The Health Care Blog – Page 636 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Even Aetna CEO Admits: We’re Toast

May 11, 2012• 15

By Joe Flower

I’ve been saying it for years (and in 3D and Technicolor in my new book Healthcare Beyond Reform): The Standard Model of Healthcare (the traditional unmodified fee-for-service, commodified, defined-benefit payment system) is broken and doomed. It’s fascinating to hear that even the CEO of Aetna, Mark Bertolini, said exactly that recently at a major healthcare technology conference — and that Forbes, a bastion of business and the private approach to everything, would publish an article on his remarks.

At Health 2.0 last fall, Bertolini said that he no longer thinks of Aetna as an insurance company, but primarily as an information company. This time, he made these main points:

Drug Data Shouldn’t Be Secret

May 11, 2012• 9

By Peter Doshi and Tom Jefferson

In the fall of 2009, at the height of fears over swine flu, our research group discovered that a majority of clinical trial data for the anti-influenza drug Tamiflu ― data that proved, according to its manufacturer, that the drug reduced the risk of hospitalization, serious complications and transmission ― were missing, unpublished and inaccessible to the research community. From what we could tell from the limited clinical data that had been published in medical journals, the country’s most widely used and heavily stockpiled influenza drug appeared no more effective than aspirin.

After we published this finding in the British Medical Journal at the end of that year, Tamiflu’s manufacturer, Roche, announced that it would release internal reports to back up its claims that the drug was effective in reducing the complications of influenza. Roche promised access to data from 10 clinical trials, 8 of which had not been published a decade after completion, representing more than 4,000 patients from every continent except Antarctica. Independent verification of the data seemed imminent. But more than two years later, and despite repeated requests, we have yet to receive even a single full trial report. Instead, the manufacturer released portions of the reports, most likely a very small percentage of the total pages. (One of us, Tom Jefferson, has been retained as an expert witness in a lawsuit relating to some of these issues.)

Slow Medicine

May 11, 2012• 5

By Danielle Ofri

I can’t tell you exactly when it happened, but sometime in the past two decades, the practice of medicine was insidiously morphed into the delivery of health care. If you aren’t sure of the difference between the two, then “God’s Hotel” is the book for you. It’s an engaging book that chronicles this fin-de-siecle phenomenon from the perspective of San Francisco’s Laguna Honda Hospital, the last almshouse in the United States.

Dr. Victoria Sweet, a general internist, came to Laguna Honda for a two-month stint more than 20 years ago and ended up staying. Laguna Honda was home to the patients who had nowhere else to go, who were too sick, too poor, too disenfranchised to make it on their own. The vast open wards housed more than a thousand patients, some for years. Laguna Honda was off the grid, and this, Sweet discovered, was to the benefit of the patients.

Unencumbered by HMOs and insurance companies, the doctors and nurses practiced a very old-fashioned type of medicine, “slow medicine,” as Sweet terms it. There was ample time for doctors and nurses to get to know their patients, and ample time for patients to convalesce. Many a written-off patient recovered within the comforting, unhurried arms of Laguna Honda.

Should Your Boss Encourage You to Take Drugs?

May 10, 2012• 6

By Michael Schrage

A top executive I know recently decided to take Inderal before making high-pressure/high-anxiety presentations. The impact was immediate. She felt more relaxed, confident and effective. Her people agreed.

Would she encourage a comparably anxious subordinate to take the drug? No. But if that employee’s anxiety really undermined his or her effectiveness, she’d share her story and make them aware of the Inderal option. She certainly wouldn’t disapprove of an employee seeking prescription help to become more productive.

No one in America thinks twice anymore if a colleague takes Prozac. (Roughly 10% of workers in Europe and the U.K. use antidepressants, as well). Caffeine has clearly become the (legal) stimulant of business choice and Starbucks its most profitable global pusher (two shots of espresso, please).

Increasingly, prescription ADHD drugs like Adderall, dedicated to improving attention deficits, are finding their way into gray market use by students looking for a cognitive edge. When one looks at existing and in-the-pipeline drugs for Alzheimer’s and other neurophysiological therapies for aging OECD populations with retirements delayed, the odds are that far more employees are going to be taking more drugs to get more work done better.

Performance-enhancing (or degraded performance-delaying) drugs will become as common as that revitalizing cup of afternoon coffee.

Should that be encouraged? Or should management pretend those options don’t exist?

Most managers would believe they’re doing a good thing if they encouraged a hard-of-hearing employee to explore a hearing aid or a visually-impaired colleague to consider glasses. By contrast, encouraging an under-performing subordinate to lose 25 pounds, get a hair transplant or contact-lenses would likely inspire a formal complaint to Human Resources and/or a possible lawsuit. Ironically, the money isn’t the issue here; the business norms associated with perceived cosmetic and aesthetic concerns are radically different from those attached to job performance and productivity.Continue reading…

Our Cancer Journey

May 10, 2012• 6

By John Halamka, MD

Kathy heads to surgery tomorrow at 7am. She’ll be NPO (nothing by mouth) after midnight. She’ll wake at 5am, shower with Hibiclens (a antibacterial prep), and I’ll drive her to surgical check in. Prior to surgery, the radiology department will insert a wire adjacent to the titanium markers that were placed in her tumor at first diagnosis. Her surgeon will use this wire to guide the lumpectomy.

Her left breast will become smaller than her right. She jokes that her career in exotic dancing will come to an end.

The operating room will call me at the end of her procedure and I’ll pick her up. Since she’ll not have had general anesthesia, we’re presuming she’ll feel good enough for a bit of an extended ride home. The last of our chickens arrives on Friday (Buff Orpington’s) and we’ll pick them up as we drive back to our new farm.

We’ll anxiously await the results of pathology. If the margins on the lumpectomy tissue are clear, Kathy will start Radiation Therapy 1-2 months after surgery, likely late June or early July.

By Labor Day, if all goes well, this phase of our cancer journey will end, although our continued vigilance for reoccurrence will be lifelong.

Hospitals or Health Plans: Who Do You Trust to “Connect” You with Your Health Records?

May 10, 2012• 18

By Vince Kuraitis

Over the past decade, I’ve seen a number of studies asking people whom they trust among various health care stakeholders. Nurses, pharmacists, and doctors always come out at the top. Beyond that:

·Trust of hospitals tends to be high (60–80%)
·Trust of health plans is at the bottom of the heap (10–20%)

Is this written in stone for the future? I don’t think so…and the dynamics for change are in motion. Please read on.

Here’s the emerging picture I’m seeing:

·Hospitals are dragging their feet in connecting you with your electronic health information.
·Health plans are highly motivated to connect you with your health information.

Hospitals Keeping You from Your Health Records

Yesterday the American Hospital Association released a 68 page letter commenting on proposed regs for Meaningful Use Stage 2. Putting aside my usual analytic tendencies, I’ll simply describe the letter as whiny, snivelly, “can’t do”, mean, and thick-headed.

When Reality TV Collides with Reality

May 9, 2012• 1

By Joan Wickersham

First, a confession: I like to watch reality TV. Not all reality TV, not often. (I wish I could say, as I would about a junky magazine, “I saw it at the hairdresser” or “ . . . while I was waiting in line at the supermarket.” But no — I sit in my living room, turn on the TV, and choose the station. I take full responsibility. Though I do also use the time to fold laundry.)

The show I’ve gotten hooked on lately is called “Giuliana and Bill.” Giuliana and Bill are on TV because they are famous for being on TV — she as a host of E! News and he as a winner of “The Apprentice.” Their eponymous reality show, about the ups and downs of their marriage, is a marvel of glitzy minutiae. Giuliana and Bill are just like us, only with a lot more Hermès accessories. They bicker; they smooch; they argue about what to have for dinner; they host New Year’s Eve in Times Square. It’s “reality” — life’s big and little moments, carefully staged to seem breezy and spontaneous. But what has hooked me on the show this year is that “reality” has suddenly collided with reality: Giuliana’s diagnosis of breast cancer.

Giuliana and Bill started as a show about newlyweds who wanted to have a baby. But the couple wrestled with infertility, and an IVF pregnancy ended in miscarriage. Before proceeding with another round of fertility treatment their doctor insisted on a mammogram.

Breast cancer was diagnosed last October; and after Giuliana’s lumpectomies failed to produce cancer-free margins, she and Bill had to decide what to do next.

Inoculate the Budget Deficit From Healthcare Reform

May 9, 2012• 1

By William G. Gale

The United States faces large federal budget deficits over the short-, medium-, and long-term. Although perhaps subject to the greatest public attention, the short-term deficits are generally thought to be helping the economy recover. In contrast, medium- and long-term deficits projected for years after the economy returns to full-employment are a source of concern: these deficits will create growing and serious burdens on the economy even if they do not lead to an immediate crisis. Economists of all political stripes agree on this point.

While extending the Bush tax cuts, if that occurs, will play a big role in making the medium and long-term deficit problems worse, economists agree that a key driver of the long-term deficit problem is growth in government spending on health care. Medicare and Medicaid, our two largest health spending programs, currently account for 23 percent of federal spending, or 5.6 percent of GDP. Under current law and optimistic assumptions for health spending, the Congressional Budget Office (CBO) estimates these programs will represent 30 percent of total federal spending (6.8 percent of GDP) by 2022 and will continue to grow thereafter.

The prospect of health-driven deficits has produced a burst of proposals for reform. Sadly, the simple truth is that we do not yet know how to reform government health programs to both rein in costs and maintain or improve quality and access.

Side Effects May Include Financial Ruin

May 9, 2012• 1

By Christopher Moriates, MD

He winced in a way that made me feel his discomfort. It wasn’t overly dramatic; it was a response of a man trying to put on a brave face and hide his pain, but – as I gently laid my hands on his belly – failing against his best efforts. This man had real abdominal pain, the kind that is impossible not to immediately empathize with. I got concerned.

“How long has this been going on?” I asked, while my mind began to immediately tick through a differential diagnosis.

“Well it probably started a year ago, but got really bad about four months ago,” this otherwise healthy-appearing, thirty-something-year-old man said.

We were in a small curtained-off area in the hectic Emergency Department at San Francisco General Hospital (SFGH). I started to wonder what in the world would possibly cause somebody to wait many months with severe abdominal pain and rectal bleeding before coming to see a doctor.

I asked a few more questions, verifying that he was indeed having bright red blood with his bowel movements, had lost at least 10-pounds over the last few months and has dealt with nausea and debilitating abdominal pain ever since the end of last year.

Wireless Big Data in the Cloud

May 9, 2012• 2

By Joseph Kvedar

I was chatting with a friend the other day about how to get people’s attention in this information-overload age, and we decided that the use of buzz words was a critical component of success. So I decided to test this catchy title and see if it leads to any more reader traffic than I usually get.

Really, I’m not messing with you. There is something to the idea of buzz word use in our search engine optimized world, but as I reflected on these three technology trends, I thought it worth pausing for a moment to reflect on just how game-changing each is for those of us in the connected health space.

Wireless/Mobile

Of all the top-of-the-hype-cycle buzz words in health care right now, mobile tops the list. And while we probably can’t cure cancer, reverse aging and find the true meaning of life with mobile technology, it really has revolutionized the world of healthcare.