June 2009

The H1N1 influenza story took some uglier turns this week. Although a pandemic was declared by the World Health Organization (WHO), most cases have been relatively mild and the fear that hit after the first flurry of cases in April has faded.

A more focused concern may soon reappear.

First, recall that the flu virus is seasonal and tends to lose its punch in the warm, humid conditions of summer. You would expect, then, that there would be a resurgence in the Southern Hemisphere, which is experiencing winter.

That seems to be happening in South America, where it has been reported that volume has soared in Argentina and that hospitals are “verging on collapse.”

Buenos Aires has been particularly hard hit with 15 fatalities and 500 suspected cases. Brazil announced its first confirmed fatality, a truck driver who had recently visited Argentina.

Second, Reuters reported yesterday that a Danish patient presented with a version of the virus that was resistant to Tamiflu, the main anti-viral tool available now to fight the flu. Researchers did say they weren’t surprised, since seasonal flu can be resistant to Tamiflu as well.

Third, the virus is constantly shifting, making it more difficult to come up with an effective vaccine. Scientists are worried now that as the swine H1N1 tears through Indonesia, it may combine with the more deadly H5N1 avian flu to create a more aggressive strain more easily transmissible among humans.

This scenario was outlined in yesterday’s New York Daily News.

“We are scared because we are the warehouse of the world’s most virulent H5N1,” Indonesian Health Minister Siti Fadillah Supari told reporters.

Henry Niman, a molecular virologist who publishes the Web site Recombinomics, which looks at the evolution of virus, compares this year’s outbreak to the 1918 influenza. That one started out mild and became more virulent in fall.

You can listen to a recent interview with Niman on a Texas radio station here. Interestingly, it is occasionally confrontational. But he addresses some of the myths surrounding the outbreak, and offers some interesting predictions.

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News arrived this morning of a rather strange marriage between America’s health insurance industry and the reality TV phenomenon.

WellPoint, which bills itself as the nation’s biggest health care insurer by medical membership, said it was teaming up with The Biggest Loser star and fitness trainer Bob Harper to help it develop a new program designed to prevent behaviorally based health problems such as smoking and obesity.

The way I read the announcement, the program will echo the show by encouraging people to basically shame others in their social network to adopt healthier behavior. They will set the proper tone by example.

This is, at its root, the basic ingredient in The Biggest Loser. Obviously, it’s a competition.

There is something about the show that makes me uncomfortable – the parading of flabby flesh before a judgmental audience, the idea that the participants are trying to lose the most weight, but they are also, in a more general way, “the biggest losers.”

Call me socially out of touch for not sitting glued to the set when the big weigh-in comes, and the shot ends with a close-up of tears welling up in the contestant’s eyes. Rather than going into detail here, my view is represented rather eloquently in this video of The Young Turks show.

So, WellPoint turns to Bob Harper. In the standard canned comment issued by the company today, Harper said, “Whether we realize it or not, when we are around others who eat healthy and model healthy behaviors, we begin to follow.

“Expanding this into a more formal, conscious effort can help each of us become role models for others in our lives. For any person who’s ever tried to quit smoking, lose weight, eat healthier or adopt a more active lifestyle, knowing you will also have an impact on others can be a powerful motivator.

“By working together with WellPoint, we hope to provide the information and tools to help millions across the country live healthy lives.”

WellPoint, along with other big insurers, has been working on wellness programs for several years. It makes perfect sense to prevent illness by changing people’s risky behavior, whether that means smoking a pack a day or paying a morning visit to McDonald’s seven days a week. From the insurance company’s standpoint, it’s far more profitable to cover folks with healthy lifestyles.

There’s some science behind the effort, too. WellPoint goes into detail in a report issued this month called The Ripple Effect of Individual Health Choices.

For example, if both a husband and wife smoke, the likelihood of one quitting rises 67 percent if the other quits first, according to a study cited by the insurer. On the other hand, if your best friend becomes obese, your chances of becoming obese goes up by 57 percent.

“People underestimate the influence they have over others when it comes to health – and the potential to help others even as they help themselves,” the report notes.

True. But in helping your friends and family, there may be a fine line between prodding them toward better health and making them feel like they’re the biggest loser. Watch this trend carefully over the next few years. It could be the most interesting reality show of all.

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Money can’t buy happiness. My grandparents lived a very poor existence during the Depression but formed a very closely knit, contented family.

The first sentence, as you’ve long suspected, is largely a bunch of bull. The second has a bit more merit, according to psychologists who met recently in Philadelphia to talk about the emerging field of positive psychology. The First World congress on Positive Psychology drew 1,500 participants who study, not just what makes people feel bad, but also what makes them flourish.

Since we’re in a recession, naturally money surfaced as a major topic. Like other Americans, psychologists’ retirement funds have taken big hits, raising questions about the quality of their lives in the future.

And it turns out that economics does have an impact on how we feel about ourselves and others. Studies show that people in poor countries aren’t as happy as those in wealthy ones, according to Ed Diener, president of the International Positive Psychology Association and a University of Illinois psychologist.

Happiness is not based strictly on how much money you make, however. One key seems to be work, and the positive reinforcement you can from it. The psychologists encourage reslience.

“One of the things that resilient people do well is, they don’t get stuck in habits of thinking,” psychologist Karen Reivich said. She helps people try to combat their “internal radio station,” voices in everyone’s dead that tends to talk about the worst that could happen.

These psychologists aren’t a bunch of Polyannas, though. James Pawelski promotes what he calls “realistic optimism.”

Look for good things that come out of events, but don’t keep your head in the sand and ignore warning signs that rough road is up ahead. That’s pretty much how we got ourselves into this economic fix in the first place.

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As a follow up to yesterday’s post, I’d like to suggest a thorough read of Wendell Potter’s testimony before the U.S. Senate Committee on Commerce, Science and Transportation.

Potter is the former head of corporate communications for CIGNA Corporation, the country’s fourth largest health care insurance company. He is now a senior fellow on health care at the Center for Media and Democracy, and is providing an insider’s view of how health insurers play both Congress and the media.

As a health care writer for the past decade, I tapped Potter for a little information, here and there. You collect it, and add it to the mix. Some of it can be valuable, and it’s need-to-know stuff for providers who have to file claims.

His testimony did not shock me. But his public comments are solid gold given the current health care reform debate. In an interview with the Columbia Journalism Review, he recalls reassessing his position with CIGNA after visiting a health fair several years ago in Tennessee.

“Out of curiosity I went and was overwhelmed by what I saw. Hundreds of people were standing in line to get free medical care in animal stalls. Some had camped out the night before in the rain. It was like being in a different country. It moved me to tears.”

He added that he was in “a unique position to know how companies made money—what they had to do to satisfy shareholders—and how the industry has been able to kill reform in the past. I had been part of those efforts and didn’t want to be part of them again.”

Potter’s indictment of the media is just as scathing. Reporters don’t take time to sift through information and public statements to shake out nuggets of truth. On deadline and under pressure to produce a certain quantity of material, they often print executive’s statements verbatim.

“I quickly learned that reporters, because they’re so busy, haven’t learned as much as they should,” Potter says. “I was able to take advantage of that.”

He talks a lot about the Medical Loss Ratio, the amount of money taken in by premiums used to pay for medical services. In fact, that’s the bread and butter of most companies. By holding down the flow of funds that go into actual medical care, the more profit there is, and the higher the stock prices go. High stock prices make for happy investors and at annual stockholder meetings, executives get applause instead of boos, and bonuses to boot.

Expect insurers to publicly support health care reform for the short term. This is a “charm offensive,” Potter says. “But, behind the scenes, they are financing efforts to kill elements they are opposed to, or they kill reform entirely.

“They will work through what they refer to as ‘third-party advocates’—people and groups that are ideologically aligned with them—and use their PR firms and lobbyists to do that work. These surrogates will reach out to radio and TV talk show hosts and conservative editorial writers.”

Check out both the CJR article and Potter’s full testimony to get a clear picture of what’s going on, and what to expect as bills come up for votes in the House and Senate.

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Wednesday, June 24

A poll released Monday showed 72 percent of Americans favor an insurance health care plan with a public option. So why do only 36 senators support it?

Sure, the Senate is supposed to be a more deliberative body and not be swayed by public opinion to the same extent as the House. But, if there’s widespread backing for this concept, and it’s getting a renewed push from President Obama, why so much resistance in the Senate?

Is it because senators are standing on good old-fashioned apple pie principles?

Maybe not. Here’s an analysis that suggests insurance company PAC money is having the greatest impact on middle-of-the road Democratic senators. According to the report:

“Liberal Democrats are likely to hold firm to the public option unless they receive a lot of remuneration from health care PACs. Conservative Democrats may not support the public option in the first place for ideological reasons, although money can certainly push them more firmly against it.

“But the impact on mainline Democrats appears to be quite large: if a mainline Democrat has received $60,000 from insurance PACs over the past six years, his likelihood of supporting the public option is cut roughly in half from 80 percent to 40 percent.”

As I’ve said, there may well be legitimate philosophical reasons to oppose this type of national health care plan, or any other approach, for that matter. An umbilical cord flowing with ready cash from major insurers isn’t one of them.

To his credit, Obama finally put pressure on health care companies, and opponents of the public option, in a news conference Tuesday.

As he correctly pointed out: “If private insurers say that the marketplace provides the best quality health care … then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.”

It’s only logical if you understand that cash is the conduit through which public policy decisions are often made.

Money doesn’t talk, Dylan said, it swears.

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Tuesday, June 23

The rough economy is sidetracking efforts by smokers to quit. It’s bad enough not to know where your next paycheck is coming from. Who needs the added stress of losing a comforting habit?

In a UK poll reported by the BBC yesterday, 23 percent said they’d put off plans to quit. Three quarters of those who do smoke say it takes some stress out of their lives and they felt like the habit helped them get through hard times.

Large pluralities said they would rather cut back on essentials like clothes and food, rather than cigarettes.

The release of the report coincides with yesterday’s signing of the new federal anti-smoking bill by President Obama, the country’s first presidential puffer since JFK. Obama has waged a two-year effort to knock off the habit, but according to various media sources still hasn’t quite licked it.

There is probably no worse (legal) habit than smoking cigarettes when it comes to harming your health. So, government taxes have skyrocketed, and now a pack of smokes runs $5.

The new law is designed to stop young people from starting the smoking habit in the first place by enforcing tougher laws on underage purchases.

There’s been progress. Smoking has continually declined in the West, although the drop has leveled off in recent years. On the other hand, those declines were accompanied increased sales in other tobacco products like cigars, snuff, and roll-your-own cigarettes.

And in China, which has more smokers than the entire U.S. population—350 million—efforts at controlling consumption have been weak. A pack of smokes goes for as little as 30 cents, according to this story today in the Pittsburgh Post-Gazette.

Will the end of the recession bring about a renewed drop in tobacco use? That, in itself, won’t be enough, because to smokers the best time to quit is always tomorrow.

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Monday, June 22

Robot technology is advancing in every part of the economy, but it is moving at a particularly fast clip in health care. A robotic wheelchair can now read the mind of a paralyzed person and take him where he wants to go.

Watch a video of how it works here. It doesn’t look pretty — users have to wear a skull cap with 16 electrodes plastered on their head. But it will soon allow people to maneuver through homes and buildings, even in crowded conditions.

It works by reading brain waves of the user, picked up by the electrodes. Designers are now working on ways to allow mid-move corrections in direction and destination.

Health care has been an obvious frontier for robot technology. But now that saving money is more important than ever, expect to see more robots at hospitals and probably even outpatient settings.

Hospitals have been using robots to deliver drugs for several years. HelpMate robots have been roaming the corridors of acute-care facilities since 1999, delivering food, pharmaceuticals and lab specimens. Hospital staff humanize them by giving them names like Rosie, Roscoe and Elvis.

Hospital administrators like them because Rosie, Roscoe and Elvis will never ask for a day off, never take a sick day, and never lobby for a raise. They don’t take coffee breaks and congregate in hallways, whispering unkind comments about management.

A few down sides have begun to appear as robot behavior clashes with human behavior. For example, when human staff boards an elevator with the hospital robot, he or she may be surprised that the machine has to reposition itself within a confined space.

Of course, there is tremendous potential here for home health aides to assist the elderly and chronically ill. You can see more details on that trend in this excellent article in Proto, the Massachusetts General Hospital newsletter. Predictably, people grow fond of their robots and begin to treat them like pets, social scientists say.

And it won’t be long before models become increasingly human-like, which will forge an even greater bond between patient and robot-helper. The Japanese have been trailblazers in this area, especially Honda, the auto manufacturer.

Asimo, as long as you’re in the kitchen, can you grab me a cold one?

Now, yes. Some of this makes people nervous. Hollywood has tended to demonize robots, and there are some potential… shall we say… drawbacks.

But the benefits would seem to far outweigh the negatives. Look for robots to become major players in every aspect of health care — even surgery and mental health services. Expect sophistication to expand exponentially throughout the coming decade.

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Thursday, June 18

Since I’m in the midst of a move, both physically and with service providers, I’m going to return to one of my favorite health topics: What’s in the fridge.

I’d posted back in May about the office in San Jose, California that had to be evacuated when its lunchroom refrigerator was cleaned out. Under the right circumstances, a fridge can be the perfect bacteria farm.

I found this photo essay on the Web. It’s a wild peek into the frontiers of food storage. A hat tip to Good Magazine for posting it.

Everyone’s going to have their own favorite. My personal choice is the fridge jammed with takeout boxes. Each photo has something to say about the refrigerator’s owner, but I particularly like the message here: “Screw it, let’s order out.”

Great stuff, but a serious question: Don’t all refrigerators have automatic defrosters these days? The apparent answer: No!

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Wednesday, June 17

While the U.S. health care debate becomes increasingly rancorous, it’s worth noting that systems in Britain and Canada are going through convulsions of their own.

The centerpiece of the Obama administration’s effort is a public alternative to private insurers. Critics will tell you that they are simply taking a stand against government-controlled health care. We hear terms like “rationing” and “socialized medicine.” But the truth is pretty simple: It’s about money.

And this, of course, is what the hollering is all about in Canada and the UK, as well.

The American system is based on profit, so you would expect money to be a focus of attention. In Britain, politicians aren’t as concerned that investors won’t make their 10 percent, or that an insurance company executive may face a multi-million-dollar pay cut.

No. It’s just that National Health Service (NHS) officials are worried about the system going broke by 2011. The BBC reports: NHS faces huge budget shortfall. NHS funding has tripled since 1997, primarily due to the aging population.

Staff cuts over the next two years are unavoidable, says the BBC, and there may be a cap on expenditures for new drugs.

“This is a situation affecting health systems all across Europe as governments experience a mismatch of income tax and expenditure budgets,” Nigel Edwards, head of policy for the NHS, told the news organization.

This issue is not being taken lightly by either providers or unions representing them. A surgeon bluntly commented, “Pull more funding from the NHS and we will be doing surgery in camping tents with pen-knives and vodka for anesthetic.”

In Canada, where health care systems are centered in the provinces, Alberta is undergoing a shakeup. The province has long been considered innovative. But a new CEO from Australia, Stephen Duckett, is making waves and promising change. At The Globe and Mail, see, The future of Medicare is in his hands.

Saving money is high on the agenda. There is a hiring freeze. And there’s talk of having non-nurses pick up more duties from registered nurses, so they can be replaced by lower-paid support staff. Privatization, which is not a popular idea in Canada, is off the table for the moment.

In short, health care is facing major change worldwide, not just in the United States. It is largely due to the aging population, but medical innovation costs money, and technology is advancing rapidly. We need creativity. One idea I’ve had is to consider allowing more masters-level clinicians into the primary care provider chain.

There’s an argument that we need market-based solutions. That’s exactly what this would be: Expand the supply of providers at a rate higher than the growth in demand, and prices would fall. Even the government option is, in a way, market based because it would increase competition.

But in each country, the goal has to be getting more for the medical dollar. That can be done if our elected officials are willing to think in new ways and not just try to prop up old systems. My fear is that politicians will instead create a new kind of skateboard and call it a Cadillac. That would be the most inefficient outcome of all.

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Tuesday, June 16

If you missed the Fifth Annual Games for Health Conference — and let’s face it, many did — you can catch up with a video tour that shows a few of the wild products that nudge folks toward good health while having a fine time playing games.

The conference was held in Boston June 11-12, but in this Web cast exergaming “evangelist” Dr. Ernie Medina captures a bit of the excitement conference attendees picked up at the event.

Games and video games, developed to treat specific conditions, were introduced, explained and promoted. One gadget allows physically challenged people to play a guitar with their feet, for example. This is in the video, so be sure to stick with it even if your mind starts wondering over to the Nintendo set.

There’s also a behavior-changing game for people with Type 1 diabetes.

“Let’s come in here today and check out the games and burn some energy and have some fun,” says Medina, as he leads us through the tour.

One that’s apparently making a splash this year is a game that helps young African men and women learn how to avoid the dangers of HIV.

The interactive game, Pamoja Mtaani, has a hip-hop soundtrack and flashes vivid street imagery. But it’s basically a soft sell, and you really don’t get to the educational stuff until later. Even then, the messages are woven into the dialog rather than spit out, lecture-fashion.

Pamoja Mtaani is getting pushed through the academic wringer at Emory University in Atlanta to see if it really does produce the kinds of behavioral changes researchers think are necessary to limit the spread of HIV.

According to an article published this month in New Science: “The slickly produced game opens with an animation of bus-hijacking in which five young strangers each get robbed of something valuable. Their mission is to scour the streets of Nairobi looking for their goods, with help from a mystic figure named Mama Africa. Break-dancing and graffiti competitions help the players advance.”

But in another part, the characters discuss HIV and who may or may not have it. Game developers wanted to be more subtle, so as not to drive away young players who may benefit.

Last year, National Public Radio said we could game our way to fitness. Better yet, we may be able to joystick our way around serious illness as well. It just makes sense to use what works.

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