November 24th, 2009

What open source can teach medical practice

Posted by Dana Blankenhorn @ 7:34 am

Categories: Consumer Information, Ethics, General, IT Management, Internet, Medical Office IT, Medical Records, Networking, Open Source, Research

Tags: Gender And Diversity, E-health, Open Source, Human Resources, Healthcare, Dana Blankenhorn

It is frustrating whenever personal medical questions become political questions.

This happens all the time. Example A, ripped from the headlines, is the kerfluffle over mammograms.

Women, doctors and politicians who hate having to go through the procedure are now screaming bloody murder over the non-existent “threat” to halt access to it.

Let’s go back to where this started. It was a population study, done on behalf of the U.S. Preventive Services Task Force,  which concluded that the risk of unnecessary treatment exceeds the risk of death from annual screenings for the disease.

It was a science paper, and it was complicated, couched in the words scientists use to describe their work with precision.

Every profession has its version of this language. Engineers do, lawyers do, even software developers do. Learning the language gives a journalist entree into these professional worlds, but it’s not an exercise most of us will, or should, go through.

Thus this study, like so many, was filtered through the lens of journalism. A flood of words failed to answer the questions women wanted answered

• What are the chances I will die from a late diagnosis?
• What are the chances I will suffer from over-diagnosis and over-treatment?

Calculate the threat to me so I can make a rational choice.

This is where technology comes into play. An Electronic Health Record (EHRs) can show you your own history, we can take your family history, we can analyze your genetic history, and we can estimate based on that.

If, that is, we have access to the larger pool of data. That’s our baseline. It’s what we need to compare your own data to before we can give you the answer you seek.

In scientific studies like this one we don’t have access. The data is locked away somewhere. Mass adoption of EHRs is going to unleash a firehose of data, and the question should occur, very soon, what to do with it.

I’m not talking here about your record. I’m talking about the gross data, this warehouse of numbers describing everyone’s condition, what is being done for us, and what the results are.

An open source attitude toward that data, within the realm of science and throughout the medical community, can help patients gain access to the benefits of that data and answer the question they ask — what should I do?

Unfortunately medicine, health IT, and medical data all suffer from a proprietary attitude born of paranoia, the fear that you may be identified in this data mountain, that your needle will appear in this haystack, and that giving everyone access to data means giving them access to you.

A database, stripped of personal information, consisting of millions of records, is safe for use by software code. The data, and the code, are what we need to provide real answers.

We are collecting the data. We need to unlock it. We are writing the code. We need to share it.

This is what open source can teach the practice of medicine.

November 20th, 2009

Paying for what does not work remains popular

Posted by Dana Blankenhorn @ 9:36 am

Categories: Consumer Information, Ethics, General, Home Health Care, Internet, Research, Wellness, genetics

Tags: Women, Cancer, Pap, Gender And Diversity, Human Resources, Dana Blankenhorn

Another Day, Another Recommendation to Relax Screening for Women.

That’s the ABC headline on today’s story that young women can avoid cervical cancer just as easily getting pap smears once every two years as every year.

This is good news. Pap smears are a hassle. If you’re a woman, or know any, you know this.

So why the pushback? Why the accusation that the Administration wants to ration necessary tests?

One reason is that women continue to die from cancer, including famous women like Stephanie Spielman (right), wife of former football star Chris Spielman. She first discovered her cancer in a self-exam 12 years ago. It took her life on its fifth recurrence.

But not all cancers kill. If you are diagnosed with prostate cancer and told it has a low Gleason score, you may be told to do nothing — watchful waiting, it’s called. Similarly not all breast cancers are invasively aggressive. Research is ongoing to find better ways to distinguish breast tumors.

Meanwhile, thousands of women are losing their breasts each year to unnecessary surgery or risking death from chemotherapy. And millions of women (as well as men) aren’t doing the first thing to prevent this disaster — losing weight.

We imagine a simple formula. Get tested and if there is cancer get treated. But what scientists are trying to tell us is there is a different formula. Get healthy and seek appropriate treatment based on how dangerous your particular cancer is.

This is just what men have been told about prostate cancer for years. It’s the refusal of some people to accept this fact that’s dangerous.

Many also refuse to accept the fact that you can do everything right and, like Stephanie Spielman, die anyway. It’s tragic, but it’s true. There is still much more to learn about cancer before it is beaten.

The bottom line is this. We know a lot about how to cut health care costs. Stay healthy. Eat right, exercise, don’t get obese. Don’t smoke. But too many think this advice is an infringement on their freedom, that magic tests and magic treatments will save us from ourselves.

They won’t. Do what works, meaning take care of yourself, and you will be less likely to rely on what does not work, frequent testing and over-treatment.

Of course, this advice can be refined if we know your genetic background, what you are most susceptible to, what is most dangerous to you. But in the end predictive medicine is just a refinement, and the advice you will get from it is similar to what doctors are saying now.

You have the best chance of staying healthy if you take care of yourself, and rely on yourself, rather than the magic of medicine, to keep you well. That is what works.

Sorry if you think this violates your freedom. You remain free to eat that brownie, to smoke that cigarette, to have that fifth beer, to overwork and to ignore your doctor.

But at some point your neighbors, who are paying for your excess, whether in the form of insurance or in the form of taxes, are going to start asking these hard questions, like why do you feel free to drink deeply from the well of cures if you’re not doing what it takes to stay well?

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

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

Canadians get a taste of American medical system with IMS Health buy

Posted by Dana Blankenhorn @ 7:28 am

Categories: Finance, General, Government, Medical Office IT, Payment Processing, Research, SaaS

Tags: IMS Health Inc., IBM IMS, CPP, CPP Investment, Sales Strategy, Sales Force Management, Personal Finance, Benefits, Payroll Solutions, Sales

You have likely never heard of IMS Health, but they’re a big deal in the current IT environment of American medicine.

IMS buys prescription records in bulk from big pharmacies, strips out the patient names but identifies the doctors, then tells drug companies of the doctors’ prescribing habits. This lets the drug companies target their sales efforts.

The picture at the right, taken from IMS’ current home page, illustrates the firm’s view of it. The little blue ball represents sales, and the nice lady has IMS knowledge to shoot it accurately.

Critics have their own view. New Hampshire sought successfully to stop IMS data collection in court, and the American Medical Association (AMA) runs a program through which doctors can opt-out.

Regardless of your view, it’s a data processing company that makes money. IMS earned $311 million on sales of $2.3 billion last year. This made it attractive, and a leveraged buy-out of the company was announced yesterday.

Which is where the Canadians come into the story. The main player here is TPG Capital, run by the renowned financier David Bonderman, but his partner in this deal is the CPP Investment Board.

CPP is the investment arm of the Canada Pension Plan, which you might compare with a privately-run Social Security system. CPP Investment seeks a return on the pension contributions of Canadians. The CPP collects the fees and pays the pensions.

Out of the CPP’s $116.6 billion in assets, private investments like this represent “just” $18.4 billion. But that’s enough money, and the law offers CPP Investment enough leeway, for it to get into some very interesting deals.

Like this one.

All of which means that Canadian pensions may be riding on the success of an American company performing computing feats that would be incomprehensible in their own country, which is a single-payer system run through the nation’s provinces.

November 3rd, 2009

Kidneys do not like those chip and diet soda lunches

Posted by Dana Blankenhorn @ 7:11 am

Categories: Consumer Information, General, Research, Wellness

Tags: Correlation, Soda, Chip, Games, Corporate Communications, Semiconductors, Network Technology, Personal Technology, Marketing, Hardware

It’s hard to eat at your desk.

Chained to your computer by a job that must be done, the traditional snack of the programmer is some chips and a diet soda. It gets you through the day.

It may not get you through the night, however, and may hasten that long, long night to come.

Yes, we’re talking about your kidneys.

Julie Lin (right) of Brigham and Women’s in Boston looked at data in the famous Nurses Health Study, going through 3,000 records, collected over time, for evidence on kidney health, matching that data to the consumption of sodas and sodium.

Linn and Gary Curhan published two separate studies, one of which found a correlation between high sodium intake and kidney function decline (that’s the chips), the other of which found a correlation between artificial sweetener intake and kidney function loss (that’s the diet soda.)

There was no such correlation between regular sugar and kidney function (although there was a separate study from Colorado linking fructose and hypertension — modern American sodas are sweetened with high fructose corn syrup).

All this was offered at the annual Renal Week event in San Diego, run by the American Society of Nephrology.

There is a difference between the correlation found here and the headline “diet soda drinkers suffer kidney problems.” A correlation is not a certainty. And all they were studying were aging nurses. They weren’t studying male computer programmers who like Sarah Palin, or young video game players — it’s not a general population study.

But Lin and Curhan did account for extraneous factors within the study, like age, smoking, obesity, and heart disease, before coming to their conclusion.

I’d say take it with a grain of salt, but that might be bad for you.

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 28th, 2009

Insurer research arm pushes comparative effectiveness

Posted by Dana Blankenhorn @ 6:03 am

Categories: Finance, General, Government, Insurance IT, Research, U.S.

Tags: Health Care, Lewin Group, Vertical Industries, Benefits, Healthcare, Insurance, Human Resources, Business Operations, Corporate Insurance, Dana Blankenhorn

The Lewin Group, the research arm of UnitedHealthcare, is pushing for greater use of comparative effectiveness in personalized healthcare,  programs tied to patients’ genetic makeup.

Attacking comparative effectiveness as “getting between you and your doctor” was a big feature of the political attack on health care reform this spring and summer, where it was called “rationing.”

But this was never the view of the insurance industry, which will control the health care market in the absence of regulation. Lewin maintains its own site on comparative effectiveness research, and delivered its latest report at a conference hosted by the drug industry.

In an online summit on comparative effectiveness hosted by The National Journal last spring, Lewin Group actuary John Sheils noted that guidelines produced by the research are adhered to barely half the time, suggesting that they be enforced with higher patient co-pays or government refusal to pay for care outside the guidelines.

These are precisely the actions anti-reform activists focused on in their attack on reform.

It’s certainly not necessary for people on the same side of the issue to have different views. But the views that will control in this case are those of The Lewin Group. Failure to pass health reform will have no impact on the move toward rationing care based on guidelines or using your genetic code to decide what is to be done with you.

If you want to fight that, take your tea party to UnitedHealth Group. Need someone to draw you a map?

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?