The Health Care Blog – Page 642 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Mission Critical: How Translation-Focused Disease Foundations May Save Medical Research

Apr 23, 2012• 1

By David Shaywitz, MD

Patients waiting expectantly for medical research to produce important new cures are finding bad news almost everywhere they turn.

Pharmaceutical companies are suffering from a much-discussed innovation crisis, as old drugs lose patent protection without new drugs to replace them; meanwhile, the small biotechs that could potentially bail big pharma out struggle to raise capital .

University scientists, for their part, are beset by an unseemly credibility crisis, as the intrinsic fragility of medical research is now vividly apparent from the soaring number of high-profile retractions, and the well-documented difficulty of reproducing many published findings outside the originator’s lab.

At the heart of this crisis is the misalignment of two very different cultures.

Academic scientists tend to focus on publishing papers, and usually assume that the results will eventually be useful. They place a high value on novelty, and relatively less value on whether the data are robust, easily reproducible by others, or truly relevant to human disease. Captivating data from putative laboratory models of disease generate publications, even if the model is not very predictive of human disease – and unfortunately, most models aren’t.

Conversely, big companies traditionally focus on generating efficiencies through scale, and on developing reproducible processes. This works very well for manufacturing, reasonably well for large late-stage clinical trials, and essentially not at all for early-stage (discovery) research.

PlaceMe: A Creepy Model For Health Information?

Apr 22, 2012• 1

By Phil Bauman

Data, information, interpretation and decision-making are among the vital components of prevention, diagnosis, management and treatment.

The problem we have today is how to gather and manage the data that our bodies radiate.

In order to solve this problem, we have to surmount other problems – which are not just technological but also behavioral, cultural and financial.

But if you want an idea of what an extreme version of data-collection might look like, check out the application Placeme.

Now Placeme is *not* a Healthcare application. What Placeme does do, however, is to continually (in almost real-time) track the places that you visit. No check-ins; no need to enter and data – the application simply runs in the background and does its magic.

When you think about that (from the cultural perspective of today), that’s creepy.

And yet, this “creepy” model is the future. It represents the technological and cultural arc that social software is throwing us. We can fight it (and should in order to flesh out the nuances so we can ensure safety) but in the long-run we shall have to accept the trend and work accordingly.

So think of Placeme in terms of what the ‘Quantitative Self’ movement is attempting to achieve.

Conference Highlights Rapid Growth of Health Impact Assessments in the United States

Apr 22, 2012

By Aaron Wernham

According to a recent poll in Washington State, 71 percent of voters supported a bill that would require the state to consider impacts on people’s health when planning new transportation projects. This poll speaks to the growing recognition that illnesses like asthma, obesity, and diabetes, as well as injuries are shaped by the conditions in the places where we live and work. To address this, we need to factor health into decisions in fields like transportation, energy, housing, and agriculture.

The level of interest in the inaugural National Health Impact Assessment (HIA) Meeting held April 3 and 4 in Washington, D.C., highlights that this approach has become a centerpiece of community, state, and national efforts to improve Americans’ wellness. An HIA is a type of study that allows decision makers to factor health into projects like planning roads, passing agriculture policy, and siting schools. I have been using HIAs for over eight years, and until recently, I knew most of the people in the field. In organizing the National HIA Meeting, I worried that we might not find 200 people to attend. Instead, we had to close registration six weeks early: more than 430 leaders in public health, urban planning, housing, transportation, agriculture, and environmental regulation participated, and many more were on the waiting list.

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, sponsored the two-day meeting, along with The California Endowment, the Centers for Disease Control and Prevention, and the National Network of Public Health Institutes.

Keynote speaker Jonathan Fielding, the director of the Los Angeles County Department of Public Health who also chairs the U.S. Community Preventive Services Task Force, gave an overview of the fast-growing approach. “The first HIAs were done roughly 12 years ago in the United States,” he said. “There has been huge progress in this field.”

At the Health Impact Project, we are tracking this growth. Today, nearly 200 HIAs have been completed or are ongoing. In 2007, there were only 27 such studies on the books.

A Response to Critics on the Founding Fathers and Health Insurance Mandates

Apr 20, 2012• 10

By Einer Elhauge

Last week, I wrote an article describing several purchase mandates adopted by the framers in early Congresses, including two medical insurance mandates imposed on shipowners and seamen. These examples rebut the claim by challengers to Obamacare that purchase mandates are wholly unprecedented in a way that allows us to infer they are unconstitutional, a claim on which they rely heavily because there is no text, history, or case law that affirmatively supports a ban on purchase mandates.

Not everyone agrees with me. Some comments to my article, here and elsewhere, have suggested that these early medical mandates are distinguishable from Obamacare because they reflect Congress’ power to enact maritime law, not its power to regulate commerce. But the Constitution’s list of congressional powers nowhere includes a maritime law clause. Early Supreme Court cases all held that the Commerce Clause was what gives Congress the power to enact maritime law. For example, in The Daniel Ball, a case decided in 1871, the Court stated that navigable waters form “a continued highway for commerce, both with other States and with foreign countries, and is thus brought under the direct control of Congress in the exercise of its commercial power. That power authorizes all appropriate legislation for the protection or advancement of either interstate or foreign commerce…” In The Lottawanna, the Court held that it was under this commerce clause power that Congress had enacted statutes that determined “the rights and duties of seamen” and “the limitations of the responsibility of shipowners.” These early medical mandates were thus enacted under the very Commerce Clause at issue in the Obamacare case.

Rebooting the Medical Meeting – 9 lessons from TEDMED

Apr 20, 2012

By Ronan Kavanagh, MD

A few things that medical meeting organisers could learn from the organisers of TEDMED.

1. Most presentations at TEDMED are 18 minutes long. This allows for large numbers of presentations with fine tuned ideas to presented in a polished digestible format to an audience. George Bernard Shaw said. “I’m sorry this letter is so long, I didn’t have time to make it shorter.” Even the most excruciating presentation is bearable if you know it’ll be over shortly.

2. Give speakers guidance on their style of presentation with specific suggestions; e.g. “think big, make the complex plain, connect with peoples’ emotions, don’t flaunt your ego, don’t read your talk, finish on time” etc. Check their slides well in advance of the talk and offer guidance. Speakers need to be guided and managed.

3. Introduce talks which stimulate thought, innovation and creativity rather than didactic hard data. It’s not always essential to have the answer or solution to make a presentation interesting.

4. Introduce an element to your meeting with speakers from disciplines outside medicine. At this TEDMED the innovative dynamic is generated by bringing together people from all sorts of disciplines passionate about healthcare; Some of the most exciting conversations / commentaries that took place this year at this years were with Architects, Climate Change specialists, Neurobiologists, Experts in Social Networks, Plant Biologists, Technology Entrepreneurs, Gamers, Military personnel, Poets, Musicians and dancers.

Meeting the Health Needs of 21st Century Veterans

Apr 20, 2012• 2

By David Anderson

After a decade of conflict in Iraq, our troops have come home, producing the largest increase in the number of American veterans since the 1970s. After Vietnam, an America tired of war and consumed with political angst neglected its veterans. Fortunately, the veterans of today are receiving the homecoming they deserve. To make that homecoming complete, America needs to ensure that our returning warriors have access to one of the most important benefits they have earned: health care provided by the Department of Veterans Affairs.

A Health Care Challenge: Fewer Battlefield Deaths, More Injuries

The United States military is the most technologically sophisticated fighting force in the world. This technological advantage means that our troops in Iraq and Afghanistan are subject to fewer casualties than in Vietnam. But those who do receive injuries are significantly more likely to survive because of body armor and the high quality of medical care. According to a study conducted by the University of Pennsylvania, only 13 percent of those injured in Iraq were likely to die compared to those injured in Vietnam, where the fatality rate was nearly 25 percent. But our ability to save lives also means that many more veterans are returning home after losing limbs or suffering from the after-effects of traumatic brain injuries (TBI) from blasts experienced in battle or as a result of improvised explosive devices.

A frightening aspect of TBI is that it can be quite difficult to diagnose. It is possible for someone exposed to an explosion to show no signs of injury until weeks or months later when symptoms—such as depression, anxiety or anger issues—become apparent. Untreated, these symptoms can lead to major depression, substance use problems, unemployment and ruined family relationships. In addition to TBI, other problems—from back injuries to exposure to toxins—may only become apparent after the veteran has been separated from service for months or even years.

Sending Some Love to Our Bodies

Apr 20, 2012• 7

By Linnea Duff

When first diagnosed with cancer, I felt as if my body had not only let me down, but actually turned on me. Some of my own DNA had gone rogue, grabbed some prime real estate in my lungs, and set up headquarters. Even when forcibly evicted, the rebel cells kept returning. Their numbers grew, and soon recruits were colonizing new neighborhoods.

Attempting to slow the spread of cancer has required unyielding vigilance. Emotionally and spiritually, I believe this has resulted in an unforeseen benefit; a chance for personal growth.

Physically, it has taken quite a toll. My body has been a battleground and I am scarred inside and out. This could potentially be distressing, as we live in a beauty and youth oriented society where great measures are taken to avoid the imperfections associated with aging and disease.

I am not afraid of getting old. I hope to hell I do. And I made peace with myself some time ago. Not only is all forgiven (the whole cancer thing), I have an abiding affection for this body of mine. We’ve been through a lot together, and somehow, some way, we both just keep on going.

Must be love.

The Dead Past

Apr 19, 2012• 1

By Alex Kozinski

I must start out with a confession: When it comes to technology, I’m what you might call a troglodyte. I don’t own a Kindle or an iPad or an iPhone or a Blackberry. I don’t have an avatar or even voicemail. I don’t text.

I don’t reject technology altogether: I do have a typewriter—an electric one, with a ball. But I do think that technology can be a dangerous thing because it changes the way we do things and the way we think about things; and sometimes it changes our own perception of who we are and what we’re about. And by the time we realize it, we find we’re living in a different world with different assumptions about such fundamental things as property and privacy and dignity. And by then, it’s too late to turn back the clock.

When I think of new frontiers on the internet I’m reminded of a science fiction story I read in college by my favorite SciFi author, Isaac Asimov. It’s called “The Dead Past,” and it goes something like this: Scientists have invented a machine called a chronoscope that can be used to view any time in the past, anywhere in the world, but this technology is strictly regulated by the government. Historians try to get licenses to view ancient Carthage or Rome, but government bureaucrats churlishly deny most requests based on mundane considerations of cost and convenience. So a frustrated historian teams up with a frustrated physicist and a frustrated journalist and together they reverse-engineer the chronoscope. They are eventually apprehended, but by that time the journalist had sent the plans to half a dozen of his news outlets; the secret is out and can never be retrieved.

And there, in the closing pages of the story, Asimov explains why the government had been so secretive about this invention:

Paying an Arm and a Leg for a Month of Life?

Apr 19, 2012• 110

By Peter Ubel

Imagine for a moment that you are an oncologist caring for a 53-year-old man with metastatic cancer, a person whose tumor has spread to lung and liver.

With standard chemotherapy, this man can expect to live around 12 months. That standard treatment isn’t all that expensive in today’s terms, only $25,000 and his insurance company will pick up the entire tab since he is already maxed out on his yearly deductible and co-pays.

But wait! Before prescribing the standard treatment, you find out there is a new chemotherapy on the market, one that costs $75,000 (in other words, fifty thousand dollars more than usual care) and has no more side effects than that standard treatment.

How much longer would patients like this have to live, on average, for you to feel that this new chemotherapy is warranted?

That’s not an easy question to answer. But it’s not an impossible one either. Clearly if the treatment would provide only, say, 1 day of additional survival on average, that would not amount to $50,000 well spent. Just as clearly, if this man could expect 10 years of additional life, no one would deny him this new treatment.

So when, between 1 day and 10 years, does it become a tough call whether to prescribe this new treatment?

Heroin Vaccine Won’t Cure What Ails Addicts

Apr 19, 2012• 5

By Angela Garcia

My aunt Marion is in the hospital dying of liver and kidney failure, the result of her 20-year struggle with heroin use. I was told of her imminent death the same day news broke about a vaccine against the drug. “Breakthrough heroin vaccine could render drug ‘useless’ in addicts,” one headline read. “Scientists create vaccine against heroin high,” proclaimed another.

Meanwhile, my aunt finds temporary relief in the ever more frequent administration of opiate pain medication — the very kind of drugs she used illegally.

The idea of an anti-addiction vaccine is not new. For nearly 40 years scientists have been working on vaccines against all kinds of addictions, including nicotine, marijuana and alcohol. There are even trials of vaccines to prevent obesity. None of the anti-addiction vaccines has yet received Food and Drug Administration approval, however, and most of the studies are still in their early stages.

The headlines trumpeting a heroin vaccine were based on a finding that the drug had proved to be effective on mice during trials in Mexico (a nation that could use some good news related to drugs). Scientists now plan to test the patented vaccine in humans. If all goes well, the vaccine could be available in five years — too late for my aunt but providing a glimmer of hope for the estimated 1 million heroin addicts in the United States. Perhaps.

Six years ago, when I was a doctoral student researching heroin addiction in northern New Mexico, I received an email from a scientist studying a possible vaccine against the drug’s use. The study was in rat models, but early results were promising and suggested the likelihood of a therapeutic effect for humans. Aware of the devastating heroin epidemic in New Mexico, which had the highest rate of heroin-related deaths in the Unites States, and of my work trying to understand it, the scientist wanted to offer some hope. He wrote that he could imagine a time when heroin addiction, in New Mexico and around the world, would be a thing of the past. I wanted to believe him, but I was less optimistic.