Discussing Consumer Driven Healthcare with @EricTopol on Friday #VoiceoftheDr

I am excited to be joined by one of the keynote speakers from HIMSS13 conference Dr Eric Topol – Author of
The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care and has been named in the list of the Top 100 Most Influential Physician Executive in Healthcare, 2012 by Modern Healthcare

We will be discussing amongst other things Patient Engagement and Consumer Driven Healthcare

As Dr Topol describes here: Consumer-Driven Healthcare Is an Uncomfortable Concept there is a lot of discomfort on the part of physicians. Historically medical knowledge was in the domain of doctors and clinical professionals – as Dr Topol describes it: “information asymmetry“
This concept is captured by Regina Holliday in her Walking Gallery

and the many jackets Regina has painted

and appear at Healthcare events around the world. You can watch a video on the idea here

The Walking Gallery from Eidolon Films on Vimeo.

And the origins of the idea here

You can view all the jackets in the gallery here

In the new world of medicine patients and clinicians will have access to all data and as Dr Topol puts it:

When each individual has access to all this critical data, there will be a real shakeup to the old way that medicine was practiced. In the past, the Internet was supposed to be empowering for consumers, but that really didn’t matter because what the consumer could get through the Internet was data about a population. Now, one can get data about oneself, and, of course, a center hub for that data-sharing will be the smartphone

But are the fears justified – will there be problems with the quality of data and challenges in turning everyone into clinical experts? Join me on Friday at 2:30 ET on VoiceoftheDoctor when I will be talking about this with Dr Eric Topol

Join me on Friday at 2:30 ET on VoiceoftheDoctor
There are three ways to tune in:
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Easy Way to Debunk Healthcare Myths

Excellent posting on FishBarrel tool that provides an easy way to report misleading claims online

FishBarrel: The easy way to report misleading health claims online
. As the author states:

With thousands of misleading health claims on the web and a report to the ASA taking around ten minutes, I’d regularly come across misleading claims but do nothing about them. So I built FishBarrel. FishBarrel is a plugin for Google Chrome that manages the process of making an ASA or Trading Standards complaint so that it takes just a few seconds. FishBarrel also tracks all text complained about in a central database. When you turn on FishBarrel, any text complained about by other users is automatically highlighted. This prevents you from submitting duplicate complaints to the ASA. Finally, FishBarrel can automatically revisit the websites later and check if the claims have been removed.

You can see a demo here

Vaccine – Making the Right Choice

So the latest book on vaccine from

Dr Paul Offit MD (head of pediatrics at Children’s Hospital of Philadelphia): Deadly Choices: How the Anti-Vaccine Movement Threatens Us All which will no doubt draw fire form the anti vaccine crowd as his previous books did. He has written widely and has several oped (listed here) all of which debunk the myths associated with vaccines in an attempt to stem the rising anti-vaccine tide.

His outstanding credentials on the subject as a vaccinologist and an expert in infectious diseases lend credibility to his position and one that is supported by the data that vaccines save lives. Despite the claims by the anti vaccine proponents of brain damage, autism, diabetes, and cancer, as Dr Offit points out  these claims are littered with misinformation, faulty research, and sly deceptions and unfortunatley offerd to fraught parents who are doing their best to make the right choices in a complex world. I have written about this before and the importance of data (Snake Oil and Detox, Vaccination and Essential Part of Child Healthcare and Wrapped in Data and Diplomas It’s Still Snake Oil), but it was the piece on the Colbert Report that I thought brought home the message:

The Colbert Report	Mon – Thurs 11:30pm / 10:30c
Paul Offit
www.colbertnation.com
http://media.mtvnservices.com/mgid:cms:item:comedycentral.com:372812
Colbert Report Full Episodes Political Humor & Satire Blog</a> Video Archive

As is often the case humor can help get the message across

Snake Oil from Martha Stewarts Show – Detox Doc

Why these charlatans get any airtime is beyond me……as picked up in Michael’s Minute: Martha Stewart Gets Bamboozled By Detox “Doc” and as he points out: 

it’s simply modern day snake oil salesman 

THe myth that we have such a toxic environment we have to detoxify is preposterous. Not a shred of evidence supporting these claims:

 

There isn’t one scientific report validating any of these claims yet people continue to believe based on the power of personal persuasion. He (Mr Junger) exploits people’s ignorance with flim-flammery tricks and deceit. If detoxification was effective he wouldn’t need shady sales techniques. Instead, there would be scientific studies demonstrating its effectiveness. Mr. Junger should want these tests to validate his beliefs. He resists efforts to measure and verify his treatment because it would be revealed as the scam it is 

You can see the marketing spin in this clip

Why is Martha Stewart allowign such tripe to be broadcast adding wieght to these claims. Don’t get fooled – our water, food  and air is safe and you don’t need to pay any money to someone to detoxify or clean your Insert name of food, air or fluid>

Killer Drugs – Tobacco and Alcohol

IF you are in any doubt about the profound effects of tobacco and Alcohol read this post and watch the video

http://www.medpagetoday.com/mediaplayer-licensed-viral/player-licensed-viral.swf

Ethyl alcohol kills large numbers of Americans every day (about 200), almost all legally.
Tobacco kills large numbers of Americans every day (about 1,200), almost all legally.

That’s 1,400 people per day – that’s over half a million people per year! For every 10 who drink 1 will become a problem drinker.

So HHS has gone with Scare Tactics for alcohol. Importantly

Scare tactics DO WORK when they are obviously, provably true, like telling a child to not sit on the railroad tracks when a train is coming.
Scare tactics DON’T WORK when they are patently false (think “Reefer Madness”).

So for alcohol take a leaf out fo Australia’s graphic advertising campaign found here
And the Montage of 20 years worth of adverts:

And some of the individual

Marriage Good for You

No real surprise but the feature in NY Times: Is Marriage Good for Your Health?

Yes it is – dating back to 1858 William Farr showed that marriage contributed to a lower mortality relative to unmarried people with widows faring the worst

Want to Stay Looking Young – Visit Your Dentist

We spend an inordinate number of money on Plastic Surgery mostly in an attempt to fight the ravages of time as evidenced by the statistics on the cosmetic surgery site:

• 2.8 Million: Number of Botox injections given in the U.S. in ’03.
• 8.7 Million: People who had some cosmetic procedure in ’03.
• 10 million: The estimated number of cosmetic patients who will have gone under the knife by the end of ’04.
• 1.9 million: number of cosmetic surgery procedures done in ’01.

That’s a  lot! But in a recent piece on NPR (As Our Skin Sags With Age, So Do Our Bones) – you can download the mp3 here. The piece makes the point that it’s not just loose skin that makes us look old but it is more to do with bone loss. In fact the original published article in the Journal of Plastic and Reconstructive Surgery (abstract here) where they reviewed 3-D reconstructions of skulls of 120 men and women of varying ages they notes that

These results suggest that the bony elements of the mandible change significantly with age for both genders and that these changes, coupled with soft-tissue changes, lead to the appearance of the aged lower third of the face.

In other words bone loss makes a significant impact on the appearance of aging in our faces. They noted

cheekbones descend making the eyes appear hollow
jawbone becomes thinner and the chin recedes (slack-jawed)

In fact for David Hunt a physical anthropologist at the Smithsonian’s Natural History Museum in Washington DC it was a “well duh”! As can be seen in the picture of the three skulls below – minimal loss on the left to dramatic loss of cheek and jaw int ie older skull the right

So what does this have to do with dentists? Well from the “guy who’s seen 30,000 skeletons:

…how to slow down that facial bone droop: Hang on to your teeth

Seems like dental and periodontal care is money well spent and probably a better investment in keeping youthful than the thousands of dollars spent on trying to repair the inevitable effects of aging.

Healthcare Insurance – Its CostCo membership for Health

It is now being referred to the as the third rail in healthcareNo one wants to touch it for fear of electrocuting themselves but it remains one of the greatest challenges facing healthcare and rising costs. The fact that healthcare insurance companies stock prices have reacted positively to the news of the loss of the 60 seat majority in the senate. The insurers have bitterly fought any notion of a public insurance plan because this would cut into their profits.

Taking a look at some recent profits: Wellpoint owner of Anthem Blue Cross – $ 2,700,000,000 which was followed by an announcement they would be raising premiums by as much as 39%……..! That’s even more than the university and education sectors astounding rate increases.  Kathleen Sebelius the Health and Human Services Secretary weighed in asking them to “justify” this. Seriously – “justify”!

All this was discussed in the “GetBetterHealth” Blog by DrStanleyFeld in a piece titled: “Are Health Insurers Killing the Goose that Laid the Golden Egg“. Pointing out the usual techniques in play to deflect criticism in an attempt to justify this behavior

using a well worn public relations technique by pointing a finger at the other stakeholders. All its administrative costs, additional reserves, and investment costs are included in the “85 cents out of every premium dollar figure.”

In fact you have to wonder which group of middlemen the Health Insurance industry falls into

You don’t need to be an economist to understand that any middleman interposed between seller and buyer raises the price of a given service or product. Some intermediaries justify this by providing benefits, such as salesmanship, advertising or transport. Others offer physical facilities, such as warehouses. A third group, organized crime, utilizes fear and intimidation to muscle its way into the provider-consumer chain, raking in hefty profits and bloating cost, without providing any benefit at all.”

and this characterization

“The health insurance model is closest to the parasitic relationship imposed by the Mafia. Insurance companies provide nothing other than an ambiguous, shifty notion of “protection.“

So what do individual personal experiences tell us about dealing with the insurance industry. Recent experince suggests that the insurance industry is misnamed. Insurance is designed to pay out for legitimate claims. Health Insurance does no such thing and is much closer to buying membership to CostCo but not as good. The CostCo model has customers paying a membership for exclusive access to lower priced of goods. If you are not a member you have to pay the higher rate.

Examination of a recent claim form showed that membership to the Healthcare Insurance club provided a discount to the billable amount of 87%. But unlike CostCo if any of the items you selected or used the insurer deems to be uncovered then you get to pay 100%. So this would be like showing up at the CostCo check out and being told that in your case the meat you purchased is not part of you membership perhaps because they think you are a vegetarian and therefor instead of paying $5 per pound you must pay $9.35 per pound

In the healthcare example a legitimate set of routine laboratory tests on blood and urine as part of an annual physical.  It is impossible for me to imagine a reason to deny basic routing screening but the system is geared to do precisely that every time a claim is submitted. SO where is all the money going… aside from posting profits and investor returns there is a big chunk in the case of Wellpoint allocated to $1.8 to $8.4 Million dollars per year for its CEO and Divisional Presidents. And UnitedHealthcare was even worse:

In a March 2007 post I stated that “ UnitedHealthcare claims that costs are out of control. Why? Who paid their CEO $1.8 billion dollars over 8 years? The amount equals $300 million dollars a year or $821,917 a day in salary and benefits to one person. What are the other top executives at UnitedHealthcare receiving in salary and benefits? Do you think these salaries affect the cost of insurance?”

I agree with the notion that we the consumer need to take greater control and management of our healthcare dollars and remove these excess additive costs. Will someone have the courage to take this on….?

What have your experiences been with insurance. Do you think you get value for money and that health insurance is part of your health solution as opposed to being part of your health problem?

Multivitamins Do No Harm but Limited Benefits

The Washington post published an article “Evidence is thin that multivitamins are beneficial, but they seem benign“. Relevant in today’s struggling economy when you consider that there is an estimated $25 Billion spent in vitamins, minerals and supplements;

over 50% of Americans take a daily multivitamin

In the interests of full disclosure I take a multivitamin and have done for many years. As is often the case – emotions, perception and marketing rule our decision-making but

some older studies have linked multivitamin use to the prevention of conditions such as breast and colon cancer and heart disease

But in fact we should be basing our views on science and

the latest research has shown absolutely no impact on health and disease prevention, over time

As described the most rigorous widely regarded study in the Archives of Internal Medicine: Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women’s Health Initiative Cohorts (Arch Intern Med. 2009;169(3):294-304.)

The study included 161 808 participants from the Women’s Health Initiative clinical trials in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements…between 1993 and 1998…disease end points were collected through 2005. documenting cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and venous thromboembolism); and total mortality.

This is an extended large cohort (combined) study and represents and excellent block of data to help establish a link between taking these supplements and preventative health benefits….the results here:

After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women’s Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women.

So the summary – no detectable benefit in the conditions study. It does not do harm

“The big takeaway message is that if someone takes a multivitamin, it doesn’t make them any healthier, but it doesn’t really harm them, either,” says lead author Marian Neuhouser, a cancer prevention researcher at the Fred Hutchinson Cancer Research Center in Seattle. “So then consumers have to ask themselves: What is really the benefit of spending money on these products, if they are not going to decrease the risk of common diseases that affect women or benefit health? It’s a waste.”

So will you stop buying vitamins – I’m moving toward that direction and may save my money for more proven ways of improving my health. What’s your experience? Do you have any other studies or data – leave your comments below

The Regenerative Nature of Meditation

He and a number of his colleagues meditate, and as they meditate they measure differences in their brainwaves. Right? And I basically said I would predict that those very same things that when you meditate and you have positive brainwave changes would also have an effect on your stem cells. He very graciously, and this is an N of one, let us measure cells in his blood before and after meditation. And what we found was a huge increase in the number of positive stem cells in blood. Largest increase I’ve ever seen after 15 minutes of meditation.

 

via speakingoffaith.publicradio.org

“Largest ever” increase in +ve stem cells resulted from meditation