The Health Care Blog – Page 674 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

We Have Cancer

Dec 22, 2011• 21

By John Halamka, MD

Cancer. It’s a word that creates fear and uncertainty. Many of the doctors I know use the word “hate” whenever they discuss their feelings about cancer.

Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer. She is not facing this alone. We’re approaching this as a team, as if together we have cancer. She has been my best friend for 30 years. I will do whatever it takes to ensure we have another 30 years together.

She’s has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey.

Here’s how it all started.

On Monday, December 5, she felt a small lump under her left breast. She has no family history, no risk factors, and no warning. We scheduled a mammogram for December 12 and she brought me a DVD with the DICOM images a few minutes after the study. On comparison with her previous mammograms it was clear she had two lesions, one anterior and one posterior in a dumbbell shape. I hand carried the DICOM images to the Breast Center team at BIDMC.

On December 13 she had an ultrasound guided biopsy which yielded the diagnosis – invasive ductal carcinoma, grade 3.

Is Nanotechnology the New GMO?

Dec 21, 2011

By Marion Nestle

Food Navigator reports that UK experts are demanding public debate and regulation of nanomaterials in foods. Without that, they warn, nanotechnology risks “facing the same fate as genetically modified (GM) foods in consumer perceptions.”

Nanotechnology is about manipulating materials on the scale of atoms or molecules, measured in nanometers (nm), one billionth, or 10⁻⁹, of a meter.

Many companies are already using nanomaterials in agriculture, food processing, food packaging, and supplements. This is not something the public has heard much about. Food companies often don’t know whether or not they are using these materials.

Nanotechnology science is new, and the industry is unregulated.

The FDA’s nanotechnology web page links to a quite thorough 2007 report from a task force, but the agency’s only guidance to date tells companies how they can find out whether they are using nanomaterials.Continue reading…

Obesity Means Lower Pay

Dec 21, 2011• 5

By DOC GURLEY

I’ve written before about obesity issues – mostly related to soda and diet soda (the message – even diet soda isn’t good for you – try to drink water instead) and also that even being a little overweight can still result in health problems. But a new study, coming out of the National Longitudinal Study of Youth, shows that obesity can also impact you economically with obese people earning less than the rest of the population on average.

Hopefully this information will help provide greater motivation for people struggling with obesity since sometimes it takes more than a simple understanding of health and self interest to sufficiently motivate people to take action. But it also raises questions about the reasons for average lower pay.Continue reading…

Startup Incubator Healthbox Announces Its First Class

Dec 21, 2011

By Laura Montini

Chicago-based startup accelerator Healthbox Chicago-based startup accelerator Healthbox announced the inaugural class of ten companies to begin its program in January 2012. Healthbox comes from Sandbox, which manages the Blues venture funds. Healthbox’s program is similar to incubators Rock Health in San Francisco and Blueprint in New York City. But instead of the $20,000 Rockhealth gives (taking no equity), Healthbox will give class members $50,000 in seed capital in exchange for 7% equity, and the companies will also have access to a mentor network, forums led by business experts and a collaborative workspace–(they may though have to move to the wilds of Chicago). The program will culminate in April with Investor Day where participants will present their businesses to a targeted group of investors. Healthbox received hundreds of applications from 26 states and eight countries with concentrations on provider workflow, consumer health, informatics, pharmacy and more. Here are the companies that made the final cut:

Twenty-First Century Personalization of Health Care

Dec 20, 2011• 3

By Charis Eng, MD, PhD

The public perception of “personalized medicine” is askew: the term is often viewed as a common treatment option for rare genetic disorders. The truth is that the power of genetic and genomic information allows physicians to offer personalized health care to their patients.

Yet personalized health care is not new: ABO blood typing is a superb example of widespread genetics-based personalized healthcare dating back to World War II, and continues to have universal applicability and will for centuries to come.

Consider a more recent example: common associations for breast cancer accounts for almost three percent of all breast cancers whereas a “rare mutation” (BRCA1-2) alone accounts for 10 percent of all breast cancers. There are currently at least nine other breast cancer predisposing genes which help knowledgeable healthcare providers make the correct diagnosis and inform patients of risks of other cancers.

Health 2.0 News

Dec 20, 2011

Funding for healthcare-focused social gaming firm Keas, kudos for HealthyRoads and HealthBox announces its first grants for promising healthcare startups, and much more– over at Health 2.0 News

Scenario Planning in a Post-ACO and Post-ACA World

Dec 20, 2011• 1

By Jaan Sidorov, MD

In a prior post, I provocatively suggested that providers, hospital boards and policymakers should hedge their bets and prepare for the possibility of a “post-ACO world.” If the Group Practice Demo’s disappointing results are any guide, the likelihood of a happy ending for accountable care organizations is on numerical par with Congress’ approval rating. While I like the mutual “win-win” theoretical construct that underlies ACO gain sharing, it also recalls a life-lesson: want you want and what you get are usually two different things.

So, if the Feds have to eventually retreat on the non-success of ACOs, what will be left in its wake? More on that in future posts.

And while the uncertainty surrounding ACOs isn’t bad enough, I have also been astonished by the battered Euro, the appearance of hospital-employed cardiologists and the absence of a Lady Gaga Christmas album. Accordingly, I have learned my lesson and assume nothing.

The Defining Issue: Not Government’s Size, but Who It’s For

Dec 20, 2011• 20

By Robert Reich

The defining political issue of 2012 won’t be the government’s size. It will be who government is for.

Americans have never much liked government. After all, the nation was conceived in a revolution against government.

But the surge of cynicism now engulfing America isn’t about government’s size. The cynicism comes from a growing perception that government isn’t working for average people. It’s for big business, Wall Street, and the very rich instead.

In a recent Pew Foundation poll, 77 percent of respondents said too much power is in the hands of a few rich people and corporations.

That’s understandable. To take a few examples:

Wall Street got bailed out but homeowners caught in the fierce downdraft caused by the Street’s excesses have got almost nothing.

Big agribusiness continues to rake in hundreds of billions in price supports and ethanol subsidies. Big pharma gets extended patent protection that drives up everyone’s drug prices. Big oil gets its own federal subsidy. But small businesses on the Main Streets of America are barely making it.

When the End of Life Is Not.

Dec 20, 2011• 7

By Marya Zilberberg

So begins this New York Times essay by Peter Bach, MD, where he talks about the inadequacy of resource use at the end of life as a policy metric. Now, I am not very fond of policy metrics, as most of you know. So, imagine my surprise when I found myself disagreeing vehemently with Peter’s argument. Well, to be fair, I did not disagree with him completely. I only disagreed with the thesis that he constructed, skillfully yet transparently fallaciously (wow, a double adverb, I am going to literary hell!) Here is what got me.

He describes a case of a middle-aged man who was experiencing a disorganized heart rhythm, which ultimately resulted in dead bowel and sepsis. The man became critically ill, the story continues, but three weeks later he went home alive and well. This, Dr. Bach says, is why end of life resource utilization is a bad metric: if this guy, who had a high risk of dying, had in fact died in the hospital, the resources spent on his hospital care would have been considered wasted by the measurement. And I could not agree more that lumping all terminal resource use under one umbrella of wasteful spending is idiotic. Unfortunately, knowingly or not, Peter presented a faulty argument.

The case he used as an example is not the case. Indeed it is a straw man constructed for the cynical purpose of easy knock-down. When we talk about futile care, we are not referring to this middle-aged (presumably) relatively healthy guy, no. We are talking about that 95-year-old nursing home patient with advanced dementia being treated in an ICU for urosepsis, or coming into the hospital for a G-tube placement because of no longer being able to eat or drink. We are talking about patients with advanced heart failure and metastatic cancer, whose chances of surviving for the subsequent three months are less than 25%. And yes, we are also talking about some middle-aged guy with gut ischemia, sepsis and worsening multi-organ failure whose chances of surviving to hospital discharge are close to nil; but in his case, instead of being clear from the beginning, the situation evolves.

Legislative Pressures

Dec 20, 2011• 2

By PAUL LEVY

As financial pressures impinge the health care system, the various players sometimes seek legislation to protect their interests. I have heard of two such situations in Massachusetts, and I offer them for your consideration and your comments.

The first involves emergency ambulance service. Earlier this year, several of the major insurers in the state stopped reimbursing out-of-network ambulance providers, and instead started to send the checks to patients who used those ambulances. Those ambulance companies now have to try to collect from people for payments, and they are losing hundreds of thousands of dollars.

(This only relates to emergency calls, not routine transfers. For routine transfers, ambulance providers already agreed to be reimbursed at agreed-upon rates with insurers and municipalities.)

I can understand why the insurers want to use lower cost ambulance services, but I have trouble imagining a more cruel thing than approaching a patient or a patient’s family after an emergency situation (which perhaps led to long-lasting disability or death) to collect funds that the insurers have sent to the family. It is also inherently inefficient and adds costs if the ambulance companies have to try collect funds from hundreds of individual patients rather than the few insurance companies.

Rep. Jim Cantwell of Marshfield has filed a bill to force insurers to pay EMS providers, and it has a cost-control provision that would give ultimate rate-setting power to local selectmen. The Fire Chiefs Association, Massachusetts Municipal Association and Massachusetts Hospital Association support this bill. This sounds like one that, in legislative parlance, “ought to pass.”

Then there is a proposal that comes out of the growth of tiered networks, in which insurers charge higher co-pays or otherwise limit coverage to patients who choose higher cost providers. Well, it turns out that some of those high-cost providers are seeking legislation that would require insurers to include them in the low-cost tier of the network. The two fields at play are pediatrics and cancer care. The providers’ argument is that they offer essential services not available at other providers, or that they offer similar services but at higher quality.Continue reading…