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November 29, 2007

Continuous Life Learning

Looking back on my notes from last semester I found pages with the title "New Things To Learn". I used to write these look-up-later notes during classes or at seminars. Kind of like jotting down words you don't know when you're reading a book. Surprisingly I actually recalled the ideas or people or articles I had written down to look up more than 6 months ago. I guess this technique worked for me.

Managing time, improving recall, and continuously adding layers to our knowledge base has become harder in today's one-click-learn world. Anything we want to know is now available to us anywhere, anytime. But is it retained? Or recalled when you most need it? Developing the right habits is key, and it all starts with curiosity, the kind of desire to learn we felt when we were 5 and saw lightning for the first time. Being a life intellectual isn't easy, but its become a necessary skill set in order to be "in the know" nowadays. Ben Casnocha espouses and promotes this kind of learning and Ed Boyden provides a detailed methodology for applying it.

The question now is not if you have to be aware and keep up with modern technology and emerging trends, but rather how you're going to do so.

November 28, 2007

Arnold Kling on Universal Health Care

"Government is not as efficient as it might seem. While the government can operate without profits, it cannot operate without taxes. Taxes discourage work, thrift, and risk-taking. The deadweight loss from taxes as a percentage of revenue is higher than insurance company profits as a percentage of their revenue."

The full article can be found here.

November 27, 2007

The Different Ways Technology and Health Care work Together

When I met Dr. Bernardo in 2004, he was working on a virtual reality simulation program educating surgeons to navigate the convoluted areas of the brain during surgery. Overlapping a 3D layer on top of an actual recorded surgery, he created a step-by-step tutorial by re-performing the surgery with simulated tools. It had to be the one of the most remarkable things I'd ever seen. Now that it's done, the course in skull base surgery is being offered at Weill Cornell Medical College in New York City.

This remarkable way of teaching using online and virtual programs has expanded to many other areas. Medical students are now watching short videos on iPods to learn how to perform ultrasounds. Nurses are using an online virtual reality network to learn how to diagnose and treat patients in the ER. Even patients are benefiting from information online. The internet has been cited as contributing factor in the recent decline in cancer rates, primarily due to early diagnosis.

This is how technology and health care are going to combine and grow, through consumer and provider engagement. Hospitals, insurers, employers all have their own incentives to be involved, but none as pure as the patient or physician's desire to improve health directly.

November 25, 2007

Overmedicated America: Reason One (continued)

NYTimes has an article out today called, Dr. Drug Rep. Its one psychiatrist's revealing story of working for Wyeth Pharmaceuticals on the side to promote certain antidepressants. Such blatant drug-pushing and doctor-marketing makes us more susceptible to taking stuff we shouldn't, or even choosing dietary, exercise or behavioral alternatives instead.

Paying attention to what outcomes are being looked at is extremely important. Mortality vs. survival rates, remission vs. response rates all make a difference in how one's study comes out. When big money is involved, there's no reason to quote results on all outcomes, just the ones that are convincing. Dr. Calter from the article elaborates...
"In his study, he emphasized the remission rates and not the response rates. As I listened to his presentation, I wondered why. Was it because he felt that remission was the only really meaningful outcome by which to compare drugs? Or was it because using remission made Effexor look more impressive than response did?"
Below are some further quotes that might entice a full read.
"Was I swallowing the message whole? Certainly not. I knew that this was hardly impartial medical education, and that we were being fed a marketing line. But when you are treated like the anointed, wined and dined in Manhattan and placed among the leaders of the field, you inevitably put some of your critical faculties on hold."

"How many doctors speak for drug companies? We don’t know for sure, but one recent study indicates that at least 25 percent of all doctors in the United States receive drug money for lecturing to physicians or for helping to market drugs in other ways."

"The term “decile 6” is drug-rep jargon for a doctor who prescribes a lot of medications. The higher the “decile” (in a range from 1 to 10), the higher the prescription volume, and the more potentially lucrative that doctor could be for the company."

"The American Medical Association is also a key player in prescription data-mining. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money."

"At that moment, I decided my career as an industry-sponsored speaker was over. The manager’s message couldn’t be clearer: I was being paid to enthusiastically endorse their drug. Once I stopped doing that, I was of little value to them, no matter how much “medical education” I provided."

November 23, 2007

The Resistance Evolution

What a shocking read! Stephen R. Palumbi's article talks about antibiotic and HIV resistance to drugs and plant and insect resistance to pesticides. Here are some stats:

That's about a 14 year difference between the year resistance was developed and the year the antibiotic or herbicide was deployed. This was written in 2001 by the way! Imagine where the cycle is now, 7 years later.

Here's the kicker:
"Up to one-third of U.S. pediatricians report overprescribing antibiotics to assuage patient concerns, particularly in cases of viral childhood congestions that cannot respond to the drug (32)."
I wonder how patients will respond when they find out they received not just a placebo which didn't do anything, but an actual drug that will now work less effectively if they have a bacterial infection.

November 21, 2007

Overmedicated America: Reason One

Incentives to prescribe and specifically prescribe certain brand names exist in subtle forms of bribery everywhere in health care. Representative DeFazio seeks to solve this with legislation requiring Rx companies to "list both gifts of $25 or more and the physicians who receive them."

I wonder if sponsored seminars, lunches, dinners and sometimes vacations count on that list. Physicians are smart enough to know they're being bought, but once the seed has been planted...

November 14, 2007

Physicians, Patients and Online Video

iHealthBeat recently featured an article called, "DrTube: Physicians Tap Online Video To Communicate With Patients". Click on the link to directly view it.

The paradigm shift in physician thinking from independent contractor to entrepreneur is a key point in the article. Connecting with patients on their level, assessing demand for services and supplying to that demand in simple terms is basic marketing but a relatively new concept in modern medicine.

Here's the bottomline:

  • Seeing is believing, so utilize online video to educate, discuss and connect with your patients
  • Personalize your practice by giving patients an inside view even before they come to your office
  • Help patients connect to each other through online support groups and video forums
Advertising in health care results in two money transfers. One, it reduces cost to the consumer since an informed patient makes better choices. And two, it increases willingness to pay for the same informed patient who now feels more comfortable with the service he/she is receiving.

Overall, information transparency contributes to the passive dialogue that occurs prior to the actual patient visit. This is a great strategy for attracting new patients and building a stronger physician-patient relationship.

November 7, 2007

Oh RHIO, Where Art Thou?

My experience at the State RHIO Consensus conference in DC was educational, but it lacked definition. Literally. A lot of great ideas were thrown around but everyone was reading from their own page when defining what a regional health information organization (RHIO) does or what health information exchange (HIE) should be all about. Then again, we were there to reach a consensus.

Convene. Coordinate. Operate. These three action items are the necessary steps to create a solid health IT infrastructure. They represented the template the conference leaders worked from.

A RHIO fits the first two and HIE the last. A collaboration of individuals representing the major health care centers convene to set policies, protocols and standards for HIE. They coordinate underlying parties and align objectives towards the common goal they reached when they were convening. Finally, the HIE represents the technical operations of setting up how the exchange will occur. The programming and technological tools that will make it work.

Beyond definitions, here are some of the neat ideas that emerged:
  1. A council of states to set privacy, safety and quality standards
  2. Getting rid of duplicate patient records and creating a Master Index
  3. Concentrating on state borders for HIE
  4. Setting up an accreditation board for vendors (beyond CCHIT)

November 4, 2007

RHIO

RHIO stands for Regional Health Information Organization. Its a mouthful for an initiative that local and state governments are working on to make your health information more accessible. Just like email, it'd be nice if you could view your medical records from anywhere; recent doctor visits, prescriptions, maybe your lab work. It'd be even nicer if a doctor could see your medical records, say if you hurt your leg hiking far away from home and were allergic to a certain anesthetic and didn't have the wherewithal (because you were in pain!) to tell him.

Local hospitals and clinics are doing an OK job getting an electronic version of what used to be all paper records installed in their offices. But with all the different Health IT (HIT) vendors out there helping this process along, somebody's gotta work on getting them connected. That's what RHIOs are for. Start small at the local to state level and work your way up to a National Health Information Network (NHIN). That's the basic idea.

I'm in DC for a State RHIO Consensus conference hoping to get more info right from the source. Stay tuned!