterior motives – for instance see these 30 seconds of Yale cardiologist Harlan Krumholz at Connected Health 2016, on how a health system CEO told him flat out:

Social determinants on becoming a physician

Jul 6, 2018• 2

By SAURABH JHA

Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is instructive.

When I first met Prashant, he was a second-year medical student in Patna Medical College and Hospital. Patna is the capital of Bihar, and Bihar is one of the poorest states in India.

Prashant brimmed with idealism and vigor. “I’ll practice in Purnea one day and serve the poor villagers,” he told me in broken English.

Prashant comes from a family of Bihari farmers who are also affluent landowners. He grew up near Purnea, a fourth-tier town in Bihar surrounded by villages. Visiting these villages is like stepping into a time machine – you can see people travelling by bullock carts but using mobile phones.

Health in 2 point 00, Episode 36

Jul 6, 2018

Back in the US of A to celebrate the nation’s birthday, Jessica DaMassa asks about Amazon buying Pill Pack, GE spinning off its health division, and what Rock Health and Startup Health’s numbers say about health tech investment–Matthew Holt

The Past, Present and Future of Health Care

Jul 6, 2018

OK, so it’s a tad of an ambitious title… but it was a talk that I gave in Finland last month. I had fun looking at the development of health and technology and suggesting a structure for the future. Plus I got to tell my Neil Armstrong joke. The talk was part of the Upgraded Life Festival in Helsinki and you can see some of the other speakers videos on their channel—Matthew Holt