Google Health Teaser

Google recently developed a partnership with the Cleveland Clinic to test its Google Health application.

Today, Google released a few teaser screenshots!

Modigliani-Miller Theorem Explained

"Think of the firm as a gigantic tub of whole milk. The farmer can sell the whole milk as is. Or he can separate out the cream and sell it at a considerably higher price than the whole milk would bring. (That's the analog of a firm selling low-yield and hence high-priced debt securities.) But, of course, what the farmer would have left would be skim milk with low butterfat content and that would sell for much less than whole milk. That corresponds to the levered equity. The M and M proposition says that if there were no costs of separation (and, of course, no government dairy-support programs), the cream plus the skim milk would bring the same price as the whole milk."

- Merton Miller from "Financial Innovations and Market Volatility"

Should your PCP be your Friend?

“The real price of everything, what everything really costs to the man who wants to acquire it, is the toil and trouble of acquiring it.”
--Adam Smith

It depends on if you think your car mechanic should be your friend. You see either professional about as frequently, mainly in times of distress. But the key difference is that your primary care practitioner (PCP) is your gatekeeper to the rest of the medical world, so it is worth your while to develop a strong relationship with one. You'll realize just how important this r'ship is when you move out of town, change your insurance, and oh yeah, get sick.

PCP shopping is essential. I just posted about the website, Vitals, which helps you do just that. There are many other sites that do the same, including the one your insurer most likely provides you (the most important!). You'll get a pretty long list of internists, family practitioners and general practitioners in your area and pretty soon you'll be scratching your head wondering just who to go to. Its pretty hard to compare doctors the way you compare cars and electronics. There's no consumer reports for physicians...at least not one that's agreed upon. But in general, keep in mind the following when making your choice:

1. Call and see how long the wait is before the next appointment. If its longer than 3 weeks, they're either really good or really inefficient. Double check if the doctor is on vacation or on service at a local hospital. That should give you a better idea of how they allocate their time. Then its up to you if you want someone reputed or someone reliable.
   
2. If you do choose the busy doc, ask who will take care of you instead when you absolutely have to come in. It could be another doctor, the head nurse or a resident. Either way, you have that much more information to work with.
   
3. Ask the secretary for a recommendation, then call again the next day and ask a different secretary. See if they'll let you speak briefly to a nurse and get her recommendation. This'll also let you know if they do phone consults either with the physician or the nurse. This way you can get triaged in quicker when you're sick.
4. See if they have an electronic medical record (EMR). This indicates many things about the practice; they're up-to-date, they're willing to spend the money to stay that way, and they want to be organized.
5. What about a website?? Do they partner with your preferred pharmacy? Can you refill your prescriptions online? Make an appointment online? Get test results online? Do they provide a personal health record (PHR) to help you organize your own health record and communicate your problems as they're happening?

Notice how none of the above goes into quality of care or bedside manner. There's very little out there to provide you with such metrics...again, its forthcoming. Who would've thought picking a doctor would be such a chore!? But its like anything else. You get what you put into it. And that all depends on how you answer the question above.

Get your Vitals Taken

George Van Antwerp posted a positive review for this site, Vitals.com, and I have to agree with him. I looked up some of the physicians I had worked with in the past and found out more about them than I ever knew before. It was startling at first to see their age, years of experience, and where they went to college. Then I started thinking about the ever-steady finding that more experienced physicians are simply better practitioners, so why shouldn't patients be aware of these characteristics?

Anyway, overall the site is really user-friendly. You can find a doc, figure out who to see for your problem and even rate the physician after your visit. Now it just needs critical mass.

More Rhetoric, Little Evidence

"When you encounter seemingly good advice that contradicts other seemingly good advice, ignore them both."
--Al Franken

This Valentine's Day NEJM article, "Does Preventive Care Save Money? Health Economics and the Presidential Candidates", speaks for itself.

"Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not. Careful analysis of the costs and benefits of specific interventions, rather than broad generalizations, is critical. Such analysis could identify not only cost-saving preventive measures but also preventive measures that deliver substantial health benefits relative to their net costs; this analysis could also identify treatments that are cost-saving or highly efficient (i.e., cost-effective)."

A visual always helps too:

Capitalism Entrapment

"The power of vested interests is vastly exaggerated compared with the gradual encroachment of ideas."
--John Maynard Keynes

I don't think there is such a legal term, but there should be. Or even better, it should be in the DSM-IV.

Capitalism's primary tenet is to promote efficiency in the interaction between buyers and sellers in a given market. Nobody really cares who is doing the selling or buying as long as they continue (and never stop) doing it. Its about the product, not the person.

I'm specifically thinking of Britney Spears. Young, talented and pretty, she makes it big on the world scene when she's 17 and now, a failed marriage and two kids later, she's suffering from a major drug problem. And selling. She sings about her problems and sells. She sings about being able to sell even though she has problems...and sells! We don't care about what's going on with her personally, we just love her music. She's enrapturing. She's entrapped.

The right or wrong of it is never clear. You can point to Bill Clinton's infidelity or Robert Downey's Jr.'s addiction or Ken Lay's corruption. But it depends which side you're on, the side that made money or the side that didn't. And money has the tendency to blind people to the hypocrisy in others' actions.

Bottomline is that as mega corporations continue to drive the mom's & pop's out of business, there's a growing disassociation between the seller and the product. To condone the behavior we want, we must ourselves live and breathe it. Eat better and exercise more if you want to curb the obesity epidemic. Become a socially responsible investor to avoid blindly funding oil, cigarettes, and fast food. Take responsibility and make yourself accountable for it, because everyone learns by example!

EDIT: How could I forget Martha Stewart!?

YOU determine the Value of YOUR Health Care

"Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened."
--Sir Winston Churchill

Heath Ledger's death was such a tragedy, especially considering the cause of his death; accidental overdose of prescription medication. Its so infuriating! We're always talking about asymmetry of knowledge and medication compliance, yet considering the scope of funding in health care, there's very little procured to make the physician-patient interaction more valuable.

We get very little time with our physicians, an average of about 10 minutes to discuss our problems. Considering a physician sees approximately 20 patients or so a day, you, as a patient, have to be succinct and clear in your relay of information and hope the doctor is a good listener. Beyond that, there's little you can change at the point-of-care.

But think of all the things that happen before you even get to see the doctor.

1. You call to make an appointment - insurance registration
   
2. Fill out forms - reason for visit, current medications, medical history
3. Sign some important looking papers - HIPAA, release of medical records
   
4. Get your vitals taken - base health status
   
5. Meet with the nurse - history of present illness (HPI), review of symptoms (ROS)
   

There's potential for breakdown and success on all these counts.

#1. Very little is more hazardous to your health than getting a huge bill from your doctor. Problem: Most likely the breakdown happened when the billing department forgot to call your insurance company and precertify you for services and procedures during your visit. Providing your insurance info is the first part of this whole process!

Solution: No matter how good your doctor's office is, check with the insurance company yourself! Make sure you know your copay and get your deductible information before you go in. After the visit, if you're prescribed a test or medication, check with the insurance company again to see where you should go. Sometimes the pharmacy or imaging center recommended by the doctor's office isn't covered under your insurance (or might not be the cheapest option!).

#2. This is probably the most important of all. Problem: You've written the same thing over and over again going to different doctors, but still you forget what that medication with the long name is called. Or you forget that you finished the course of your antibiotic treatment a few weeks ago. Or you decide that the headaches you've been having every so often are not important for your dentist to know. And did you fax your records from the previous 5 doctors you saw? Do you even remember the second one's name!? The list continues.

Solution: Get all your medical info in one place. Find a doctor that offers a personal health record (PHR) or web portal. Go online to HealthVault, RevolutionHealth, WebMD and fill in the blanks. These sites have put in a lot of work to make it easy for you. If you prefer paper, get a file folder and drop all your info in there. Take a CD, print out your record or take the file folder with you to the doctor's office so you don't forget anything!

#3. Complicated legal forms are a necessary evil. Problem: You don't really care about what you're reading so you sign and date at the bottom and hand them in. The front desk secretary files it away along with your ins. card and photo ID and when you come in the next time, for some reason you have to repeat this process.

Solution: Fill out your medical forms first and hand them to the secretary. Take the time to read what HIPAA is all about and fill out your PCP's name in the medical release form so he/she is notified of the current visit. If you can, check if the doctor's office has an electronic medical record (EMR). This avoids the practice losing papers (because they get scanned in electronically) and saves you time from filling out everything all over again. Also, request a copy of your medical records so you can enter them online or put them in your file folder. A doctor's office has to comply with your request within 30 days (10 if you're from NY)!!

#4. Don't worry about white coat syndrome. You're here to talk about what's wrong and get a medical opinion. On top of that, you came prepared! So relax and let the nice ladies fuss over you.

#5. This is where the nurse will go over everything you wrote down. Problem: There's a game of telephone being played here where the front desk talks to the MA who talks to the NP who talks to the doctor. To their credit, most of it is documented.

Solution: Your job is to be repetitive and stick to your story. Keep in mind the top 3 things you came in to discuss. Don't go on and on about how tired you felt after the Giants tailgate. Nurses usually ask you about pertinent things you might have overlooked like recent minor illnesses, allergies, or over-the-counter medications you're taking. Pay attention and be detailed about your answers.

By the time you get to see the doctor, both of you will have a clear idea of what your record represents and what you're coming in about. After restating the top 3 issues, the repetition can stop. Let the doctor ask the questions, be concise in your answers and ask for further explanation if you don't understand something. By the time you leave, you should have a general understanding of your treatment plan. Ask a nurse or MA for definitions and medical pamphlets after to make sure you have a full understanding . Remember, you're on the clock, so coming in organized prepares everyone for what's important; your health care!

McMe, Myself, and I

"Caveat emptor; 'Let the buyer beware'"
--Laidlaw v. Organ, John Marshall

Super Size Me is a good movie in presentation. A great movie in fact. I haven't eaten McDonald's in a very long time - at least 6 years - and now I definitely know I'm better off for it.

(Weird thing is, I ended up craving some Mickey D's by the end!)

The Last Bite

"Probably the difference between man and the monkeys is that the monkeys are merely bored, while man has boredom plus imagination."
--Lin Yutang

If you like something, do you want more and more of it? Most people generally believe that to be the case. Money, sex, food, friends, free time; in general, the pleasures of life that bring us happiness. But sometimes actually having more of that thing we like doesn't leave us as satisfied as having one less of that thing and wanting one more.

Think about it. Experiencing that mental and emotional desire of meeting a budgetary goal, enjoying a romantic night with your beloved, and craving that last bite of dessert is much more potent than getting as much of those things as we want. You meet a challenge, distance does make the heart grow fonder and too much dessert is bad for you. Its what whets your appetite for more that's enjoyable, not binging on your favorite dish (which just leaves you feeling bloated and sick).

This can be applied. Next time, get one less scoop of ice cream than you want, have one less drink, stop before you're full, spend five minutes less in the shower, get home a little earlier from the bar, watch one less hour of TV. You'll keep craving that activity to the point when you just have to have all of it. And that's one of the greatest feelings in the world.

What's up with the Food Pyramid?

"If you can't easily trace a food back to its source in nature, don't eat it."

--Gregg Avedon

While tracking the evolution of the food pyramid, I became delighted, confused and shocked all at once. What was once holy 15 years ago has now turned completely on its head. A few pictures will help...



What's going on here!? The red meat is now split at the top with white bread, rice and pasta to be used sparingly when before the steak image was lumped in with nuts and fish at 2-3 servings/day and the bread, rice and pasta were at 6-11 servings/day!! Quite the shift don't you think?

Look towards the bottom for daily exercise and plant-based oils as a major component and also the addition of alcohol in moderation. This is in line with what we've all been hearing over the years, but what strikes me is how long it took to get the message out there. I remember my sister and cousins being taught the old pyramid only 4 years ago in middle school and high school. Even if parents have been keeping up with the latest news and research, how are they supposed to explain to their kids that what they're being taught in school is wrong?

If you visit USDA's food pyramid site now, you'll find the most latest version called, MyPyramid. It basically allows you to customize the pyramid based on your age, sex, weight, height and level of physical activity. After inputting all the relevant values, the site provides detailed recommendations and even lets you pick a plan that will lead to a healthier weight (based on your original values). Definitely worth a look. About time they decided to shy away from a one-size-fits-all model.



If you're interested in the progression of changes in the pyramid and want to learn more about why it was so flawed to begin with, check out this page.

EDIT: Here's even more from the Harvard School of Public Health on USDA's flawed methodology in constructing the original food pyramid and how to determine what really is good for you to eat.