Health – Page 88 – artdiamondblog.com

Google and Microsoft Seek to Shift Health Care Power to Consumers

Source of graph: online version of the NYT article cited below.

(p. C1) In politics, every serious candidate for the White House has a health care plan. So too in business, where the two leading candidates for Web supremacy, Google and Microsoft, are working up their plans to improve the nation’s health care.

. . .

(p. C8) If the efforts of the two big companies gain momentum over time, that promises to accelerate a shift in power to consumers in health care, just as Internet technology has done in other industries.

Today, about 20 percent of the nation’s patient population have computerized records — rather than paper ones — and the Bush administration has pushed the health care industry to speed up the switch to electronic formats. But these records still tend to be controlled by doctors, hospitals or insurers. A patient moves to another state, for example, but the record usually stays.

The Google and Microsoft initiatives would give much more control to individuals, a trend many health experts see as inevitable. “Patients will ultimately be the stewards of their own information,” said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.

Already the Web is allowing people to take a more activist approach to health. According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year.

It is common these days, Dr. Halamka said, for a patient to come in carrying a pile of Web page printouts. “The doctor is becoming a knowledge navigator,” he said. “In the future, health care will be a much more collaborative process between patients and doctors.”

Microsoft and Google are hoping this will lead people to seek more control over their own health records, using tools the companies will provide.

For the full story, see:

STEVE LOHR. "Dr. Google and Dr. Microsoft." The New York Times (Tues., August 14, 2007): C1 & C8.

(Note: ellipsis added.)

Health Care Costs Are High and Rising

Source of graph: online version of the Omaha World-Herald article quoted and cited below.

The article quoted below summarizes a seminar by Dr. John Abramson. He was right to highlight the high costs of health care in the U.S., though he didn’t show any special insight in suggesting solutions.

(p. 1D) Costs are out of control, he said, and yet the United States, out of 22 developed nations, pays the most per person for health care and ranks last in having citizens lead long, healthy lives.

For the full story, see:

STEVE JORDON. “Employers urged to cure health system.” Omaha World-Herald (Weds., August 22, 2007): 1D & 2D.

Source of cartoon: online version of the Omaha World-Herald article quoted and cited above.

Free Market Can Provide Better, Cheaper Health Care

"Eve Linney, 5, who had an infected finger, went with her family last week to a walk-in clinic at a Duane Reade drugstore on Broadway in Manhattan. Her father, John, is at the counter." Source of caption and photo: online version of the NYT article quoted and cited below.

Clayton Christensen and co-authors in Seeing What’s Next, make a plausible case for the improvement of health care through disruptive innovation. A key aspect of their vision is the increasing role of nurse-practitioners in taking on increasingly routinized tasks, a development they see as generally both effective, and cost-efficient.

The article excerpted below suggests that this trend is promising, if it does not get killed by the government, and by organized medical doctors protecting their turf from competition.

(p. A1) The concept has been called urgent care “lite”: Patients who are tired of waiting days to see a doctor for bronchitis, pinkeye or a sprained ankle can instead walk into a nearby drugstore and, at lower cost, with brief waits, see a doctor or a nurse and then fill a prescription on the spot.

With demand for primary care doctors surpassing the supply in many parts of the country, the number of these retail clinics in drugstores has exploded over the past two years, and several companies operating them are now aggressively seeking to open clinics in New York City.

. . .

More than 700 clinics are operating across the country at chain stores including Wal-Mart, CVS, Walgreens and Duane Reade.

New York State regulators are investigating the business relationships between drugstore companies and medical providers to determine whether the clinics are being used improperly to increase business or steer patients to the pharmacies in which the clinics are located.

And doctors’ groups, whose members stand to lose business from the clinics, are citing concerns about standards of care, safety and hygiene, and they have urged the federal and state governments to step in to more rigorously regulate the new businesses.

. . .

(p. A16) Patients, however, have flocked to the clinics, according to a new industry group, the Convenient Care Association.

“I think it’s great you don’t have to make an appointment. That could take weeks,” said Ezequiel Strachan, 33, who lives in Manhattan and walked into the clinic at the Duane Reade store at 50th Street and Broadway on a recent morning for treatment of a sore throat. “People here value their time a lot.”

The average waiting time for an exam at such clinics nationwide is 15 to 25 minutes, according to the Convenient Care Association.

The association estimated that 70 percent of clinic patients have health insurance and are using the clinics because of convenience. For them, costs may not be much different from those at doctors’ offices, because the same insurance co-payments apply. But uninsured patients could reap substantial savings.

In New York City, one in five residents lacks a regular doctor and one in six is uninsured, according to a recent survey by the city’s Department of Health and Mental Hygiene, and overcrowded emergency rooms are often their first resort for routine care.

. . .

MinuteClinic officials insisted that there was nothing improper in the relationships between providers and the drugstores and that medical care is not being compromised.

“We are transparent with regulators,” said Michael C. Howe, the chief executive of MinuteClinic, which is based in Minneapolis and operates more than 200 clinics nationwide. using the motto “You’re Sick, We’re Quick.”

Mr. Howe said the concerns of doctors’ groups and other critics “are being raised by voices of people who have not really studied the model.”

Preliminary data from a two-year study of claims from MinuteClinic by a Minnesota health maintenance organization, HealthPartners, which was released to The Minneapolis Star Tribune in July, showed that each visit to the retail clinic cost an average of $18 less than a visit to other primary-care clinics, but that pharmacy costs were $4 higher per patient.

Duane Reade, New York City’s largest drugstore chain, which opened four clinics in Manhattan in May, plans to open as many as 60 more across the city in the next 18 months. A key difference at the Duane Reade clinics is that they use doctors, while nurse practitioners and physician assistants typically provide the care at most retail clinics.

For the full story, see:

SARAH KERSHAW. "Tired of Waiting for a Doctor? Try the Drugstore." The New York Times (Thurs., . August 23, 2007): A1 & A16.

(Note: the title of the online version is "Drugstore Clinics Spread, and Scrutiny Grows." Ellipses added.)

"Dr. Maggie Bertisch saw Eve while her mother, Claire, waited." Source of caption and photo: online version of the NYT article quoted and cited above.

Feds Force Us to Fluoresce, Causing Migraines and Epileptic Seizures

Source: screen capture from the CNN report cited below.

The new energy bill signed into law on Weds., Dec. 19, 2007, included a provision to force us all to fluoresce starting in 2012. In the CNN report cited below, Dr. Sanjay Gupta summarizes recent research suggesting that fluorescent bulbs cause a significant increase in the number of migraine headaches and epileptic seizures.

For the full story, see:

Dr. Sanjay Gupta. "Eco-bulbs and migraines." CNN Report. Posted online on January 4, 2008.

Source: screen capture from the CNN report cited above.

Huge Health Gains from Vaccines

Source of graphic: online version of the WSJ article quoted and cited below.

I hypothesize that most of the health gains from modern medicine come from a few advances, with vaccines being a very prominent example. (My hypothesis implies that many health care procedures do relatively little to increase health and longevity.)

(p. A18) Death rates for 13 diseases that can be prevented by childhood vaccinations are at all-time lows in the United States, according to a study released yesterday.

The study, by the Centers for Disease Control and Prevention in Atlanta, and published in The Journal of the American Medical Association, is the first time that the agency has searched historical records going back to 1900 to compile estimates of cases, hospitalizations and deaths for all the diseases children are routinely vaccinated against.

In nine of the diseases, rates of death or hospitalization declined more than 90 percent since vaccines against them were approved, and in the cases of smallpox, diphtheria and polio, by 100 percent.

In only four diseases — hepatitis A and B, invasive pneumococcal diseases and varicella (the cause of chickenpox and shingles) — did deaths and hospitalizations fall less than 90 percent. Those vaccines are all relatively new — the one for chickenpox, for example, was adopted nationally only in 1995. Also, some diseases like hepatitis typically strike adults, who are less likely to be immunized.

The results “are a testament to the fact that vaccines can drive diseases down to near nil,” said Dr. Gregory A. Poland, chief of the vaccine research group at the Mayo Clinic.

For the full story, see:

DONALD G. McNEIL Jr. "Sharp Drop Seen in Deaths From Ills Fought by Vaccine." The New York Times (Thurs., November 14, 2007): A23.

Prominent Transplant Surgeon Endorses Market for Kidneys

Source of graphic: online version of the WSJ article quoted and cited below.

(p. A1) Amid a severe kidney-donor shortage, an idea long considered anathema in the medical community is gaining new currency: payments for people willing to give up a kidney.

One of the most outspoken voices on the topic isn’t a free-market libertarian, but a prominent transplant surgeon named Arthur Matas.

Dr. Matas, 59 years old, is a Canadian-born physician best known for his research at the University of Minnesota. Lately, he’s been traveling the country trying to make the case that barring kidney sales is tantamount to sentencing some patients to death.

"There’s one clear argument for sales," Dr. Matas told a gathering of surgeons earlier this year. The practice, currently illegal in the U.S., "would increase the supply of kidneys, save lives and improve the quality of life for those with end-stage renal disease."

The doctor supports a regulated market only for kidneys, since live donors can give one up and survive without excessive health risks. (Transplants of other organs, such as livers and lungs, pose greater complications to a living donor.) And Dr. Matas doesn’t rule out financial incentives for the families of deceased donors.

For the full story, see:

LAURA MECKLER. "Kidney Shortage Inspires A Radical Idea: Organ Sales As Waiting List Grows, Some Seek to Lift Ban; Exploiting the Poor?" The Wall Street Journal (Tues., November 13, 2007): A1 & A22.

Source of image: online version of the WSJ article quoted and cited above.

Unwashed Hospital Worker Hands Often Spread Disease

"A special light reveals deadly bacteria." Source of caption and photo: online version of the NYT article quoted and cited below.

If health care in the U.S. were a free market, with unregulated entry, and real consumer choice, it is hard to believe that some Wal-Mart-of-health-care wouldn’t come along that would gain huge market share and profits by providing its employees incentives to wash their hands.

(p. A1) PITTSBURGH — At a veterans’ hospital here, nurses swab the nasal passages of every arriving patient to test them for drug-resistant bacteria. Those found positive are housed in isolation rooms behind red painted lines that warn workers not to approach without wearing gowns and gloves.

Every room and corridor is equipped with dispensers of foamy hand sanitizer. Blood pressure cuffs are discarded after use, and each room is assigned its own stethoscope to prevent the transfer of microorganisms. Using these and other relatively inexpensive measures, the hospital has significantly reduced the number of patients who develop deadly drug-resistant infections, long an unaddressed problem in American hospitals.

The federal Centers for Disease Control and Prevention projected this year that one of every 22 patients would get an infection while hospitalized — 1.7 million cases a year — and that 99,000 would die, often from what began as a routine procedure. The cost of treating the infections amounts to tens of billions of dollars, experts say.

But in the past two years, a few hospitals have demonstrated that simple screening and isolation of patients, along with a relentless focus on hygiene, can reduce the number of dangerous infections. By doing so, they have fueled a national debate about whether hospitals are doing all they can to protect patients from infections, which are now linked to more deaths than diabetes or Alzheimer’s disease.

. . .

(p. A16) Dr. Richard P. Shannon, who championed a program to reduce catheter infections at Allegheny General Hospital in Pittsburgh, was able to show administrators that the average infection cost the hospital $27,000. He demonstrated that reimbursement payments for weeks of extended treatment were not keeping pace with actual costs. “I think it was assumed that hospitals didn’t mind treating these infections because they were getting paid for it,” Dr. Shannon said.

A major emphasis at the Pittsburgh hospitals has been hand hygiene. Studies have consistently shown that busy hospital workers disregard basic standards more than half the time. At the veterans hospital, where nurses have taken to pushing elevator buttons with their knuckles, annual spending on hand cleaner has doubled.

For the full story, see:

KEVIN SACK. "Swabs in Hand, Hospital Cuts Deadly Infections." The New York Times (Fri., July 27, 2007): A1 & A16.

(Note: ellipsis added.)

In the photo on the right, Pittsburgh nurse Bill Cunningham, "puts on a gown and gloves before approaching patients with infections." Source of graph, caption, and photo: online version of the NYT article quoted and cited above.

Entrepreneur Bets His Wealth on a Risky, Important Project

"Alfred E. Mann, at his home in Beverly Hills, Calif., has put nearly $1 billion of his own money into developing an insulin that can be inhaled." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. C1) LOS ANGELES, Nov. 15 — Pfizer, the world’s biggest drug company, flopped miserably with a seemingly can’t-miss idea. But Alfred E. Mann is so certain he can succeed that he is betting nearly $1 billion of his own money on the effort.

Pfizer’s failure was a form of insulin that people with diabetes could inhale rather than inject. But last month, after selling only $12 million worth of inhaled insulin in the first nine months of the year, Pfizer said it would take a $2.8 billion charge and abandon the product.

Mr. Mann, the 82-year-old chief executive and controlling shareholder of the MannKind Corporation, is not deterred. He says his company’s inhalable insulin is not just a way to avoid needles but is medically superior to Pfizer’s product and to injected insulin.

If he is right, he could help change the way diabetes is treated.

“I believe this is one of the most valuable products in history in the drug industry, and I’m willing to back it up with my estate,” Mr. Mann said at his 23,000-square-foot mansion overlooking the San Fernando Valley. The interview took place on a Saturday evening, which Mr. Mann said was the only opening in his seven-day work schedule.

Despite Mr. Mann’s remarkable entrepreneurial career — he has founded more than a dozen aerospace and medical device companies — there are people who wonder whether he has so much invested in this latest effort, both financially and emotionally, that he cannot see any odds against him.

“I don’t know of an individual who has spent as much of a personal fortune on a long shot,” said Andrew Forman, an analyst with WR Hambrecht & Company. Mr. Forman said MannKind faced numerous regulatory and patent challenges, as well as possible competition from the leaders in injected insulin, Eli Lilly and Novo Nordisk, which are also developing inhalable products.

For the full story, see:

ANDREW POLLACK. "Betting an Estate on Inhaled Insulin." The New York Times (Fri., November 16, 2007): C1 & C5.

"The inhaled insulin device, about the size of a cellphone." Source of caption and photo: online version of the NYT article quoted and cited above.

Cuba’s Best Doctors Not Blind to Incentives Offered by “Communist” Government

"Patients at the Ramón Pando Ferrer eye hospital in Havana." Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A4) Cuban doctors abroad receive much better pay than in Cuba, along with other benefits from the state, like the right to buy a car and get a relatively luxurious house when they return. As a result, many of the finest physicians have taken posts abroad.

The doctors and nurses left in Cuba are stretched thin and overworked, resulting in a decline in the quality of care for Cubans, some doctors and patients said.

For the full story, see:

JAMES C. McKINLEY Jr. "Havana Journal; A Health System’s ‘Miracles’ Come With Hidden Costs." The New York Times (Tues., November 20, 2007): A4.

Von Hippel Promotes User-Driven Innovation

"Eric von Hippel of M.I.T., left, and Dr. Nathaniel Sims, with hospital devices Dr. Sims has modified. Mr. von Hippel says users can improve on products." Source of caption and photo: online version of the NYT article cited below.

Some innovation is done by the devoted for free. But in his books, and in the article excerpted below, I think von Hippel puts too little emphasis on the entrepreneur and the entrepreneur’s profit motive, as drivers of innovation.

One example is the Moveable Type free program that underlies this, and many other blogs. It is often described as one of the best blog platforms, but it is hard to use for a non-techie, kludgey, and very limited in some obvious ways. For example, there apparently is no way that I can make comments to the most recent 10 entries visible on the main blog page. And there is only limited backup capabilities. And the spell-checker does not have "blog" in its dictionary, and asks me if I really meant to type "bog."

You can bet that if Moveable Type was produced for profit, they would have provided users these obvious capabilities. And I would rather pay for a more capable program, rather than get a less capable program for free.

(p. 5) DR. NATHANIEL SIMS, an anesthesiologist at Massachusetts General Hospital, has figured out a few ways to help save patients’ lives.

In doing so, he also represents a significant untapped vein of innovation for companies.

Dr. Sims has picked up more than 10 patents for medical devices over his career. He ginned up a way to more easily shuttle around the dozen or more monitors and drug-delivery devices attached to any cardiac patient after surgery, with a device known around the hospital as the “Nat Rack.”

. . .

What Dr. Sims did is called user-driven innovation by Eric von Hippel, a professor at the Massachusetts Institute of Technology’s Sloan School of Management. Mr. von Hippel is the leading advocate of the value of letting users of products modify them or improve them, because they may come up with changes that manufacturers never considered. He thinks that this could help companies develop products more quickly and inexpensively than with their internal design teams.

“It could drive manufacturers out of the design space,” Mr. von Hippel says.

It is a difficult idea for research and development departments to accept, but one of his studies found that 82 percent of new capabilities for scientific instruments like electron microscopes were developed by users.

. . .

One problem with the user-innovation model is that it can run into intellectual property rights protections. . . .

. . .

. . . , Mr. von Hippel’s ideas are up against more conventional forms of user-aided design, such as sending anthropologists to study how people use products in their daily lives. Companies then translate their research into new designs.

Even some of Mr. von Hippel’s acolytes remain cautious. “A lot of this is still in the category of, ‘You could imagine this working out really well,’ ” says Saul T. Griffith, who as an M.I.T. engineering student was part of a group of kite-surfers who developed products for their sport that have since become commercialized. Mr. von Hippel wrote about Mr. Griffith in his 2005 book, “Democratizing Innovation.”

For the full story, see:

MICHAEL FITZGERALD. "Prototype How to Improve It? Ask Those Who Use It." The New York Times, Section 3 (Sun., March 25, 2007): 5.

(Note: ellipses added.)

von Hippel has two main books in which he defends his user-driven innovation ideas:

von Hippel, Eric. The Sources of Innovation. New York: Oxford University Press, 1988.

von Hippel, Eric. Democratizing Innovation. Cambridge, MA: MIT Press, 2005.

Accepting an 80% Pay Cut for a Chance to Defy Death

David Sinclair (left) and Christoph Westphal (right). Source of photo: online version of the NYT article cited below.

Humans are often risk-averse, but are also often willing to accept greater risk, in the pursuit of a really important goal.

SIRTRIS PHARMACEUTICALS wants to sell you the elixir of youth. Yet the company’s founders are neither cranks nor quacks, but include a well-regarded Harvard scientist and a serial entrepreneur.

Imagine a pill, derived from a compound found in something as benign as red wine, that treated the most feared and debilitating diseases of aging: illnesses like diabetes, neurodegenerative conditions like Alzheimer’s and Parkinson’s, and many forms of cancer. Imagine, furthermore, that this pill had no injurious side effects. Imagine, finally, that the pill’s only side effect conferred what human beings have always wanted: an increase in life span. That’s what Sirtris wants to create.

. . .

Mr. Sinclair, who at the relatively youthful age of 37 is already renowned for his investigations into how we grow old, discovered in 2003 that a molecular compound called resveratrol, found in red wine and other plant products, extends the life span of mice by as much as 24 percent and the life span of other animals, such as flies and fish, by as much as 59 percent.

Dr. Westphal, a self-described “geek” who relaxes by reading papers in academic journals like Nature and Science, was stunned by Mr. Sinclair’s discovery, and visited him in his lab to discuss the implications for drug development. The two soon decided to start a company.

“I figured if there’s going to be one chance that I’d take an 80 percent pay cut to be the C.E.O. of a company rather than general partner in a venture firm, then this was it,” Dr. Westphal, 39, told me when I visited Sirtris’s offices in Cambridge, Mass. “If we’re right on this one, everyone’s going to want to take these drugs and they’re going to treat many of the major diseases of Western society.”

. . .

“Nobody knows why we age,” Mr. Sinclair explained to me. “We’re working on genes that increase fitness and defenses against diseases. The body mounts those defenses when it’s under adversity. Caloric restriction is one of those triggers and the molecules we’re developing are also one of those triggers.”

Dr. Westphal and Mr. Sinclair stress that they are not working to “cure” aging, a condition that, so far at least, is common to all humanity and that most physicians do not consider a disease. “Curing aging is not an endpoint the federal drug agency would recognize,” Dr. Westphal says dryly. Instead, both men say, they are working to ameliorate the diseases of aging.

While Mr. Sinclair has bragged that resveratrol is as “close to a miraculous molecule as you get,” much uncertainty surrounds his research and the commercialization of his discovery faces many challenges.

. . .

Sirtris hopes to have its first drugs in commercial production by 2012 or 2013. While that may seem far off, it’s wonderfully fast for the biopharmaceutical industry, where development is onerously slow, difficult and uncertain.

This speed of research and development owes much to Dr. Westphal’s energy and Mr. Sinclair’s ambition.

“For as long as I can remember, I’ve wanted to develop drugs that combat diseases of aging,” Mr. Sinclair says. “As soon as I realized I was mortal, I started to worry. I set a goal to see if we could make drugs that would target the diseases of aging in my lifetime. I didn’t know it would be possible at all — and I didn’t know it would happen so quickly.”

For the full story, see:

JASON PONTIN. "SLIPSTREAM; An Age-Defying Quest (Red Wine Included)." The New York Times, Section 3 (Sun., July 8, 2007): 3.

(Note: ellipses added.)