The Health Care Blog – Page 62 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Dear Patient, If You Have to Treat a Cold, Know This:

Feb 9, 2023

BY HANS DUVEFELT

Americans hate being sick. There are too many cold medicines out there to remember by name. But there are really only a handful of different drug classes to consider.

In order to choose any one of them, be clear about what you want to accomplish. It’s actually very simple.

1) Make my cold go away faster: Zink, echinacea, visualization/manifesting, sauna, prayer (may be mostly placebo effect ).

2) Stop my nose from running (including post nasal drip): You’ll want the crud to leave your body as soon as possible, so turning off the drain pipe that your nose has become can increase the risk of stagnant mucous in your sinuses becoming secondarily infected. But intermittent use of a decongestant (pills like pseudoephedrine, diphenhydramine or nasal sprays like Afrin) can help you look healthier than you are for an important Zoom meeting.

3) Make my nose run and relieve the pressure in my sinuses: Lots of fluids, room humidifier/vaporizer, shower steam, nasal steroid spray, guaifenesin (Mucinex) or even nasal lavage (Nettipot), but I personally have reservations about that one.

THCB Gang Episode 115, Thursday February 9

Feb 9, 2023

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday February 9 at 1PM PT 4PM ET were futurist Ian Morrison (@seccurve); medical historian Mike Magee (@drmikemagee); patient safety expert and all around wit Michael Millenson (@mlmillenson); and delivery & platform expert Vince Kuraitis (@VinceKuraitis). There was the usual chat and a lot of conversation about the future of Medicare, Medicare Advantage and the CVS acquisition of Oak Street.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

What is Health Care’s LEGO?

Feb 8, 2023

BY KIM BELLARD

Last week the esteemed Jane Sarasohn-Kahn celebrated that it was the 65^th anniversary of the famous LEGO brick, linking to Jay Ong’s blog article about it (to be more accurate, it was the 65^th anniversary of the patent for the LEGO brick). That led me to read Jens Andersen’s excellent history of the company: The LEGO Story: How a Little Toy Sparked the World’s Imagination.

But I didn’t think about writing about LEGO’s until I read Ben’s Cohen’s Wall Street Journal profile of University of Oxford economist Bent Flyvbjerg, who studies why projects succeed or fail. His advice: “That’s the question every project leader should ask: What is the small thing we can assemble in large numbers into a big thing? What’s our Lego?”

So I had to wonder: OK, healthcare – what’s your LEGO?

Professor Flyvbjerg specializes in “megaprojects” — large, complex, and expensive projects. His new book, co-authored with Dan Gardner, is How Big Things Get Done. Not to spoil the surprise (which would only be a surprise to anyone who hasn’t been part of one), their finding is that such projects usually get done poorly. Professor Flyvbjerg’s “Iron Rule of Megaprojects” is that they are “over budget, over time, under benefits, over and over again.”

In fact, by his calculations, 99.5% of such projects miss the mark: only 0.5% are delivered on budget, on time, and with the expected benefits. Only 8.5% are even delivered on budget and on time; 48% are at least delivered on budget, but not on time or with expected benefits.

As Professor Flyvbjerg says: “You shouldn’t expect that they will go bad. You should expect that quite a large percentage will go disastrously bad.”

He has two key pieces of advice. First, take your time in the planning process: “think slow, act fast.” As Dr. Flyvbjerg and Mr. Gardner wrote in a Harvard Business Review article recently, “When projects are launched without detailed and rigorous plans, issues are left unresolved that will resurface during delivery, causing delays, cost overruns, and breakdowns….Eventually, a project that started at a sprint becomes a long slog through quicksand.”

Second, and this is where we get to the LEGOs, is to make the project modular; as Mr. Cohen puts it, “Find the Lego that simplifies your work and makes it modular.”

Elia Stupka, Angelini Ventures

Feb 8, 2023

I’ve been friends with Roberto Ascione for many years. Roberto is a keen Napoli fan who on the side runs the Healthware Group and also the Frontiers Health Conference that I’ve been going to for many years (and where Jess DaMassa is co-MC). Recently Healthware acquired the media company pharmaphorum and hired star reporter (and another friend) Jonah Comstock, ex MobiHealthNews and HIMSS Media. THCB will be doing some occasional cross-posting with pharmaphorum starting with this interview of the boss of a new and well heeled Italian health tech VC fund!–Matthew Holt

Elia Stupka, Managing Director at Angelini Ventures, talks to Paul Tunnah, pharmaphorum founder, about his career, life passions and the exciting launch of Angelini Ventures – a €300 million fund paving the way for healthcare transformation across digital health and life sciences

COVID-19 myocarditis illusions: A new cardiac MRI study raises questions about the diagnosis

Feb 7, 2023• 2

BY ANISH KOKA

One of the hallmarks of the last two years has been the distance that frequently exists between published research and reality. I’m a cardiologist, and the first disconnect that became glaringly obvious very quickly was the impact COVID was having on the heart. As I walked through COVID rooms in the Spring of 2020 trying to hold my breath, I waited for a COVID cardiac tsunami. After all social media had been full of videos from Wuhan and Iran of people suddenly dropping in the streets. My hyperventilating colleagues made me hyperventilate. Could it be that Sars-COV2 had some predilection for heart damage?

Happily, I was destined for disappointment. There never was a cardiac tsunami from COVID.

There were, unhappily, lots of severely ill patients with lungs that were whited out who quickly developed multi-organ dysfunction while hospitalized. The lungs were where almost all the action was. Every other organ got hit hard because of the systemic illness that unfortunately often is a downstream result of a severe respiratory illness. Cardiac Cath labs waiting for some major influx of COVID heart damage not only didn’t see patients presenting with COVID heart attacks, but they idled as patients terrified of coming to the hospital stayed home rather than come to the hospital with chest pain. (Public health messaging about COVID appears to have kept people away from hospitals, and autopsy series of deaths during the pandemic found that reduced access to health care systems (for conditions such as myocardial infarction) was further likely to be identified as a contributory factor to death than undiagnosed COVID-19).

So imagine my surprise when I saw peer-reviewed research based on a cardiac MRI study come out in 2020 suggesting that 78% of patients who survived COVID may have significant heart damage. A more detailed read of the paper, of course, threw up massive problems. The article and authors were more suited as writers for Oprah and Dr. Phil than for a well-respected academic journal. But the damage was done, and the notion that COVID was attacking hearts spread via a social media influencer class that should have had the credentials and smarts to know better, but clearly didn’t.

What Scientists and Historians Understand: Without Truth, Progress Is An Impossibility

Feb 6, 2023

BY MIKE MAGEE

“This too will pass, honey!” That’s what my mother used to say when any of my eleven brothers and sisters or I seemed to be overwhelmed by whatever. And largely, now, three quarters of a century since my birth, she was mostly right. Whether in personal lives or the life of our nation, over a span of time, the slope has been slight, but upward.

But there are weeks, like this past one, where we are forced to witness the beating death of an innocent 29 year old black man at the hands of police in the very city where Martin Luther King was slaughtered 55 years ago, when it would be easy to lose hope. Why not, as Trumpets actively promote, just lie? Why not create “alternate realities?”

Witness Gov. Ron DeSantis. What he fails to realize, in his attempts to white wash Black History from Florida schools, is that the accurate and full disclosure and discussion of our complicated American history ultimately supports progress and optimism. This is because the record shows that we have the capacity (admittedly in very small steps) to improve ourselves and our ability to manage self-governance.

Science has a long history of opposition to politicians who oppose truth-telling. Louis Pasteur famously urged fellow scientists to “worship the spirit of criticism.” When challenged to provide a rationale for his faith in full disclosure, he replied, because “everything is fallible.”

There was another scientist of the same era who was born with an iron spine and a love for honest learning. Her mother had emigrated from Wales shortly after our Civil War. Born into a farming family on January 29,1881, Alice Evans lived to be 94. Along the way she became the first women scientist to work as a bacteriologist for the U.S. Department of Agriculture, and the founding president of the Society of American Bacteriologists (American Society for Microbiology).

Descriptions of her include an “unending intellectual curiosity, independent spirit, and unflinching integrity.” She received her education at Cornell’s College of Agriculture and at the University of Wisconsin’s College of Agriculture. After working on improving the flavor of cheddar cheese for three years, she headed to Washington D.C. to join the new federal Dairy Division. She had applied as A. Evans at the urging of her male mentors knowing the federal government had no taste for female scientists. As she was later quoted, “I was on my way to Washington where I had not wanted to go and where I was not wanted.”

With access to my records, I took my business elsewhere

Feb 3, 2023• 2

By EPATIENT DAVE DEBRONKART

I had a skin cancer diagnosed in November. It’s my third, and I researched the last one heavily, so I knew what I wanted (Mohs on the nose). But the hospital that did the diagnosis insisted I wait and have a consult visit in January, and *then* they’d let me schedule the procedure, probably in March.

I said I know what treatment I want – can’t I schedule the surgery now? They said, “That’s not how we do it.”

So I went home and called around. Beth Israel Deaconess Medical Center said if I could get them the information they would book me for January, right then and there.

How long did it take me to get them the data? 15 minutes. I went back to the first place’s portal and downloaded my visit note and pathology report and emailed it all to BIDMC. An hour after I dialed the phone I had the appointment I wanted.

Patient power. I took my records – and my business – elsewhere.

This is of course a nightmare for providers who think they can lock us in. And it’s a dream come true for providers who have been longing to win us away by providing better service.

(I would have had the surgery before now, within January, but COVID struck so we postponed.)

Medical record access is empowering! Thank you to those who worked so long and hard to create these policies!

It’s also great news for providers who are trying hard to be #patientcentric: now we can easily reward them with our business!

It’ll be even better in the coming years because data #interoperability via FHIR will let apps and hospitals go GET the data … or, even better, let consumers already have their data in their own app, to do anything they want with it. True patient autonomy.

Dave deBronkart is a patient activist, speaker and author. This was originally published on his LinkedIn page

THCB Gang Episode 114, Thursday February 2 1pm PT 4pm ET

Feb 2, 2023

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday February 2 at 1PM PT 4PM ET are futurist Ian Morrison (@seccurve); fierce patient activist Casey Quinlan (@MightyCasey); writer Kim Bellard (@kimbbellard); and Olympic rower for 2 countries and all around dynamo Jennifer Goldsack, (@GoldsackJen).

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

13 Year Old McAllen

Feb 2, 2023

BY IAN MORRISON

As a Scot, obviously I am a whisky fan, and although I prefer the smoky malts of Islay (where my grandfather was from and where I visit my friends there frequently), I am also a huge fan of McCallan 18-year-old whisky, the sticky toffee pudding of single malts.

But as all policy wonks know, McAllen Texas is not famous for whisky but for Atul Gawande’s “Cost Conundrum” article in the New Yorker, in 2009 which is still required reading in medical school and MPH classes and was arguably the cornerstone of Obama health policy and the ACO movement.

Dr. Atul Gawande described overutilization and high cost of Medicare revealed by Dartmouth Atlas nationally and zeroed in on McAllen Texas. Compared to El Paso (a seemingly like comparison) McAllen was the most expensive place in America for healthcare based on Medicare claims data. Gawande highlighted the entrepreneurial, doctor-owned, Doctor Hospital at Renaissance DHR in Edinburg, TX as having fancy, modern technology while the community as a whole seemed underserved.

I have always had unease with just using Medicare data to judge costs, because there was no recognition of what I was observing on my travels, namely an enormous variation in commercial prices (not simply utilization) in hospital costs in terms of paid claims by self insured employers. Poignantly, sources at the time claimed McAllen, Texas had among the lowest commercial insurance premium places in the country. Interesting.

Practicing Medicine without a License: When Patients and Politicians Play Doctor

Feb 1, 2023• 1

BY MICHAEL KIRSCH

We’ve all heard the adage, leave it to the professionals. It’s typically used when an individual has wandered out of his lane. How many folks go beyond their knowledge and skills with home projects, for example, who must then hire a real professional to mop up the mistakes? Luckily for me, the only tools that I – a gastroenterologist – know how to use are a colonoscope and an endoscope, so there’s no chance that I will be tempted to perform any plumbing or electrical tasks at home.

Although patients are not medical professionals, they routinely bring me results of their own medical research which suggest possible diagnoses and treatments. Often, these are patients whom I am meeting for the first time. I applaud patients who strive to be informed participants in their care. Indeed, there have been instances when a patient has brought me a valuable suggestion that I had not considered. But these are uncommon occurrences. A few computer clicks by a patient is not equivalent to the judgment and experience of a seasoned medical professional. It’s unlikely, for example, that I will agree that a patient’s elevated temperature is caused by malaria, despite this appearing on a patient’s internet search on the causes of fever.

However, even when I feel that a patient’s research results have no medical merit, the ensuing conversation is always valuable for both of us. I am in the room and can address the issue directly in real-time. I am the patient’s guardrail to protect him from careening off the road. I can explain right then the importance of being guided whenever possible by sound medical evidence. So, while I truly welcome the dialogue and recommendations from patients, I think that the maxim leave it to the professionals applies. Isn’t this why patients come to see us?

There’s a new player on the scene masquerading as medical professionals dispensing medical advice to the public. And in this case, there are no effective protective guardrails protecting patients as we doctors routinely do. I am not referring to middle of the night telemarketers or companies promising that probiotics are the panacea of our time.

As absurd as this sounds, politicians are now authorizing medical treatment for various diseases and conditions. Politicians? Could this be true?