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Free Lunch: David Cay Johnston off the leash

Sep 20, 2008• 5

By Matthew Holt Freelunch

A version of this review appeared at Spot-on last week, but as you know over there I get heavily edited by Chris Nolan who’s a real journalist and all that. The beauty of the zero cost of publishing online is that you can show lots of versions. This is what it looked before it got to her. Enjoy.

Despite being buried in Health 2.0 work, somehow I’ve been managing to read a few books lately. But none of them have been quite as staggering as Free Lunch, the latest from former NY Times investigative reporter David Cay Johnston.

Johnston’s best known for his exhaustive investigation into how corporations and very very rich individuals subvert the tax code so that they pay less, while the rest of us pay more. But in this book (probably because he’s no longer a NY Times Reporter and is off the leash of restraint that the Grey Lady seems to put on its reporters) he gets almost biblical in calling out the cheats, crooks and murderers.

And when I say murderers, Johnston is talking about John Snow, Bush’s former treasury secretary — yup the one who did such a great job regulating the sub-prime mortgage market that the potential for a credit and housing collapse in the latter part of this decade was avoided…oh, wait….

23andme gets unwanted publicity

Sep 19, 2008• 11

By Matthew Holt

Sergey Brin, Google co-founder and husband of 23andme co-founder Anne Wojcicki, has announced that he has the gene for Parkinson’s disease and that his mother carries it to. She already has the disease, as did her aunt. Sergey has written about this on his new blog Too and it was picked up by the NY Times. Unlike the issues around Steve Jobs and his cancer, there’ll be no impact on Google’s business. If—and it’s only an “if”—Brin develops Parkinson’s it’ll be many many years from now. However, Parkinson’s is a very serious condition which people are right to dread—the father of one of my best friends has it, and his life is extremely grim.

Coincidentally I was doing my “spit” for 23andme just a few minutes ago when this story went on the NY Times site. So I can’t tell you about my results from them yet. I have though had my genome sequenced by Navigenics. Thus far none of the results have been compelling enough to make me actually do anything.

That of course is also Brin’s problem. At the moment there’s nothing he can actually do. In Genomics diagnosis is now running far far ahead of capacity for treatment.

But the hope of services like 23andme, Navigenics, DeCodeMe, and others aimed at promoting cures and treatments like CollabRx and Cure Together, is that the body of knowledge from both genomics and overall patient experiences will advance fast enough that the current situation of “more diagnosis with less ability to change the outcome” will slowly change to one where knowing your likely health future will help you avert some of the worse consequences.

Let’s hope so for Sergey’s sake and all of ours.

UPDATE: Just to clarify the headline, I don’t mean that 23andme does not warrant or deserve this publicity, or that they have done anything at all bad here. When I say "unwanted" I mean they are getting publicity for their service because of a situation that no one would want to happen to them (or to Sergey Brin). But of course that’s true for many many great health care services of all stripes.

Tags: Genomics

Cognitive Dissonance in U.S. Health Care

Sep 19, 2008• 40

By MAGGIE MAHAR

Princeton economist Uwe Reinhardt is well known as one of the bluntest—and wittiest—critics of U.S. Healthcare. Last week, we both spoke at a conference organized by Princeton’s Policy Research Institute on “Access to Universal Health Care: New Jersey, the Nation and the Globe. As usual, I learned something from Professor Reinhardt.

Earlier this year, New Jersey Governor Jon Corzine received a somewhat startling letter from Princeton economist Uwe Reinhardt. The missive was appended to a report from the “New Jersey Commission on Rationalizing Health Care Resources,” a Commission that Corzine had asked Reinhardt to chair.In the letter, Reinhardt expresses “some personal observations on the inconsistent expectations Americans have of their health system,” describing “these inconsistencies” as “a form of cognitive dissonance.” Reinhardt goes on to explain that, in his view, these inconsistencies reflect “certain deeply ingrained traits in American culture that stand in the way of a rational health care system.”He concludes: “In short, Governor Corzine, in my professional view, the extraordinarily expensive, often excellent just as often dysfunctional, confused and confusing American health system is a faithful reflection of the minds and souls making up America’s body politic.”After reading the letter, Governor Corzine had one question: “You’re not going to publish this in the report, are you?”

In fact, the letter did appear at the front of the report. And last week, at a conference on “Access to Universal Health Care: New Jersey, the Nation and the Globe” sponsored by Princeton’s Policy Research Institute, Reinhardt circulated said letter. It served as a good companion to Reinhardt’s speech, which compared what we euphemistically call our health care “system” to systems in other parts of the world.

McCain, Obama and Palin show ignorance on economic turmoil

Sep 19, 2008• 4

By Don Johnson

The presidential candidates, Sen. Obama and Sen. McCain, and the
vice presidential candidate, Sarah Palin are showing in their comments
on the financial crisis that none of them understand the crisis, the
economy or what’s behind the financial crisis.

They all need to sit down with their financial advisers and learn
what is going on so they can at least pretend to be smart about markets
and the economy.

What they are saying and the ignorance they’re displaying is simply appalling.

The treadmill-desk mashup goes primetime

Sep 18, 2008• 16

By Sarah Arnquist

Could walking at a tortoise pace all day long in the office keep you thin or help you lose weight?

Many people seem to think so and have built themselves treadmill desks — basically a treadmill with a raised platform for their computer and phone. Moving at less than 1 mile per hour all day long helps them burn between 250 and 350 calories a day. Don’t believe me? See this New York Times article. (Illustration by Eric Lister, from Gelf)

A couple of years ago, when I wrote a story about people using treadmill desks for the online magazine Gelf, the phenomenon was just beginning to surface on personal blogs. It’s clearly taken off. (David, the Gelf editor who assigned me the story, now has is own treadmill desk.)

There’s actually a lot of science behind the idea of work-walking, which comes mostly from the Mayo Clinic. Dr. James Levine and his team published research in Science back in 2005 showing that thin people tend to fidget and move around more often than overweight people, thus burning more calories. They call it NEAT— Non-exercise Activity Thermogenesis.

Two years ago, Levine, an endocrinologist, told me that he wanted this idea to go beyond a few individuals. He wanted corporations to embrace the idea, or at least promote practices that get employees moving more.

We’re a fat nation, and our evolutionary biology combined with our current environments practically guarantee we remain so unless we adopt some creative interventions. This definitely is a step in that direction.

Health Wonk Review is up

Sep 18, 2008

Jaan Sidirov at Disease Management Care Blog did a great job combining the best of the health blogs for this issue of Health Wonk Review.

Controlling costs is the central problem in U.S. health care

Sep 18, 2008• 10

Sbeller_headshot_small By Stephen Beller

The central problem in the U.S. health care system isn’t cost or insurance, per se, it’s the challenge of increasing health care value to the patient/consumer.

That means we must improve the poor quality and inefficiency of care, so that we all receive only the care we need, delivered in a timely and effective manner, without waste and over-treatment, and with a focus on integrating “well-care” (prevention and self-management) with sick-care.

It also means dealing with the knowledge void, an ironic situation in which our health care community is drowning in oceans of information, yet no one knows the best ways to prevent health problems and treat them cost-effectively, especially when you take individual differences into account. To address this problem, we need better health information technologies, as well as a collaborated effort to develop, disseminate, and deliver cost-effective evidence-based care.

If consumers were to receive high value health care in this manner, costs would be lower since poor care costs more and delivering only the minimal necessary care typically results in better outcomes! More appropriate care, delivered competently and cost-effectively through cost-conscious, patient-centered “medical homes,” for example, is the only way to control costs long-term.

Weak analysis about the “demise of Health 2.0”

Sep 17, 2008• 24

By Matthew Holt

Everyone’s favorite naysayer Dmitriy Kruglyak is getting very self-satisfied this morning about the failure of Revolution Health to change the world in three years. Normally, I leave Dmitriy’s bizarre wofflings alone, but because he’s directly "pointed the finger" at me and by extension at my partner Indu Subaiya, it’s time to respond.

While there may be a demise in Steve Case’s investment, Dmitriy proves yet again that his background as a software geek with no background in understanding the health care system — and his professional jealousy as the creator of a failed conference about blogging — gets in the way of his limited analytical skills of what he claims I’ve been saying about Health 2.0.

Yes, Indu Subaiya and I founded the Health 2.0 Conference to focus on the use of new participatory software tools in health care. Had Dmitriy paid attention when he attended the conference in 2007 he would have noticed that the audience was asked, what would be the future of the search, social networking, & consumer tools that made up Health 2.0? The response was that 70% felt that these tools would be adopted by mainstream health care companies, rather than become a standalone industry. Which was exactly what I have been saying all along.

On the Road Again: Health 2.0 Motorcycle Tour

Sep 17, 2008• 1

By David Kibbe

Kibbemotorcycle

In "Zen and the Art of Motorcycle Maintenance," Robert Pirsig writes about the different reactions to our experiences living with modern technology, which he describes as romantic, classic, and a third and completely separate element and perspective, which he calls Quality.

I’m finding that there is a bit of all three in my Health 2.0 motorcycle tour and the interviews along the way. It’s a curious revelation, and I’m somewhat awestruck by the relevance of his musings about how we lived during the 1970’s to our situation here in the new century with health, wellness, and the Internet.

Exploring and conquering new health care frontiers

Sep 17, 2008

By Scott Shreeve

The September/October issue of Health Affairs is dedicated to reviewing concepts of the medical home. It is most likely the most current, authoritative, and impressive review of this emerging idea. Health Affairs is an excellent resource for health policy wonks to gather, but in recent years has become more accessible to the general health care audience. I would recommend it as required reading for anyone interested in learning about this trend.

Simultaneously, there have been some recently updated “state of the industry” reports coming out of the retail health clinic world. As noted by Jane Sarasohn-Kahn, the fact that more and more retail clinics are being created has increased access, improved quality through an evidence based approach to a limited set of clinical conditions, but has not done nothing to address the cost issue. In fact, increasing the supply of retail clinics, has simultaneously increased the demand for these services. This is a common phenomenon within healthcare, and the supply driven demand has been well described particularly in the hospital setting.