Study Questions Fat and Heart Disease Link - NYTimes.com

Study Questions Fat and Heart Disease Link - NYTimes.com: "Many of us have long been told that saturated fat, the type found in meat, butter and cheese, causes heart disease. But a large and exhaustive new analysis by a team of international scientists found no evidence that eating saturated fat increased heart attacks and other cardiac events."

So, another long-standing medical axiom seems to have bitten the dust.



I have always maintained that reasonably healthy people who eat a balanced diet will remain reasonably healthy. Given the diversity in the genetic makeup of our bodies, a one-rule-fits-all formulaic approach can only be relevant to average people. Of course, none of us is 'average.' We are all unique.



I believe we will eventually learn what foods are best for each of us based on our genome. We are getting closer to that goal as research gallops ahead.



'via Blog this'

Interview with Founder of 23andMe Genetics Testing Company

This interview with Anne Wojicicki, the founder of the direct-to-consumer genetics testing company 23andMe provides her view of the potential of genetic testing for citizens.

My genetic information is in their database and I have been fascinated with the outputs provided.

I hope the FDA soon approves what they are doing as it relates to medical information so that the updates relevant to my DNA will continue.

An interesting dialogue about the FDA controversy is available here at Ycombinator.

From the Start, Signs of Trouble at Health Portal - NYTimes.com

This story in the NY Times, normally a strong supporter of this Administration, reveals that the the health portal rollout was and is a colossal failure. Meanwhile, TeamObama has obviously been lying to the American people about it, if we are to believe this story.

Having been associated with complex information technology systems over the years, I am not surprised.  This one is even more fragile because users are not trained in its use and had high expectations because of experience with other complex website that work.  This situation was made doubly worse because Administration officials failed to tell the truth and properly set expectations.

Thank God our military software systems are normally thoroughly tested before deployment and work as they should.

This mess is a direct result of the politics surrounding ObamaCare and the fact that so many people disapprove of it. The roll-out failure is sure to further drag down its popularity and rightly so.

Will it be soon that top Administration officials will be fired? I think it's likely that Secretary Sibelius will lose her job.

From the Start, Signs of Trouble at Health Portal - NYTimes.com: "Interviews with two dozen contractors, current and former government officials, insurance executives and consumer advocates, as well as an examination of confidential administration documents, point to a series of missteps — financial, technical and managerial — that led to the troubles."

'via Blog this'

Will the Trend Continue?

An interesting factoid chart showing life expectancy and death rates over time from two major diseases, cancer and heart problems.

Capitalizing on the sequencing of the human genome and the rapid development of biotechnology and gene therapy may lead to effective personalized medicine which can be used to prolong life.

(Hat tip to Fidelity Investments for the chart)

A fundamental question arises as to whether we have an economy, a society and a culture that can afford the luxury of long life. Need to ponder this one some more.

The Health Risks Of Being Left-Handed - WSJ.com

The Health Risks Of Being Left-Handed - WSJ.com:

A fascinating story in the WSJ (may be behind the paywall) about the research and implications of left-handedness.

 "•Six of the last 12 U.S. presidents, including Barack Obama and George H. W. Bush, have been lefties.
• Left-handed people earn on average 10% lower salaries than righties, according to a recent study. Findings of some earlier studies on income have been mixed.
•Despite popular misperceptions, lefties aren't more accident prone than right-handed people and don't tend to die at a younger age.
•Left-handedness has been linked to increased risk of certain neurodevelopmental disorders like schizophrenia and ADHD. Mixed-handedness is even more strongly associated with ADHD.
•Most people's brains have a dominant side. More symmetrical brains of mixed-handed people may explain the link to some neural disorders."

Continuous Compression CPR

Continuous Compression CPR is worth knowing. This short video explains how to do it.

Recession Drains Social Security and Medicare - NYTimes.com

Recession Drains Social Security and Medicare - NYTimes.com:

When will this pending train wreck classify as a crisis? The bad news isn't new, but the problem has been put off for years because no federal politician, George Bush excluded, would even touch this third rail of politics. Years of warnings by the former Comptroller General of the U.S., David Walker, went unheeded.

Many Congresses have fiddled while Rome is burning. The siren's call of universal coverage, much more appealing to the voters they were courting has masked the real problem...the run up in costs. Medicare and health care costs have long been out of control. No wonder yesterday's announcement by the health care industry of their 'intent' to reduce the growth in costs by 1.5% annually.

I have here said previously that the only real way to control costs is to ration care. No one wants to hear it, but that's the truth of the matter. Health care, like the State of Vermont's Legislature has a spending problem, not a revenue problem.

In Vermont for example, health care is now the third largest contributor to the gross state product, exceeded only by government (#1) and manufacturing (#2)

"...As a result, the administration said, the Medicare fund that pays hospital bills for older Americans is expected to run out of money in 2017, two years sooner than projected last year. The Social Security trust fund will be exhausted in 2037, four years earlier than predicted, it said.

Spending on Social Security and Medicare totaled more than $1 trillion last year, accounting for more than one-third of the federal budget...."

Swine Flu: Current Status and Worst Case Scenario -- Seeking Alpha

Swine Flu: Current Status and Worst Case Scenario -- Seeking Alpha:

Here's one of the best descriptions of what we know now about the "Mexican Swine Flu" written by a physician at Seeking Alpha.

"...sometimes totally new viruses emerge: new combinations of swine, avian, and human influenza viruses. When this occurs, as is the case now, no previous vaccine or previous infection will afford any protection from the new virus. The 'Swine Flu' virus now spreading around the globe is a unique and novel combination of swine, bird, and human viruses.

Unlike SARS, which was an avian virus with relatively low human to human transmission, this new virus appears to readily transmit between humans. Fortunately, except in Mexico, this new virus has, so far, produced a relatively mild case of the flu. There is only one report of a hospitalization in the U.S., but no serious illness. Also, no increase in ER visits has been noted, which the CDC and local health departments monitor closely.

Fortunately, researchers report that this new virus does respond to Relenza (GSK) and Tamiflu (RHHBY.PK and GILD), the two anti-viral compounds that are readily available and in mass production. That's the good news, so far. A new virus that has produced a mild case of the flu outside of Mexico, but, does transmit easily from person to person."

Transformation of Medicine and Biotechnology

We are making that inexorable move toward medicine informed by biotechnology and enabled by a common (hopefully), sharable, individual, digital medical record. This is the so-called third revolution in biotechnology and medicine following the description of DNA by Watson and Crick 50 years ago and the identification of the human genome 10 years ago.

The Economist describes it all in this story ending with:

"The coming convergence of biology and engineering will be led by information technologies, which in medicine means the digitisation of medical records and the establishment of an intelligent network for sharing those records. That essential reform will enable many other big technological changes to be introduced.

Just as important, it can make that information available to the patients too, empowering them to play a bigger part in managing their own health affairs. This is controversial, and with good reason. Many doctors, and some patients, reckon they lack the knowledge to make informed decisions. But patients actually know a great deal about many diseases, especially chronic ones like diabetes and heart problems with which they often live for many years. The best way to deal with those is for individuals to take more responsibility for their own health and prevent problems before they require costly hospital visits. That means putting electronic health records directly into patients’ hands"

Study Finds PSA Test Saves Few Lives - NYTimes.com

Study Finds PSA Test Saves Few Lives - NYTimes.com

As awful a killer as cancer is, a reliable test for prostate cancer does not exist. Until one is available, I choose not to be PSA tested unless my physician can factually persuade me otherwise.

Will someone please tally the health care costs that would be saved if this test were not routinely performed?

Massachusetts Faces Costs of Big Health Care Plan - NYTimes.com

Massachusetts Faces Costs of Big Health Care Plan - NYTimes.com:

I don't claim any expertise in health care, but the only practical and direct way to reduce system health care costs is to spend less. That seems logical to me, but the answer is not one we want to receive on a personal level.

The push in the past few years has been for universal access and insurance coverage for everyone. That may be wonderful for those individuals not now covered by insurance and who go without care or use the ER, but it will not, by itself, reduce the systemic costs for health care. Reducing overheads can help to control costs, but no breakthrough solution will occur in that arena until we have a standard, universally-used electronic record for each of us.

I'd really be interested to hear arguments otherwise. Until then, I agree with "some health policy experts."

"...Some health policy experts argue that changes in payment practices will not be enough to slow the growth in spending, even when combined with other cost-cutting strategies. To truly change course, they say, the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care."

Well - Vitamin Pills - A False Hope? - NYTimes.com

Well - Vitamin Pills - A False Hope? - NYTimes.com:

I have long maintained that a balanced diet for generally healthy people is more than sufficient to provide essential nutrients for the body. Some supplements may be useful for specific problems, e.g., niacin for ' bad' cholesterol, but generally they are unnecessary for general health maintenance. This view seems to be supported by large and well-conducted trials.

The supplements business, including vitamins and minerals, is BIG business with lots of money spent advertising these nostrums, but I doubt they have any practical health effect, as recent studies appear to be revealing.

"“...I’m puzzled why the public in general ignores the results of well-done trials,” said Dr. Eric Klein, national study coordinator for the prostate cancer trial and chairman of the Cleveland Clinic’s Glickman Urological and Kidney Institute. “The public’s belief in the benefits of vitamins and nutrients is not supported by the available scientific data.” [emphasis added]

Everyone needs vitamins, which are essential nutrients that the body can’t produce on its own. Inadequate vitamin C leads to scurvy, for instance, and a lack of vitamin D can cause rickets.

But a balanced diet typically provides an adequate level of these nutrients, and today many popular foods are fortified with extra vitamins and minerals. As a result, diseases caused by nutrient deficiency are rare in the United States..."

Editorial - The Travails of Tom Daschle - NYTimes.com

Editorial - The Travails of Tom Daschle - NYTimes.com:

Bravo to the Times for calling this one right.

Daschle embodies the sleazy side of Washington's revolving door like so many others before him. Making the kind of money he did for influence peddling in an industry he will be intimately involved with stretches credibility. Daschle should withdraw his name and/or Obama should disinvite him.

"Mr. Daschle is another in a long line of politicians who move cozily between government and industry. We don’t know that his industry ties would influence his judgments on health issues, but they could potentially throw a cloud over health care reform. Mr. Daschle could clear the atmosphere by withdrawing his name."

The Evidence Gap - Health Care That Puts a Computer on the Team - Series - NYTimes.com

The Evidence Gap - Health Care That Puts a Computer on the Team - Series - NYTimes.com:

For too long the essential need for electronic medical records has been debated ad nauseum with paranoid concerns about privacy and confidentiality. These attributes must and can be managed well, but no system is perfect as long as humans build, maintain and use it.

The benefits far outweigh the costs and I hope Obama can trigger the huge change needed in both technology and public attitudes. A $50 billion commitment is just what the doctor ordered to move us out of the dark ages.

My new physician has agreed to use email with me when appropriate. Perhaps the day is not far away when electronic records will dominate and my dog-eared brown folder will disappear into the bowels of a shredder.

"...The Bush administration has left it mainly to advocacy and the private sector to introduce digital medicine. But President-elect Barack Obama apparently plans to make a sizable government commitment. During the campaign, Mr. Obama vowed to spend $50 billion over five years to spur the adoption of electronic health records and said recently that a program to accelerate their use would be part of his stimulus package..."

"...For most doctors, who work in small practices, an investment in electronic health records looks simply like a cost for which they will not be reimbursed. That is why policy experts say any government financial incentives to use electronic records — matching grants or other subsidies — should be focused on practices with 10 or fewer doctors, which still account for three-fourths of all doctors in this country. Only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published in The New England Journal of Medicine...."

This conclusion is the key to success:

"...The quality of care goes up dramatically just by having information instantly,” Dr. DeVries said. Yet, as her colleague and veteran of computer medicine Dr. Melski notes, there is no payoff to technology alone — only in people using technology wisely.

“We have to restructure our medical culture,” he said. “We have to promote a culture that believes in the evidence and is trained in analyzing the evidence. It’s the only long-run answer to the challenges we face in health care — evidence-based medicine.”

Dean Kamen's Genius - A Prosthetic Arm

Dean Kamen in New Hampshire is one of those special few engineering geniuses in our nation. You'll remember him as the inventer of the Segway which is an amazing device but has had limited popularity.

But please click on the link below to watch this video to see what he's doing recently. It's mind blowing and wonderful.

http://www.ted.com/talks/view/id/82

Microsoft Rolls Out Personal Health Records - New York Times

HealthVault is a Very Big Deal

This will take a little time to mature and all the privacy wonks will rant about trusting Microsoft (or any company) with important personal information, but I think momentum will build rapidly. It really is time for a rapid move to Electronic Health/Medical Records. If consumers push this option with their health care providers while Microsoft pulls the health care industry into it, we may have a very significant achievement. Meanwhile, a host of others are planning similar services. Uncharacteristically, Microsoft is first in this space. They must believe in a first mover advantage. Perhaps we are on an accelerated path where inertia will not rule.

The really big issue, though is standards. With the critical nature and broad uses of EHR, the standards issue looms very large and is not easy to resolve. Some industry and government groups are surely working on these issues, but I don't know if the process has matured. I doubt that Microsoft has a set of open standards for HealthVault.

Here's a good description of the problem from the Forbes article referenced below:

"There is no shortage of skeptics for a dozen reasons. "The concept behind it is dead on track, but it won't work very well" without a better way to integrate data from local doctors, predicts medical data guru Brent James, vice president for research at Utah's Intermountain Healthcare. The bottleneck, he says, is that there is no universal way to get blood test results, imaging scans and other basic data from thousands of local doctors and labs onto the Web.

"The intercommunications don't exist to get the data from where they now live into this central format and back out again to the physicians and nurses who would use them," James says."

In thinking about our health care conundrum (cost too high; quality not as good as it could be; private vs. public insurance; too many without coverage, etc.), I'm reminded of Milton Friedman's (a world-respected free market advocate and Nobel prize winning economist) answer to a question using health care in the U.S. as an example of the need for more market-based medicine.

Question: Is there an area here in the United States in which we have not been as aggressive as we should in promoting property rights and free markets?

Answer: Yes, in the field of medical care. We have a socialist-communist system of distributing medical care. Instead of letting people hire their own physicians and pay them, no one pays his or her own medical bills. Instead, there's a third party payment system. It is a communist system and it has a communist result. Despite this, we've had numerous miracles in medicine. From the discovery of penicillin, to new surgical techniques, to MRIs and CAT scans, the last 30 or 40 years have been a period of of miraculous change in medical science.

On the other hand, no one is happy: physicians don't like it; patients don't like it. Why? Because none of them are responsible for themselves. You no longer have a situation in which a patient chooses a physician, receives a service, gets charged, and pays for it. There is no direct relation between the patient and the physician. The physician is an employee of an insurance company or an employee of the government. Today a third party pays the bills. As a result no one who visits the doctor asks what the charge is going to be - somebody else is going to take care of that. The end result is third party payment and, worst of all, third party treatment.

Question: Following the recent expansion in prescription drug benefits and Medicare, what hope is there for a return to the free market in medical care?

Answer: It does seem that markets are on the defensive, but there is hope. The expansion of drug benefits was accompanied by the introduction of health savings accounts - HSAs. That's the one hopeful sign in the medical area, because it's a step in the direction of making people responsible for themselves and for their care. No one spends somebody else's money as carefully as he spends his own." *

HealthVault is a step in the direction of 'making people responsible for themselves.' I hope we can absorb this thinking, rather than trot down the gloomy path of 'socialized' medicine.


Update: 10/5/07

More here on HealthVault:

Microsoft: We’re good for your health by ZDNet's Mary Jo Foley -- Microsoft has been signaling its intentions to enter the health-records-management space for more than a year. On October 4, the company finally provided an official game plan of what it's readying on the health care software and services front.

Here is The Economist's take on the announcement.

Forbes has a piece on HealthVault, too.

*quote from Imprimis, a publication of Hillsdale College, July 2006 -Volume 35, Number 7

The Entitlements People - New York Times

Fiscal and Leadership Crises - Allies in "Mardi Gras" Thinking

David Brooks nails it. Newt Gingrich tries to add visibility to it with his American Solutions initiative, but current national leadership does nothing about the fiscal crisis facing this country. How long will we pretend that the train is still on the rails when the federal government spends without restraint on entitlements (even the word for this loaded with expectations that all this spending is necessary and right)?

"In the different reality, everybody plays by Mardi Gras rules. The norms are different, masks are worn and certain unpleasant facts fall away. Presidential candidates vow to offset the cost of health care plans through “cost savings” measures, and everybody pretends those savings are actually real. Republicans promise tax cuts and people pretend those pledges are not absurd. Democrats vow to pay for their grand spending plans by raising taxes on the rich, even though each one percent increase in the top tax rate only produces $6 billion in revenue. The Mardi Gras norms are built on a fiction — that the current budgetary path is sustainable — and once you enter that fiction, then all sorts of other fictions become necessary and trickery piles upon trickery until all the standards of behavior are turned upside down."

Google and Microsoft Look to Change Health Care - New York Times

Google and Microsoft Look to Change Health Care - New York Times

I'm encouraged that these two giants are actively engaged in leading the transition to online health records because massive inertia exists within the medical establishment to move to online health records. This inertia is not so much willful as it is snarled in the regulatory and privacy webs that keep such an enormous project from moving ahead more rapidly.

Approaching the problem from the patient/consumer perspective is the right direction as long as we end up with systems that are fully interoperable. The last thing we want is several incompatible and competing systems. Standards for electronic medical records are key to this and much work is underway in this arena. The question is how long the process will take. The Wikipedia reference above suggests to me that we are many years from implementation of a universal EMR.

Consumer 'pull' may yet overcome industry/establishment 'push' if the patient options are easy to use. I hope the debate can ratchet up soon so this show can get on the road. I find it archaic that I cannot communicate with my primary care physician via email. I don't expect that he would personally handle all my email, but office staff could assist with simple questions, prescription refills, etc.