The Health Care Blog – Page 961 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Researchers question publishing ethics of leading economics journal

Oct 21, 2008• 1

By Sarah Arnquist

Update: The Harvard Health Policy Review site is back up with an apology and disclaimer for not seeking a response from the JHE editors.

A Harvard Health Policy Review article that details two researchers’ account of unethical editing at the Journal of Health Economics (JHE) mysteriously has gone missing from the Internet (but not entirely–here’s the PDF). Actually, the journal’s entire site has been taken down.

The article is full of drama that rivals a John Grisham thriller. It involves the Ivy League, corporate greed, a suggestion of tainted science, and legal threats — which I’m guessing may not be over.

In the "missing" article, University of Pennsylvania sociologist Donald Light and health economist Rebecca N. Warburton, of Canada’s University of Victoria, recount their two-year ordeal to publish a critique of a 2003 study published in JHE, in which Tufts researchers — using confidential data supplied by drug companies — estimated research and development costs for a new drug at $802 million.

Light and Warburton had several criticisms of this article, namely the undisclosed conflicts of interest of the Tufts authors. But they say the JHE editors thwarted their efforts to publish a fair critique.

The "missing" article details the back and forth between the JHE editors (three of whom are Harvard professors) and the original authors. Light and Warburton called it "ultimatum editing," and said the editors "violated almost every ethical standard set for editors."

At one point in the process, Light and Warburton even threatened to sue. Alan Millstein agreed to make a legal case on behalf of the authors and drafted a complaint. “He did not expect much in monetary damages, but expected to win before a jury, revealing to the world how leading economists handled an independent critique of a key article concerning the high costs of drug development form an industry-sponsored research center.”

Merrill Goozner wrote about the conflict in his post, "Where’s Harvard’s Missing Health Policy Journal?" PharmaGossip also writes about the missing journal here.

You can lead a horse to evidenced-based medicine but …

Oct 20, 2008• 7

By Merrill Goozner

Note: This post first appeared at Goozner’s blog, Gooznews.

A new important and depressing study appeared last week in the Journal of the American Medical Association. Researchers who poured over Medicare records found that
less than half of seniors (44.5 percent) with stable coronary artery
disease who complained of symptoms like angina were whisked off to the
catherization lab for percutaneous coronary interventions (PCI) like
balloon angioplasty and stenting without first confirming by a stress
test that they were indeed suffering from reduced blood flow to the
heart (ischemia). Guidelines published by American College of
Cardiology, the American Heart Association and, significantly, the
Society for Cardiology Angiography and Intervention call for the tests.

Previous studies among the commercially-insured population are even
worse. Only a third of patients in the under-65 crowd with stable heart
disease but having symptoms are likely to have gotten a stress test
before getting PCI.

Why is this important? Let us count the ways:

* PCIs have increased 300 percent over the past decade and
accounted for at least 10 percent of the increase in Medicare spending
since the mid-1990s.

* Medicare spends $10,000 to $15,000 per PCI.

* While PCI may reduce ischemia and angina more effectively than
drugs, more than a half dozen studies conducted over the past decade
have established that in terms of reducing deaths or heart attacks, PCI
is no better than drugs alone.

* Patients who fail a stress test and then get PCI do better and have shorter hospital stays; and

* Patients who get PCI with minimal symptoms, with or without the
stress test, are at increased risk of repeat procedures and may
experience a deterioration in their overall quality of life going
forward.

Video games to revolutionize health and health care

Oct 20, 2008• 6

By Douglas Goldstein

The worldwide video gaming industry is a thriving business – with hardware and software sales reaching 43.5 billion in 2007 and projected to grow to more than 61 billion in the next 4 years. This growth isn’t propelled by just the latest teenage gaming craze, but by a variety of nontraditional organizations integrating video games, immersive simulations and virtual worlds to improve effectiveness and engagement across all business lines.

The October release of a new book, Changing the Game: How Video Games are Transforming the Future of Business, underscores this notion that video games are becoming a valuable tool for mainstream business. Used for everything from marketing to training to increasing productivity, “the evolution of video games has definitely given companies the ability to create virtual sandboxes that can provide a competitive edge.” As importantly, gaming can also create opportunities to reduce costs and increase profitability.

It may be surprising to some that the health care industry has been among the first to recognize the ‘game-changing’ potential of games in business and other environments. Leaders in the health care sector are now embracing video games as an integral part of a digitally enabled health culture.

MRIS: The good, the bad and the useless

Oct 20, 2008• 4

By Christine Gray

Note: This post first appeared at e-patients.net

Gina Kolata’s must-read article in last week’s Science Times points out vast differences in the quality of MRI’s as well as vast differences in the expertise of the radiologists who interpret them.

Patients need to understand this, because physicians sure as Hades aren’t going to tell you.

Kolata uses sports injuries as example. With suspected cancers, the stakes are life and death. A poor MRI was part of the reason my daughter nearly failed to get a proper diagnosis of a malignant sarcoma in her arm, and then nearly failed to get the proper treatment.

Personal health records and the law

Oct 20, 2008• 4

By Bob Coffield

The October edition of the Health Lawyers News, a publication of the American Health Lawyers Association (AHLA), contains an article I co-authored with Jud DeLoss, a principal in the law firm of Gray Plant Mooty, who blogs at Minnesota Health IT. On the eve of the Health 2.0 Conference this week the article provides a look at some of the legal issues around PHRs.

The article, The Rise of the Personal Health Record: Panacea or Pitfall for Health Information (pdf version),
provides an introductory background on the changing world of PHRs,
highlights Health 2.0 and covers some of the legal implications and
compliance issues for PHRs. We are working on a longer and more
detailed analysis that will be turned into a Member Briefing for the Health Information and Technology Practice Group.
I would appreciate your posting a comment on topics or legal
implications that we might consider covering in the full Member
Briefing.

If you are a health lawyer, law student interested in
health law or otherwise interested in the the legal aspects of the
health care industry and not already a member of AHLA
— think about joining.

Bob Coffield is a health care lawyer practicing in Charleston, West Virginia in the law firm of Flaherty, Sensabaugh & Bonasso, PLLC who blogs on health care legal issues at Health Care Law Blog.

Finding ‘Original Faith’ but not in the health care system

Oct 17, 2008• 13

By Paul Maurice Martin Paulmartin

Thank you to The Health Care Blog for this opportunity to share my patient’s
perspective on health care and how it has helped shape my new book, Original Faith: What Your Life Is Trying to Tell You. I should mention at the outset that the book speaks to human experiences and actions, not doctrine. It argues neither for nor against any form of religious belief.

My progressive illness began with the sudden onset of what was misdiagnosed for several years as Myofascial Pain Syndrome. Despite eleven years of research and medical travel, no diagnosis was ever reached. For the past several years I’ve been housebound, increasingly bedridden and essentially without access to medical care related to my condition, which includes severe peripheral neuropathy and osteoporosis, connective tissue degeneration, and special adaptive needs. My situation may be a good starting point for considering the cracks – or crevasses – in the system.

In an under-regulated health care environment where the only bottom line is the bottom line of increasing profit margins, those with long-term illnesses that are difficult to diagnosis or treat are literally not worth the extra time and effort. Here’s one example from my own experience; I could give many more.

The toughest job in America

Oct 17, 2008• 14

By Jane Sarasohn-Kahn

Today, the loneliest job in American isn’t being the Maytag repair man. And the hardest job in America isn’t necessarily the Presidency. It’s being a state governor.

Take Pennsylvania (the state I call my home). Governor Ed Rendell sought the position with an explicit goal of expanding health insurance to uninsured Pennsylvanians. After two years in the job, Rendell is facing declining tax revenues, increasing costs. Rendell is already facing a $281 million deficit in this fiscal year, which could increase to over $1 billion. A detailed analysis of this story was published by PR Newswire, "Pennsylvania’s Loss of Employer Health Coverage Outstripping National Average."

The Kaiser Commission on Medicaid and the Uninsured has been studying other state initiatives targeting covering the uninsured. The Commission has found that in California, Illinois and New Mexico, for example, have been unable to broaden health insurance access to citizens without it.

Do you have an Avatar?

Oct 17, 2008

By Robin Strongin

THCB Note: This post first appeared at The Disruptive Women in Health Care Blog. There’s lots more great posts. Check it out!

If you don’t have an avatar, you may want to seriously think about creating one. I
am. I’ll admit it, at first I was skeptical, but the more I see the
benefits of virtual worlds, the greater the value and potential I can
see for health care.

An Avatar, as Wikipedia notes, is “a computer user’s representation
of himself/herself or alter ego.” (Hmmm, wonder what Joe the Plumber’s
avatar might look like)…

Avatars are used in virtual worlds like Second Life and Whyville.

Second Life

Second Life is the most well-known virtual world with more than 13
million registered users. It is primarily a social environment with a
strong creative component, since any user is allowed to create content
within the world. This highly-modifiable environment makes Second Life
uniquely suited to educational campaigns. For example, a space could be
created to simulate the everyday difficulties that people with mobility
challenges (i.e., people in wheelchairs), cataracts, or
diabetes-related eye illnesses face to help educate those without these
conditions.

Whyville

Whyville is an educational virtual world geared towards preteens and
children (ages 8 to 15) whose goal is to engage its 3 million users
across a broad array of subject areas, including healthy living, art,
history, and social issues. One could imagine an opportunity for
multi-generational education by creating “DiabetesTown” within Whyville
that would educate users about the importance of proper diet and
exercise, regular vision screening, and what life is like for friends
and relatives with diabetes.

Innovations in second life

Oct 17, 2008• 1

By Alice Krueger (SL: Gentle Heron)

THCB Note: Alice Kreuger recently updated THCB about all the exciting things she’s doing in Second Life on Virtual Ability Island. Here is a quick rundown. If you’re unsure about second life, check out this video.

We just opened Virtual Ability Island, which is accessed through our Web site. Newcomers with disabilities can come directly to the island from the site, including opening a new SL account and creating their avatar, entirely bypassing the Linden Labs orientation facilities.

Our innovative orientation facility is disability-friendly, and the instruction there is divided into two parts, beginning and advanced. The beginner course covers six basic skills that can be learned and practiced in an hour. The instructional sequence for newcomers is linear, provides embedded practice, and is based on principles of andragogy, the theory of adult learning.

Tracking media coverage of health care

Oct 16, 2008• 5

By Chris Weaver

Headlines and A1 charts stuck with the stock market, Washington’s changeling rescue
proposals and the plights of anxious finance firms in the week between the Palin-Biden debate and John McCain and Barack Obama’s town hall face off last Tuesday. The economy was a subtext to most of the other issues drawn into the election vortex.

Coverage of two issues – health care and taxes – nearly doubled. Health care stories increased across all media from 256 stories to 439. Tax stories rose from just over 400 for the week to nearly 800 between the weeks ending Sept. 29 and Oct. 6, according to stories polled for the LexisNexis Analytics dashboard.

This spike in incidence is not unrelated. Tax stories are hot as voters stare at a growing deficit and watch their 401k’s plunge, but tax talk has also become a predictable symptom of health care reform stories.