November 17th, 2009

Keep your genes to yourself after this weekend

Posted by Dana Blankenhorn @ 9:03 am

Categories: Curioisities, Ethics, General, Government, IT Management, Medical Records, U.S., genetics

Tags: Insurance Company, Health Care, Genetic Information Nondiscrimination Act, Family History, Insurance, Vertical Industries, Healthcare, Benefits, Business Operations, Corporate Insurance

The Genetic Information Nondiscrimination Act (GINA) goes into force this weekend, and the regulations will impact more than the mere collection of genomes.

The Act was passed last year and signed by then-President Bush.

It makes it illegal to base insurance eligibility or even rates on genetic data, including family histories. Some insurers had been giving discounts to people who completed family history questionnaires. No more.

Employers are already complaining. Some say common health risk assessments will no longer be legitimate. Some complain that wellness programs will be hurt.

Some employer groups and insurers wanted the law’s implementation delayed. Lawyers are already going ka-ching. People who don’t like lawyers are wringing their hands.

The American Medical Association has told its members that physicians should no longer participate with insurers on genetic testing, and even limit disclosures of genetic data to law enforcement.

Basically the new law puts your family history, including your genetic make-up, under requirements similar to those of HIPAA. Just as doctors can’t share your medical data with outsiders, they can’t share your family history either. This may require changes to Electronic Health Record (EHR) software, especially on the server side.

The New York Times says the law will have some unintended consequences. If a CEO’s father and grandfather died of heart attacks at age 50, and the board refuses to promote him to the top chair at age 49, he could have a tort.

Some data can still be collected. There’s a “water cooler” exception, so if you tell the boss about your mom’s breast cancer they can hear that. Or if they later read her obituary in the paper. Or if they ask why you took family leave and you say it’s because your dad has pancreatic cancer.

GINA may be impacting you right now, because many companies are engaged in “open enrollment programs” for next year’s health insurance. There are no longer discounts for giving the insurer data. Some analysts think the new law is America’s definitive statement that they don’t want insurers playing their present expansive role in the health care system.

As with everything, there are unintended consequences. Some baseball teams have used genetic tests to identify (and set the age for) players from Latin America. One basketball team refused to re-sign a player without a genetic test. Perhaps, as Roberto Duran once said, no mas.

One more thing. The blog Queerty notes that if they ever find the the “gay gene” employers can’t test for it, nor discriminate against you based on it. They’ll have to rely on finding your two tickets to “Gypsy”, or meeting your companion at the company picnic. (Hey, I love “Gypsy.”)

November 17th, 2009

The emergency room myth busted

Posted by Dana Blankenhorn @ 6:11 am

Categories: Curioisities, Ethics, General, Government, U.S.

Tags: Tort, Emergency Room, Insurance, Financial Planning, Business Operations, Corporate Insurance, Finance, Dana Blankenhorn

One of the more interesting aspects of watching the health reform debate evolve is looking closely at the arguments of reform opponents.

1. Tort reform, they shout. OK, want to federalize insurance torts? No way. Then how do you put tort reform into this bill?
2. Buy across states, they shout. OK, want to federalize insurance regulation? No way. Then how can you overrule state regulations?
3. Let the poor die. OK, but what about our being a Christian nation? Let charities take care of it. And when they’re inadequate, as they are?
4. The poor can go to emergency rooms.

It’s this last one that got the attention of Harvard Medical School researchers. So they combed through data from The National Trauma Data Bank, which has 2.7 million cases from over 900 trauma centers.

Guess what they found? As reported in the Archives of Surgery, uninsured people had higher risks of death, even adjusted for age, sex, type of injury, etc. In some cases, like operating rooms, they were nearly twice as likely to die as insured patients, from the same injuries.

Brent Eastman, newly-elected chair of the American College of Surgeons, which runs the journal in question, added a tut-tutting commentary, calling the findings disturbing.

Opponents of reform can hang their hats on this. One of the authors of the new study, Dr. Atul Gawande (above), is known to be very much in favor of health reform.

He authored the piece in The New Yorker describing why costs in McAllen, Texas are much, much higher than elsewhere in the state, pointing to conflicts of interests among doctors who own hospitals.

In Gawande’s latest article, for The New York Times, he got together “positive outliers,” people from cities whose results and costs are better than average. Just by copying their best practices, he writes, we could save $1,500 per Medicare patient, slow inflation to 3% per year, yet improve quality.

We now return you to your regularly scheduled trolling.

November 13th, 2009

I'm in a nanny state state of mind

Posted by Dana Blankenhorn @ 8:45 am

Categories: Consumer Information, Curioisities, General, Government, Home Health Care, Internet, U.S., Wellness, state government

Tags: State, Tobacco Company, Rates, Taxes, Free Trade, Financial Planning, Finance, Dana Blankenhorn

The headline is that the U.S. smoking rate has stalled at over 20%, but the news is those places that have the strongest “nanny state” policies against smoking and smokers are still making progress, while those that don’t are not.

In other words, the nanny state works.

The government broke out its numbers by age, race and education, as well as by state.

Rates are highest among native Americans (more than one-third), among those with limited education (nearly half of those with a Graduate Equivalency Diploma (GED) smoke), and in coal country (rates are highest in Kentucky and West Virginia).

Rates are lowest where elements of social control are strong (Utah leads at 11%), and where policies aggressively fight smoking (California is second at 14%). The rate in New York, where the state tax for each pack of cigarettes is now $2.75, dropped from 18.3% in 2007 to 16.8% in 2008.

Smoking is the leading cause of preventable death in the U.S., killing over 1,000 people each day, the CDC said, with 1 in 10 of those deaths being caused by second-hand smoke.

The real scandal, shown in the chart above, is that only 3% of the excise taxes and settlement dollars collected by states go to smoking cessation programs. While $24.9 billion is available, the states spend just $75 million. Tobacco companies spent $13 billion in advertising in 2006.

In other words, we’re being outgunned better than 13-1 even though we’re putting out twice as much money to fight smoking as the tobacco companies are laying out to keep it around. That’s Halliburton-like efficiency.

If you want to save money on health care, in other words, maybe you too need to get into a nanny state state of mind. Or just become a little more personally intolerant of having smokers around you, so you don’t wind up among the 100 non-smokers killed by cigarettes each day.

November 12th, 2009

Watch BPA get taken seriously now

Posted by Dana Blankenhorn @ 7:15 am

Categories: Curioisities, General, Research, Wellness

Tags: China, Exposure, Study, Industry, Worker, BPA, Strategy, Management, Dana Blankenhorn

The warnings about Bisphenol-A (BPA), which we began covering here some time ago, have mainly gone unheeded. (Picture from China’s Peoples Daily of a chemical explosion in Jilin, China.)

It’s hard to take the flexibility out of plastic. It’s hard to create something new in quantity. It might be expensive to spray something other than BPA into metal food cans. And then what about liability?

And what’s it hurting anyway? Mood and memory? Is it making you fat? Is it making girls mean?

Big deal.

How much you want to bet that changes now that China has discovered male workers exposed to BPA had a high incidence of erectile dysfunction.

The Chinese study, in the British journal Human Reproduction, leaves a lot of questions unanswered. Just how high was the exposure of these workers? Are exposures of American chemical industry workers comparable? What level of BPA exposure causes harm, and at what level of exposure do we find what types of harm?

There’s going to be a boom market in medical studies aimed at answering these questions.

BPA has been in common use for over 30 years. It’s probably in you right now, probably more of it than you think.

The chemical industry is going to fight any attempt to limit its use or (later) to take legal responsibility for the consequences. Here is how the American Chemistry Council has responded to the most recent news:

• The Chinese study has limited relevance to consumers.
• Last year’s study by Consumer Reports is inconsistent with what regulators say.
• Other studies have limitations and unclear conclusions.
• Exposure levels in baby bottles are very, very low.

Wash, rinse, repeat. And don’t forget to put out a Web site that claims to be unbiased but is in fact an industry front.

Asbestos makers could be isolated from the rest of the industry and allowed to run down. The makers of BPA are a who’s who of America’s chemical industry. Bayer, Dow, GE, Sunoco. BPA is part of the green energy push.

But if it’s going to make our little soldiers go limp, I’m sure we can find a way to get rid of it.

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 6th, 2009

House due for its health reform vote tomorrow

Posted by Dana Blankenhorn @ 5:54 am

Categories: Curioisities, Finance, General, Government, U.S.

Tags: Protest, Democrat, Republican, Health Care, U.S. Senate, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Defying a Republican Day of Rage on the Capitol steps, House Democrats said they will vote through a health reform bill, with a public option, on Saturday.

For history buffs, the protest came a little over 40 years after the left’s infamous Days of Rage, a series of protests against the Vietnam War that turned violent and tarred all liberals for a generation.

Yesterday’s event featured most of the House Republican leadership and signs comparing reform to Naziism, Maoism, and the Joker as played by the late Heath Ledger.

There was no violence, just a star turn by Minnesota Rep. Michele Bachmann (right, naturally), the tea party’s Janis Joplin, who performed a medley of her greatest rhetorical hits and basked in the love.

Keith Olbermann called the protest “an orgy of veiled threat,” but perhaps getting him riled was part of the point. (Snarks might say Bachmann took another little piece of Keith’s heart now, ba-bee.)

As the vote neared President Obama became more visible, appearing at the White House briefing room to tout endorsements of the House plan by the American Association of Retired Persons (AARP) and the American Medical Association (AMA).

For the bill to become a law, it must be merged with a yet to-be-passed Senate bill, then go through both Houses again. Opponents of reform in the Senate may have to depend on Sen. Joe Lieberman (CFL-Conn.), who as noted last week has said he would support a filibuster aimed at killing any proposal with a public option.

After a decade of Democrats watching Lieberman as Droopy Dog playing Hamlet (will he, won’t he, he din-nit) now Republicans can enjoy that thrill. Starting Monday he will have become their Obi-Wan Kenobi, their only hope.

Here is the smart takeaway on all this (as opposed to the smart-aleck takeaways above). Once whatever passes passes (or doesn’t) employers know the environment into which they’re putting a major portion of their budgets, and can firm decisions on whether to hire, or how much, next year.

The show has been fun, but it needs to close.

UPDATE: Maybe not tomorrow, maybe later. Like some old rock concerts I don’t remember.

November 5th, 2009

PriceDoc bringing price transparency to you

Posted by Dana Blankenhorn @ 11:45 am

Categories: Curioisities, General, Internet, Medical Office IT

Tags: Patient, Health Care, Price, PriceDoc, Patrick Bradley, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Whenever I write about health care policy at ZDNet Healthcare one demand comes from readers loud-and-clear.

People want price transparency. They want to know what things cost. They want doctors to compete the way everyone else does.

That’s what PriceDoc is starting to offer, and it’s going national.

PriceDoc launched earlier this year, using Seattle as a test market. It’s now soliciting doctors nationwide to list their prices for $49/year$49/month, aiming to sign up 10,000 by the end of the year and then “turning on the spigot” with a little consumer advertising in 30 major markets.

NOTE ON CORRECTION: All doctors are listed free. The $49 fee covers their filing of profiles with credentials, descriptions of specific services, listing prices, and participating in special offers. The company is looking to reduce or eliminate the fee in the future.

Patrick Bradley is the CEO. “We can deliver new cash-paying patients. Physicians love cash-paying patients.”

While the focus in Washington is the health insurance market, expanding it or controlling its costs, Bradley says there is already a $200 billion cash market for health care. It’s not just the uninsured, but patients who may lack specific coverage for their teeth, their eyes, or for alternative treatments like chiropractic.

Buyers in this market want very much to know how much something will cost before they get it done. PriceDoc delivers.

In the PriceDoc model doctors sign up to show their qualifications and specialties, and are encouraged to post prices for common procedures.

Initial reaction from doctors was mixed. “Some are very big believers in transparency. Others are more reluctant to post prices. They want patients to call them. What we’re finding is those who are getting called for a price decide to post prices, knowing they’ll get more hits.” Play the game by the rules and you can win.

The current site is organized with folders, but Bradley has already seen the future and has a patent pending on a bidding system.

“You search out a provider, and if they have a posted price you can make a counter offer. That online negotiation and verification is covered in the patent.”

Even without direct bidding, PriceDoc has had one big impact on price. Bradley calls it the PriceDoc special price.

“We post those at the top of the page. It is a price for a procedure with a special condition. An orthodontist may post a special price for a specific time of day. You come in between 10-2 I’ll give you a better deal.” Airlines call this yield management.

So if you’re uninsured, or just not insured for a specific procedure or discipline you need (you want nice acupuncture, Mister?) you should soon be able to give PriceDoc a whirl.

And we’ll find out if the claim that transparency lowers prices is right.

November 2nd, 2009

Obamicans rebranding NHIN-Connect as the Health Internet

Posted by Dana Blankenhorn @ 7:45 am

Categories: Curioisities, General, Government, Hospital IT, Insurance IT, Internet, Medical IT, Medical Office IT, Medical Records, Open Source, U.S.

Tags: Health Care, Obama Administration, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

The Obama Administration has a new brand for the NHIN-CONNECT service that debuted earlier this year.

The Health Internet.

(The button to the right is currently on the CONNECT home page.)

CONNECT is a set of open standards and protocols, originally developed under contract by Harris Corp., primarily using technology from Sun Microsystems (soon to be part of Oracle).

Among the open source tools in NHIN-CONNECT are the GlassFish application platform, the Java Composite Application Platform Suite (CAPS) SOA Platform, and the Sun Java Identity Management suite.

Since its April launch the Department of Health and Human Services has been hosting a series of “code-a-thons” where programmers can dissect and improve the software. About 100 participated in the first such event in August.

The frame of a health Internet is drawing effusive praise from Robert Kolodner, who was the last National Coordinator for Health IT under the Bush Administration, and who recently went to Open Health Tools.

All this is part of an important policy turn by the Obama Administration which, as Kolodner’s support for it indicates, really has nothing to do with politics.

Under the Bush Administration, policy favored contractors, who kept their work proprietary. The hope was that privatizing development would save government money in the long run. The Veterans Administration even lost control of its own lab software, after decades seeking to develop it internally under its VistA system.

Now the VA’s CIO thinks VistA is the bees knees, and the open source movement has even invaded the Defense Department, which appears to welcome its new penguin overlords.

Having health records moved nationwide under a set of open, accessible standards is also great news for Personal Health Record (PHR) systems like Microsoft HealthVault and Google Health, which may soon have a single set of open standards every proprietary system is writing to.

The pitch that NHIN-CONNECT is a “health Internet” reflects all these changes. Ordinary citizens won’t access the system, but they will be able to gain its byproducts, including PHRs delivered through tech companies, insurers or hospitals.

It’s real health reform, and it cost nothing that wasn’t already being spent under the previous Administration.

November 2nd, 2009

Don't cry for me Joe Lieberman

Posted by Dana Blankenhorn @ 7:09 am

Categories: Curioisities, Finance, General, Government, U.S.

Tags: Democrat, Lieberman Software Corp, Joe Lieberman, Option, Liberals, Leadership, Vertical Industries, Benefits, Healthcare, Healthcare Reform

The good news on health care reform today is the movie is nearly over.

Democrats are facing up to the choice that faced them from the start of the debate. They can either tell their grassroots to suck on this and pass a bill moderates within both parties will accept, one without a public option, or they can roll their opponents in a parliamentary floor fight.

The question was put by Sen. Joe Lieberman, who now says he will vote with Republicans to filibuster any bill with a public option in it. The leadership bill includes a public option, but Lieberman plus a united Republican caucus mean that bill can’t come up for a vote.

No reform is better than a public option, he told CBS’ Face the Nation.

House Democrats, meanwhile, are pushing ahead with a bill that includes the public option, plus new regulatory authority for the Federal Trade Commission over health insurers. This despite the fact the public option they have crafted would only get a 2% market share, according to the Congressional Budget Office.

Liberals are calling for Lieberman’s political head on a platter. Matt Osborne of The Huffington Post says including the public option makes the leadership bill a budget measure eligible for reconciliation, so a filibuster would be out of order. Markos “Kos” Moulitsas notes Lieberman was for ending filibusters as a freshman Senator.

Of course tossing aside Lieberman might leave moderates in both camps without a party at all. Could we have an American version of England’s Liberal Democrats come out of this?

Stay tuned. I think a dance number is coming up.

October 27th, 2009

Open source nanotech project launched

Posted by Dana Blankenhorn @ 6:54 am

Categories: Curioisities, General, Research, Robots

Tags: Nanotechnology, CANNXS Project, Open Source, Dana Blankenhorn

An Australian research scientist has launched a project aimed at making nanorobots an open source technology.

The CANNXS Project is based at the Center for Automation in Nanobiotech in Melbourne, Australia.

Adriano Calvacanti (right) compared his project to Linux in an open letter recently sent the UN Secretary General. The letter, which referenced the work of the late ZDNet blogger Roland Piquepielle, is aimed at building momentum and support for the effort.

He writes:

The concept is similar to the Linux approach on open source development. Hence, the work on analysis, hardware architecture, software, and information can become part of a global community to advance nanobiotechnology and biomedical instrumentation. Our aim with CANNXS is to enable everyone to have free access to nanobiotech knowledge.

The whole effort, including technical contributions and donations given to CANNXS, and sales generated from products and services developed and provided from such an open source initiative goes integrally for further research to effectively fight and cure cancer, diabetes, cardiovascular diseases, and aneurysms.

The idea of doing biology through open source has been around for years, but the high cost of research, the fact that patent rights are clear in this area, and the huge pay-offs to corporate inventors have throttled it until now.

The ambivalence even extends to CAN’s own home page, which bills itself: “Since 2004 - your partner for nanobiotech business.”

Can Adriano Calvacanti become the Linus Torvalds of biology?