By Archelle Georgiou. “Dr G. Any ideas on the best way to lose weight?” “What do you think about (name the supplement) for losing weight?”

Diet and nutrition questions are some of the most common that I get on Fox. My response always begins with the calorie speech—”In order to lose weight, calories consumed must be less than calories expended.” I consistently take a hard stance on the physics of weight loss which makes some people bristle, especially those who believe that their weight issues are hormonal, genetic, or “their metabolism.” I emphasized this very black and white perspective in my February blog, Weight Loss 101: Count Your Calories, where I explained, mathematically, how my own 2-1/2 pound weight loss was fully explained by the energy expenditure of some increased physical activity.

After 7 months, I’ve lost a total of 7 pounds and the thermogenic reality is a 24,500 calorie deficit. The bigger achievement, however, is the insight into my personal relationship with food.

Hunger does not necessarily mean that my body needs to eat. Emotional-eating has been a way of life for me. I just accepted this behavior as one of my (many) flaws until I learned about the physiologic effects of two hormones that have a powerful influence on the urge to eat—or not. Ghrelin is produced mainly by the stomach and pancreas. Levels are normally high before meals and make us feel hungry. Leptin, its counterpart, is produced by fat cells and causes feelings of satiety and reduces sugar cravings. When leptin levels increase after meals, the brain signals us to stop eating. Here’s the problem: These appetite-controlling hormones are not simply regulated by the body’s nutritional status. Ghrelin (or should I say, gremlin!) levels increase with sleep deprivation. (Maybe this is why I was at my heaviest during my residency?) And, leptin levels, or the body’s sensitivity to it, may diminish in the presence of emotional stress. Just educating myself was enough to give me the willpower to—PAUSE–before reaching for an extra helping or sneaking a second dessert. If I can objectively convince myself that I am calorie-deficient…fine. Open mouth, insert food. However, if I am tired, frustrated, angry or brewing with Greek emotional drama, then instead of using food as a Band-Aid, I try to address the root cause by sleeping, meditating, taking a walk, ….whatever it takes. (more…)

With Disruptive Women in Health Care Real Women on Health! Reveals Power of Patient Advocacy

Real Women on Health!, the multi-channel platform and online community for women, reveals the power of patient advocacy with a leading healthcare blog community, Disruptive Women in Health Care. The two online media forces have invited key influencers from the Health 2.0 movement for a three-part call-in, live on-line radio series starting in August.

The Real Women on Health! online radio show will allow experts to share their ideas on how to use technology to promote collaboration between patients, their caregivers and medical professionals. The shows will feature Indu Subaiya, co-founder of Health 2.0, Jane Sarasohn-Kahn, health economist, principal of THINK-Health, Trisha Torrey, Guide to Patent Empowerment, Regina Holliday, medical advocate and muralist and several others. “We’re excited to bring together these women innovators to share their visions of Health 2.0 and what it means for healthcare’s stakeholders – which should be every one of us,” says Robin Strongin, founder of Disruptive Women in Health Care and President and CEO, Amplify Public Affairs.

Innovative companies and entrepreneurs in Health 2.0 are developing the most effective tools and approaches to healthcare in this new century, and are looking for new ideas from all sources. “We know how important collaboration and communications are to transforming healthcare today”, says Kelley Connors, founder of Real Women on Health! and President of KC Healthcare Communications LLC. “Listeners who call in will have the chance ask questions, and share their ideas as well – it’s all about sparking a dialogue on patient advocacy,” she added.

Topics and guests include:

Tuesday, August 3rd 12:00pm – 1:00pm EST: Topic: How ‘Health 2.0’ is Evolving and Why You Should Care.” Featured guests, Indu Subaiya, co-founder of Health 2.0, a leading showcase where healthcare transformers share news and ideas around technology and patient communities, and Jane Sarasohn-Kahn, health economist, principal of THINK-Health and founder of one of the most influential blogs in healthcare, Health Populi.

Thursday, August 5th 12:00pm – 1:00pm EST: Topic: “Patient Empowerment: How to be Your Own Best Advocate.” Featured guests, Trisha Torrey, Guide to Patent Empowerment, About.com and quoted in this month’s “O” Magazine, and Regina Holliday, medical advocate and muralist, painter of “73 cents,” a depiction of challenges she faced to acquire her late husband’s medical records as he struggled with cancer (“73 Cents” also cover of British Medical Journal 9/09).

Later in the month, the show will also explore how healthcare professionals are using social media to enhance communications with patients.

There are two ways to listen and/or participate in what will be fascinating conversations — listen online at www.blogtalkradio.com/realwomenonhealth or call toll-free (646) 929-2625.

For more information on this series or how to sponsor shows, please contact Cassie Holm, cassie@realwomenonhealth.com or call 201-417-1309.

By Diana Long.  At the end of May I participated in Disruptive Women’s  Breakfast Series, Childhood Obesity:  A Big Fat National Challenge.  We were supporting the First Lady’s Let’s Move campaign. 

Don Mathis, a fellow panel member, and CEO Community Action Partnership provided an interesting perspective.  “We’ve watched the obesity numbers for adults more than double over the last three decades.  Why didn’t we realize that it was just a matter of time before we saw the same trend in our children?”  Childhood obesity has tripled over the last 30 years and now stands at 17% of children and adolescents (ages 2-19); the percentage of overweight children is at, or above, 30 percent in 30 states.  Obese children and adolescents are more likely to suffer from high blood pressure, cholesterol, Type 2 diabetes and are more likely to have learning problems.

At the end of last month the CDC released a new report on adult obesity.  The news is “America’s waistline is still growing, or holding steady in some states, but not shrinking at all.”  In other words, we’re still fat.  Thirty-four percent (34%) of us are overweight and another 31% are obese.  If you’re wondering if this includes you, according to the National Institutes of Health “anyone with a body mass index (a ratio between your height and weight) of 25 or above – that’s someone, for example, who is 5-foot-4 and 145 pounds — is considered overweight.  Anyone with a body mass index of 30 or above — such as someone who is 5-foot-6 and 186 pounds — is considered obese.”  You can check out your own BMI using the quick calculators on the CDC or WebMD websites. 

So who’s the fattest?  The CDC Report states “In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women”.  Some good news, however, “The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.”  A 2009 analysis commissioned by Trust for America’s Health and the Robert Wood Johnson Foundation found that “the Baby Boomer generation has a higher rate of obesity compared with previous generations.  As the Baby Boomer generation ages, obesity-related costs to Medicare and Medicaid are likely to grow significantly because of the large number of people in this population and its high rate of obesity.  And, as Baby Boomers become Medicare-eligible, the percentage of obese adults age 65 and older could increase significantly.”

In her June 6, 2010 DW blog Fox TV’s Dr. Archelle Georgiou shared questions from her viewing audience that were especially interesting to her.  Charles, a 5’8” gentleman weighing in at 215 lbs., wrote in for help with his weight problem.  When he received Dr. Georgious’ advice, however, he seemingly took offense (or had a good sense of humor) and asked “So what you’re saying is I’m fat?”  “Yup!”, she replied, then editorialized “I’m amazed at how often people convince themselves that the BMI definitions of overweight and obesity don’t apply to them.” (more…)

By Michelle King Robson. People, especially women, always ask me how they can make a difference. How can one person make a difference in the lives of many? How can we advocate for the health and wellness of all women?

When I started EmpowHER, I had a mission – to improve women’s health, and change their lives…one woman at a time.  Now, I am asking YOU to do the same. You alone can help thousands even hundreds of thousands of women just by telling your story, sharing the stories of others, and telling other women about what is sure to be one of the most powerful movements in women’s health and wellness this decade. 

I want to tell all of you about EmpowHER’s 1,000 Women campaign: www.1000women.com.

Through our 1000Women campaign, EmpowHER is recruiting 1,000 women who will then each tell 1,000 women about this campaign. Our goal is to  create the biggest movement for women’s health and wellness in recent history!!!!

So how can you help?

• Advocate for your own health and wellness by sharing your personal health story on 1000Women.com
• Advocate for the health and wellness of others by voting on inspiring stories on 1000Women.com
• Spread the word by simply entering your email address for campaign updates, and sharing this campaign with every woman you know!

When we have reached our goal of reaching 1,000,000 women, EmpowHER will donate $50,000 towards women’s health research, and YOU will have had everything to do with that! See, just a few seconds of your time, your email address and 1,000,000 women’s health can be improved and lives changed – just like that.

Every woman who recruits 1,000 women or more to vote on their story will receive a special presence on 1000Women.com. They will also be featured in major local and national PR efforts, which will help spread the word on health advocacy for you, and each other.

This is your chance to share your story with the world. This is your chance to change the lives of the women you love. This is your chance to enable friends, family and strangers to advocate for their health and well being. I am calling on you to get involved. We NEED your help!

By Pamela Cipriano. On July 13, 2010, the clock started running for eligible providers, hospitals, and critical access hospitals, to become meaningful users of certified electronic health records (EHR). Under the direction of the Secretary of Health and Human Services, the Centers for Medicare and Medicaid, together with the Office of the National Coordinator for Health Information Technology (ONC) released the final rules that lay out the first two years of requirements for eligible professionals to qualify for incentive payments included in provisions of the American Recovery and Reinvestment Act of 2009 through the HITECH act (Health Information Technology for Economic and Clinical Health).  View the press conference led by Secretary Sebelius.   (Disruptive Woman Regina Holliday, spoke at the press conference)

Seven months and 2000+ professional and public comments later, the final rules lay out a three phase graduated approach of requirements for demonstrating meaningful use of certified EHRs.  Since not one stakeholder group is wholly enamored with the rules, they are more than likely equitable and balanced.  Listening to the feedback, the ONC made a number of changes from the proposed to the final rules, taking into account concerns about the speed and scope of implementation of criteria to qualify as a meaningful user.  Groups across the industry gave faint praise as they acknowledged the greater flexibility in the final rules and an easing of some of the requirements.  The phased approach lays out the goal for Stage 1 as capture of data in coded format, Stage 2 exchange of information with emphasis on guiding and supporting care processes and coordination, and Stage 3 improving outcomes by focusing on decision support with improved access to comprehensive patient data.

With quality at stake, the meaningful use incentives tie payments to achieving advances in health care processes and outcomes.  The payments are intended to help accelerate use of HIT. Fortunately there is already broad agreement that populating data into EHRs, using electronic prescribing, reviewing and sharing data across providers and settings, and reporting on quality measures has a positive effect on care.  Dr. Don Berwick, newly appointed Administrator of the Centers for Medicare and Medicaid, emphasized that the new rules define the use of EHRs that is “meaningful to care and to people,” emphasizing the direct improvement in patient safety, transparency, and access to data resulting in better, safer, and more reliable care for everyone.  Certified EHRs help providers know more about their patients, make better informed decisions, and reduce costs of care.  Electronic systems can reduce potential for errors, and enable consumers to work with their providers to coordinate and manage their care.     (more…)

By Robin Strongin. Please join me in welcoming a stellar group of women to our roster:

	Jane Sarasohn-Kahn, a health economist and management consultant who has worked with health care stakeholders in the U.S. and Europe for over two decades.
	Marcia Nusgart, a pharmacist with a deep expertise in reimbursement and coding.
	Michelle King Robson, a nationally-recognized women’s health advocate and founder, chairperson and CEO of EmpowHER, a health media company for women.
	Regina Holliday, a DC-based patient rights arts advocate, whose work became part of the recent health reform debate.
	Sally White, the executive director of Iona Senior Services in Washington DC
	Trisha Torrey, known as Every Patient’s Advocate, is a newspaper columnist, radio talk show host, About.com’s expert in patient empowerment, and a national speaker who teaches patients how to navigate the unwieldy and dysfunctional health care system.

Please read through their bios and prepare to be amazed.

By Robin Strongin. It didn’t receive much attention in the context of oil wells being capped and financial services legislation being passed, but the Federal Communications Commission (FCC) took a step last week that could make a profound difference for Americans who live in rural parts of the country.

The FCC voted unanimously to have the federal government pay a greater share of broadband Internet costs for rural health care providers, and the commission also expressed its intent to subsidize the construction of broadband networks.

Why is this important?  Over the past 25 years, according to the Center for Health Transformation, over 500 rural hospitals have shuttered their facilities.  And, while 25 percent of the U.S. population lives in rural areas, only about one in ten doctors base their practices in sparsely populated areas, creating a serious physician shortage.  For many, it’s an economic hardship to drive a few hundred miles to see a specialist.  Broadband access can bridge those distances and help physicians and rural patients share vital information.

The FCC has a $400 million annual spending cap for rural health care telecommunications programs, but it wasn’t spending all of that money.  So, now it will pay 50 percent of monthly broadband charges for eligible health providers, instead of 25 percent.

It’s not a lot of dollars in the grand scheme of federal outlays, but if it can help bring quality health care closer to those living in America’s wide open spaces, it’s one of our nation’s better investments.

By Stephanie Mensh. During the next week or so, various Federal, state, and local government agencies as well as consumer organizations will be celebrating the 20^th anniversary of the landmark legislation, the Americans with Disabilities Act (ADA), signed into law on July 26, 1990. 

My husband suffered a stroke that resulted in speech and mobility impairments around the time that the ADA became law.  The ADA continues to help my husband and family by increasing awareness and accessibility for people with disabilities to fully participate in our community, to go to school, work, shop, movie theaters, restaurants, and hotels, to use public transportation, to access hospitals and health care, and to have a place to call “home.”

The ADA rights also extend to caregivers of people with disabilities.  Balancing the demands of a full-time job and taking care of a family member with a disability or chronic illness can be difficult, even with the most understanding employer. Under ADA caregivers, male or female, are protected from job discrimination resulting from real or perceived family commitments. (more…)

By Robin Strongin. When the Obama Administration announced the new regulations expanding preventive care, ensuring that essential screenings and tests would be covered without co-pays for deductibles, my first thought was that this may be one of the most important provisions of health reform in terms of improving the overall health and well-being of the American people.

My second thought concerned forests, falling trees and sounds we may or may not hear.

The history of health care in the United States is, in large part, defined by sound policies and vital programs that are not accompanied by effective outreach to  the patients and consumers who have the most to gain from these innovations.  Thus, new provisions expanding preventive coverage have the potential to be like the proverbial tree falling in an empty forest.  If we don’t do a good job letting people know these services are more accessible, will they take advantage of them?

I think of the millions of people who are eligible for Medicaid or for Children’s Health Insurance Programs who aren’t enrolled.

I think of the widespread confusion that existed in the early days of the Medicare Part D prescription drug program until several organizations stepped in to conduct coast-to-coast information sessions with seniors.

And I think of the story that just appeared in the New York Times (http://www.nytimes.com/2010/07/15/health/15chen.html?_r=2&ref=health&pagewanted=print) regarding the growth in usage of the “medical home” model for health care.  (I prefer the term health home, but that’s for another post.) As Dr. Pauine Chen pointed out in the Times, empirical evidence is showing that the medical/health home – shorthand for greater care coordination between the patient’s primary care physician, specialists and other health care professionals – is working.  A demonstration project sponsored by the American Academy of Family Physicians showed that the new model was improving quality of care, efficiency of operations and physicians’ job satisfaction.

But patients hated it, because no one bothered explaining to them why their one-on-one relationship with their health provider was being replaced by a one-in-three or one-in-four relationship with multiple providers, even if it resulted in better care.

And, thus, does this new innovation in health care delivery fall within the proud history of U.S. health care in which great ideas are not linked with communication to the patient.

As health reform is implemented, both the public and private sectors need to do better, beginning with outreach to let people know about the new preventive care coverage and, more importantly, to ensure that Medicaid expansion and the new subsidies to help make private health insurance more affordable affect the people for whom they are intended.

By Glenna Crooks. On Sunday July 4, HealthDay News reported on a June 30 Environmental Health Perspectives item that the health benefits of cycling in an urban environment outweigh the risks. Huh? I asked myself.

I live in Center City Philadelphia and far too many cyclists – I’ll go out on a limb and say a majority – are a menace. They ride on pedestrian walkways, sometimes IPod hearing-impaired, weaving through pedestrians. They ride on the wrong side of the roads, the wrong way down one-way streets and weave between traffic lanes. They do not stop for red lights. In fact, some bikes don’t have brakes.

I’ve been nearly hit twice by cyclists running red lights, coming from between trucks and therefore not visible to a pedestrian until they appear suddenly, inches away. And, at 6:10 AM several months ago, while taking a work-out jog on a paved path along the Schuylkill River with my trainer Morris (March Man of the Month), was rammed from behind by a cyclist. Though it was clearly past dawn, he did not see me, perhaps because his head was down to lower the drag created by an upright body, going fast on a path that is frequented by walkers of all ages.

The accident has cost me nearly $500 a month in out-of-pocket expenses since, to address the back pain it caused. I’m lucky, though. Around that same time two pedestrians were killed in my neighborhood by cyclists.

I had visions – no, nightmares – of public policymakers seeing this report and encouraging more cycling in the US. Who on earth would believe that cycling was safe, I wondered? How could I change their minds? I had to read beyond the first sentence to understand. (more…)

By Robin Strongin. Republicans on Capitol Hill are still steaming over President Obama’s decision to install Dr. Donald Berwick as administrator of the Centers for Medicare and Medicaid Services via a recess appointment (http://www.politico.com/news/stories/0710/39759.html), bypassing the normal confirmation process which would have included a hearing before the Senate Finance Committee.

Now, GOP members of the Finance Committee are insisting, in a letter to committee chairman Max Baucus (D-MT), that a hearing should take place anyway.  In their letter, they argue that the lack of such a forum “casts a shadow over (Berwick’s) legitimacy and authority to serve as administrator during a critical time for CMS.”

That rhetoric may be overhyped.  After all, Berwick is hardly the first nominee, Democratic or Republican, to take office by virtue of a recess appointment.

Nonetheless, there is a legitimate point here that a hearing needs to take place.  But, while Senate Republicans want to grill Berwick on his now-infamous speech that some interpret as extolling the virtues of Britain’s National Health Service, I believe there is a far more compelling reason for him to face congressional inquisitors.

By 2014, approximately 30 million now-uninsured Americans are going to be joining the ranks of those with health coverage and, in so doing, significantly increasing the utilization of health services.  As many analysts have pointed out, if this utilization escalation happens within our current health care system, it’s reasonable to expect health costs to shoot skyward without a commensurate increase in quality and cost-effectiveness. (more…)

By Mary Grealy.  An organization of health industry chief executives today applauded federal regulators for being responsive to the concerns of hospitals and physicians in constructing the final “meaningful use” regulations that will determine the allocation of health information technology (HIT) incentive funds.  But, said the president of the Healthcare Leadership Council (HLC), the newly-released rules leave some critical issues still unaddressed.

HLC president Mary R. Grealy said that, even though her organization was still analyzing the regulations, “it’s clear that federal regulators paid close attention to the more than 2,000 comments they received on the proposed rule, and that they have been responsive to concerns that the initial regulations placed the “meaningful use” bar so unrealistically high that the health technology revolution would have been slowed instead of accelerated.”

The “meaningful use” regulations establish standards that health providers must meet in order to qualify for a share of the more than $27 billion authorized by Congress in last year’s economic stimulus legislation.

The Healthcare Leadership Council is a coalition of chief executives from all sectors of American healthcare.

Ms. Grealy said, “An example of this responsiveness is seen in the fact that the rules no longer require that, in the initial stage of implementation, all of a health provider’s administrative transactions must be included in an electronic health record.  That simply wasn’t realistic.  Those requirements are now in Phase 2 of implementation, which is achievable.”

She said, though, that legitimate concerns remain.  For example, the regulations should consider each campus of a multi-campus hospital system as a separate entity in qualifying for HIT incentive payments.  And, she said, health providers who have built and succeeded with their own information technology systems should be grandfathered into the universe of successful “meaningful use” qualifiers, but that doesn’t appear to be the case based on an initial review of the rules released today.

Nonetheless, Ms. Grealy said, “we’re seeing important progress with these regulations.  Clearly, the administration saw there was a gap between the theoretical standards they initially wanted to apply and the real-world challenges that physicians and hospitals face in achieving HIT advancement.   We all want the benefits that come from information technology – enhanced patient safety, more cost-efficient operations, greater use of evidence-based medicine – but to make strides forward, regulators and providers need to be moving at a coordinated pace.”

Orignially posted on Prognosis: A Healthcare Blog on July 13th

By Santi Bhagat, MD.  It seems that children with chronic medical conditions and disabilities (CMCD) just disappear into thin air when they grow up.  No-one tracks these young people, so we have no idea what happens to them.  We don’t know if they have insurance and doctors; are sick and in emergency rooms; go to school and have jobs; and/or live independently and have social lives. It is estimated that 600,000 young people with CMCD enter adulthood every year, into a system devoid of any supports and services, a system that is completely unprepared for them.  

To help improve things for children with CMCD as they transition into young adults , Physician-Parent Caregivers (PPC), is launching EMERGE–a new campaign  next week…stay tuned…I will be blogging more about that in the coming weeks.  

In the meantime, I would like to introduce a special PPC young adult leader, Amy Long.  Amy is one of America’s 8.2 million amazing young adults with CMCD who push through barrier after barrier and never give up on their dreams.  Amy gave me permission to share her first person account of what it is like to be a young adult with a chronic medical condition.  She calls it, the Google Circus.

GOOGLE Circus

Five years ago, I aged out of my pediatric skeletal dysplasia clinic (a place for kids with bone diseases).   I will never forget my first two adult medicine experiences….The first happened late one Fall evening. 

I was in college dorm my senior year and I woke up  from a late afternoon nap with a terrible headache, flashes of light and floating dots in my vision. I have a rare connective tissue disorder and form of arthritis called Kniest Syndrome that puts me at risk for a detached retina.  The flashes of light and floaters are common symptoms of retina disease.  Retina detachment is only fixable in the first 24 hours. I immediately called Student Health who told me they could get me into see an eye doctor next week.  I tried to explain that I couldn’t wait that long but no one seemed to take me seriously. All the doctors had left for the day. I called a friend and we drove the Emergency department.

We arrive. I spell Kniest no less than 3 times for the tirage nurses. They lead me back to the eye exam room and leave the door open with my chart hanging there. The doctor grabs my chart, starts to come in, looks at my file. His eyes widen and he backs out of the room. Through the open door I watch him try to Google Kiiest Syndrome.  He flips through the links and then finally after five minutes comes back in and sheepishly asks me, “So what exactly is going on?” I tell him, yeah I have a migraine-like headache, and I am seeing stars. I have a collagen disorder that causes high myopia and thus very fragile retinas. “Yes, yes, how exactly do you spell your condition?” I spell Kniest 2 more times.  I then watch him turn around and type Kniest Syndrome into Google. (more…)

Disruptive Woman Regina Holliday’s testimony at the release of the final rules on meaningful use on Tuesday.

Straight from AHRQ….

This week HHS announced final rules to help improve Americans’ health, increase safety and reduce health care costs through expanded use of electronic health records (EHR).  The announcement marks the completion of multiple steps laying the groundwork for the incentive payments program.  One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology. Select to access the announcement.