For the last few months, I’ve been working with a stellar all-volunteer team who has put together a great event that brings together innovators in Health Information Technology.

Won’t you join us?! Learn more here!

When: Wed, 03/14/2012 – 5:00pm – 8:30pm

Where: Washington Museum of History and Industry
2700 24th Avenue East
Seattle, WA

*** WE HAVE EXTENDED OUR EARLY BIRD RATE UNTIL 5:00 PM, FRIDAY, MARCH 9 ***

Health IT is transforming our healthcare system. Healthcare reform, industry consolidation, and demographic changes have spurred a significant increase in the U.S. healthcare industry’s use of technology to improve health and enhance the patient experience while trying to help control the ever-increasing cost of care. New players are emerging and cloud computing, social media, and mobile technology solutions targeting patients and healthcare providers are creating new opportunities.

Join us for our March 14 MIT Enterprise Forum and discover how NW technology entrepreneurs can identify these opportunities and succeed in the health IT market. Our panel of industry thought-leaders moderated by Rob Coppedge, Vice President of Business and Corporate Development at Cambia Health Systems, includes:

• Sailesh Chutani, CEO, Mobisante
• Peter Gelpi, CEO, Clarity Health
• Luis Machuca, President & CEO, Kryptiq Corporation
• Gwen O’Keefe, MD, Chief Medical Informatics Officer, Group Health

Our panel will provide an overview of major health IT trends, the new opportunities technology presents for both patients and healthcare providers, as well as explain how this may enable change in the traditional healthcare industry cost structure. Most importantly, our speakers will identify business opportunities and what regulatory restrictions such as HIPAA really mean for the NW technology entrepreneur community.

Audience Takeaways

During this event, you will learn:

• How the health IT market has changed in the wake of healthcare reform and government investment incentives
• What different types of care and cost models might look like, and what opportunities those present for entrepreneurs
• Potential sources of funding for innovative health IT technologies
• Approaches entrepreneurs can take to handle barriers presented by government regulations such as HIPAA

Look, I get that not everybody is as geeky as I am on these issues, but if you’re writing on health for a national newspaper, these findings should in no way be a surprise to you. Representing it as such to your readers really demonstrates how little attention you’ve been paying to your chosen profession.

Americans Exercise More, But Still Get Fatter

Well, the headline got it right, but when you read the post, you get the same yadda, yadda about ‘lowering caloric input,’ ‘avoiding fat,’ and ‘exercising more.’

Just another reminder to look the other way when you hear the conventional wisdom. There is a new wave coming. Stick with me and I’ll keep you right out front on the leading edge.

Interestingly, the article does not appear with the link above any more. Here’s the article I coped from my

Our workouts aren’t keeping up with our pig-outs.

That fitness routine is soooo not working. More Americans are spending some of their leisure time exercising, yet folks just keeps piling on the pounds.

Here are the cold, hard facts. About 35 percent of adults engage regularly in physical activity when they’re not working, according to estimates based on a 2009 nationwide survey. That’s up from 32 percent in 2008.

Now, what’s the scale tell us? Not good. More people in the U.S. are obese than ever. In 2009, about 28 percent of people in the U.S. were obese, up a fraction of a percent from 2008.

But hop in the Wayback Machine and check the weights in 1997. Nineteen percent of people in the U.S. were considered obese then.

There’s not a moment to lose in doing something to reverse the weight trend. A recent study found that a substantial decline in the rate of heart attacks could be fleeting as obesity and diabetes become more prevalent.

Exercise can only burn so many calories. Eating better is crucial. Recommendations for new nutritional guidelines would cut saturated fats even more than in the past and promote healthier foods, like fruits and vegetables.

But maybe you want to try some more reps of that time-honored weight-loss exercise move — pushing back from the dinner table.

What you *really* need to do to be healthy (which, by the way, will lead to healthy weight) is drastically reduce carbohydrate consumption (eliminate sweets and processed carbs), get your inflammation down (principally by upping your Omega-3 and reducing your Omega-6), getting your Vitamin D in a good range (50ng/ml, remember?) and lifting heavy things on a regular basis (see my BBS posts).

None of this aerobics and calorie restriction, OK?

The Truth About the Drug Companies: How They Deceive Us and What to Do About It

While it’s gotten to be pretty easy to pick on the pharmaceutical industry of late, this laser-focused book does more than just lob a few broadsides. It pretty much eviscerates every one of the major arguments put forth by the pharmaceutical industry for their practices.

The author is Dr. Marcia Angell, who has had a front-row seat having worked on the staff of the New England Journal of Medicine for 20 years – winding up her career there as Editor In Chief in the late ‘90s. It’s hard to over emphasize the gravity of someone of Dr. Angell’s experience and stature writing a book like this that, as far as I can tell, doesn’t pull a single punch. I suppose it shouldn’t be an enormous surprise, She is married to Dr. Arnold Relman whose book A Second Opinion does much of the same for the entire practice of medicine in the US.

A Second Opinion: Rescuing America’s Health Care

Though this book is kinds long-in-the-tooth by medical policy issues standards (having been published in 2004) it’s not just a little depressing to note that the fundamentals haven’t changed (although, I should be fair and note that there have been some changes in the margins – will get to those in a bit)

So, what are the big takeaways, just in case you don’t read the book . Well, here are a few:

• By any objective measure, pharmaceutical companies pay *at least* twice as much for marketing and promotion of their products as they do for research and development of products. It might do well for you to really take that in. An industry that constantly bombards you with the holier-than-thou pronouncement of the centrality of their products to life itself, spends at least twice as much in marketing and promotions than it does for the actual science.
• ‘Education’ to physicians and other care providers, is actually nothing more than a form of marketing. Everyone knows this but most choose to remain silent and play along
• ‘Research’ (i.e. many of the clinical trials used to tout the capabilities of drugs) are nothing more than marketing in disguise. This is especially the case for the ‘Phase IV’ trials that take place after a drug has come to market. These trials are almost exclusively biased towards enabling the results to be used as marketing and promotions fodder – not for the purpose of actually determining the effectiveness of the drug or comparing its effectiveness with other treatments.
• The price-fixing of the cost of drugs in the US (brought to you by millions of dollars in lobbing might heaped on your local legislators) is a putrid, steaming pile of excrement that is hard to believe those in charge sit in every day without expiring from the fumes.

Now, to be clear, I’m clearly not against pharmaceuticals, per se. We are able to live longer, healthier lives because of the breakthroughs in pharmaceuticals. There is a point at which one has to ask: are the benefits that are accruing to us now worth the cost?

Not only does Dr. Angell lay it on pharma, she also makes a few, common-sense suggestions for you, the consumer, to consider when encountering the medical care system:

When your doctor prescribes something, ask:

• Where’s the evidence this works at all, or better than another, older, drug?
• Are you getting your ‘evidence’ from the pharma rep, or was there an independently-funded, well-designed clinical trial that proved it was better?
• Do you have any financial ties related to the prescription?

Other tidbits:

• Ask your elected representatives if they receive contributions from the pharmaceutical industry.
• Ignore direct-to-consumer ads for prescription drugs.

In this installment, I highlight Obesity Myths dot com (by the way, I’ll typically refrain from actually linking to the sites – I know it’s silly). Came across this site after doing a little reading in connection with my recent post on corn syrup. Here are a few whoppers:

• Myth: High Fructose Corn Syrup Uniquely Contributes to Obesity
• Myth: Soda Causes Childhood Obesity
• Myth: Obesity Has Made Diabetes Epidemic

Turns out our friends at Obesity Myths are an offshoot of The Center for Consumer Freedom. Here’s what CCF say about their funding sources:

Who funds you guys? How about some "full disclosure"?
The Center for Consumer Freedom is supported by over 100 companies and thousands of individual consumers. From farm to fork, from urban to rural, our friends and supporters include businesses, their employees, and their customers.
The Center is a nonprofit 501(c)(3) organization. We file regular statements with the Internal Revenue Service, which are open to public inspection.
Many of the companies and individuals who support the Center financially have indicated that they want anonymity as contributors. They are reasonably apprehensive about privacy and safety in light of the violence and other forms of aggression some activists have adopted as a "game plan" to impose their views, so we respect their wishes.

It would be funny but it’s hard to laugh while fighting the gag reflex.

Another perspective given to us by the crowd can be found at SourceWatch.org:

The Center for Consumer Freedom (formerly called the "Guest Choice Network") is a front group for the restaurant, alcohol, tobacco and other industries. It runs media campaigns which oppose the efforts of scientists, doctors, health advocates, environmentalists and groups like Mothers Against Drunk Driving, calling them "the Nanny Culture — the growing fraternity of food cops, health care enforcers, anti-meat activists, and meddling bureaucrats who ‘know what’s best for you.’"

Starting out smoking

Rick Berman launched the Guest Choice Network in 1995. Its initial funding came entirely from the Philip Morris tobacco company. Guest Choice Network was formed so as to appear not to be "owned" by Philip Morris; address restaurant owners lack of interest in Philip Morris’ "Accommodation Program" and broaden industry appeal. According to a September of 1995 letter from Mr. Berman to Barbara Trach, PM’s Sr. Program Manager for Public Affairs, GCN was designed to:

"Create an aggressive mentality by (restaurant) operators (to oppose) government smoking bans."

Well, it was probably already obvious to most readers that these people are just shillin’, but I thought I’d drive the point home here since it passed my field of view.

Stay tuned for more on the DBT front. I’ve got a few more queued up for you. These next ones might not be such a slam dunk for some of you.

While I’m all for less consumption of corn  syrup in all its form (high-fructose or otherwise), I wonder if we’re just going back to the good ol’ ‘natural’ sugar. That the fructose/glucose mix of sugars (whether cane or beet) is virtually equivalent to corn syrup is still lost on most people. The encouraging sign is the whole Sweet Surprise campaign (can’t bring myself to link to it … do a search if you want to find it) might possibly wind up backfiring on the whole lot of sweeteners given that the one accurate claim of the campaign – that corn syrup is not that different from sugar – is one that is likely to stick.

If you’re interested in an eye-opening look at the whole corn shtick, check out the movie King Corn. Two college buddies from the east coast find out sets of their respective grandparents came from the same little town in Iowa and they set out to discover their roots and learn all you never wanted to know about the brave new agribusiness world of corn production. You’ll be interested (but, perhaps, not surprised) to find that corn functions more like a raw material used in the production of other things that it functions like a ‘food.’ Available on demand at Amazon, Netflix and other places, I’m sure. Perhaps even at your local library?

In the April journal of the Obstetrics and Gynecological Survey, there was an alert put out to all Obstetricians, Gynecologists and Family Physicians regarding the mounting evidence of a a strong association between some common complications related to pregnancy and child birth (preeclampsia, spontaneous preterm birth, gestational diabetes, and fetal growth restriction) and the mother’s vitamin D levels.

In fact, they highlight the “significant, intractable disparities” that exist in rates of major pregnancy outcomes between black and white women. Given, as I have noted before, that only THREE PERCENT (3%) of black people in the US have sufficient levels of circulating Vitamin D, it should not be surprising that these scientists believe there may be a connection. You may recall that this ‘sufficiently’ level is 30 ng/mL which is still not optimal (50 ng/mL). While we do not have broadly-collected data on this statistic, one would expect the percentage of black people in the optimal range to be very close to –0-.

There is a summary of this report available on PubMed. Also, our just slightly offbeat, but always on point Dr. Joseph Mercola has a very comprehensive write up on the topic entitled "How Sunshine Can Prevent Birth Defects". Here’s just a sample of the things Dr. Mercola covers in this eye-opening article:

• Birth Defects
• Vitamin D Deficiency and Brain Damage
• Maternal Vitamin d Deficiency Causes Learning Disabilities
• Dyslexia, Poor School Attendance, Low Apgar Scores And Low Birth Weight
• African-Americans Are at a Much Higher Risk
• Severe Vitamin D Deficiency More Than 20 Times More Common in Young Black Women

You don’t have to wait for all the studies to come in. Hopefully I’ve convinced you to alert all those who are pregnant or thinking of becoming pregnant need to get their Vitamin D in to the optimal range (remember, 50ng/mL).

While the Qlience medical home model is one I have strongly advocated, I have my reservations about the extent to which they can be broadly successful in the areas where we need it the most: caring for patients living with chronic conditions. Yes, I’m sure they can provide great services for the large majority of young, healthy people, but their contribution to the overall healthcare dollar is relatively small (depending on who you ask between 5% and 10%).

But when it comes to advancing chronic care management, you need a medical home that is not silo’d off from the rest of the continuity of care. Quite the contrary, the medical home needs to be the fulcrum around which all care is managed. Yes, I know some think ‘managed’ an ill-advised word to use – loaded as it is with 1980’s ‘managed care’ baggage. However, that’s exactly what’s needed to ensure the appropriate care if provided and care is truly coordinated to reduce errors and duplication of effort.

Don’t quite see how the Qliance model works in the big bad world of chronic care management, but I like the concept.

In an earlier post, I expressed my delight that we were able to get substantive health insurance reform signed into law in this country. To say (as some have) that this step was not a big deal just flies in the face of the facts … it really was a big deal (I know, ‘cause Joe told me). It is also true that no matter how much we change the rules around how medical care is financed, unless we take on the much more difficult task of re-orienting the incentives for care around patient outcomes emphasizing both primary and secondary prevention, it just won’t matter. At current course and speed, we’re headed off a cliff.

Enter Don Berwick. Actually, he entered almost two decades ago as the seeds for the Institute of Healthcare Improvement took hold. He has been a relentless and tireless advocate for outcomes-based, patient-centered care. If anyone was wondering how ‘serious’ the current administration is about getting value for our healthcare dollar, this is an emphatic answer.

To get a glimpse of where he want to take this thing, he threw down the gauntlet (in 2008) on the site only a true health wonk could love – Health Affairs:
The Triple Aim: Care, Health, and Cost

As the white-hot conflagration of issues related to health system reform raged in the US in 2009, I acquired an almost insatiable appetite for learning more about the complex issues facing US health care. For my regular readers, it may not be a surprise to you that I forged a point of view that might be considered a league apart. Not that I found no merit in the various points of view being expressed, but that I found each perspective having fairly major flaws that seemed obvious to me.

For example, those who hew to the idea that ‘free market’ mechanisms are the optimal way through which we obtain the best value out of our healthcare system don’t seem to notice that ours is the most profit-oriented system in the entire industrialized world and we spend more per capita (by a long shot) than anyone else. Wouldn’t those in law enforcement consider this a clue? To dismiss the variance by touting the ‘additional costs’ of world-leading medical breakthroughs in medical devices and pharmaceuticals begs the question ‘To what end?’ – given the well-documented paltry outcomes (overall morbidity, infant mortality, life expectancy, etc.). Also, while you could make a theoretical argument that pharmaceutical company, medical device and hospital profits lead to better care (by enabling investment in better approaches to care – I am not convinced), I have yet to see a single remotely defensible argument that links insurance company profits to improved health outcomes.

Still waiting.

Conversely, those who tout ‘single-payer’ as a cure-all do so, it seems to me, as a matter of faith. Setting aside the political and economic obstacles in the way of instituting a ‘single-payer’ system in the US, I’ve yet to see a cogent explanation as to how single-payer in and of itself transforms healthcare. Yes, it would certainly increase access to medical care, but it is no solution at all to ensuring that said access is sustainable for the long term. My other problem with ‘single-payer’ is more ethereal. I just have an aversion to mono-culture. It seems to me that we need an approach that is not just functional for now, but also sustainable and adaptable over the long term. A diversity of approaches is needed in order to achieve that end. I’m not convinced a single approach to funding the entire system would give us that adaptability. We will still need to innovate as time moves forward and the best way to enable innovation is to have a diversity of ideas that would not be fostered by a single-payer approach.

So, over the course of many months, I mulled whether I would begin to use these pages as a vehicle to express my thoughts on broader health policy issues in addition to the health/wellness topics I started off with. Finally in January 2010, I made some initial, tepid steps. But it still lacked coherence. Am I touting myself as a health policy wonk type? (a mini-Uwe) Am I advocating on behalf of a specific, well-established point of view? (well, I guess not, if I’m saying that all of the major entrenched positions have significant flaws). It finally occurred to me the role I was taking on was that of a ‘health citizen.’ Citizen in the most active and broadest sense of the word which encompasses being an informed and active participant in the political, economic and social life of your society not as a self-appointed ‘expert,’ but as a private citizen very focused on pushing us to deliver value out of every element of the system.

So, what does it mean to me to be a ‘health citizen?’

• While this is readily obvious, it seems to continually get lost in the debate: health care and medical care are not interchangeable. In fact, if we were to assign a percentage impact of medical care on the overall health of society, it would constitute no more than 15% of the total. What are more important are the social determiners of health: clean water, sanitation, protection from toxins, good education, nurturing human interactions. The extent to which we lay the burden of health care on those who deliver medical care we feed into the monster that has become the medical-industrial complex. A health citizen understands this distinction and acts accordingly.
• Each of us needs to take personal responsibility to use medical care resources thoughtfully and judiciously. We must begin to think of our medical care resources in a similar way to our natural resources. These services have now become part of the ‘commons’ we all share. Consuming an inordinate amount of these resources out of fear or simple entitlement furthers the ‘tragedy of the commons’ to which citizens will not contribute. It has also been well demonstrated that more medical care is not necessarily better medical care. A health citizen uses only what he or she needs even to the point of questioning the need for things that their care provider recommends.
• In a direct tie-in to the wellness thrust of this blog, to the extent we can improve our own health, the easier it becomes to be an asset to the health of our society as opposed to a liability. It seems very odd to have to point this out given that one would think the primary incentive for making healthy choices is to, well, be healthy. It is apparent, however, that many millions of us continue to make choices we all know to be detrimental to our health. This is exacerbated by the bankruptcy of the conventional dietary (low-fat/high-carb) and exercise (chronic cardio) wisdom that is detrimental to many millions more who are acting on this disastrous advice and believe they are doing the right thing for their health. A health citizen takes part in bringing forth the new conventional wisdom.
• Engaging with others is obviously a central part of being human. A health citizen participates actively in a community that supports each other in pursuing better personal wellness in addition to pursuing better health for the broader society.

This whole idea is a work in progress and I’d be interested in your thoughts about it as I hone this into something that can make a difference.

Thanks for getting through this one, I know it’s long!

The health reform bill that has just been passed (officially “Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010”) has been hashed, re-hashed and covered in more places than I can count. However, as is practically always the case, the Kaiser Family Foundation has the most even-handed, complete and timely description of what’s in the bill. I highly recommend you spend time with the summary they’ve provided:

Summary of Coverage Provisions in Health Reform Bill

He’s now trained his sights on a very specific, and uncommon issue: that of the use of checklists during surgical procedures.

The Checklist Manifesto: How to Get Things Right

Seems like an odd thing for a surgeon of international renown to spend his time on: the lowly checklist. But the results speak for themselves. In a controlled trial involving eight hospitals all around the globe (from rural Tanzania, to Amman, Jordan to Seattle, Washington) they observed double-digit reductions in major surgical complications and in deaths. He correctly notes that if there were a pharmaceutical drug or medical device that could produce these results, every newspaper around the world would be blaring the headlines. But, in this case, there’s no big payday – only improved outcomes for patients.

As it happens, Seattle was one of the first stops in the obligatory book tour that ensues, so I got a chance to meet and speak with him. In his talks, he provides some greater context to the work in the book. For example, the impetus for exploring the approach of using checklists during surgery (his study focuses exclusively on surgery) was engendered by the success of checklists in aviation. It may come as a surprise that there are checklists for pilots even in emergency cases like the plane landing on the Hudson last year.

Truth be told, the pioneer of using checklists in medical procedures is Dr. Peter Pronovost of Johns Hopkins. By creating a brief (must take no longer than 90 sec), simple checklist of the most crucial items needed to ensure central line catheters are applied safely, his checklist resulted in Johns Hopkins eliminating (as in reducing to –0-) infections for these procedures. He went on to do a pilot for all the hospitals in Michigan which led to those hospitals becoming the exemplar for patient safety for central line catheterization. But he doesn’t write for the New Yorker. Nor did he take on the massive effort of organizing a controlled study in hospitals all over the globe (that’s massive) and organize the team to produce the results of those efforts.

One additional thing to note about these checklists (in addition to their brevity) is that they need to be very carefully crafted to ensure that only the most critical items that are likely to be missed/overlooked are covered. It’s common to think of a checklist as being exhaustive, detailed and cumbersome. Obviously, that wouldn’t work in this context. Further, as you can’t set foot in the OR unless you know what you’re doing, the checklist is not a READ-DO checklist (like a recipe), but a DO-CONFIRM checklist where you’re pausing before each critical juncture to confirm that everyone is on the same page and has completed all the crucial activities for the safety of the patient and the increased success of the surgery.

One final insight that occurs to me is that this idea could have legs with patients. This is because once this issue becomes common knowledge, it could be one of those things that patients begin demanding of their providers. It’s something any patient can easily grok (Do you have a checklist, or don’t you?) without having to know anything about the intricacies of care.

Here are a couple of media links you might find interesting as well:

Doctor Saved Michigan $100 Million (Pronovost)http://www.npr.org/templates/story/story.php?storyId=17060374

Atul Gawande on Charlie Rose
http://www.charlierose.com/view/interview/10792