Enlarge Mark Lennihan/AP

Later this year, if all goes as expected, a generic version of Lipitor will become available in the U.S.

Mark Lennihan/AP

Later this year, if all goes as expected, a generic version of Lipitor will become available in the U.S.

Chances are very good that the next prescription you fill will get you a generic medicine.

Three-quarters of prescriptions these days are filled with a generic. And the proportion keeps climbing.

Later this year, if all goes according to plan, the biggest generic switch in the history of the pharmaceutical industry will go down. Cholesterol-fighter Lipitor, the best-selling prescription medicine in the world, will lose U.S. patent protection, clearing the way for legal, inexpensive copies.

The wave of generics to treat conditions ranging from depression to high blood pressure can save consumers plenty of dough.

 

If your health insurance covers prescription drugs, you'll have a lower copay for a generic versus a brand-name drug. The exact savings would depend on the particulars of the plan, but could easily hit $20 or $30 a month.

If you have to pay for your medicines yourself, some big-box retailers and drugstore chains sell generics for rock-bottom prices.

Over the next couple of years lots of other big-selling brands will also go generic. Think Plavix, a blood thinner, and Actos, for diabetes, just to name two.

Why are there so many generics all of a sudden? Well, the wave actually got rolling a few years ago. Now, though, some of the biggest brands are involved.

The reason for all the action is that patents are expiring on medicines launched during the 1990s, which is looking more and more like a golden era of productivity for the pharmaceutical industry.

Typically the patents for prescription pills last about a dozen years or so. And as the clock runs out, the generics makers rush in.

How do American feel about generics? We asked more than 3,000 people last year in a survey conducted with Thomson Reuters. Eight-five of people said generics are as safe and effective as brand-name drugs. And 90 percent said they're willing to take a generic when one is available.

By DAVID E. WILLIAMS

Over the last decade, the United States has intentionally made itself less attractive to immigrants, forgetting that immigration has been a huge driver of the country’s economic success. In a recent article (America needs a 21st century immigration policy), leading entrepreneurs, executives and investors including Steve Case and Sheryl Sandberg said:

To some, the link between immigration reform and economic growth may be surprising.  To America’s most innovative industries, it is a link we know is fundamental.

The global economy means companies that drive U.S. job creation and economic growth are in a worldwide competition for talent.  While other countries are aggressively creating policies and incentives to attract a highly educated workforce, America has stagnated.  Once a magnet for the world’s top minds, America now faces a “reverse brain drain” and is no longer the first choice for many entrepreneurs creating new companies and jobs.

America needs a pro-growth immigration system that works for U.S. workers and employers in today’s global economy.  And we need it now.

Openness and encouragement of immigration is vital for the success of health care reform. Why?

Immigrants innovate and create economic growth. This growth is how the country gets wealthier and better able to support health care expenses without raising tax rates

Immigrants tend to be younger, so they mitigate the overall aging of the population, making it easier for the country to afford its commitments to older citizens

Immigrants can use their intellectual capital and training â€"whether acquired abroad or hereâ€" to fill health care jobs such as primary care physician, pharmacist, nurse that would otherwise go unfilled

President Obama actually understands this dynamic, but has to tread carefully since immigrant bashing is so popular on the right. But unfriendliness to immigration is all over in the place. For example in Massachusetts the state has decided â€"for short-sighted financial reasonsâ€" to exclude legal immigrants from subsidized health insurance. With luck, that decision will be overturned as unconstitutional by the state’s Supreme Judicial Court.

I agree with the Republican rhetoric of the need for a “pro-growth agenda.” Low taxes and limited regulation can certainly play a part. But policies that encourage immigration, especially of younger, well educated people, are absolutely essential. We need it for the economy as a whole and for the health care economy in particular.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.

Filed Under: THCB

Tagged: David Williams, health care reform, Immigration May 25, 2011

If you or your child or any member of your family gets infected with common cold, you may decide to consult your doctor/pediatrician/family doctor. As most doctors are busy and appointment with your doctor may be brief, it is wise to know and learn the topics you need to discuss with your doctor, regarding common cold anyone of your family member may be suffering. Prepare for your appointment with your doctor and know what questions to ask your doctor and what to expect from your doctor.

You should be prepared for appointment before seeing your doctor. Write down the symptoms you or your child or any member of your family may have and for how long you may have the symptoms. Write down if there is any medical information or any medication being received for other medical ailment, about the patient of common cold worth mentioning to your doctor. Mention any recent exposure to people with similar symptoms. Finally write down what questions you might ask your doctor during appointment. You should also ask you doctor about the ways to prevent common cold.

You may ask the following questions:

• What is/are the causes of the symptoms?
• How long it may take for symptomatic improvement?
• What medications or foods to be avoided during treatment?
• Is there any need for tests?
• Am I contagious?
• When it is safe to return to work or school?
• Is there any home remedy or steps taken at home that will be helpful?

Your doctor may ask following questions before writing treatment for you:

• What are your symptoms and for how long they are present? Did all symptoms start at the same time?
• Is there any change in the symptoms severity (improved or worsened)?
• Do you have fever?
• Did you closely interact with any individual recently with similar symptoms?
• What medications/supplements you (patient) are taking at present?
• Do you at present have any illness (acute or chronic)?

You may be asked some other questions by your doctor based on different patient setting. Your doctor may ask different set of question to different patients with similar illness. Be prepared to answer the above mentioned questions accurately.

Related posts:

How to Prepare Yourself for Cold Sores, for Appointment with Doctor

How to Prepare for Doctor’s Appointment for Ringworm?

Reduce Common Cold by Reducing Risk Factors

What is Common Cold?

Symptomatic Treatment of Common Cold

Symptoms of Common Cold

Prevention of Common Cold

Prepare yourself for Appointment with your Doctor for Nail Fungus Infection

Treatment of Common Cold

Global impact of Common Cold

By JOE FLOWER

[Note to the reader: Anything that is in italics and square brackets (such as this note) is addressed to you, personally. Yes, you. Try it on, see if it fits.]

Healthcare has, right now, the greatest opportunity we have seen in our lifetimes to make a big change, to rebuild itself in a hundred ways to become better for everyone, and cheaperâ€"to get cheaper by getting better. We’re not talking “bending the cost curve,” cutting a few points off the inflation chart. We’re not talking a little cheaper, a little less per capita, a few percentage points off the cut of GDP that healthcare sucks up. We’re talking way cheaper. Half the cost. You know, like in normal countries.

We’re not talking a little better, skipping a few unnecessary tests, cutting the percentage of surgical infections a few points. No. Don’t even think about it. We’re talking way better. Save the children, help the people who should know better, nobody dies before their time, no unnecessary suffering. Seriously.

I don’t know how high you want to aim, but personally, I think we should aim at least as high as the cutting-edge programs and facilities that are already out there, in the system as it exists today, cutting real healthcare expenses of real people, even “frequent fliers,” by 10, 20, even 30 percent, while making them healthier, much healthier. At least. To me, that’s a wimpy goal, just doing as well as some other people are already doing. Because these programs are just getting off the ground. They’re in the first few iterations. The stretch goal, the goal we can take seriously, is to cut real costs by 50 percent, by making people healthier. There is at least that much potential out there.

All the Ways the System Doesn’t Work

You want a little convincing? Here’s an easy little exercise: You know how the system actually works. [Note: Yes, you do. You’ve been around the block, right?] Pull up an empty notes page on the laptop, iPad, Blackberry, iPhone, whatever, and just start writing a list of all the frustrations you can think of, the thousand and one ways that the system does not drive toward the best health at the least cost for the people it servesâ€"the missed handoffs, the wrong person/wrong drug mistakes, the lack of engagement with the patient’s life, all that. [Note: My guess? You can come up with a better and longer list than I can. Every person I talk to who actually works in health care has buckets of this stuff for me, every time I talk to them.]

Now do a little imagination exercise: Go down that list, stop at each item, and imagine some way in which the system eliminated it. Imagine that there was some systemic change that made it nearly impossible to give the wrong person the wrong drug, some change that meant that everybody got good health coaching, nobody ever got an operation that actually won’t help them, whatever is the inverse of each frustration on the list. Imagine what each of those changes would mean to the effectiveness and cost of healthcare.

Now imagine that somebody, somewhere, has done just that. Somebody is solving that problem, in ways that can be duplicated where you are. Because that is what I am seeing happen all across healthcare, and it’s a breathtaking story.

A Word about Systems

Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you were 10 times more likely to live through each mile you drove than your father or grandfather was 60 years ago.

Why? Are we better drivers? Nah. Seatbelts, airbags, tougher DUI laws, breathalyzers, graduated licensing for teenagers, anti-lock braking systems, better highway designs, crash barriers, rumble strips, median barriers, steel-belted radial tires that don’t blow out, crumple zones, better bumpers…system tweaks that work, that make it 10 times as hard for even a terrible driver to kill himself or you.

It’s the system, not the individuals. We have only started on the thinnest little wedge of that kind of thinking about healthcare. That kind of thinking will take us way beyond “evidence-based medicine” to what is coming to be called “evidence-based health.” Evidence-based medicine does everything necessary to stabilize diabetic shock patients, gets their blood sugar under control, gives them the right prescriptions and sends them home. Evidence-based health goes home with them, if necessary, does whatever it takes to find out why they were in shock in the first place, what it takes to make sure that they fill the prescriptions, eat better, get good advice and don’t end up back in the ER in a month.

The Reform Is Not the Change

The federal healthcare reform law is a catalyst, and enabler, and an accelerator of the change we are going through. It is not the change itself, and is not even the cause of it, because the change is driven by much larger economic and demographic factors, especially by the crushing cost of healthcare. If the reform law were to go away, the change would not go away.

Here’s why the change is actually happening: As all these factors have come together, everybody in the business has come to believe that their usual way of doing business is crumbling under them. Doctors, hospitals, home health agencies, insurers, employersâ€"everyone is desperate to find a new footing. And no one has found a certain footing yet.

Eight Methods for Screwing This Up

So this is, as the sportscasters say, our game to lose. It’s our change to screw up. And we can screw it up, big time. In case you are interested in helping that happen, here are eight ways to go about it:

Pretending it’s not there. Denial. A few tweaks. Business as usual. Same-old. Flavor of the week. Hey, it’s not my problem. I can squeak through to retirement anyway. [Note: Hello.]

Pretending it’s there and we know exactly what it is. We know its address and its measurements, the forms to fill out and the boxes to tick off. It’s all execution. Trust me, I’ve done this before. [Note: Actually, you haven’t. Nobody has.]

Fending off risk. Going for the safe choice. Pulling up the drawbridge. Hunkering down. We can’t afford to extend ourselves in this budget cycle. If we try that, it’ll just piss off the doctors. Better wait until this whole thing settles out. [Note: Let us know how that works out for you. From here, it looks like the waters are rising really fast.]

Grabbing an answer. Downloading a package. Not recognizing the edge of panic in your voice when you say reassuringly, “This is what works. This is the solution.” [Note: When the problem is not simple or static, the solution is not unitary.]

Mistaking it for an opportunity for empire. Building ACOs as regional monopolies to push up our compensation and grab market share. [Note: Consider this. How would your answer change if the question was not “How do we grow the enterprise and make our careers safer?” but instead was truly (truly nowâ€"be brutally honest, at least with yourself) “How do we help the people we serve better? How do we ease the suffering? How can we do that for more people? Cheaper? Earlier?”]

Making it a turf war. Grabbing territory. Knocking out the other guy.

Pretending it’s not a turf war, and losing it. Standing by while the other guy eviscerates your hold on the market. [Note: Of course people are going to treat it like a turf war. When everyone’s livelihood is threatened and their value is challenged, that’s what they do. That doesn’t mean you have to. In some games, the only way to win is to not play.]

Gaming the system. Figuring the angles. Making “What’s in it for me? What’s in it for us?” the only questions worth asking. [Note: Here’s the invitation: Play a bigger game. The author Harriet Rubin said a marvelous thing. She said, “Freedom is a bigger game than power. Power is about what you can control. Freedom is about what you can unleash.”]

Consider This

“Since death alone is certain, and the time of death is uncertain, what shall I do?” Yes, I’m quoting somebody. Never mind who. No, don’t write it down. Don’t Facebook it, Tweet it, stick it in Evernote, e-mail it to someone. In fact, don’t even think about it. Don’t think it through, generate options, prioritize. Stop. Just sit with it, just for this one moment: “Since death alone is certain, and the time of death is uncertain, what shall I do?”

Whoever you are, however you have defined yourself so far, you have your hands on some portion of this great rambling chaotic sacred Grand Guignol parade we call healthcare. You have some influence. You can nudge it, poke and prod it, re-shape it, help it grow, make new connections, try new skills. Healthcare is where we bring our suffering, and our tricks to defeat suffering.

We can do this. It is as if the sky has opened up, a break in the pattern; there is an urgency, a swiftness to events, a tide, a moment, a momentum. Let’s roll.

With nearly 30 years’ experience, Joe Flower has emerged as a premier observer on the deep forces changing healthcare in the United States and around the world. As a healthcare speaker, writer, and consultant, he has explored the future of healthcare with clients ranging from the World Health Organization, the Global Business Network, and the U.K. National Health Service, to the majority of state hospital associations in the U.S.  He has written for a number of healthcare publications including, the Healthcare Forum Journal, Physician Executive, and Wired Magazine.  You can find more of Joe’s work at his website, imaginewhatif.com, where this post first appeared.

This piece was first published in the May 19, 2011 Hospitals and Health Networks Daily, from the American Hospital Association.

Filed Under: THCB

Tagged: Healthcare system, Joe Flower, Methodology May 21, 2011

Common cold is a very common health problem around the world and nobody is immune to common cold. Old and young, all are affected by common cold, although the severity and frequency of common cold infection may be different among different age group individuals. Younger age groups of individuals are more prone to get infected by common cold causing virus in compare to older individuals. As individuals age, they become immune to common viruses which cause common cold.

The economic impact of common cold is huge. Although the disease is not serious, it can reduce work capacity in the sufferer for approximately a week during every attacks of common cold. Given the fact that, most individuals (healthy as well as unhealthy individuals suffer from common cold) suffer a few attacks of common cold every year the economic burden for individuals and the world is enormous. The work capacity reduces due to common cold and there is also expense for treatment of common cold, both of which takes a huge toll in the finance of individuals as well as to the State.

Common cold scenario in United States:

It is estimated that in United States alone approximately 100 million visits to doctors (which is only the tip of an iceberg, as most individuals suffering from common cold do not visit doctors) for common cold and estimated cost of which is approximately 8 billion dollars a year. Of approximately 100 million doctor visits for common cold, approximately a third receive antibiotics (although most doctors and health experts know that antibiotics are not indicated for treatment of common cold), which is one of the major reason for development of antibiotic resistance due to overuse and unnecessary use of antibiotics. Americans also spent more than 3 billion dollars a year on OTC (over the counter) medication for symptomatic relief of common cold.

It is estimated that approximately 100 to 200 million school days are missed by school age children every year and as a result, to care for the children parents also miss equal number of workdays (100 to 200 million) every year. In addition to this, workers miss approximately 150 million workdays a year due to common cold, the total value of this is estimated to be over 20 billion dollars a year. This statistics explain the enormity of the health and economic impact of a mild and common disease such as common cold.

This is the scenario of common cold only in United States, the global impact of common cold can be easily guessed from this.

Related posts:

The Global Burden of Diarrhea

What is Common Cold?

Causes of Common Cold

Symptoms of Common Cold

Treatment of Common Cold

Risk Factors of Common Cold

Global Scenario of Herpes Zoster

How common is ringworm?

How common is Retinal Detachment?

Alternative Medicine in Treatment of Common Cold

Enlarge Mark Lennihan/AP

Later this year, if all goes as expected, a generic version of Lipitor will become available in the U.S.

Mark Lennihan/AP

Later this year, if all goes as expected, a generic version of Lipitor will become available in the U.S.

Chances are very good that the next prescription you fill will get you a generic medicine.

Three-quarters of prescriptions these days are filled with a generic. And the proportion keeps climbing.

Later this year, if all goes according to plan, the biggest generic switch in the history of the pharmaceutical industry will go down. Cholesterol-fighter Lipitor, the best-selling prescription medicine in the world, will lose U.S. patent protection, clearing the way for legal, inexpensive copies.

The wave of generics to treat conditions ranging from depression to high blood pressure can save consumers plenty of dough.

 

If your health insurance covers prescription drugs, you'll have a lower copay for a generic versus a brand-name drug. The exact savings would depend on the particulars of the plan, but could easily hit $20 or $30 a month.

If you have to pay for your medicines yourself, some big-box retailers and drugstore chains sell generics for rock-bottom prices.

Over the next couple of years lots of other big-selling brands will also go generic. Think Plavix, a blood thinner, and Actos, for diabetes, just to name two.

Why are there so many generics all of a sudden? Well, the wave actually got rolling a few years ago. Now, though, some of the biggest brands are involved.

The reason for all the action is that patents are expiring on medicines launched during the 1990s, which is looking more and more like a golden era of productivity for the pharmaceutical industry.

Typically the patents for prescription pills last about a dozen years or so. And as the clock runs out, the generics makers rush in.

How do American feel about generics? We asked more than 3,000 people last year in a survey conducted with Thomson Reuters. Eight-five of people said generics are as safe and effective as brand-name drugs. And 90 percent said they're willing to take a generic when one is available.

By DAVID WILLIAMS

I often hear from hospitals that they’re being squeezed greatly on cost and not getting paid enough by government and private payers. I have some sympathy for this argument, but on the other hand somehow this country outspends every other country by at least two to one, and hospitals are a big part of the reason.

So what gives?

An article in yesterday’s Wall Street Journal (One Way for Hospitals to Cut Costs of Tests), reporting on an Archives of Surgery study, provides part of the answer.

Making physicians aware of the costs of blood tests can lower a hospital’s daily bill for those tests by as much 27%, a new study suggests.

Researchers simply told the doctors what things cost.

“There was no telling anyone when, or when not, to order a particular test,” says Elizabeth Stuebing, a study co-author…

But she says it shows what can happen merely by giving physicians information they don’t usually have. “We never see the dollar amount of anything,” Dr. Stuebing says. “The first week I stood up and said that in the previous week we’d charged $30,000 on routine blood work and I could hear gasps from the audience.”

The situation doctors are in today is sort of like being sent to a store and told to get what they need, but not paying for the goods and not  knowing the prices of the items or even which items are expensive and which are cheap. That’s certainly a formula to run up the bill, even if inadvertently â€"which is what the “gasps from the audience” indicate.

The experiment was analogous to putting prices on the items in the store, but still letting the shopper buy whatever they thought they needed. That’s a step in the right direction but not exactly draconian from a cost control standpoint! (Of course there are some cost control measures hospitals impose centrally, which is different from my shopping analogy.)

I have mixed views on whether physicians should be exposed to what things cost. Pricing in hospitals is not like pricing in stores, because “charges” are often a small fraction of what’s ultimately reimbursed. I don’t know that I want doctors making tradeoffs based on faulty data or an incomplete understanding of patient preferences.

Still, letting doctors know what’s cheap, moderately priced and expensive is a good idea. In this case it seems to have held physicians back from ordering things that weren’t needed. And it does give a peek at how bloated expenditures in medicine are today.

It also underlines the fact that we are far from the point where consumers can control costs by having “skin in the game.” Do we expect patients to challenge daily blood draws on the basis of their cost and medical necessity? I don’t.

Filed Under: THCB

May 19, 2011

Whey protein is a byproduct produced during producing cheese from whey. Whey is liquid which remain after milk is curdled and strained for producing cheese. There are reports from some studies, which suggest that whey protein have anti-inflammatory and anti-cancer activity in laboratory tests animals (rodents such as mice, rats etc.), but the similar effects in human is uncertain and unknown. Whey protein and its beneficial health effects on humans is making whey protein very popular. Whey protein is also becoming very poplar protein (food) supplement. New studies and research is being conducted globally on whey protein and its health benefits and its properties of reducing risk of diseases.

Whey protein has become a very poplar dietary and protein supplement and gaining in popularity over many other supplements. The reason of the popularity of whey protein can be attributed to a great extent to the alternative medicine community, who promote the good qualities of whey protein and its health benefits.

Whey protein is rich source of amino acids and there are claims that it has good effects on reducing heart diseases and cancer. We all know the uses of proteins (proteins are the building blocks of human body) and amino acids (used as fuel and in producing and synthesizing proteins). Milk protein (and whey protein is produced from milk protein) has most of the amino acids we need (essential amino acids) for health and protein synthesis. By supplying all the essential amino acids required for protein synthesis, whey protein can be used as one of the best dietary and protein supplements.

Presently there are mainly three forms of whey protein available in the market namely, concentrate, isolate and hydrolysate forms. The concentrate form of whey protein contains 30% to more than 80% of protein and also have good amount of carbohydrate and bioactive compounds and low cholesterol. Isolate form of whey protein contain more than 90% of protein (by weight) and low carbohydrates and fats. Hydrolysate form of whey proteins contain partially digested proteins, which makes it easier to digest and absorb proteins and as a result, this form is also costlier than other forms.

Related posts:

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Know about Sources of Protein

Important facts about Essential Amino Acids

Important facts about Essential Amino Acids

Protein Requirement for Us

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What are the Functions of Proteins?

What are the Functions of Proteins?

Factors that alter Energy/Nutrients Need

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Enlarge Mark Lennihan/AP

Later this year, if all goes as expected, a generic version of Lipitor will become available in the U.S.

Mark Lennihan/AP

Later this year, if all goes as expected, a generic version of Lipitor will become available in the U.S.

Chances are very good that the next prescription you fill will get you a generic medicine.

Three-quarters of prescriptions these days are filled with a generic. And the proportion keeps climbing.

Later this year, if all goes according to plan, the biggest generic switch in the history of the pharmaceutical industry will go down. Cholesterol-fighter Lipitor, the best-selling prescription medicine in the world, will lose U.S. patent protection, clearing the way for legal, inexpensive copies.

The wave of generics to treat conditions ranging from depression to high blood pressure can save consumers plenty of dough.

 

If your health insurance covers prescription drugs, you'll have a lower copay for a generic versus a brand-name drug. The exact savings would depend on the particulars of the plan, but could easily hit $20 or $30 a month.

If you have to pay for your medicines yourself, some big-box retailers and drugstore chains sell generics for rock-bottom prices.

Over the next couple of years lots of other big-selling brands will also go generic. Think Plavix, a blood thinner, and Actos, for diabetes, just to name two.

Why are there so many generics all of a sudden? Well, the wave actually got rolling a few years ago. Now, though, some of the biggest brands are involved.

The reason for all the action is that patents are expiring on medicines launched during the 1990s, which is looking more and more like a golden era of productivity for the pharmaceutical industry.

Typically the patents for prescription pills last about a dozen years or so. And as the clock runs out, the generics makers rush in.

How do American feel about generics? We asked more than 3,000 people last year in a survey conducted with Thomson Reuters. Eight-five of people said generics are as safe and effective as brand-name drugs. And 90 percent said they're willing to take a generic when one is available.

By ROBERT REICH

One of my regrets in life is losing the chance to debate Mitt Romney and whip his ass.

It was the fall of 2002. Mitt had thundered into Massachusetts with enough money to grab the Republican nomination for governor. Meanwhile, I was doing my best to secure the Democratic nomination. One week before the Democratic primary I was tied in the polls with the state treasurer, according to the Boston Herald, well ahead of four other candidates. But my campaign ran out of cash. Despite pleas from my campaign manager, I didn’t want to put a second mortgage on the family home. The rest is history: The state treasurer got the nomination, I never got to debate Mitt, and Mitt won the election.

With Trump, Gingrich, Bachmann, and possibly Palin now in the race for the Republican presidential nomination, “GOP” is starting to mean Goofy, Outrageous, and Peculiar. Mitt would pose the most serious challenge to a second Obama term.

I say this not because Mitt’s mind is the sharpest of the likely contenders (Gingrich is far more nimble intellectually). Nor because his record of public service is particularly impressive (Tim Pawlenty took his governorship seriously while Mitt as governor seemed more intent on burnishing his Republican credentials outside Massachusetts). Nor because Mitt is the most experienced at running a business (Donald Trump has managed a giant company while Mitt made his money buying and selling companies.) Nor, finally, because he’s especially charismatic or entertaining (Sarah Palin can work up audiences and Mike Huckabee is genuinely funny and folksy, while Mitt delivers a speech so laboriously he seems to be driving a large truck).

Mitt Romney’s great strength is he looks, sounds, and acts presidential.

Policy wonks like me want to believe the public pays most attention to candidates’ platforms and policy positions. Again and again we’re proven wrong. Unless a candidate is way out of the mainstream (Barry Goldwater and George McGovern come to mind), the public tends to vote for the person who makes them feel safest at a visceral level, who reassures them he’ll take best care of the country â€" not because of what he says but because of how he says it.

In this regard, looks matter. Taller candidates almost always win over shorter ones (meaning even if I’d whipped him in a debate, Romney would probably still have won the governorship). Good-looking ones with great smiles garner more votes than those who scowl or perspire (Kennedy versus Nixon), thin ones are elected over fat ones (William Howard Taft to the contrary notwithstanding), and the bald need not apply (would Eisenhower have made it if Stevenson had been blessed with a thick shock?).

Voices also matter. Deeper registers signal gravitas; higher and more nasal emanations don’t command nearly as much respect (think of Reagan versus Carter, or Obama versus McCain).

And behavior matters. Voters prefer candidates who appear even-tempered and comfortable with themselves (this was Obama’s strongest advantage over John McCain in 2008). They also favor the candidate who projects the most confidence and optimism (think FDR, Reagan, and Bill Clinton).

Romney has it all. Plus a strong jaw, gleaming white teeth, and perfect posture. No other Republican hopeful comes close.

What does Mitt stand for? It’s a mystery â€" other than a smaller government is good and the Obama administration is bad. Of all the Republican hopefuls, Romney has most assiduously avoided taking positions. He’s written two books but I challenge anyone to find a clear policy in either. Both books are so hedged, conditioned, boring and bland that once you put them down you can’t pick them up.

Mitt is reputed to say whatever an audience wants to hear, but that’s not quite right. In reality he says nothing, but does it in such way audiences believe they’ve heard what they want to hear. He is the chameleon candidate. To call Mitt Romney an empty suit is an insult to suits.

Yet Romney is gaining ground over Obama. According to the most recent Marist poll, in a hypothetical presidential matchup Obama now holds a one percent point lead over Romney,  46 to 45. In January, Obama led Romney by 13 points.

Why is Mitt doing so well? Partly because Obama’s positions are by now well known, while voters can project anything they want on to Mitt. It’s also because much of the public continues to worry about the economy, jobs, and the price of gas at the pump, and they inevitably blame the President.

But I suspect something else is at work here, too. To many voters, President Obama sounds and acts presidential but he doesn’t look it. Mitt Romney is the perfect candidate for people uncomfortable that their president is black. Mitt is their great white hope.

Robert Reich served as the 22nd United States Secretary of labor under President William Jefferson Clinton from 1992 to 1997. He shares many of his thoughts and columns at Robert Reich.org, where this post first appeared.

Filed Under: THCB

Tagged: GOP, Mitt Romney, Political candidates, Robert Reich May 10, 2011

There are more than 100 different viruses which can cause common cold. But the most commonly involved virus is rhinovirus, which cause up to half (50%) of all common cold infections. Other commonly involved viruses include corona viruses (which is a type of picorna virus and causing 10-15% of common cold infections), influenza viruses (causing 5-10% common cold infections), para-influenza viruses, human respiratory syncytial viruses, adenoviruses, enteroviruses etc. Among adults majority of common cold infections are due to corona viruses with 99 known serotypes and probably larger numbers of unknown serotypes.

All humans (non healthy as well as healthy persons) are susceptible to common cold infections, and preschool children are particularly more prone to get infected by common cold viruses. Immunity against one type of virus does not help in preventing infection by another type of common cold causing virus and a person may have common cold several times a year.

Common cold is common in particular season or time of the year. Common cold is more common during time of fall and winter season due to several reasons. During winter people tend to remain closer to each other in compare to summer or other seasons, which makes it easier to transmit the virus from one person to another. In the tropical regions where winter season is mild or absent, common cold is more frequently seen during rainy season, may be due to getting wet in rain more frequently.

Children are more prone to common cold in compare to adults and aged persons, as children have not developed immunity against most common viruses responsible for cold. As children grow older the frequency of attacks of common cold reduce. Children also tend to have frequent cold de to close mixing with peer age group.

Related posts:

What is Common Cold?

Symptoms of Common Cold

How to Prevent Cold Sores?

How common is Rotavirus Infection?

What are the Complications & Treatment of Cold Sores?

Cold Sore: Things You Need to Know

Symptoms of Cold Sores

Some common Questions about Shingles or Herpes Zoster

Is there any Home Remedy Available for Cold Sores?

How to Prepare Yourself for Cold Sores, for Appointment with Doctor

Jodie Morris/Kaiser Health News

Under federal law, health insurers must spend at least 80 percent of premium revenues on medical services or quality improvement.

Consumers in nine states owed an expected $95 million in rebates from their health insurers might not see those rebates after all.

Those states' regulators are asking the Obama Administration to ease up on rules that say insurers must spend at least 80 percent of their premium revenue on medical care or quality improvements.

The regulators say some insurers are unable to quickly make the changes needed to hit that spending target â€" and would have to pay rebates to consumers. They say that, without relief, insurers would flee their markets, leaving some policyholders unable to qualify or afford other coverage.

Not so, say consumer advocates, who say most insurers should be able to meet the spending rule.

 

"The end impact will be to deny consumers the millions in rebates they expect to get on this year's premiums," says Carmen Balber, Washington director of the advocacy group Consumer Watchdog.

Under the federal health law, insurers must spend at least 80 percent of premium revenues on medical costs or quality improvements; the remainder can go toward administrative costs, broker commissions and profits. Many health plans, but not all, already meet that target.

The spending requirement, called the "medical loss ratio," applies to all health plans, except those offered by companies that are self-insured, where an insurance company just does the paperwork, and the employer decides what the benefits include.

The waivers sought by the states would affect only individual policies bought by people who don't get coverage through their jobs. Nationwide, more than 18 million Americans purchase their own policies.

Up to 9 million Americans with individual policies and in group plans could be eligible for rebates, according to government estimates.

In the states asking for an adjustment, potential rebates total more than $95 million for policies in effect this year.

The Department of Health and Human Services is expected to rule soon on requests from New Hampshire and Nevada to ease the rule. Other states that have applied are Florida, Kentucky, Louisiana, North Dakota, Georgia, Kansas and Iowa. Maine has already been granted an adjustment, with insurers there being allowed to spend only 65 percent of revenue on medical care during each of the next three years.

In deciding whether to lower the target in some states, the administration will weigh how many insurers might leave a market, how many people would be affected and whether policyholders have other options, such as special insurance pools for people with health problems, says Steven Larsen, deputy administrator of the Center for Consumer and Insurance Oversight at HHS.

He says deciding on the states' requests is a balancing act: While insurers should be pushed to spend more on medical care, it "might not be in consumers' best interest" to drive them out of the marketplace.

Because of that, some analysts predict that the administration will grant most of the states' requests.

"The last thing the Obama administration wants is the Des Moines Register writing about 500 people who lost their health insurance in Iowa because of the Obama health plan," says Robert Laszewski, a consultant to the health care industry and a former insurance executive.

By Marco Smit

At Health 2.0 Advisors we not only scan and analyze the healthcare innovation landscape incessantly, we also share our thoughts and insights with clients and at conferences at times. On that note, on May 13 at 10am I will be moderating a panel on cloud-computing in healthcare at Tiecon 2011. It is the first panel right after the ‘interesting’ Steve Case speaks â€" Marissa Meyer from Google closes on Saturday evening.

Cloud-computing is one of the topics that Health 2.0 Advisors will start sharing more perspective on in public this year, in addition to unplatforms/mobile, analytics, and care delivery innovation. What these topics all have in common is that they are forces rapidly changing the healthcare landscape (competitive landscape, business models, patient-provider dynamics, other) and companies are grappling where they all fit in with their strategies and business realities.

This Tiecon 2011 panel is a good reflection of that: cloud-based EMR-systems where a novelty 18 months ago, but the number of companies offering them (stand-alone or embedded in e.g. a practice management suite), has exploded since. But cloud-computing goes far beyond EMRs of course. That is why the panel will cover a range of experiences, struggles, and expectations for the future of the cloud from large (IBM, Kaiser Pemanente) and small â€" but rapidly growing (Practice Fusion, CareCloud) â€" companies that have cloud-computing in their DNA.

Marco Smit is President of Health 2.0 Advisors, the market intelligence arm of the Health 2.0 family.

Filed Under: Health 2.0, THCB

Tagged: Health 2.0 May 9, 2011

Common cold is an infectious disease of upper respiratory tract (mainly nose and throat), caused by virus. Common cold is the most common infectious disease affecting humans. It is estimated that adults on an average contact common cold two to four times a year and children on an average contact common cold 6-12 times a year. Most common causative viruses are rhinoviruses and corona viruses, although there are more than 100 different viruses which can cause common cold and cause great variation of symptoms of common cold. Common cold is usually a harmless disease, although it may trouble you greatly. It is not uncommon among healthy individuals also and a healthy person may have a few attacks of common cold each year. The symptoms of common cold generally last for a week to 10 days and resolve spontaneously. If symptoms do not resolve within a week, you should consult your doctor. Sometimes symptoms may last as long as three weeks.

Common symptoms of common cold are fever, sore throat, runny nose, cough etc. Watery eyes, frequent sneezing and nasal congestions may also occur in common cold. All the symptoms mentioned here may or may not be present in one individual.

What are the synonyms of common cold?

The synonyms of common cold include acute coryza, flu, cold, nasopharyngitis, acute viral rhinopharyngitis etc.

Common cold, influenza and other types of upper respiratory tract infections (RTI) are collectively called influenza like illnesses.

There is a common phrase about common cold, that “if you get treated for common cold by visiting a doctor, your common cold will be cured in a week and if you do not receive any treatment for common cold, you will be cured in seven days”. This phrase explains about common cold better than any explanation, as far as treatment requirement for common cold is concerned.

Common cold generally needs no treatment or if treated, it should be symptomatic treatment.

Related posts:

How to Prepare Yourself for Cold Sores, for Appointment with Doctor

Symptoms of Cold Sores

Some Common Questions about Nutrition Intake

Cold Sore: Things You Need to Know

Is there any Home Remedy Available for Cold Sores?

How to Prevent Cold Sores?

What are the Complications & Treatment of Cold Sores?

The Global Burden of Diarrhea

Treatment of Ringworm

Acute Diarrhea

Enlarge iStockphoto.com

Big Sky and relatively big enrollment in high-risk pools.

iStockphoto.com

Big Sky and relatively big enrollment in high-risk pools.

Though it's nearly 2,000 miles from Washington, Montana plays an oversized role in the health care debate. Its senior senator, Max Baucus, was one of the biggest players in crafting the sweeping federal health law.

And now Montana leads the country in the proportion of people who have signed up for the health law's insurance program for those with pre-existing conditions.

Still, the absolute number is quite low. Montana has signed up just 198 people.

 

In fact, as of the end of March, 18,313 people nationwide had signed up for the Pre-Existing Condition Insurance Plan â€" up from 12,437 on Feb. 1, according to data released today.

The numbers remain far below initial estimates for the high-risk pools established in the 2010 health law. Two reasons: high premiums and consumers' lack of awareness about the program.

The plans, which are run either by individual states or by the federal government if the states opted not to participate, became available to most people last September. They are intended to serve as a bridge until the insurance market reforms are implemented in 2014, when insurers will no longer be able to deny coverage or charge higher rates for people with pre-existing conditions.

The Congressional Budget Office had estimated that as many as 4 million uninsured Americans would be eligible for the program and that 200,000 would be enrolled by 2013. And the Chief Actuary of Medicare and Medicaid estimated that 375,000 people would enroll in these high risk pools by the end of 2010.

Citing the low enrollment, some Republicans including Rep. Fred Upton (R-MI), have criticized the administration's handling of the program.

The cost of the plan, and the fact that many people still don't know about it, may be keeping enrollment down.

But administration officials point to the trend and are optimistic.

"We're encouraged by the jump in enrollment and we're excited to build and expand on our recent outreach efforts to reach even more people," said Richard Popper, director of insurance programs at the federal Center for Consumer Information & Insurance Oversight.

Enrollment varies widely by state. Pennsylvania has the highest enrollment with 2,684 people while North Dakota has enrolled just six people.

The U.S. Department of Health and Human Services lowered premiums in the plans it runs by about 20 percent this year and asked the states running their own programs to consider lowering their rates as well. Despite the slow start, Obama administration officials have said they are pleased with the program.

Most states require applicants to show proof that they've been rejected for coverage by a private insurer within the past six months or been denied coverage for certain benefits. At least a dozen states, including Pennsylvania, give applicants the option to provide a doctor's note as proof they have a pre-existing condition such as cancer or rheumatoid arthritis.

HHS has hired a private contractor to administer the programs it runs in states but generally they have enrolled fewer people than states running their own program.

Michael Keough, executive director of Inclusive Health, which runs the plan in North Carolina, credits increased awareness and lower premiums for the enrollment increase.

His plan cut rates by 10 percent across the board in January and rates fell as much as 30 percent for people between ages 55 and 64. The average premium for a 50-year-old in the plan is $285 with a $3,500 deductible.

More than 1,500 people have signed up for the program in North Carolina as of April, doubling enrollment since February.

"The trend line is increasing and that is what you want and the program is starting to have the desired impact," Keough said. "The plans still have the shadow of the original expectations to live with however accurate or not."

By CHRISTOPHER J. ASAKIEWICZ

Personal data privacy once again has taken front stage in Sorrel v. IMS Health, Inc.[1] Vermont passed the Vermont Confidentiality of Prescription Information Law that allows doctors which prescribe drugs to patients, to decide whether pharmacies can sell their prescription drug prescription records.[2] IMS Health as well as other health information companies contested the law, arguing that the law poses a restriction on commercial speech as access to such information helps pharmaceutical companies market their drugs effectively to doctors. The Supreme Court is now tasked with determining the constitutionality of the restriction on access to prescription information with regards to our First Amendment. [3]

However, this post is focused on the secondary effects asserted in amici curiae briefs supporting the petitioners of allowing companies to purchase such information, specifically the concern of data privacy and patient re-identification. [4] Under the Health Information Portability and Accountability Act (HIPAA), personal health information is de-identified by your local pharmacy prior to such information being shared with any third party. By de-identifying the data, your personal data cannot, it is believed, be linked or traced back to you. De-identifying your health information is a way for covered entities to share your information without your consent or authorization and in accordance with the law. The information once shared is completely anonymized. After the transfer to a third party, like IMS Health, your information is solely data of zeros and ones that translate to dates of dispensing and drug names. No longer does your prescription record list your name or month or day of birth. [5]

Briefs in the case assert that data mining firms could, hypothetically, create profiles based on these de-identified prescription records. Such prescription profiles would constitute certain patient’s prescription habits, including an individual’s medication types, pharmacies visited and dates dispensed. The briefs argue that linking and mining further public information to these drug profiles could result in patient re-identification.

IMS Health, Inc., of course, asserts that it has no knowledge of any patient re-identification and it protects such records with all the security privacy measures set forth under HIPAA and as strengthened by Health Information Technology for Economic and Clinical Health Act (HITECH). So what is the issue, I ask?

A pharmaceutical company does not need nor want to know who you are. Aggregate data is more beneficial to a marketing company, rather than just one record with your name on it. What benefit would a company get from a record that says, John Doe, DOB: 01-Jan-1984? The company could send you a mailer, but under the current regulations, you can opt out of the marketing material and it stops there. However, what helps a pharmaceutical company is aggregate datasets that say Dr. Jane Doe, MD writes 100 scripts for Lipitor ® a month. No one cares if the patients are unidentifiable, and most likely, the pharmaceutical company wants to keep it that way. Not only will the de-identified data be cheaper to buy, but it also assures the third party purchasing the data that it is not aiding a HIPAA violation.

Last, it is also asserted that there is no penalty for re-identification of personal health data, but there are stark penalties under HIPAA for “a person who knowingly … (1) uses or causes to be used a unique health identifier; (2) obtains individually identifiable health information relating to an individual; or (3) discloses individually identifiable health information to another person.” [6] If the offense is committed with the intent to sell, transfer or use the individually identifiable health information for commercial advantage, the penalty could be up to $250,000 and 10 years imprisonment. [7] If claims are brought against companies, like IMS Health, the companies will surely argue they are not covered entities subject to the penalties under HIPAA; however, this does not prevent civil lawsuits against them.

What will happen if a breach occurs due to patient re-identification? Most likely, the current healthcare environment where many companies are acting under corporate integrity agreements or deferred prosecution agreements, promotes reporting, if not out of altruistic purpose at least a compliance purpose. With this said, once reported to both the Department of Health and Human Services, Office of Civil Rights, as well as, in most states, the Secretary of state, privacy and confidentiality laws require notification to be provided to the patient that has been re-identified. This patient whose privacy rights have been infringed can then bring an individual civil claim against the organization responsible for the disclosure of their health information as well as the collateral damages caused by the unauthorized disclosure. Now, what company today wants to get involved with this type of bad publicity?

In conclusion, just because the possibility exists that a patient can be re-identified with data mining practices, does not mean that our current environment will foster such. The nine Justices of the Supreme Court need to be more concerned with the First Amendment and the commercial speech implications of their ruling, rather than amici curiae briefs supporting public policy positions based on unwarranted fears of patient information disclosure.[8]

I therefore urge you to put yourself in the role of your favorite Justice and consider if you should be more concerned that a company is going to buy your prescription records and try to determine that you took amoxicillin for a sinus infection when you were five years old, or if that company would rather purchase all the information you posted on Facebook ® or other social networking sites, including all the locations you have checked in. Which do you think is more useful to market its products? It is with this mindset that you must consider if the regulation directly advances the governmental interest “in protecting the public health of Vermonters, … the privacy of prescribers and prescribing information” and is no more extensive than necessary to serve that interest. [9]

This post first appeared on Health Reform Watch, the web log of the Seton Hall University School of Law, Health Law & Policy Program.

Christopher J. Asakiewicz, JD, works for ImClone Systems Corporation, an affiliate of Eli Lilly and Company. He graduated from Seton Hall Law in 20011 with a concentration in Health Law.

Filed Under: THCB

Tagged: Christopher Asakiewicz, HIPAA, Personal data, Privacy, Sorrel v. IMS Health May 5, 2011

Diagnosis of hemolytic anemia:

Hemolytic anemia is diagnosed based on clinical findings (the symptoms of hemolytic anemia such as pale skin, breathlessness, generalized weakness etc.) and certain laboratory investigations. The first test (laboratory test) done for diagnosis of anemia (including hemolytic anemia) is hemoglobin estimation. According to World Health Organization (WHO) hemoglobin level below 130 grams per liter blood in adult male is anemia and hemoglobin level below 120 grams per liter blood in adult female is anemia. Once anemia is diagnosed the next step is to find out type of anemia (such as hemolytic anemia, iron deficiency anemia, pernicious anemia etc.). The laboratory tests done for diagnosis of hemolytic anemia include peripheral blood smear microscopy, estimation of bilirubin (mainly unconjugated bilirubin), Coombs test, estimation of lactate dehydrogenase, hemosiderin and urobilinogen estimation etc.

Peripheral blood smears microscopy:

This is an important investigation in diagnosis of hemolytic anemia. The red blood cell morphology may show abnormality such as the red blood cells become smaller and rounder (spherocytes). There may be fragments of red cells in the peripheral blood smear. The reticulocytes (the precursors of red blood cells) may be higher in number.

Bilirubin level will be elevated (normally 0.1 to 0.8 mg per 100 ml blood), which may cause jaundice. Coombs test (direct Coombs test), if positive indicates hemolysis (breakdown of red cells) due to immune response. Increased hemosiderin level in urine indicates intravascular hemolysis.

Treatment of Hemolytic anemia:

The definitive treatment of hemolytic anemia depends on the cause of the anemia. Symptomatic treatment of hemolytic anemia (as well as all other types of anemia) includes blood transfusion (packed red cell transfusion or whole blood transfusion), especially if anemia is marked.

If extravsacular hemolysis is predominant, removal of spleen (splenectomy) may cause improvement of hemolytic anemia, as most red cells are red cells are removed from circulation by spleen. If hemolytic anemia is due to immune related cause treatment with steroids may be helpful.

Related posts:

Know about Hemolytic Anemia

Pathophysiology of Hemolytic Anemia

What are the Causes of Hemolytic Anemia?

Treatment of Iron Deficiency Anemia

What are the Symptoms of Iron Deficiency Anemia?

What are the causes of Iron Deficiency Anemia?

What are the Complications of Iron Deficiency Anemia?

Who are at Risk of Iron deficiency Anemia?

Prevention of Iron Deficiency Anemia

How Amenorrhea is diagnosed?

Enlarge iStockphoto.com

Big Sky and relatively big enrollment in high-risk pools.

iStockphoto.com

Big Sky and relatively big enrollment in high-risk pools.

Though it's nearly 2,000 miles from Washington, Montana plays an oversized role in the health care debate. Its senior senator, Max Baucus, was one of the biggest players in crafting in the health law.

And now Montana leads the country in the proportion of people who have signed up for the health law's insurance program for those with pre-existing conditions.

But the absolute number is quite low. Montana has signed up just 198 people.

 

In fact, as of the end of March, 18,313 people nationwide had signed up for the Pre-Existing Condition Insurance Plan â€" up from 12,437 on Feb. 1, according to data released today.

The numbers remain far below initial estimates for the high-risk pools established in the 2010 health law. Two reasons: high premiums and consumers' lack of awareness about the program.

The plans, which are run either by individual states or by the federal government if the states opted not to participate, became available to most people last September. They are intended to serve as a bridge until the insurance market reforms are implemented in 2014, when insurers will no longer be able to deny coverage or charge higher rates for people with pre-existing conditions.

The Congressional Budget Office had estimated that as many as 4 million uninsured Americans would be eligible for the program and that 200,000 would be enrolled by 2013. And the Chief Actuary of Medicare and Medicaid estimated that 375,000 people would enroll in these high risk pools by the end of 2010.

Citing the low enrollment, some Republicans including Rep. Fred Upton (R-MI), have criticized the administration's handling of the program.

The cost of the plan, and the fact that many people still don't know about it, may be keeping enrollment down.

But administration officials point to the trend and are optimistic.

"We're encouraged by the jump in enrollment and we're excited to build and expand on our recent outreach efforts to reach even more people," said Richard Popper, director of insurance programs at the federal Center for Consumer Information & Insurance Oversight.

Enrollment varies widely by state. Pennsylvania has the highest enrollment with 2,684 people while North Dakota has enrolled just six people.

The U.S. Department of Health and Human Services lowered premiums in the plans it runs by about 20 percent this year and asked the states running their own programs to consider lowering their rates as well. Despite the slow start, Obama administration officials have said they are pleased with the program.

Most states require applicants to show proof that they've been rejected for coverage by a private insurer within the past six months or been denied coverage for certain benefits. At least a dozen states, including Pennsylvania, give applicants the option to provide a doctor's note as proof they have a pre-existing condition such as cancer or rheumatoid arthritis.

HHS has hired a private contractor to administer the programs it runs in states but generally they have enrolled fewer people than states running their own program.

Michael Keough, executive director of Inclusive Health, which runs the plan in North Carolina, credits increased awareness and lower premiums for the enrollment increase.

His plan cut rates by 10 percent across the board in January and rates fell as much as 30 percent for people between ages 55 and 64. The average premium for a 50-year-old in the plan is $285 with a $3,500 deductible.

More than 1,500 people have signed up for the program in North Carolina as of April, doubling enrollment since February.

"The trend line is increasing and that is what you want and the program is starting to have the desired impact," Keough said. "The plans still have the shadow of the original expectations to live with however accurate or not."

By AMY ROMANO

I’ve been writing about safe and effective maternity care for years and direct a coordinated national effort to transform maternity care, but this is a post where the political gets personal.

Last weekend, I attended the birthday party for the sweetest one year old. There were all of the typical rituals â€" hands and face covered in cake frosting, a pile of toys and new clothes, and a tuckered out babe falling asleep as the party wound down. But this birthday was bittersweet, because it also marks the anniversary of a crisis that very nearly cost the life of this child’s mother, my friend.

Nine days after giving birth, rather than gazing with equal parts sheer love and sheer exhaustion at her baby, my friend â€" we’ll call her  Near Miss Mom â€" was unconscious in an ICU on a ventilator, recovering from the emergency hysterectomy and blood transfusion that had saved her life.

I’d say Near Miss Mom had become a “statistic” but we keep no statistics on near miss maternal events, even though multiple agencies and organizations have sounded alarm bells about the rising rate of maternal mortality and have cautioned that for every maternal death, there are many more near misses. Legislation just introduced in the House by Representative Conyers would, among other provisions, establish steps toward a standard definition and routine counting and reporting of maternal near misses.

Because if we’re not counting near misses, we’re not systematically learning what our health care system could be doing to avert them, and for that matter the deaths that do occur. A  just-released report from a state-wide, multi-year investigation of maternal deaths in California found that 38% were likely to be preventable. Let’s take Near Miss Mom’s case, which almost certainly could have been averted far before she was so close to death.

Near Miss Mom almost died:

• Because her postpartum discharge teaching didn’t include anything about how to recognize and get help for postpartum hemorrhage â€" even though she had three major risk factors for hemorrhage

• Because the hospital had no protocol to systematically deal with late postpartum hemorrhage â€" even though the largest maternal quality collaborative in the country has a freely available toolkit for that

• Because no one was measuring her blood loss while she sat in the ER on two different occasions for hours at a time â€" even though she was sitting in a pool of blood so deep it was pouring over the tops of her thighs and the sheets had to be changed more than once

• Because she had to “wait in line” for the MRI and then wait some more for someone to interpret it â€" even though there are less sophisticated but equally effective methods to rule in or out the rare defect they were concerned about.

• Because no one in the ER communicated the severity of her condition to the obstetrician who was “overseeing” her care â€" even though the OB was in house and could have visited her herself. When she finally reached Near Miss Mom’s bedside, it didn’t take her long to call a Code Red and assemble the team for the emergency hysterectomy.

Patient safety advocates and experts will see some familiar themes in this list â€" lack of standards and accountability, poor communication, system failures â€" and although  maternity care is the most common reason for hospitalization, how often do we think of hospital safety as it pertains to maternal health? My best guess is that the disconnect arises from the fact that childbearing women are usually healthy and therefore (physically at least) resilient. Unlike patients who enter the hospital sick or injured, it can take many errors and system failures to actually kill a mother. Yet this means the problems can get so immense and intractable before we see the accumulation of harm. That adds up to a lot of women coping with preventable injury, illness, and emotional trauma at the same time that they should be experiencing the joys and taking on the challenges of new motherhood.

I recently asked Near Miss Mom recently what it felt like to be bleeding to death. Her response wasn’t what I expected, but knowing what I know of the fractured and fragmented system, it’s not surprising.

“Honestly, I don’t know. I was so overwhelmed with the lack of care in the ER and by my OB practice that I wasn’t really thinking about bleeding to death. But why would I? No one thinks about that as a possibility. I mean, I assume no one does. Why would we when we have an expectation of proper care? It wasn’t until I was admitted and in my room, and the OB was asking why the blood was taking so long that I realized I was potentially screwed. My first thoughts were my daughter and husband and would I be there for them. Right after that I went into shock so not much time to truly think about actually dying. I mean, dying? Really? I knew I was bleeding all day but I never thought they would let me reach the point of near death.”

Since the moment Near Miss Mom began her recovery, her most fervent hope has been to help make sure this doesn’t happen to any one else ever again. Unfortunately, when we met with her OB team after the fact, they declined her offer to be involved in quality improvement efforts because those matters are confidential. They also told her that she would need to meet separately with the ER team because they run their own quality improvement programs and the OB Department can’t influence what the ER does (if that’s not silo thinking, I don’t know what is). Then they asked if either of the companions she brought with her for support and advocacy were lawyers and, just for good measure, billed her insurance company for the time spent meeting.

Near Miss Mom has been trying for a year to use her story to spark desperately needed improvements in maternity care, but has encountered road blocks at every turn. Even writing down her story has been too much at times, as she deals with still incomplete medical records, post traumatic distress triggers, and the time and energy constraints all new mothers face.

But she is ready to make change and as her first public acts of activism, Near Miss Mom will join a delegation to get lawmakers to sponsor the Maternal Health Accountability Act and she will use her story to ask others to donate blood in the month of May to honor Mother’s Day. Near Miss Mom writes,

“Without the people who donated blood, I would not be here. It wasn’t only the surgery that saved my life. It was the blood. Eleven strangers saved my life. And saved my baby’s mother.”

I will be at Near Miss Mom’s side for both of these courageous acts of activism. We hope others will do the same in their own communities. Will you join us?

Amy Romano, MSN, CNM, is the Project Director of the HYPERLINK “http://transform.childbirthconnection.org” Transforming Maternity Care Partnership, a multi-stakeholder collaborative effort to achieve a high-quality, high-value maternity care system, coordinated by Childbirth Connection.

Filed Under: THCB

May 3, 2011

Enlarge iStockphoto.com

How much salt is too much?

iStockphoto.com

How much salt is too much?

Might be time to dust off Woody Allen's Sleeper, the 1973 movie that, among other zany things, told us all the foods that we thought were bad for us (think steak and hot fudge) were found by future generations to be good.

A provocative study in the latest issue of JAMA suggests that moderate salt intake might be no problem and that for many people diets very low in salt could be a recipe for trouble.

European researchers studying nearly 4,000 people as they aged found increases in systolic blood pressure were associated with increases in salt measured in the urine. (Sorry, that's how the researchers could accurately quantify how much salt people had in their systems.)

 

Changes in diastolic blood pressure (the bottom number in blood pressure readings) didn't show a relationship with salt.

And, perhaps most interesting of all, the increases in salt and diastolic pressure were not associated with an increase in deaths from cardiovascular disease, such as heart attacks and strokes. Indeed, people with less salt in their urine were more likely to die from cardiovascular causes.

Surprising, right? Previous research has predicted, for instance, that lowering salt intake just a little â€" a half-teaspoon a day â€" would save the lives of at least 44,000 Americans a year.

Well, it wasn't surprising to Dr. Jan A. Staessen, a hypertension researcher at the University of Leuven, who is the senior author on the paper. He told the news@JAMA blog:

We started this research more than 25 years ago, and in all our studies, it was almost impossible to find an association between blood pressure and 24-hour sodium excretion. We were a bit surprised to see an inverse relationship between sodium intake and cardiovascular death.

He acknowledges that limitations of the study don't make it easy to explain exactly what's going only. Staessen theorized that cutting way back on salt can "activate some of the systems that conserve sodium and they are known to have a negative influence on cardiovascular outcomes." In any case, he said, the findings should give pause to people making population-wide recommendations to cut salt intake.

The Centers for Disease Control and Prevention, one of the big proponents of lower salt consumption, isn't so sure about that. In an interview with the New York Times, CDC's Dr. Peter Briss faulted the study, saying it was small, included relatively young subjects and had relatively few cardiovascular deaths.

Among the people in the the study, there were 84 deaths due to cardiovascular disease. The majority of those â€" 54 â€" occurred in the third of people who happened to have the lowest salt consumption.

The limitations, Briss said, make it hard to draw conclusions that would overturn the previous work that has link increased salt intake and bad health outcomes. "At the moment, this study might need to be taken with a grain of salt," Briss told the Times.

The European researchers had no financial conflicts of interest to report. They received funding from a bunch of governments.

By GLENN LAFFEL, MD

Amazon Web Services (AWS), “the cloud” for many, experienced a serious interruption in service beginning on April 21st. The problem lingered for at least 6 days. Many websites that relied on Amazon services went down or saw their performance degraded during the event.

The AWS failure disproportionately affected startups like Foursquare, Quora and Reddit, companies that are “focused on moving fast in pursuit of growth, and less apt to pay for extensive backup and recovery services.”

One of the affected companies was a health care startup. What follows is a transcription (including typos) of an AWS Discussion Forum that this company initiated 24 hours after the outage began. The company’s contributions are in italics.

Life of our patients is at stakeâ€"I am desperately asking you to contact

Sorry I could not get through in any other way. We are a monitoring company and are monitoring hundreds of cardiac patients at home. We are unable to see their ECG signals since 21st of April. Can you please contact us? Or please let me know how can I contact you more ditectly. Thank you.

Oh this is not good. Man mission critical systems should never be run in the cloud. Just because AWS is HIPPA certified doesn’t mean it won’t go down for 48+ hours in a row.

(+30 minutes since comment thread began) Well, it is supposed to be reliable…
Anyway, I am begging anyone from Amazon team to contact us directly. Thank you
â€"
Go to your backups? Or make a big deal out of it on the forums maybe someone will take a look. In any case anecdotal empirical evidence has shown don’t bother with premium support its a freaking joke.
â€"
Thanks for the comments, but we are really desparate. Amazon team â€" please contact us
â€"
(+10 hours since comment thread began) Not restored. Not heard from Amazon. People out there â€" please take a look at our volumes! This not just some social network website issue, but a serious threat to peoples lives!
â€"
Your only option at this point is Premium support. However, they’re just going to tell you to wait. Sorry.
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(+ 13 hours) There is some progress. 2 servers are operational and one still not working. Unfortunately, the one on which we have the most patients
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Aren’t you braking some compliance laws by not having a highly-available environment?
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You put a life critical system on virtual hosted servers? What the hell is wrong with you
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Not sure whether you’re plain incompetent or irresponsible. Anyway, you should be ashamed and prepare yourself with lots of money to pay for the lawyers. Would it be so difficult to have a contingency plan? another provider? or even another availability zone? Are you so fsklong dumb as to think that nothing could ever happen to a data center.
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(+ 15 hours) This is a home based system, not an intra hospital system. So the promised 99.95% uptime is fine. But this situation showed that the promised 99.95% = fiction… BTW. All three servers are working â€" hopefuly the situation will remain stable
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While I’m not going to suggest Amazon shouldn’t be ashamed of themselves.. I have to admit this is a pretty sickening tale. If I were running a system that could potentially lead to loss of human life. You’d better believe hot-spare data center would be in my mind.
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Your CTO will be a serious liability, and your board is going to crush your C*O staff very soon, if they’re awake. If you haven’t notified doctors and patients already, your liabilities just got worse. If you can’t roll over your IP routing, then you should not be in business. This should be going to a different server and duplicated by your own policies to ensure compliance with ALL regulatory requirements. You’re failing and you probably don’t even know how bad your company is failing. If I were you, I’d beg John Halamka to guide you out of this mess.
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“This not just some social network website issue, but a serious threat to peoples lives!” Which begs the question, why did you leave yourself â€" and your patients â€" open to this risk in the first place? I hope for your patients’ sake that you begin taking more seriously your IT planning. Since you apparently don’t have a fail-over â€" and are waiting for Amazon anyway â€" you might want to think about solving the weakness you built into your own system, i.e., start working on an alternative method of getting what you need. And if you can’t find a way to do that even now, I submit that you should never have launched your service at all.
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Not even your servers are redundant? One of your servers is offline, and there’s not a hot swapable replacement? for a life-critical system? Man, pray God nothing happens, because on contrary, the responsibles for this design are surely going to serve sometime on a nearby prison.
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If you were smart, you would have a distaster recovery plan for just this kind of thing. Judging from your lack of said preparations, you lot figured the cloud never goes down, and got greedy by not wanting to spend money on hot standby machines on a different infrastructure. Good going. Hope none of your cardiac patients croak because you’re going to get sued into next week…
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(+15 hours) As I wrote, this is not a life saving system.Which does not mean that patient’s life cannot be saved using it.That is all I have to say. Good luck to others
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Dude/Dudet. You put that patients lives are at stake in your title … Don’t try to back track. Just admit it was stupid and move on.
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Ah, so the title of this thread was a ruse? Either it isn’t so critical after all, and shame on you for trying to make it seem like it was, or else it is critical, and now you’re lying about it in order to not be shamed by others. Either way, shame on you.
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A perfect case study of what NOT TO DO. Why gamble when people’s LIVES are at stake!?
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We all do mistakes, but the important thing is learn from them. I’ll also have to review and change my policies. As for Amazon, it is a total shame that didn’t give ANY kind of assistance not even to this request. Regards
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Agreed. Sounds like he’s a startup. Failing over to other data centers is extremely expensive to set up and operate. Particularly if his data is write-heavy. No reason for everyone to go all self-righteous on him. In the end, the market will decide. if his patients die, he’ll be fired and/or his company will go out of business. Others will learn, the marketplace will move on.
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This is a Hoax. There are NO Patients in Danger. This was pure Hype from a Sick Person. Don’t fall for this BS. Use your Common Sense. Nobody in charge would allow this FruitCake to load any sort of critical monitoring systems up. You have been had. I respect your very real emotions, and your helpful and constructive responses to this fool, but he made all of this up, to get a Rise out of you. Next time, be more logical and think, before you answer crap like this.

Pizaazz Note: The long-term impact of the AWS outage on cloud computing is uncertain. It may be negligible. IDC estimates that corporate cloud computing will grow by more than 25% per year to $55.5 billion by 2014.

Glenn Laffel, MD, PhD, is a successful entrepreneur in health information technology. He blogs at Pizaazz.

Filed Under: THCB

Tagged: Amazon, Cloud Computing, Cloud-based EHR, Glenn Laffel May 2, 2011

Enlarge Frederick M. Brown/Getty Images

California anesthesiologist Michael Port fills a syringe with the anesthetic propofol in 2009.

Frederick M. Brown/Getty Images

California anesthesiologist Michael Port fills a syringe with the anesthetic propofol in 2009.

Modern medicines can be lifesavers. But they don't do much good if patients can't get them.

And, these days, drug shortages are a real problem. Turns out that a record number of medicines â€" to treat conditions ranging from cancer to life-threatening infections â€" are in short supply, the Washington Post reports.

There were shortages of 211 drugs last year, three times the number in 2006.

One of the worst problems is with cytarabine, a medicine for various forms of leukemia and lymphoma.

 

Shortages of the antibiotic amikacin and acyclovir, an antiviral, have "contributed to patient deaths from infections that were only sensitive" to those drugs, according to a 2010 survey of more than 1,800 health professionals conducted by the nonprofit Institute for Safe Medication Practices. Some drugs used in surgery, such as the anesthetic propofol, have also been hard to find.

The ISMP survey found doctors, nurses and pharmacists "feel unsupported by the Food and Drug Administration" in dealing with the shortages and are "perplexed regarding why the U.S. is experiencing drug shortages of epic proportion that are often associated with third-world countries."

What's causing the shortages? The FDA, which tracks the growing problem with medically necessary drugs, says some of the most important factors are manufacturing difficulties. There are raw material shortages in some cases. Reduced factory capacity due to industry consolidation is another issue. And some companies have dropped older drugs, leaving manufacturing in the hands of fewer companies.

"The types of products we're seeing shortages of are really concerning," FDA's Valerie Jensen, told the Post. "This is affecting oncology drugs, critical-care drugs, emergency medicine drugs. We're doing everything we can under our current authority to try to deal with this situation."

This report of recent activity in Massachusetts may be of special interest to my out-of-state readers. The insurance exchange set up by the Legislature when the MA health care access bill was passed has gotten very good grades. The folks there have had many things to balance, and they have done it thoughtfully. This report was posted on April 22 by Glen Shor, the current Executive Director. He succeeded Jon Kingsdale last April.

April showered us with reasons to be optimistic about the state of health care reform in Massachusetts.

Faced with projected 11% membership growth in the Commonwealth Care program next year as people lose unemployment benefits â€" and no additional resources to cover that growth â€" we encouraged our Medicaid managed care organizations to deliver high-quality, cost-effective coverage for less. They came through for the taxpayers with savings of $80 million, meaning that our members will not have to face the prospect of benefit reductions or unaffordable co-payments.

There was also good news for small business owners looking for an easy way to find affordable health insurance for their employees. Starting in July, we are eliminating all up-front fees for purchasing coverage through the Health Connector and will be launching a wellness program and premium discounts for qualifying small businesses. Within a few months, we will also be expanding the choice of health insurance carriers available to small businesses through our easy-to-use, online shopping experience â€" and even adding an additional carrier for individual purchasers. Our unsubsidized Commonwealth Choice program has doubled in membership over the past year-and-a-half, and these upgrades should make it an even more appealing tool for comparing options and choosing coverage that best suits one’s needs.

And, of course, the fifth anniversary of Massachusetts health care reform was officially marked by Governor Patrick and others at the Dorchester House this month. While we are proud of the fact that 98.1 percent of our residents and 99.8 percent of our children have coverage, the event poignantly showcased that reform isn’t just about numbers. It’s about helping people. We’re succeeding on both fronts.

On the national scene, the Massachusetts experience continues to be closely examined as other states begin to develop their health insurance Exchanges. Partnering with MassHealth and the University of Massachusetts Medical School, we were successful in obtaining a $35.6 million three-year federal grant that will not only help us share our technological knowledge and practices with other New England states but also improve our web-based shopping experience for Massachusetts consumers and small businesses.

Video: A Crash Course In Beating The Cubicle Trap

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A crash course in beating the cubical trap. Breaking up a day of inactivity with movement, even if just for a few minutes, can make a difference.

On this week's podcast we're getting physical, with lots of stories about the dangers of a sedentary life. Whether you are suffering from knee pain like our colleague Richard Knox, or just feel weary after a day sitting at your desk, the solution might be to get moving.

We'll hear a story of some folks who have taken this advice to heart; they've installed "treadmill desks" at work.

Plus, we'll discuss child nutrition. Schools in L.A. are getting rid of flavored milk, thanks to the efforts of celebrity chef Jamie Oliver, and soon, many schools might find it easier to get produce from their neighbors to put into their school lunches. Meanwhile, the Obama administration wants to curb marketing of sugary foods to children â€" but the response by some to the guidelines hasn't been all that sweet.

You can find the podcast at the bottom of the page under the podcast heading. To subscribe to the Your Health podcast, click here.