Idea #102 for May 31st, 2009: Scaring Them Straight or WHO Recommending Images on Cigarette Warnings

In past posts, I’ve advocated getting tough on curbing smoking, but this news coming from the World Health Organization seems a little extreme. The WHO is recommending that nations institute new warnings on cigarette packages that show images of smoking’s consequences, including pictures of diseased organs and cadavers. Examples of the types of pictures the WHO is pushing can be seen on this Wall Street Journal blog, but they are rather disgusting so click at your own risk.

Citizens of some nations are not well informed on the dangers of smoking; in China for instance, only a third of those surveyed knew smoking could cause heart disease. Graphical warnings have been successful in lowering smoking rates in countries like Brazil and Canada, so the WHO does have reason to believe these warnings could be effective at reducing the 5 million annual smoking-related deaths.

Still, I think this might go a little too far for use in the US, where I’d like to believe that we are pretty well-informed of the dangers of smoking. I do advocate enlarging, or making more prominent, the textual warnings currently on cigarette packages. Even displaying images can be fine, I just feel that overly graphic images like the ones the WHO recommends could potentially offend non-smokers who happen to see them. Another effect of second-hand smoking, if you will.

Read the AP story here, see the WHO’s press release here, and check out this Wikipedia page on tobacco warnings around the world.

Idea #101 for May 30th, 2009: Just a Few Minutes of Your Time or Online Cardiovascular Health Assessment

A hospital near Chicago has a simple online tool that it hopes will lower the incidence of preventable heart disease. It’s a risk assessment calculator that takes only a couple minutes to complete. A staggering number of heart disease cases are preventable, and health workers’ are trying to make potential victims more aware of their risk. In fact, a physician at that hospital estimates that 90-95% of their cases of heart disease are preventable. With almost a million deaths a year in the US related to heart disease, there is clearly a need to catch early warning signs and risks of cardiovascular issues before they become deadly.

The tool asks for some basic information like age, weight, blood pressure, and family history, as well as checkboxes for a number of symptoms. Then, your estimated risk level is displayed and if the risk is determined to be high, a free cardiac screening is offered. In those cases, users enter their contact information and a nurse will follow-up by telephone.

Of the 7,000 people who’ve taken the test this year, more than a third have been deemed high-risk. Similar tools are available on other hospital websites as well. It’s a pretty low-cost way to reach out to patients who may otherwise be unable or unwilling to see a doctor. This is an example of a simple tool that should be publicized more and, hopefully, will compel potential heart disease patients to take the necessary steps to thwart the problem.

Read the story about this in the Chicago Tribune and try the test yourself here

Idea #100 for May 29th, 2009: What is EMR or The Heart of the Matter? Part 1

On this very special 100th post edition of Health365 I am tackling perhaps the heart of all contemporary healthcare issues. That issue is defining truly, madly, deeply, what, in fact, is an EMR… Today that is a question when I ask 1000 physicians I get 1000 different answers.

Recently I was speaking with a senior physician at a very prestigious American hospital with virtually unlimited funds, it’s a short list, I am not going to name names. Despite having an EMR system and “digital workflow” and having spent nine figures on getting there, the doctors at this facility are today, in fact, doing their progress notes on… paper. After the fact data gets entered back into the electronic system, hopefully sooner rather than later.  The doctors for a variety of reasons can’t make the digital progress note work in real time and reverting to paper is workable for the time being. While they may claim to be using EMR, I think it’s hard to call  what they have truly an EMR. This reminds me of the story told in “The Data Model That Almost Killed Me” . Delayed entry in many cases, particularly in a hospital environment with the expectation of a “digital workflow”, can be worse than the paper process that existed before the “EMR” implementation. It is going backwards not forwards.

So what does make an EMR, I think there is really a pretty simple forumla that works in all the cases I am familiar with. There are three parts to an EMR: technology + reasonable cost = improved patient outcomes. Something that fails to meet the laugh test on any of those three components cannot be considered an EMR. An EMR that improves patient outcomes but comes at an exorbitant price is not an EMR. Same goes for one that is cost-effective, yet has no positive effect on patient outcomes. Taking a look the major hospital I eluded to above they spent well beyond what any sane person would consider reasonable, they are now not even really using the technology they paid for and they have yet to measure any substantive improvements in patient outcomes, while the system is technically working I would call it a failure as an EMR.

Pinning down the precise meaning of “improved patient outcomes” can be a difficult task and is outside the scope of this first post, but I’ll touch on it in a forthcoming entry. There is a lot of confusion about the differences between EMR, EHR, PHR, etc., but arguing over those kinds of semantics is a waste of time, frankly. The main point is the equation I just mentioned, if you don’t have those three components, the rest is immaterial. As the feds wrap up their testimony (including my contributions) on meaninful use more and more I hear amongst those in the know that this 20 billion dollar incentive package is going to result in more of the same, that is more nine figure “EMR” installations where the key data points still make their way to paper first. There is hope though, there is a shining example of how EMR can be done not perfectly but very well on a very large scale and of all institutions it is facilities run by the VA that make the grade. Congress knows this but have not yet learned the lessons of why the VA has been successful and instead focused on superficial elements. The remainder of the posts in this series will delve deeper into the issue of EMR, what is it and how to do it, so stay tuned…

Idea #99 for May 28th, 2009: The Money Trail or Distributing Cancer Funding Fairly

Cancer deaths are on the decline in this country — certainly good news. But some of the fastest growing cancers are receiving the least funding in the way of vital research. As a CBS News story points out, there is a large disparity in research funding among various types of cancer. For instance, breast cancer receives a larger chunk of federal dollars compared to lung or stomach cancers, relative to the number of respective deaths attributed to them. That’s not to say that breast cancer research funding should decrease, but federal money should be used to balance some of the gaps in funding.

Lung cancer has far more annual deaths attributed to it than any other cancer in the US (about 160,000 deaths). Yet in 2007, it received less than a quarter of the federal funding allotted to research for breast cancer, which claims about 40,000 lives per year. Part of the problem is the stigma attached to lung cancer. The fact that most of its victims are, or once were, smokers has led the public to assign some amount of “blame” to lung cancer sufferers, and that is reflected in the amount of money and attention it receives. Of course, that is a ridiculous notion considering that, a) about 2/3 of all cancers are in some way related to lifestyle choices, and b) 10-15% of lung cancer victims have never touched tobacco.

On the other side of the equation, breast cancer research efforts have had tremendous success in spreading awareness and raising money. Federal funding seems to have followed public opinion; not only does breast cancer receive a great deal of charitable contributions, it also receives more than twice the National Cancer Institute funding of any other type of cancer. Some cancers will always receive more charitable contributions than others, depending on how effective their awareness campaigns are. But federal dollars should be distributed in a more fair manner, so that victims of less-known cancers still have a fighting chance.

Read the story at CBSnews.com and see cancer statistics here and here.

Idea #98 for May 27th, 2009: Nowhere To Go But Up or Change at the FDA

The new leadership at the FDA is promising to change the way the organization operates, along with changing the way success should be defined. In an essay published in the New England Journal of Medicine, new FDA head Margaret Hamburg wrote that “the ultimate measures of the FDA’s success should reflect its fundamental goals and go beyond such intermediate measures as the number of facilities inspected or drugs approved.” The new leadership is making it clear that the primary concern of the FDA should be Americans’ health, not industry (as it seemed to be in the past).

Regarding food safety, Hamburg wants the FDA to focus on prevention of foodborne illness instead of simply reacting after the fact, as they tend to do now. Also, they want to be able to work closer with the USDA on the matter, which has been a source of trouble in the past. Outside of food safety, the FDA now plans to work closer with the CDC on matters such as swine flu. Inter-agency cooperation has been difficult in the past, and getting by that obstacle would certainly make the FDA more effective.

Given their failures in the past, it’s a positive development that the FDA now seems to be learning from debacles like the salmonella outbreak in peanuts last year. The FDA has a long way to go before the public regains confidence in the organization. It’s refreshing to hear that the they are taking a new approach, but whether the promised changes will come to fruition is still up in the air. We’ll see how much of that idealism fades with the realities of bureaucracy and private interests.

In the media, see: the Wall Street Journal, the AP, and the New England Journal of Medicine.

Idea #97 for May 26th, 2009: How Many Free Meals? or Gift Reform in Vermont

Vermont is moving forward with a law that will require all gifts from drug and device be disclosed to the public. The law, which will take effect July 1st, will also ban the free meals often given by drug companies to healthcare providers. Data from 2008 in Vermont shows that about half of the state’s licensed practitioners received some sort of payment or gift from drug or device makers. The gifts totaled $2.9 million in that year, about a third of which was used for free meals.

Vermonters will soon be able to know which (if any) of their providers received gifts from which drug company, as well as the value of the gifts. Gifts can include things like lodging, paid speaking engagements, free meals, or direct payments. Greater transparency in healthcare is always welcome, and this is a major step forward. The public has a right to know if the possibility of conflict of interest exists among their providers. Since the FDA has not implemented major reform or regulation in this regard, it’s good to see Vermont’s state legislature stepping up.

Read about the bill in the NY Times or on this blog.

Idea #96 for May 25th, 2009: Shopping Around or Price Comparison Tool for Medical Procedures

California has implemented a new idea that more regions should consider adopting. It’s an online tool that allows users to compare prices for common medical procedures among the state’s hospitals. You select the procedure (from 28 elective surgeries), the county and the city, and the tool will list all the hospitals that perform the surgery along with their respective prices and average length of stay. It’s important to note that the prices reflect what an uninsured patient should expect to pay; they do not factor in insurance coverage.

California was able to construct the tool partly because of a state law that requires hospitals to report costs for common procedures. There are limitations in its current form, though. The only searchable data is for the year 2007 and does not include Kaiser hospitals, which account for a large portion of California’s hospitals. Also, there are no metrics for quality of care, only price. “Shopping around” is difficult in healthcare, but a tool like this has the potential of providing valuable assistance to patients looking for the most cost-effective option for their procedure.

Use the tool for yourself here, or read more about in the San Francisco Chronicle or on bizjournals.com.

Idea #95 for May 24th, 2009: A Painful Reality or Kidney Stones Among Children Climbing

Pediatricians across the country are seeing a new, unusual trend: higher incidence of kidney stones in children. Kidney stones are most common among middle aged males, but in the last few years, they are becoming more frequent among children — and even toddlers. What’s likely responsible for the trend is childhood obesity. Factors like high blood pressure, high cholesterol and diabetes are believed to contribute to the formation of kidney stones.

Dietary factors like too much sodium and too little calcium intake may also be at play here. In 2005, children were found to be getting 50% more sodium in the diets than in 1995. And in 2001, a study found that 68% of 7 to 9 year-olds exceed the daily recommended amount of sodium intake. Consuming too much sodium can cause kidney stones.

This is another wake-up call for us regarding the state of our nation’s health. The vast majority of cases of childhood kidney stones are preventable, so there shouldn’t be a need for us to spend time and money on treating this disorder.  Just changing kids’ lifestyles should be enough to make this problem go away. That means encouraging them to become more physically active and steering them away from diets high in sodium and calories. Continuing on the current track will surely lead to much more serious problems than just kidney stones.

See more about the kidney stone problem in the LA Times and on naturalnews.com

Idea #94 for May 23rd, 2009: Reaching Out or Free Health Screenings

In rough economic times, citizens are cutting back on spending across the board, including on healthcare. A survey found that about 60% of people are forgoing health spending amid the recession. But skipping preventive care now can have dire consequences late. One way to reach out to people who would otherwise forgo care is through free health screenings.

Various free screenings are available from time to time in regions across the country. For instance, hospitals may offer free cholesterol screenings once a year. Walgreens and the AARP have teamed up to provide mobile health screenings over the next two years. In this case, buses full of staff and equipment will tour the country and offer their services for free.

The Walgreens/AARP program is estimating they will be able to conduct 2.5 million screenings in 3000 communities over that period. The scope of their screenings will include measuring cholesterol, blood pressure, and glucose levels in an attempt to identify chronic conditions like diabetes and hypertension. Last year, their screenings found that about 73% of people tested had high blood pressure. That just underscores the need for more outreach and patient education, especially in an economic climate where more patients are unable to afford proper care.

Read about the Walgreens/AARP program here, and see other screening information in the LA Times.

Idea #93 for May 22nd, 2009: Solar Damage or Sunscreen Usage and Skin Cancer

A lot of the blame for astronomical healthcare costs gets placed on insurance companies, medical facilities and a host of other factors, but there’s also some blame placed on patients themselves. Of course there are plenty of illnesses that are totally out of one’s control, but there are other illnesses that can be avoided (or at least mitigated) by taking preventive measures. A glaring example, which is in the news recently, is Americans’ complacency when it comes to using sunscreen.

According to a Consumer Reports poll, 31% of Americans say they never use sunscreen. While it’s expected that a small percentage of certain people with limited sun exposure wouldn’t use sunscreen, this number is surprisingly high. Even among people who planned to spend two hours in the sun — a long time, really — only 27% of men said they usually apply sunscreen in that scenario.

The American Cancer Society says that skin cancer cases are actually increasing. More than a million cases of skin cancer are diagnosed per year, along with about 60,000 cases of malignant melanoma. The number one cause of skin cancer is exposure to UV rays, which is preventable. Wearing sunscreen or avoiding sun exposure are the best ways to prevent skin cancer, along with regular skin exams from a doctor. A sizable segment of the American population needs to change their attitudes when it comes to skin cancer prevention. Maybe it means better sun health education in schools, or making sunscreen available at parks and beaches. Regardless, there are about a million cases of cancer a year that we could erase by becoming more sun-smart.

Read about this news in: ABC News, USA Today, and see sun safety tips from the American Cancer Society.