Vol. 42 April 1, 2011 Updates on Health Care Reform

March 31, 2011

“You can always count on Americans to do the right thing – after they’ve tried everything else.”
-Winston Churchill

Mitt Romney announces his candidacy for Governor of Massachusetts

Persistently harassed by Tea Party leaders and other conservative Republicans for the inclusion of the “individual mandate requirement” in his Massachusetts Health Care Reform Act and tired of defending it as “good for Massachusetts but not necessarily for [insert name of any state in which Romney is that day]”, Mitt Romney has announced that he will abandon his exploratory campaign for the Presidency. He will return to Massachusetts to run for Governor against Duval Patrick. “Since this annoying issue of the individual mandate just won’t go away, I am going back to Massachusetts to undo it,” said Romney.

Donald Berwick, MD apologizes to Congress for his extreme behavior during his hearing

Though most reviewers remarked on Dr. Berwick’s evenhanded responses to the sometimes hostile questioning at the Senate Finance Committee hearing on his nomination as CMS Administrator, this blogger has a different view. I was present in the hearing room just after the TV cameras and microphones were turned off. Dr. Berwick, having kept his cool for so long, literally exploded, cussing the senators for their “mean-spirited, narrow-minded, myopic views of the federal government’s role in health care”. “Arguing with you is like talking to a dinner table.” When this outburst hit You Tube via someone’s cell phone the next day, Dr. Berwick quickly apologized. “As a pediatrician I thought I knew how to control temper tantrums, but somehow that hearing just conjured up all the adolescent turmoil that I thought I had outgrown, and I flew off the handle. I am extremely sorry, but am very thankful that my staff took away my iPhone before I was able to tweet.”

President Obama was so shaken by Dr. Berwick’s outburst that he has begun seeking a replacement; one who has experience in public policy, is a strong individual, is acceptable to most Republicans, and who is currently unemployed.  Arnold Schwarzenegger springs to my mind, though he is rumored to have returned to acting, “I lift things up and then put them down.”

Sarah Palin withdraws her opposition to “Death Panels”

According to David Williams writing for the Health Care Blog: “Chief among Sarah Palin’s assaults on truth and reason is her contention that providing reimbursement for end-of-life planning sessions with a health care provider is tantamount to a “death panel” where a “bureaucrat can decide based on a subjective judgment of [a person’s] ‘level of productivity in society,’ whether they are worthy of health care.” One ingredient of end-of-life planning is patients’ opting for palliative care. He summarized a recent study in New York state where patients who received palliative care cost Medicaid almost $7000 less in hospital costs per admission than a matched control group that didn’t receive palliative care. Patients receiving palliative care spent less time in the intensive care unit and were less likely to die there. They were also more likely to receive hospice care after discharge and to be discharged to appropriate settings.

Impressed by this report and other studies, Sarah Palin has withdrawn her opposition to the reimbursement of  “Death Panels” to help patients and families plan for end-of-life care. However, her newly found acceptance of rational end-of-life care is tempered by the unintended consequence of the increased satisfaction of families receiving palliative care.  “Most people on Medicaid are unemployed, deadbeats, or probably illegal immigrants, so why should we be spending time and money increasing their satisfaction with our health care system?”

Starbucks will add Urgi-Care Centers to their stores

Howard Schulz, CEO of Starbucks, announced that as of April 1 they would be establishing urgent care counters in selected urban stores. He is impressed with the successful implementation and rapid growth of convenient medical service centers in CVS pharmacies and wants to remain competitive in the crowded field of one-stop-service retail stores. According to Schultz, “Starbucks is the quintessential experience brand and the experience comes to life by our people.  The only competitive advantage we have is the relationship we have with our people and the relationship they have built with our customers.”

Analysts remark that this move is consistent with Starbuck’s image as a “home away from home and work” where one can go to relax, listen to music, buy a CD, work on a computer, read a newspaper, eat a snack, trip over a stroller, smile at the dogs tied up outside the door, and …get a cup of coffee.

Schulz also announced that a new flavor shot, “Potassium Iodide”, will be introduced in selected West coast stores in response to recent consumer inquiries there. Despite the phenomenal growth of medical marijuana stores in California and Colorado, Starbucks has no current plans to add this to their offerings. “A double espresso mocha caramel Vente is as high as you can go at Starbucks for the moment.”

Congress to hold hearings on what to call the new medical care payment system

The Accountable Care Organizations (ACO) proposed by the Affordable Care Act (ACA) will require the replacement of fee-for-service provider payments with a collecting together of all kinds of medical care bills which will then be paid out of a single account. Congress has known for a long time that no one knows what “ACO” means, and now, no one seems to agrees on what to call this new billing and payment method. The CMS, GAO, AMA, AHA, and AAMC just issued issued a report of their study of possible labels and asked for congressional hearings on their conclusion. Here are selected samples of the rejected names and their recommended conclusion:

“fee-splitting”– Though functionally similar to ACO methods the AMA objected to this because of their successful, long time efforts of labeling it as unethical.

“capitation” (also called “capitation-light” or “neo-capitation”) – Again, though functionally very similar to the ACO method, it was felt that this word had too many negative political, economic, and patient-control associations.

“global payments” – This one was very popular and is still in use by some people, but the negative associations with the weird weather we are having and with Al Gore nixed it. The fact that “global” corporations seem to be very successful in  avoiding anti-trust litigation was a definite plus for this label.

“rational budget allocation” – Sounded too much like the U.K. National Health Service,  definitely requires the advance planning dreaded by most physicians, and the  second word was the only one with a meaning accepted by all.

“single payment to all medical providers for a patient’s illness for life” (SPAM PILL)- An accurate statement, but much too long for an acronym or sound bite, and though the acronym implies a use of electronic networking (good), it has an  annoying connotation (bad).

After many meetings, exhaustive staff work, and numerous drafts of over 100 pages each the report finished with this final conclusion:

‘The one word that captures the collective nature of the new payment system with both warm, fuzzy connotations and a positive image is ‘bundling’, as in the soft, warm bundling of a baby in a blanket. Who could be threatened by that?”

HAPPY APRIL FOOLS DAY


Vol. 41 March 7, 2011 “Hey, PC Guys, Get Over It!”

March 7, 2011

Physicians are buying and using iPads and iPhones just like the rest of the world because EITHER:

“The iPad is intuitive, easy to use, reasonably priced, easy to carry around, and has a lot of apps that have been developed for the platform. People — not just doctors — love the experience of using an iPad.”
OR
“Apple has developed a very appealing hardware platform in the iPad. Recognizing the market strength and lock-in to their walled garden they are creating with consumers, Apple is targeting key market segments to create new revenue streams and business models. Health care is the next target for Apple’s aggressive smarts.”

This “coincidence vs. conspiracy” theory was advanced in a recent Health Care Blog.

The Apple II that I bought for my middle school son decades ago looked like a typewriter and had mostly empty air inside its case. Granted it needed a fan and lots of air around it to keep cool, but I suspect that Apple knew that we would be much more comfortable buying something that looked and worked like a typewriter to replace our typewriter. Apple continues to appeal to our comfort zone. “Hey, PC guys, get over it!”

During my years as a hospital administrator a decade or so ago the weekly mantra from the hospital’s Chief Information Officer seemed to be, “The critical step for implementing EMR is to get over the hurdle of the physician/computer interface.” He was talking about the proprietary computerized information system in our hospital. At the same time, some cardiologists in our hospital were asking when would they be able to review lab results and write orders from their Blackberrys (then) and  (now) iPads and iPhones.  Then, the initial single, desk top computers at the nurse’s stations were quickly overwhelmed with people trying to use them. Clunky computers on mobile stands began to appear to decompress the nurses’ station, and the competition with IV poles, wheelchairs, and other medical devices for noisy “banging rights” began. Now, a physician standing quietly in the hall between patients can review office schedules, review an EKG record from his office, check for on-call nights next month, answer patients’ emails, and maybe review some labs. Of course, the physician could also be checking a stock portfolio, scanning the movie directory, or sextexting the new ER nurse she met last month. Who cares?  The physician wants to write orders, dictate a note, and review a discharge summary while standing there. “Hey, PC guys, get over it.”

A banker spending a day shadowing two physicians in an educational program sponsored by our local medical society summed up his impression of the day with, “The physician’s job is a day-long quest for credible data.” That quest can extend from home to office to hospital to lab to x-ray to nursing home to other’s offices, etc. Much of that time that physician will be on his/her feet literally moving around. Why do they like a light, thin, easy to read, easy to navigate, hand-held computer? “Hey PC guys, get over it.”

James Gleick, author of “The Information”, states that it is neither the media nor the type of technology that transforms human societies. It is the information, and the way in which people communicate with each other. “Hey PC guys, get over it.”

By the way, the future is here. My three-year-old grandson was shown how to swipe his father’s iPhone and touch an icon so that he could pick out his favorite music to listen to. (He is, of course, “above average” in both reading and music appreciation. All of my grandchildren are, of course, “above average” in something.) Soon after his iPhone lesson he went next door to play, saw that their TV was on, and swiped the screen a few times with no result. He turned and announced, “TV broke.”
OK, he could use a little help with sentence structure, but I’m sure “there’s an app for it”.

[This post is a week early because I will be on vacation and off the grid for a while, and I didn’t want to expose my sensitive iPhone to any salt spray.]


Vol. 39 February 15, 2011 Ten Really Fun Facts

February 11, 2011

Satchel Page’s advice for living a long time was right. “Don’t look back. Something may be gaining on you.”

There is a significant association between gait speed and 10-year survival for participants older than 75. If a person can’t walk 20 feet in 10 seconds the risk for early mortality is high. (1)

Grandma was  wrong about cranberry juice.

311 college-aged women drank cranberry juice or a placebo twice a day for six months after being treated for a urinary tract infection (UTI). Recurrence rates of UTIs were the same in both groups. In fact, the women who drank the cranberry juice had twice as many recurrences with E. Coli, the bacteria that cranberry juice is supposed to be most effective against. (2) Cranberry juice contains over 200 active compounds, so “the little berry that defies” science will continue to do so for a while.

Grandpa is still going strong down under.

31% of 2800 Australian men aged 75-95 reported having sex at least once in the past 12 months and 43% reported having sex “less often than desired.”  “A lack of a partner” was cited as the reason by 21%. (3)

French men drink the Irish under the table … and into the ground!

91% of French men surveyed consumed alcohol once weekly while only 61% of Irish men did so. Average DAILY alcohol consumption in French men was 33 grams while Irish men consumed only 22 grams daily. In 10 years of follow-up the Irish men had TWICE the number of adverse coronary events (heart attack or death due to cardiac disease) than the French. You might say that the Irish are just poor losers…or perhaps that wine is better for your heart than beer and whiskey. (4)

Some Super Bowl losses are more permanent than others.

The 1980 Los Angles Ram Super Bowl loss was associated with a 15% increase of cardiac deaths in Los Angeles in the 14 days after the game. The increase was highest in women and those over age 65. In 1984 the Los Angles Raiders won the Super Bowl and cardiac deaths dropped by 1% (5)

Sometimes “progress” can be relative.

The odds of getting killed in an automobile accident in New York City today is about the same as getting killed in a horse accident in 1900 (about 1 in 20,000 – 25,000) (6)

Baseball players CAN see better than umpires.

“On average, a baseball players’ vision is 20/12 which means a baseball player can see from 20 feet what a normal person can see at 12 feet. Normal vision is 20/20, of course. The best the human eye can see is 20/8, so 20/12 is halfway to the best human vision possible.” Major League Baseball did not respond to an offer to evaluate umpires’ vision. (7)

It’s about the same ON or OFF the job.

Percentage of unemployed Americans who take a nap each day: 39%     Percentage of employed Americans who do: 31% (8)

Sperm and the Proton Channel.

“A recent study directly measured whole-cell electrical activities in human sperm using patch-clamp methods and found that the proton channel HV1, which is sensitive to both the membrane potential and the pH gradient, is the predominant mechanism used by sperm to achieve intracellular alkalinization which is necessary for motility and interaction with the egg coat.” (9) I can’t find either the Proton Channel or HV1 on my TV. I wonder if the Australian grandpas get it?

But what about Rock and Roll?

“Adolescents who were enrolled in a school-based drug prevention program were less likely to engage in unprotected sex or sex with multiple partners 7 years later.” (10)

References:

1. JAMA 2011 Jan 5; 305:50, Studenski
2. Clin Inf Dis 2011 Jan 1; 52:23, Barbosa-Cesnik
3.Gen Med Jour Watch, vol. 31, 5,  p.26
4. BMJ 2010 nov 23; 341:c6077, Ruidavets
5. Clin Card, Feb. 2011; 34;2 102-107, Kloner
6. Harper’s Index, Dec. 2010, p.11 and 68
7. Interview with Dr. Daniel Laby, opthalmologist to the Red Sox, Boston Globe G, Feb. 22, 2010, p.3
8. Harper’s Index, Aug 2009, p.13 and 63
9. New Eng J Med 362:20, May 2010 p.1935
10. J Adolesc Health  2009 Aug; 45:111, Ellickson


Vol. 36 January 1, 2011 New Year’s Resolution Diets

January 1, 2011

 

A NEW YEAR’S RESOLUTION IS SOMETHING THAT GOES IN ONE YEAR AND OUT THE OTHER.
– attributed to both Oscar Wilde and Anonymous
just another reminder not to believe everything you read on the web


It is very hard not to write about New Year’s resolutions at this time of year since almost everyone (83%) say they make them, and the majority of us (64%) are not following them six months later. Just one Google search turned up a myriad of medical New Year’s resolutions from a variety of medical institutions and medical newsletters. Some were even age-restricted; “Parental Resolutions” and “Children Resolutions” (3 different age groups). Most seem related to eating healthier, exercising more, losing weight, and new this year, “refrain from bullying”.

New Year’s resolutions probably originated in 156 B.C. when Janus, the two-faced God able to look both forward and backward at the same time, was selected as the symbol of January. Julius Caesar really closed the deal in 46 B.C.when he decreed that January would be the first month of the year. Of course, now-a-days we “have an app for it”.

One problem with resolutions is that they usually exhibit some ambiguity or are overly general, without specificity.  For instance, how does one “eat healthier”? Oneprofessor of nutrition ate Twinkies, Dorrito Chips, and Oreos for 10 weeks and lost 27 pounds. His ‘bad cholesterol dropped by 20%, his “good” cholesterol increased by 20%, and his triglyceride level dropped by a whopping 40%. He did this by lowering his calorie intake from 2600 calories a day to under 1800. And that was his point. Weight loss is a result of reduced calories alone. The mix of carbohydrates, fats, and proteins is not important in a “weight-loss diet”. Any diet works, if it reduces your calorie intake.

This is probably bad news to the developer of the Debt Diet. Drawing a parallel between reducing debt and losing weight, she riffs on the benefits of diversifying source of calories just like the diversification of your investments between cash, stocks, bonds, real estate, etc. She even uses the common 30-30-30% portfolio numbers for the three major food groups (see Zone Diet). Well, we have seen how financial diversity didn’t protect most of us very well, and it appears that diet diversity might be just as useless in protecting us from obesity. The last of the top ten principles of the Debt Diet gives an interesting spin on exercise. If you have trouble avoiding debt and have difficulty reducing your spending, just make more money!  If you have trouble losing weight by reducing your calories, just do more exercise!

Medical science hasn’t been that helpful either. One study (1) found that a high-fat diary diet reduced your chance of developing diabetes over the 14 year study period by 60% while another study (2) showed that people over 70 years of age eating a low-fat diet reduced their chance of dying by 40%. Death or diabetes? The “bottom line” according to one study author is “we shouldn’t change our dietary habits based on one study.”

Calories, as you probably know, is actually a measure of heat. That is why we refer to “burning calories”. The Thermal Diet recommends dropping your body temperature so that you have to “burn calories” to maintain a normal body temperature. The suggested methods go all the way from “carrying your sweater instead of wearing it” to reading the newspaper   while immersed in a bath tub of ice water. This theory sounds exactly like my mother’s theory that eating ice cream reduced the temperature of your stomach and that you burned calories to raise it back up, so ice cream was non-fattening! I didn’t really believe it then either.

The “perception” of healthier can be misleading, as we know from the study that showed that by adding just 3 celery sticks to a meal of a hamburger, or a bacon-and-cheese waffle, or beef chili, or a meatball-pepperoni cheese steak over 900 people dropped their estimate of the calories in that meal by 43 calories. A companion study showed that people who ate at restaurants “claiming to be healthy” underestimated the calorie count on their served meals by up to 56%. The researcher labeled this belief that “good food will fight bad foods” as the “dieter’s paradox”, because the net result, of course, is increased calories, and we all now know that the only way to lose weight is….

Even “grandma’s apple pie” is no longer as healthy as it used to be according to Michael Phillips, keynote speaker at the 2010 Winter Conference of the Northeast Organic Farming Association. “Now it takes 12 apples a day to keep the doctor away. Today’s Red Delicious apple is 30 mutations away from the original fruit discovered in Iowa in the 1880’s.”

So, can we look to our newly ubiquitous electronic tools to help us out here?  It turns out that one of the most popular electronic tool, Facebook, may in fact make things worse. Several studies have shown that if the friends in your  social network (non-electronic) are obese, you are more apt (by up to 57%) to be obese.  These studies (3) involved thousands of people pre-Facebook, BUT they found that the network effect was present even when individuals were geographically distant from each other. (see pictogram below)

References:
1. Ann Int Medicine, Dec. 20. 2010
2. Jour Am Dietetic Assoc. , Dec. 22, 2010
3. NEJM, Nov 1, 2007, 375:1866  and  NEJM, July 26, 2007, 357:370

 

A 2,200 person network. Yellow are obese. Green are not.


Vol. 33 November 15, 2010 More Things That Threaten or Kill…or NOT

November 16, 2010

“When good things go bad,
and vice versa.”

 

CELL PHONES DON’T CAUSE CANCER- (1)
Despite ample scientific evidence to the contrary much buzz continues about cell phone usage causing brain cancer. Why is that ? A recent review in Scientific American magazine points out how hard it is to prove a negative. I am reminded about the story of the English farmer spreading purple dust over his fields last year. When asked why he did that he replied “To keep the lions away”.  The questioner pointed out that there had been no lions in England for at least four centuries. “Works pretty well doesn’t it,” was the proud rejoinder.

A $24 million study (2) of 12,000 regular cell phone users, half of whom already had brain cancer, found no correlation between cell phone use and the two most common brain tumors. A recent article in Skeptic magazine stated that the non-correlation was because,  as my oldest son the engineer often says to me, “It’s just physics.” X-rays and gamma rays can cause cancer because their radiation energy can disrupt chemical bonds inside cells, about 480 kilojoules per mole (it’s just a physics energy term). A cell phone generates radiation of less than 0.001 kilojoules per mole. Whatever kilojoules per mole are, it is clear that cell phones don’t generate very much of them; no where near enough to disrupt chemical bonds. The article’s author notes that probably the only way to hurt someone’s brain with a cell phone is to throw it at his/her head. I would add that since HPV (a virus) is associated with cervical cancer and is more apt to be present in sexually active women, I guess you could cause cancer with a cell phone by sexting!

ALCOHOL EVERY DAY KEEPS THE DOCTOR AWAY (3)
Italian researchers (God bless those guys) have shown that two or three alcoholic drinks a day reduces heart attacks or strokes by 25% in men who have already undergone cardiac by-pass surgery. Brigham and Women’s Hospital researchers found that women who consume two to four drinks daily in mid-life may have better health at age 70 than those who didn’t imbibe.

At last the definition of “too much to drink” has been quantified. For decades the definition of “drinking too much” was “drinking more than your doctor”. Now moderate drinking has been defined as one drink a day for women and two drinks a day for men. “One drink” is a shot and half of liquor, or 5 oz. of wine, or a 12 oz. glass of beer. One of the reasons that people drink too much is that they are unaware of how much they are becoming “addicted”. Recent data from a Boston Medical Center study (4) suggests that just by having people complete a questionnaire of a dozen questions they become aware that maybe they have an addiction. Fully a third of those “screening positive” on the self-administered questionnaire were voluntarily abstaining from alcohol and drugs six months later.

Of course, if you leave the country your alcohol problem may get worse. What? The alcohol consumption of college kids twenty-one or older DOUBLED their alcohol intake when studying abroad. For those under twenty-one, their alcohol consumption actually TRIPLED.(5) Hopefully that means that they went from one beer a day to three which doesn’t sound as bad somehow.

NATURAL FOODS AND HERBS ARE ORGANIC, BUT CAN BE HARMFUL
Of 40 herbal supplements tested by the federal Government Accounting Office 37 contained trace levels of at least one hazardous compound. Presence of steroids and other active pharmaceuticals were also found. The FDA has been “regulating” dietary supplements since 1994, but this new report from the GAO suggests how loose that regulation of a $14.8 billion industry (2007) is. Even pure supplements can cause more trouble than expected. Review of  nine clinical trials involving 118,000 people using Vitamin E revealed that those taking Vitamin E had a 22% higher risk 0f hemorrhagic strokes. (6)

EVEN DRUMMING CAN BE DANGEROUS…AND NOT TO JUST YOUR EARS
A 24-year-old woman came into MGH with belly pain and shock and spent 61 days in the hospital with the diagnosis of intestinal anthrax. As you might imagine, the state health department (two actually) and the CDC were soon joined by the FBI in pinning down the source of the anthrax. It turned out that she had recently participated in a drumming event in New Hampshire. Cultures from the site and two of the animal skin drums grew out anthrax. Presumably drumming of the anthrax-contaminated hides produced an aerosol of anthrax particles which she swallowed. (7)

References:
1.Scientific American, October 2010, p.98, Michael Shermer
2. Internat Jour of Epidemiology, “Brain tumor Risk in Relation to Mobile Telephone Use”
3. Am Heart Assoc conference, reported in Boston Globe, Nov 15, 2010
4. MASBIRT, reported in Boston Globe , Nov. 15, 2010
5
.Findings, Harper’s Magazine, December 2010, p.84
6. Scientific American, August 2010, p. 24
7. New Eng Jour Med, August 19, 2010, p. 766


Vol. 25 July 15, 2010 “Meaningful Use” of Electronic Health Records (EHRs)

July 15, 2010

Incentive payments via Medicare and Medicaid reimbursements to hospitals and clinicians for implementing electronic medical records under the 2009 HITECH Act (Health Information Technology for Economic and Clinical Health) require the “meaningful use of EHRs to achieve specified improvements in care delivery”, not just adoption of a hardware and software system.

On July 14, 2010 the ONC (Office of National Coordinator) of HIT (Health Information Technology) of DHHS (Department of Health and Human Services) released “The Final Rule” of “meaningful use” criteria/regulations that will have to be met by both hospitals and clinicians to receive HITECH incentive money.

Number of pages of regulations/criteria in “The Final Rule”:  846

Number of years The Final Rule will actually “rule”: 2

  • The Final Rule is no where near “final”. It will merely govern the first two years of HITECH incentive payments and will be revised as the ratcheting up of EHRs standards and implementation occur over the 10 years covered by the HITECH Act.

Total amount of money estimated to be paid out over the 5 years of HITECH incentives: $27 Billion

Amount per clinician estimated to be paid out for HITECH incentives over 5 years by Medicare and Medicaid respectively: $44,000 / $63,750

Deadline for EHR implementation by clinicians to obtain the maximum incentive payments: October 2011

Year in which incentive payment is replaced by a reduction in reimbursement rates (“penalties”) for hospitals which have not implemented “meaningful use” of EHRs : 2015

Number of core measures (“data elements”) that are mandatory for “meaningful use”: 15

  • These measures are basic identification and demographic data elements that are essential to any medical record and represent a reduction from the original 23 measures. (ex. vital signs, allergies, medication list, problem list, smoking history, etc.)

Per cent of patient EHRs that must have these mandatory measures by 2011:  30 – 80% depending on the data element

  • This represents a major change from the initial draft that called for 100 % compliance in the first two years.
  • CPOE (computer provider order entry) will be required only for medication orders and the compliance threshold will be at least one CPOE medication order for 30% of the patients.

Number of optional measures to be chosen by the clinician or hospital for inclusion: 5 out of a list of 10

  • Ex. incorporate lab data as a structural data element, produce summary of care for referrals or transfers, summit immunization data to registries, etc. Many of these also have less than 100% compliance requirements.
  • Recording of advance directive status (Health Care Proxy) in 50% of patients 65 years or older is one optional measure specifically for hospitals.
  • Patient access to their records via PHR (Personal Health Record) or a Patient Portal is NOT a listed criteria yet.

Number of quality measures that are mandatory under HITECH to report to DHHS electronically in 2011-12: 6

  • The three mandatory ones, blood pressure level, tobacco use, and adult weight screening, and three additional ones chosen by the clinician from a myriad of “quality measures” represent a marked reduction in the “burden of quality reporting” contained in the initial draft.

Number of Regional Extension Centers to be established by DHHS to help hospitals and clinicians implement EHRs:  70

  • See article by Atul Gawande, MD proposing the application of the successful agricultural “extension agents” model of 1914 to health care reform of 2010 in New Yorker magazine 12/14/09. See also Alain Enthoven’s critical rebuttal of the model in Health Affairs 12/22/09.

Words from the letters of the acronyms of EHRs, ONC, and HIT:   “RECON THIs”

  • Loose translation: Keep your eyes posted for many future developments.
  • Also, better than “CHRIsT, NO!”

References:
1. Health Care Blog, July 14, 2010, “Meaningful Use” Margalit Gur-Arie
2. NEJM online, Health Care Reform Center, “Meaningful Use Regulations”, July 13, 2010, David Blumenthal


Vol. 18 April 1, 2010 APRIL FOOL’S ISSUE

April 1, 2010

APRIL FOOLS DAY (according to one theory that ignores the 13th century literature references to “april fools”) was created around 1582 when the Gregorian calendar moved the first day of the New Year from April 1 to January 1. Those who persisted in calling April 1 “New Year’s Day” were often sent phony invitations to  New Year’s parties. Other pranks to fool people, usually performed in the morning, were soon added to the phony party invitations. Someone who pulled a prank after noontime on that day was also called a “fool”.

THE TRADITION CONTINUES.

NIH REPORTS THAT ONLY 20% OF AMERICANS ARE ACTUALLY OBESE.
The NH discovered an error in its formula for calculating Body Mass Index  (BMI), a widely used standard of obesity which is posted on their website. The calculation error results in a grossly overstated BMI which negates decades of provocative research on obesity. The White House spokesperson for Michelle Obama declined comment by saying, “We have other more important health care issues on the front burner right now”. The NIH regrets any inconvenience that this may have caused, reassures researchers that study grant funds will not be reclaimed,  and states, “Hey, we can’t be right about everything.”

LAST SUPPER PORTIONS HAVE INCREASED 69.2% OVER THE LAST MILLENNIUM.
In a related study, and a timely one at that, two researchers studied 52 paintings of the Last Supper and concluded that the size of the main course in the paintings had increased by nearly 70% over the centuries. Plate size increased by 66% and bread size by 23%. The authors of this study published in the International Journal of Obesity just in time for Easter speculate that the increasing sizes reflect the increasing abundance and affordability of food over the years. (Apparently there is nothing new about “Super Size Me”.) (1)

H1N1 (SWINE) FLU PROGRAM A BIGGER STIMULUS THAN THE BANK BAILOUTS
The Government Accounting Office (GAO), the federal government’s premier watchdog agency, reports that the H1N1 (swine flu) epidemic efforts created more of an economic stimulus than the bank bailouts. The amount of money pumped into media outlets by the educational efforts was exceeded only by the amount paid to pharmaceutical companies for manufacturing and distribution of the vaccines, now readily available in excess supply due to underuse. More importantly, much of the trickle down economic benefits occurred in the offices of pediatricians, internists, and family physicians; our lowest income bracket health care providers. When asked by the GAO for comments, the CDC replied, “Hey, we can’t be right about everything.”

VIDEO GAME EXPERIENCE MORE BENEFICIAL THAN HONOR GRADES.
Army recruits with a history of prolonged play on video games have better success records as tank commanders and drone pilots than the valedictorians from the same schools. The study speculates that the better hand-eye coordination and enhanced perception of spatial relationships of the video game players accounts for the large discrepancy in skills between the two groups of students. The study authors speculate that these findings could be generalized to include endoscopic, laparoscopic, angioplastic, and other “minimally invasive”  procedures. “Perhaps it is time we altered our application standards for medical school and post-graduate clinical training.”

VEGETABLES CAN LOWER IQs.
Organic vegetables are suspected of  lowering the IQ in young children by at least 10 points. This result of a study of children in Western Massachusetts, Southern California, Oregon, and other tree-hugging communities surprised the authors who had received funds for the study from the National Association of Vegetable Investors (NAVI). A parallel study in rabbits revealed that carotene (the color in yellow and green vegetables) has a strong affinity for nerve synapse proteins in the brain. The carotene  binds tightly with the nerve protein, slowing the response time, EXCEPT in the occipital lobe which is responsible for vision. (Your grandmother was right after all. Eating carrots can help your eyesight.)

WEARING GALOSHES (OR RUBBERS) IN THE MOVIES DOES NOT HARM YOUR VISION.
This small study revealed no change in vision between children who removed their galoshes while in the movie theater and those who did not. The study authors concluded that “Mothers and grandmothers can’t be right all the time, either”, but admitted that the study result was weakened by its small size since they had trouble finding enough kids who still went to a movie theater to watch movies.

OLIVES IN A MARTINI ARE AS GOOD AS OLIVE OIL IN REDUCING CHOLESTEROL.
“You just have to drink enough of them” say the study’s authors.

PASSAGE OF HEALTH CARE REFORM BILL CAUSES MASSIVE SHIFT OF LOBBYISTS.
Lobbyists for bankers, business groups, hedge funds, insurance firms, Wall Street brokers, and others in the  financial sector are poised to reclaim their historical position as the number one group in expenditures to influence Washington policy now that the health care bill has been passed. The Committee for Truth in Politics, its membership and financing still a secret, has already spent $5 million in advertising opposing proposed financial reforms. The Center for Responsive Politics, which tracks spending by lobbyists, speculates that the financial sector lobbyists want to get back to its spending level of the past decade of $3.9 Billion. (2)

CELL PHONE USAGE MAY INCREASE FERTILITY.
In the midst of the scientific controversy about whether or not the low-level radio frequency (RF) coming from cell phones can cause brain tumors, one study has unexpectedly shown an increase in the birth rate in those women using the cell phone more than an hour a day. The mechanism of enhanced fertility is not known. “We compared the actual time spent on voice calls, texting, twittering, and Facebook and found no fertility differences among them, so we don’t think it is associated with just an increase in social intercourse. Likewise, we found no differences between heavy daytime users and heavy nighttime users.” Dr. Siegal Sadetski, a researcher at Israel’s Gertner Institute, stated, “Scientifically speaking, we don’t have proof yet, but as a public health concern, I’m saying we definitely should adopt precautions.” (3)

References:

1. Believe or not, this fun fact is actually true. Wansink and Wansink from Cornell and VWI are the authors. Look it up!
2. Actually some of these names and amounts are true. Check out Center for Responsive Politics website.
3. This quote is true too, but is wildly out of context. 


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