November 16th, 2009

Niacin best for raising good cholesterol

Posted by Dana Blankenhorn @ 5:42 am

Categories: Aging, Consumer Information, Drugs, Finance, General, Home Health Care, Medical Equipment, Research, Wellness

Tags: Cholesterol, Dana Blankenhorn

Want more of that good HDL cholesterol?

(Picture from Costco.com.)

Try a timed-release niacin, and be skeptical if your doctor gives the sales pitch for Zetia or Vytorin.

The authority for this is a study dubbed ARBITER-6, which was stopped suddenly this summer, with the study’s authors insisting safety had nothing to do with it.

It was a question of efficacy.

The results, described in the New England Journal of Medicine, make clear that niacin does better at the main job, keeping arteries open.

“The use of extended-release niacin causes a significant regression of carotid intima–media thickness when combined with a statin and that niacin is superior to ezetimibe.”

Ezetimibe is the generic name for the active ingredient in Zetia, while Vytorin combines the same drug with a generic statin, simvastatin.

This does not mean ezetimibe is worthless. It works. It just doesn’t work as well as niacin.

This has important implications for anyone who, like me, has a family history of hypertension and high cholesterol. But if you want to save some serious money, look further.

The ARBITER-6 study compared ezetimibe with Niaspan, a drug form of timed-release niacin. But you can get similar dosages, for a lot less, with a supplement containing the same stuff. I use something called Slo-Niacin.

On most insurance plans you’ll pay $10/month for a generic statin and $30/month for Niaspan, or $30 for Zetia, “saving” $10 by using Vytorin (which contains the statin).

But Costco offers 150 Slo-Niacins for about $10, so even if you double your dosage to 1 gram (as many doctors recommend, taking one in the morning and one at night to prevent flushing), that’s $14/month for simvastatin and niacin, or $30/month for Vytorin.

Last time I got checked out, my combination of simvastatin and 1 gram of SloNiacin per day was working like a champ. Total cholesterol under 150 and a ratio of bad to good that had my doctor putting exclamation marks on my chart.

The paragraphs above, combined with the results of ARBITER-6, represent the heart of comparative effectiveness, and the way we old-timers can interpret those results to stay healthy for less.

As health IT begins collecting hundreds of millions of health records over the next several years studies like this will become easier to do, and they will be more accurate, given the larger number of records being studied.

But this is bad news for drug-makers. You not only have to prove safety, not only prove that your drug does what it claims, not only prove you’re better than a placebo, but you now have to prove you’re better than alternatives before you’re going to get the big money.

Bad for drug companies, good for patients. That’s what comparative effectiveness studies are all about.

November 12th, 2009

What Intel wants in health care

Posted by Dana Blankenhorn @ 6:10 am

Categories: Aging, Assistive Technology, Gadgets, General, Home Health Care, Home Health Care Equipment, Medical Equipment, Rehabilitation

Tags: Health Care, Intel Corp., Venturebeat, Vertical Industries, Benefits, Healthcare, Sales Strategy, Human Resources, Sales, Dana Blankenhorn

Our Tom Foremski is shocked, shocked that Intel is launching a camera that reads.

What’s going on, he asks? Intel is terrible at consumer products. (Picture from Intel.)

But the Intel Digital Health Group is as serious as a heart attack, and the Intel Reader is part of it. The device is actually a specialized computer, combining a camera, optical character recognition, and a voice chip.

I have a stake in this, because my daughter is dyslexic and my mother blind. I appreciate the hard work that went into this. The $1,500 price tag is off-putting, but Moore’s Law tells me that in time it should come down.

And therein hangs our tale.

Intel produces what is now a commodity. It is the dominant supplier of chips but margins are thin. It needs higher margins to thrive.

Health care offers those higher margins. Health care and assistive technologies offer humongous margins because production runs are often small and sales channels thin. Venturebeat says the Intel Reader, for instance, will be going to CTL, Don Johnston, GTSI, Howard Technology Solutions and Human Ware.

None are exactly Best Buy. These are specialty resellers. Johnston, for instance, specializes in technology for dyslexic and autistic kids.

Still, these are growing markets. The Intel Health Guide, for instance, is aimed at the business of aging in place. There are 76 million of us baby boomers and we’re not getting any younger — ka-ching.

And let’s look again at the Reader. Products for the blind, for the autistic, and for the dyslexic are traditionally seen as separate markets. Here we have one product that addresses all of them. That means more sales which can drive down costs. In this business that’s an innovation.

So there is potential here for the perfect marketing storm. A company that can drive down costs enters a market with enormous margins. It can get fat on slimmer margins than those it finds in the market. As it drives down prices it expands the market — I might get that Reader for my daughter when it comes in at $400 (and in time it will).

This can truly be a win-win-win. The assistive technology and health care markets want lower prices, which Intel can deliver. Lower prices will expand the reach of things like aging in place technologies and readers for the dyslexic. Intel can build a highly-profitable business that in time delivers top line growth as well as bottom line growth.

Sure, there are specialty channels to figure out. Sure there are new marketing skills here Intel has not yet mastered. But price can cover that up while those skills are learned. This is the lesson Japanese and Chinese producers have been teaching us for decades.

And if they want to offer a review unit, I’ve got some good testers coming in for Christmas.

November 11th, 2009

Why not pay for what works?

Posted by Dana Blankenhorn @ 11:44 am

Categories: Drugs, Gadgets, General, Government, Home Health Care Equipment, Hospital Equipment, Insurance IT, Medical Equipment, Medical IT, Medical Office Equipment, Rehabilitation, U.S., state government

Tags: Patient, Health Care, McCaughey, Insurance, Financial Planning, Vertical Industries, Benefits, Healthcare, Business Operations, Corporate Insurance

In all the hullabaloo over health reform, Charles Silver and David Hyman write at The Health Care Blog, a key point of cost control has been lost.

Paying only for what works.

Silver and Hyman are law professors, not doctors. They point to a RAND Corp. study saying that “one-third or more of all procedures performed in the United States are of questionable benefit.” (The illustration is from the study.)

What happened to this simple idea?

The way to enforce it is through comparative effectiveness. Analyze data from millions of patients, develop best practices, and move physicians toward the most cost-effective solution.

This is what every other country does, regardless of how they pay for care. Formularies drive care, based on cost effectiveness. Anyone who wants to go outside what works had better have a good explanation. Often, going outside what works is simply forbidden, or patients are told to buy it with their own money.

Isn’t that how you set priorities? Why should governments or insurance companies act differently?

Unfortunately this was one of the first dominoes to fall in the debate. Reform opponents like Betsy McCaughey called this “getting between a patient and their doctor.”

This happened in conjunction with the debate over the Obama stimulus, and the subject was health IT. The purpose of the HITECH Act’s $19.2 billion in stimulus was to collect the data that would drive decisions on what to pay for.

McCaughey’s scare worked. Explicit promises were made not to use comparative effectiveness in any way to deny care, not to use evidence to decide what we should pay for.

The alternative to evidence is politics. Silver and Hyman note that millions of insurance dollars are spent annually on entirely non-medical treatments like Christian Science, but there’s more:

Lobbying from providers and supportive patients explains why many states already mandate coverage of elective services like in-vitro fertilization, massage therapy, and visits to athletic trainers. Concerns about the efficacy and cost-effectiveness of treatments are washed away by a stream of campaign contributions, and sad stories about patients who can only obtain the “necessary” services if the insurer will pay for them.

This is what is wrong with the present system. State regulation of insurance is based on politics, so your coverage includes any procedure that becomes politically powerful in your state. That’s why insurance costs are rising through the roof.

There is nothing wrong with paying for prayer but it’s not medicine, they write. There’s nothing wrong with in-vitro fertilization but it’s optional, not something everyone should have to cover.

Thus, by tossing away evidence as a way to rule-out certain coverages, you pay for a lot of stuff you don’t need.

Silver and Hyman wrote to argue against a politically-motivated individual mandate. Any mandate should be based on science, not politics, and by giving up on comparative effectiveness early in the process, it became impossible to set that standard, either through the federal government or through the states.

If this was Betsy McCaughey’s intent, she is fiendishly clever. Health care will remain a growth industry, because Americans will keep having to pay for stuff that doesn’t work, regardless of whether reform passes or fails.

November 10th, 2009

What's up with the rabbit penis, doc?

Posted by Dana Blankenhorn @ 8:57 am

Categories: Consumer Information, Curioisities, General, Rehabilitation, Research

Tags: Technique, Organ, Rabbit, Productivity, Dana Blankenhorn

News that the Wake Forest Institute for Regenerative Medicine (yep, WFIRM) has successfully grown rabbit penises in a lab set off a media feeding frenzy.

These are fully-functioning organs. The rabbit recipients went at it like, well, rabbits.

But there is more to this story than meets the snark.

This is an important proof-of-concept test for Dr. Anthony Atala (right), the center’s director.

The concept is that cells from a reduced organ are sprayed onto a collagen matrix, then bathed with compounds that stimulate cell growth and left in kept in an environment that duplicates the temperature and chemical makeup of living tissue.

The success of the technique means Dr. Atala could also grow new noses, new ears, perhaps even new fingers that are fully compatible with, and in many cases nearly identical to, the originals. This is not a fancy “stem cell” technique but a more straightforward one with wide application.

The news comes just months after Dr. Atala formed an Alliance for Regenerative Medicine that not only includes other colleges like Stanford and Georgia Tech but corporations like Geron and Johnson & Johnson, along with venture capitalists like Kleiner Perkins.

The aim of the group is to maintain political support for research and for the technique itself, said Geron CEO Thomas Okarma in the group’s initial press release.

The apparent success of the technique may be the best advertisement of all.

Although we know what Jay Leno will say about it. “Does this mean Cher can finally become a grandmother?” Rimshot optional.

November 4th, 2009

How fast can remote monitoring move?

Posted by Dana Blankenhorn @ 12:07 pm

Categories: Aging, Always On, Assistive Technology, General, Government, Home Health Care, Home Health Care Equipment, Internet, Medical Equipment

Tags: Monitoring, Standards, Approval, MedApps, Quality, Business Operations, Dana Blankenhorn

Remote medical monitoring, the use of sensors and networks to detect changes in patients and deliver alerts to caregivers, has been growing throughout this century. (Picture from Abledata.)

This week’s approval of an Alcatel-Lucent TeleHealth Manager by the FDA is just the latest 510(c) approval in a long line.

• RODA got approval for remote heart monitoring in 2002.
• St. Jude’s Medical has been getting remote monitors approved since 2004.
• Medic4All got approval on its VMS-01 telemedicine system in 2006.
• Medtronic has had heart monitors that can be pinged remotely for over three years.
• MedApps has been selling a remote diabetes monitoring system over the counter since 2007.
• ExpressMD got approval for its Electronic House Call system in April.

Not everything is rosy in this business, and not all the fault lies with government. Insurers are reluctant to reimburse, which makes no sense since these systems save enormous amounts of money. BIOTRONIK’s remote heart monitors have been approved to replace doctors’ visits.

Where Intel (and its new partner GE) can provide a service to the whole industry is by helping to streamline these approvals, from both industry and the FDA.

Electronics are insanely reliable. The links available between devices, base stations, and caregivers, via the Internet, are also improving thanks to Moore’s Law. You can even get remote health monitoring through WiFi.

What the industry needs to get past the analysts’ hockey stick graphs are standards. Technical standards, payment standards, approval standards. This is no longer rocket science, it’s not experimental.

Make it part of the technology mainstream, let remote monitoring benefit from Moore’s Law economics, and medicine will be truly transformed, in Internet time.

October 29th, 2009

Diabetes can be kept at bay

Posted by Dana Blankenhorn @ 6:23 am

Categories: Aging, Consumer Information, Drugs, Ethics, General, Home Health Care, Research, Wellness

Tags: Diabetes, Dana Blankenhorn

Want to save billions of dollars on America’s health bill?

Cut the rate at which people come down with diabetes.

(The site from which this illustration was taken, at Doctorsecrets.com, has a great page on diabetes, explaining the cause, the symptoms, effects and treatment in plain English.)

Right now 24 million Americans have diabetes and another 57 million are in a “pre-diabetic” stage. The latter group’s risk can be cut in half, over 10 years, with self-discipline on diet and exercise, along with a generic drug called metformin.

The latest study, published in The Lancet’s Online First journal, was a follow-up to the Diabetes Prevention Program, an earlier study which showed diet and exercise reduced onset of the disease 34% over four years, and metformin cut it by 18%, compared with rates using a sugar pill.

In the follow-up people who had been on the placebo or metformin were offered the lifestyle program, since it was proven to have benefits.

While some media reports pushed the lifestyle angle exclusively, the study made clear that those who exercised and ate right but also took the drug maintained their weight loss, while those who made the changes without it gained some weight back.

On average, losing weight alone delayed the onset of diabetes by four years, drug therapy alone reduced it by two years. Those over 60 did even better with lifestyle changes than younger patients.

The American Diabetes Association maintains an online test to assess your risks of Type II diabetes.

While it is fun to say “it’s their fault,” meaning the patients (and it is to an extent), the refusal by society to treat a chronic condition like diabetes runs against medical ethics. It’s not going to happen.

Preventable deaths in the tens of millions to suit your ideology are not in the cards.

Prevention costs a lot less than treatment, and much of the savings expected from health reform is based on studies like this which prove that prevention works.

October 23rd, 2009

Could diabetes fight the obesity epidemic?

Posted by Dana Blankenhorn @ 11:03 am

Categories: Consumer Information, Drugs, General, Home Health Care, Medical Equipment, Research, Wellness

Tags: Diabetes, Novo Nordisk, Hormone, Dana Blankenhorn

People who become obese have a high risk of diabetes. People with diabetes are often told to lose weight.

A new Novo Nordisk drug called liraglutide, which it’s marketing as Victoza, may provide an answer to both problems.

A study conducted in Denmark found today that it’s safe and effective as a treatment for Type II diabetes. (Yes, it beat the placebo, too.)

In higher doses it also helps patients lose more weight than a standard weight loss pill, Xenical. Plus it reduced blood pressure.

Novo Nordisk is based in Denmark, and while its stock rose in response to the news it fell back to pre-announcement levels within a day.

The drug is given once a day by injection. While many Type I diabetics are accustomed to injecting themselves with insulin, many Type II diabetics are given pills as a first-line treatment.

Still the idea of a single treatment for both early-state diabetes and weight loss drew enormous media interest.

Arne Astrup, who conducted the study, told the BBC the drug mimics the behavior of a natural hormone called GLP-1, which is released by the small intestine after you eat. The hormone tells the brain you’re full and the body to produce digestive insulin, but the effect dissipates quickly.

The drug allows your body to feel the effects of GLP-1 for a full 24 hours, making it resistant to the body’s natural self-destruct mechanism.

Critics will note that this is an injected drug, while Xenical is a tablet. Some are also questioning its use in weight loss.

Want some?

October 22nd, 2009

Immelt seeks to unite healthcare with Silicon Valley mainstream

Posted by Dana Blankenhorn @ 5:45 am

Categories: Events, Finance, Gadgets, General, Hospital Equipment, Medical Office Equipment

Tags: General Electric Co., Health Care, Immelt, Vertical Industries, Benefits, Healthcare, Web 2.0, Human Resources, Internet, Dana Blankenhorn

A lot was written about GE chairman Jeff Immelt’s appearance yesterday at the Web 2.0 Summit, but one key point can’t be emphasized enough.

Jeff Immelt was at the Web 2.0 Summit. He wasn’t at a health care show. He was pitching tech people.

Immelt deliberately brought something with him designed to get a little Silicon Valley wow, a handheld ultrasound called the Vscan the size of an old-fashioned cell phone.

Sounds cool, but African techs have been able to take complex readings on phones for some time, with results compiled elsewhere and reports delivered to the field.

More important than what was in Immelt’s hand was what was in his pocket, namely a pen GE can use to sign off on up to $250 million in venture capital money. The idea was “this is what we can do, now you show us something better and we’ll do business.”

It was probably no accident that GE Healthcare picked the same day to announce a screening test for cancer-related proteins with Eli Lilly. Immelt wants to link the creativity of Silicon Valley to the health IT and health technology mainstream. He wants the people on both sides of the divide competing for the same pile of cash.

All this is part of a general transformation of the company away from the Jack Welch era, which was about finance and entertainment, back to the company’s roots in technology. Every great GE chairman reinvents the company around a vision, and this is Immelt’s.

The vision is starting to pick up believers, like Alexander Wissel at Seeking Alpha. Calling GE “America’s largest mutual fund” because of its size and scope, he nevertheless rates it a buy as the “ultimate recovery play.”

Health technology and health IT both represent technology, but they have been focused outside the Valley. The health and cure tail has been wagging the technology dog. GE wants to reverse that, and if it can this Web 2.0 Summit will have turned out to have been a watershed.

October 21st, 2009

Don't tase me in the chest, bro

Posted by Dana Blankenhorn @ 9:01 am

Categories: Ethics, Gadgets, General, Research

Tags: Chest, TASER International Inc., Workforce Management, Training And Certification, Human Resources, Dana Blankenhorn

The stun gun game will never be the same.

Taser International has formally notified customers that shocking someone in the chest can cause an “adverse cardiac event.”

Publicly the company is not backing away from the idea that Tasers are relatively safe.

The company says its October 12 training bulletin should be seen only as a recommendation to “avoid controversy” and maintain safety by, say, shocking people in the gut.

The company’s home page still features this impressive picture of a new model with the slogan “upgrade to a semi-automatic.”

But customers, and the plaintiff’s bar, are now on notice. Next time a suspect is zapped in the chest and dies there is going to be a lawsuit.

Certainly political opposition to the Taser remains. A site maintained by relatives of a Canadian tasing victim features the names of 451 people it says died from use of the product, whose inventor, Jack Cover, went to his grave early this year insisting his aim was always to save lives, not take them.

Despite its protests, this is a serious reversal for the company. Police love the product, and politicians who love police also like to try and demonstrate its safety.

But the cops are now on notice. Don’t tase me in the chest, bro. Don’t go Taser happy if you want to stay out of court.

This will doubtless lead to some hesitation in firing the weapon at suspects. Yes, firing. The newest Taser product, the XREP, released early this year, is a tiny Taser bullet that an be fired from 12 mm shotguns.

Cops think using a Taser isn’t shooting a suspect, and that subduing people with a Taser is not harmful. Usually, it is. But now, the company admits, that might not always be the case. Police will have to consider that before pulling out the weapon, and probably have to file an incident report each time they do.

October 13th, 2009

JAMA studies push the need for H1N1 flu shot

Posted by Dana Blankenhorn @ 7:01 am

Categories: Consumer Information, Ethics, General, Hospital Equipment, Internet, Medical Records, Physician Information, Research

Tags: Patient, Hospital, H1N1 Flu, Dana Blankenhorn

The Journal of the American Medical Association has put a number of studies concerning H1N1 “swine” flu on its public Web site, and they make for scary reading.

(What’s the great comic W.C. Fields doing here? Stay tuned.)

Like the 1918 pandemic this bug seems to seek out the young and healthy. If you’re sick enough to be hospitalized there’s a fair chance you won’t come out alive. Modern medicine is better than it was a century ago but we still haven’t licked this thing.

Still want to avoid the H1N1 shot, assuming that it’s offered to you? Really? Really.

OK, let’s go through the research:

• Health care workers get little protection from fancy masks. Workers given ordinary medical masks had a nearly 1 in 4 chance of getting the disease. The same for those given fancy N95 fitted masks. Many medical workers have been resisting getting the shot.
• Hospitals must be prepared for extraordinary burdens in the face of H1N1. “Hospitals must develop explicit policies to equitably determine who will and will not receive life support should absolute scarcity occur.” Short version, convene the death panels now.
• Doctors in New Zealand and Australia tried a technique called ECMO (a heart-lung intervention usually used on premature infants) on 68 severely ill H1N1 patients. These young patients had a 21% mortality rate. The study’s authors believed they did well. Six of the survivors were still in intensive care when the study was completed.
• A study of early victims in Mexico found critical illness concentrated in the young, with 58 of 899 patients admitted to the hospital. Among these 58, hospital admission “was associated with severe acute respiratory distress syndrome and shock, and had a high case-fatality rate.” If you were sick enough to go to the hospital you were sick enough to die.
• A study in Canada of 168 patients admitted to intensive care, including kids, found a median age of 32, with nearly one-third of the patients children. A variety of techniques were tried but overall, about 18% of these patients died.

I have noted in comments here a blase attitude toward H1N1, and a definite resistance to get protection against it, for a variety of reasons.

W.C. Fields (above) famously called death the “fellow in the brite nightgown.” A few years ago Donald Fagan turned this into a catchy song. To those unconcerned about H1N1 feel free to hum it on your way out the door, when said fellow gives you the victory hug.