By Archelle Georgiou. A report of child abuse is made every ten seconds and three million cases involving almost 5.5 million children are reported each year.   This tragedy occurs at every socioeconomic level, across ethnic and cultural lines, within all religions and at all levels of education.

This issue has never impacted me, my family or anyone close to me, but since childhood, I have been passionate about protecting children from abuse.  As early as age ten,  I was in Rock Creek Park (in Washington, DC) on a picnic with my family when I saw a mother whipping her young children with a tree branch.  I marched up to her and demanded that she stop.  As recently as a month ago, while patiently waiting for a table at IHOP,  I noticed a mom yanking so hard on her toddler’s arm that she was pulling her up from the floor.  “Um…excuse me,” I said calmly as I kept texting on my phone, “but if you keep doing that you might dislocate her shoulder.”  She stopped yanking then and angrily tried to defend herself.  I stayed within her striking striking distance and secretly hoped that she’d hit me so that I could call the police…and protect an innocent 2 year old.  (more…)

By Archelle Georgiou.

“So, how was China?”

We recently returned from China and Vietnam and have been asked this question many times by curious friends, family, and colleagues.  Recognizing that we live in a world of soundbites and that no one really wants to hear every detail about our fourteen day trip, I’ve responded by focusing on the experiences and observations that had a lasting impact on how I think.  There were three: one is personal, one is political, and one is professional.

Personal: While “Made in China” is present on everything from chatchkas to clothing labels to housewares, and although China’s thriving economy is a frequent topic in the business world…I simply wasn’t expecting to see their ultra-modern infrastructure.  I went to China with a visual image that was pre-Mao.  Shame on me.  Instead, I saw 14 story shopping malls, a Shanghai skyline best described as “New York on steroids,” an efficient and clean subway system, and construction cranes on every square block. While analysts predict an economic and building bubble that will deflate soon…there is national confidence that China’s  5 Year Plan (for 2011-2015) will address these risks.  Take a look at the well-defined, measurable goals regarding their economic targets, innovation, the environment, people’s livelihood, social management, and reform.  The Plan is translated into action down to the individual citizen level to assure that they achieve their goals.  We may not agree with socialist/communist ideals, but step back for a moment and imagine how much progress the US would make if we had a unified plan regarding our nation’s advancement.

How was China? A strong world power.   Never again will I refer to China as an “emerging economy.” They have emerged, and there are a few things that the US can learn from them. (more…)

By Archelle Georgiou. The use of Avastin for breast cancer was addressed by the U.S. Food and Drug Administration this week. The outcome was devastating for Roche and an emotional one for many women who believe the FDA is subjecting them to a death sentence.  As usual, there are a variety of perspectives to take into consideration.

The history: In 2008, Avastin was given preliminary approval by the FDA for the treatment of breast cancer on the condition that the company would do more studies to demonstrate its effectiveness. Many women have been successfully treated with Avastin — a billion dollar drug for Roche.

But when Roche submitted the required follow-up studies in 2010, the data showed that there was no benefit from the drug for treating breast cancer.  Studies did not show significant impact on mortality or  improvement in quality of life.  In addition, the drug was associated with some significant side effects such as high blood pressure and blood clots.

In December, 2010, an FDA panel voted to withdraw the drug’s approval as a treatment for breast cancer.  Roche appealed the decision, and earlier this week, an FDA panel hearing the appeal unanimously decided, in a 6-0 vote, to withdraw the drug’s indication for breast cancer.  The final decision on whether or not Avastin loses the indication is ultimately up to the FDA Commissioner, Dr. Margaret Hamburg.

If Hamburg supports of the panel’s recommendation is critical. At the same time, this will fuel even more emotion and protests among patients. Here’s why:

• From the FDA’s side: The FDA issued a provisional approval with the explicit understanding that the final decision would be based on more conclusive studies. If the FDA maintains the drug’s approval despite the lack of scientific data, this would likely impact all of their future decisions to offer provisional approvals for potentially life-saving drugs.
• From the patients’ side: Women who have benefited from the medication have clearly voiced their opinion that the doctors and patients, not regulators, should decide whether or not to get potentially life-saving treatment.

An important fact to keep in mind is that Avastin will remain on the market because it is FDA-approved for certain types of lung, colon, kidney and brain cancers. Therefore, Avastin will still be available “off label” for treating breast cancer when patients and their doctors believe that it is the best option.  In those situations, the only real challenge will be a barrier to access is a financial one since expensive drugs used “off-label” are frequently not a covered benefit and very few women can afford to $80,000 per year out of pocket for Avastin. (more…)

By Archelle Georgiou. There have been several blogs and articles written on the grammatical appropriateness of “health care” versus “healthcare.”  In Michael Millenson’s post on The Health Care Blog, he explains that the Associated Press (AP), which dictates journalistic style standards, says the correct usage is “health care.” Two words. Most major journals, newspapers, and media sites follow this convention, but it may not be the end of the debate.

There is an equally accepted convention that says that “health care” is correct when there is reference to a provider’s action, and “healthcare” is used when it is an adjective to modify another noun or verb—healthcare system or healthcare marketing—for example. And, there are many sites that shift, very consistently, between these two approaches depending on the sentence structure.  

I can live with 2 different literary conventions … but here is what is keeping me up at night and: literary styles change. 

“Airline” used to be “air line” and “website” was formerly “web site.” Similarly, there is pervasive evidence that the “health care” is turning into “healthcare.” In my own cursory review of sites that I respect–WebMD.com, Kaiser Family Foundation, the Institute of Medicine, I found that “health care” and “healthcare” are used interchangeably without grammatical rhyme or reason.

So, why do I care? And, why should you care that the adjective, “healthcare,” is well on its way to becoming a noun or a verb? In fashion, style changes drive revenue. On Twitter, eliminating the space creates capacity for one more character. However, in health care, eliminating the space and turning two words into one, will have a negative impact on people, their well-being, and thereby, worsen an already deteriorating system.

Take a moment to do an experiment:

1)    Write the following sentence on a piece of paper: Healthcare is important.

2)    Show the paper to a few different people, and ask them to explain what the sentence is referring to when it says “healthcare.” Listen for the meaning they ascribe to the word “healthcare.” What is the first thing they say? Most likely, they refer to insurance, access, costs, and/or health reform.  Do any even refer to the quality of care that they receive from doctors or other care providers? Do they refer to the importance of their own lifestyle behaviors? Probably not. In my experiment en route from Minneapolis to San Diego yesterday, with an n=5, only XX said anything about care, and only as an after thought.  (more…)

This post was co-authored by Disruptive Woman Archelle Georgiou and Emma Dougherty, Senior Analyst at TripleTree and originally published on the firms blog site, Uncommon Clarity. It was also posted on Archelle on Health.

9 million. That’s how many web hits are returned during a Google search for “Accountable Care Organization,” and reflects the countless articles, white papers and opinions that have been published regarding the potential successes and more likely pitfalls of the proposed ACO mandate. As highlighted in TripleTree’s recent post, our team is continuously evaluating the business development opportunities being fueled by the demands and requirements of these new provider organizations.  Last week, the members of our Healthcare Executive Roundtable recently discussed and debated an element of the ACO equation that is not typically highlighted but is clearly a critical component of ACO success (or failure)…Trust.

In boardrooms around the country, health care executives are focusing on the technical requirements for their future ACO’s clinical and administrative systems. They are pouring over spreadsheets and attempting to understand the data and analytical tools that will be necessary for adequate financial and quality of care reporting. Getting these operational elements “right” is important; however, these business leaders should also focus on designing a culture – and the corresponding behaviors, communication, and incentives that will fuel strong and collaborative relationships between the ACO and its community of providers.

As Ed Brown, CEO of Iowa Clinic puts it, “People are unclear about what the value-based world looks like, and they’re unsettled on what clini­cal integration really means. And nobody has really made it work.”  This lack of clarity around the value-based model will make it challenging for providers to leave the financial security blanket of the traditional fee-for-service payment engine.  Moreover, influencing them to modify their approach to patient care for the benefit of the system and the promise of shared savings is a monumental effort. Success by any measure will largely depend on the trust established between providers and the ACO organization itself. ACO’s should prioritize establishing trust with providers in three key areas:

• ACO Operations and Management:  Providers need to trust that the ACO is well run. Understanding the organizational governance, expertise of the management team and core capabilities (strategic assets) will help generate confidence that the ACO is well-positioned to generate enough shared savings to make participation worthwhile. In addition, it is critical that the ACO measure and report management performance metrics that demonstrate its accountability to the providers. (more…)

McGuire: The Land Grab is Misguided

By Archelle Georgiou. The former chairman and CEO of United Health Group Dr. Bill McGuire recently discussed the opportunity for wireless health (or technology enabled healthcare or whatever you want to call it), wasteful spending on EMRs, the need for interactivity among healthcare technology applications, opera, education and much much more. Dr. McGuire is the Vice Chairman of TripleTree Holding Company and is delivering one of the keynotes at the upcoming Wireless-Life Sciences Alliance Convergence Summit in San Diego next month. TripleTree is an investment bank and one of the founding members of the WLSA and the summit.

Read on for an edited version of our recent conversation with Dr. Bill McGuire.

How do you characterize the opportunity for wireless health? Could you also provide us with some sense of the current investment climate — a lot of activity? A lot of interest but not a lot of activity?\

I like to position it as: How can we build products, services, and systems that facilitate the eventual appropriate health and wellbeing for the people in this country and elsewhere. In pursuit of that and in consideration of all that has been done — both good and bad — and all that is yet to be done, which is significant and formidable, I think the whole area of technology enabled healthcare or mHealth or any term you’d like to apply, offers significant opportunity to meet that end. It still remains to be seen obviously what the most appropriate areas and most beneficial areas will be to accomplishing that. When it comes to investments, of course, there will be a lot of investments in things that don’t make any difference or are not contributory to the kind of outcomes I am describing.

What kind of things?

If you look at what has happened in last several years particularly with reform: These huge expenditures that have been directed at technology applications in healthcare. I’m afraid we will see that we have spent an enormous amount of money for marginal or no gain. It’s very indiscriminate. That’s classic healthcare, though and classic investing: ‘Let’s just throw money at things.’

You have the whole idea of applications on cell phones for example. Embedded among [the thousands] of health apps out there are probably a few that will make a difference in the lives of some people. Those apps should theoretically lower costs and improve outcomes, but most of these apps exist because we happen to like apps, it’s a nice story, so we chase them. Discerning what is ultimately going to make a difference and result in the kind of outcomes we are looking for, which is differentiated from just investing money, is the critical issue. The smart investors, smart developers, smart policy makers and so on will benefit from that. The land grab that is going on right now — just throwing money at it — is a little bit misguided.

Another issue is the lack of interactivity among these technology applications. The fragmentation and silos continue. Rather than determining how to piece a number of necessary components together, we have a lot of independent efforts out there to chase after something. We ask for electronic medical records (EMRs) but we don’t necessarily put out standards of performance and interactivity between them. So when someone comes along and asks to gather data or information we know that we can’t get it from each and everyone of them. (more…)

By Archelle Georgiou. At 9:55 am on a Wednesday morning. I was 15 miles from home and making good time getting to my 10:30 meeting until I realized that I’d left the power cord for my Mac computer at home. There was no way I’d have enough battery power to get through my presentation. So, I had a choice: turn around, go home and be late or run by the mall and buy a new power cord at the Apple store.  Since the mall was only ¼ mile away, I could arrive just as the store opened and likely be the first customer. The decision was easy.

As expected, the parking lot had a scant number of cars and I got a plum spot by the entrance. Racing past several stores en route to my destination, I noticed employees in the sporting goods store dribbling basketballs waiting for their first customers. Gap associates were folding and re-folding jeans while Sephora employees were sampling products and primping in the mirror. The mall was empty.

And, then I got to the Apple store…it was packed. No, this wasn’t the day the iPad2 was being released although the store had already received 200 calls since 8 am from people wanting to know if it was available. What were all those people doing there? Buying Apple products; playing with Apple products, taking classes on how to use Apple products, and getting expert help from the Apple whiz kids at the Genius Bar.

After witnessing this scene, it was no surprise that Apple was in the #1 spot on Fortune’s List of Most Admired Companies in America—again–for the 4^th year in a row. Apple’s wildly successful performance is not new news to any of you; the high level themes are innovation, product, and brand.  We’ve read about them many times. But, how can CEO and leaders of companies translate these themes into their business? That’s the diplomatic way to tee up this blog. The real question is: What can health care companies do to be more like Apple?

1.    Fit in: In 2008, Apple leaped into the #1 spot in Fortune’s rankings (from #7 in 2007.) Steve Jobs himself said, “Apple products work, and if you buy more than one, they work better.” In other words: integration.

Yes, Apple has a fully integrated platform. But, Apple wouldn’t be as successful without the relationship and integration with Microsoft products. Early on, the company recognized they needed to fit into the prevailing system.

The number of new health care developments that are being generated are dizzying: billing programs to accelerate payment of patients’ copayments; software to maximize performance in pay for performance initiatives, IVR systems that increase patient engagement, incentive programs to enhance compliance with needed behavioral changes. The founders/developers are passionate that their cutting edge innovation will increase “quality and decrease cost.” However, too many of these great ideas aren’t designed to fit into the operational complexities of a hospital, doctor’s office, health system, or payor. And, despite the promise of more revenue and profitability, decision-makers can’t bear to layer any more chaos to an already chaotic system.

True systems integration may be prohibitively expensive for start-up or early stage companies, but at a minimum, be prepared to offer a feasible operational/process solution that achieves integration. How? Roll up your sleeves and invest time in learning how the system is wired: the back office operations in a doctor’s office, the politics of hospital revenue management, the benefits, claim and administration realities of insurance.   (more…)

By Archelle Georgiou. This week’s Sunday New York Times had its usual array of breaking national and international news on the front page, but my loudest “Oh No!” came when I turned to page 14 of the Magazine. Randy Cohen, author of The Ethicist, announced that he is retiring his column. For those of you who are not familiar, Cohen’s weekly column typically posed two moral/ethical dilemmas followed by his expert analysis and perspective.

This column has been part of our family’s Sunday morning ritual since it started being published 12 years ago. Bagels, lox, coffee…and… The Ethicist column. We all knew the routine

1.Archelle reads the dilemma. Twice.
2.Each daughter, youngest to oldest, must take a definitive position and defend it with clear rationale (yes, even Zoe is included in the lineup)
3.David, then Archelle, declare their positions. (I always go last since I seem to have the strongest opinion and don’t want to influence everyone else.)
4.Family debate…aka…we argue.
5.Once we’re exhausted or reach an impasse, we read Cohen’s expert opinion.

This discussion, every Sunday, week after week, was valuable for teaching the girls a process for deciding between right and wrong. The everyday scenarios that Cohen presented were a non-threatening way to proactively work through many of the seductive temptations that they would inevitably face later in their lives.

From December 2002: Is it okay to Google some one you’ve started dating to check up on them?  SN, New York
In 2002, this was a dilemma. In 2011, this seems like a no-brainer. 

From May 2004: I am an American posted to Vietnam, where pirated movies on DVD are cheap and ubiquitous, and legitimate copies are nearly nonexistent. Would it be ethical to purchase pirated DVD’s if I also join a monthly unlimited-rental service like Netflix? Ben Moeling, Hanoi, Vietnam
Arielle found herself with this exact dilemma as she spends the year in China.

From September 2007: A friend and I will soon take the LSAT.  His father, a psychiatrist, gave him Adderall to help him take the test. I asked if he could share some with me, and he said that would be unethical. Is it? Isn’t his dad’s giving him the Adderall unethical? Name Withheld, Austin, Tex.
The sharing of Adderall on college campuses is rampant.

The lifelong impact of this column became evident in 2005 when Athena was preparing for her Bat Mitzvah and matter of factly announced to us and the Rabbi that she wasn’t sure whether she believed in God. Since God and religion are merely a construct for moral/ethical decision-making, we were unconcerned about whether she believed in “God” but were very concerned that she develops a solid framework for distinguishing right from wrong.

Cohen’s ethics column was a non-threatening, familiar vehicle for helping Athena navigate through the process of maturing her moral framework. After 10 months, Athena developed her own set of “ethical decision guidelines” that she proudly shared in her Bat Mitzvah speech with our 130 guests: When faced with a dilemma, avoid decisions/actions that:

•are against the law
•don’t give you a good gut feeling
•you wouldn’t be proud to tell your mom
•you wouldn’t want on the front page of the Wall Street Journal

Making ethical decisions is learned, not innate. It’s a skill, not a talent. It takes practice and improves with feedback, debate, and, most importantly, self-reflection. It requires that you look at your own actions and honestly assess your intentions.

Is it ethical to sign an employment non-compete without really intending to honor it since its unlikely to be enforceable anyway?

Is it ethical to use ICD-9 codes that are not accurate but that assure a patient’s medical services will be reimbursed?

Is it ethical to accept a Senior Discount when a hotel clerk mistakenly assumes you are over 65?

Is it ethical to have dinner with a friend when on a business trip and then submit the entire restaurant bill as a business expense?

What decisions would you make in these scenarios?  Some may seem so innocent…but are they?

Cohen may be retiring his column but his dilemmas are very alive on the New York Times website. Read them. Debate them. Help your kids mature their moral maturity and continue to refine your own. We all need probably need some help in this arena. It’s a process that never ends.

Originally posted on Archelle on Health on March 3rd.

By Archelle Georgiou. The President quit smoking. Yup, it’s true. The First Lady said so during a press conference last Tuesday. Later in the day, Robert Gibbs, the Press Secretary, confirmed that the President has worked hard to kick the habit.

Well, only the Secret Service knows for sure whether or not the President is still sneaking a few puffs. But, regardless, I admire his accountability to himself, his family and to the public. Obama has ‘fessed up to his vice. “This is not something that he’s proud of – he knows that it’s not good for him,” Gibbs told reporters. Obama hasn’t tried to rationalize his behavior or made excuses. And, he hasn’t implied that simply cutting back is good enough. He has plainly said that smoking isn’t good for him…or for anyone else.

Compare that to Surgeon General Dr. Regina Benjamin. Let’s call it like it is…she’s fat. And, so are 63% of Americans. But, the real question is: Is she accountable to herself and, more importantly, to the public? Is she helping address the obesity epidemic…or is she fueling it?

Having a svelte figure is not, and should not, be a prerequisite to being “America’s doctor.” Many who have defended the Surgeon General argue that her job is to make health care and policy decisions for the country — “not to look hot in a pair of skinny jeans.” Good point, great sound bite, but clearly a defensive stance. No one expects her to be thin–just realistic and evidence-based about her current weight.

Experts estimate that Benjamin is at least 40 pounds overweight and wears a size 18. Women in this size range report a BMI between 32-34, and using standard American size charts, her waist measurement is estimated at 34.5 inches. She is not a little overweight or in a gray zone. Benjamin squarely falls into the obese category and likely has an abdominal girth that is dangerously close to, if not over, a critical threshold. (FYI…a waist size greater than 35 inches in women and 40 inches for men is considered high risk.)

There is no question that she needs to lose weight. However, when asked about her weight issues in interviews, she rationalizes by focusing on her treadmill endurance and her goal of climbing Mount Kilimanjaro. “The goal isn’t to lose weight,” Benjamin frequently says. “It’s to be healthy and enjoy it.”

Same skeleton...with and without excess fat.

Take a look at this picture of a body with and without excessive fat. It’s painful just looking at it. And, Benjamin doesn’t have a weight loss goal? Really? Not even 5-10% of her body weight? What kind of a message is this? What if Obama said that the goal was not to stop smoking but to be healthy? The subliminal message: It’s okay to be overweight, oops, obese. (more…)

By Archelle Georgiou. Ever have a deconstructed cupcake? It was our favorite dessert in QSine, the specialty restaurant aboard our cruise on the Celebrity Eclipse. Plain cupcakes were served with chocolate, vanilla, and caramel icing along with four types of sprinkles. While we all had the same ingredients, we each created our own (almost) perfect concoction.

And, during a long and relaxing sea day, I started reading The 5 People You Meet in Heaven, Mitch Albom’s fictional story about Eddie, an amusement park maintenance man who dies and goes to heaven.  When Eddie arrives in the afterlife, he encounters five strangers, but then he realizes how each one of them had significantly influenced his life on earth as they taught him about sacrifice, forgiveness, love, and interconnectedness.

Who knows what happens when we transcend from this existence to the next. But, why wait for heaven? There are individuals who have stepped into your life and forever shaped who you are and how you think. They are the heavenly people you have met on earth.  

Rich

At 16, I left home for the first time to attend an 8-week summer camp. During the day, I was part of a small group of students selected to work in a biological warfare laboratory in Fort Detrick, Maryland. At night, we integrated with a larger group of kids enjoying traditional summer camp activities. Too shy to participate,  I sat by myself writing letters to my parents. Tired of coaxing me to get involved, all the counselors decided to leave me alone—- except Rich who thought I needed some individual attention. During his time off, he took me swimming and running and taught me to dance—all firsts for me and the first time I realized that love exists.  While Rich and I may have had a different future had our lives intersected at another time, he is still my dear friend 33 years later.

Stephen

My first surgery rotation in med school was with Dr. Stephen Kopits,  a pediatric orthopedic surgeon specializing in the treatment of dwarfs.  Voted “Baltimore’s Best Doctor” I was most excited about scrubbing in with him during his famous 12-hour surgeries where he untwisted, de-coiled and re-built the skeletons of his very small patients. But, it wasn’t his technical excellence in the operating room that made an indelible mark on my career. It was the relationship he had with his patients.

Most of his “little people,” as they prefer to be called, ranged in height from 24 to 36 inches. At 6’2”, Kopits towered over them, even while sitting in a chair. So, in clinic, he’d sit on the floor, legs crossed Indian style,  and made direct eye contact with his patients as he spent hours answering questions, drying their tears, and reassuring them that they could live a full and productive life.  “Archondoula, always remember” he said in his thick Hungarian accent, “you have to love your patients.”  I never saw Dr. Kopits after my rotation but when I learned that he died of a brain tumor in 2002, I sobbed.  He taught me what it really means to be physician. (more…)

By Archelle Georgiou. Have you ever wondered what dictates the pace of the healing process?  Why do some of people recover from a cold in a day and in others, it lingers for 1-2 weeks? Why do some college students with mononucleosis lose a semester of college due to extreme fatigue but others just need a little extra sleep for a few weeks? Why do some adults just take one day off from work to get their wisdom teeth extracted and others are home, on narcotics, for a week?

Yes, level of severity, comorbidities, and complications drive variation, but is the “each person is different” rationale completely about the differences in cellular physiology?

Exactly 2 weeks ago, Isabella, our 13 pound dog, a shitzu-bijon mix and a bit of a diva, was spayed. In human medical terms, she had a total abdominal hysterectomy–1-1/2 inch incision, anesthesia, and removal of her ovaries and uterus. When I picked her up from the vet, she was subdued, and as he handed her over, his post-op instructions were “Follow her lead, she’ll tell you how she’s feeling.” Within 24 hours, she was eating and drinking with normal bowel and bladder function. She didn’t appear to need any pain medication; in fact, our bigger challenge was trying to protect her stitches and keeping her from running laps around our kitchen counter.

As I watched her recovery, I was amazed. If she were human, she’d be in the hospital for 2 days, on narcotics for 2 weeks, and unable to drive for 4 weeks. And, regardless of the actual healing process, the “standard of care”  would be for her ob-gyn to authorize 6 weeks of disability…whether she needed it…or not. 

“Why the stark difference?”

There are many possible reasons. Clearly, dogs have a different biology than women. Their abdominal wall muscles are thinner and they don’t experience the same hormonal shifts post-operatively. In addition, they are generally more physically fit which accelerates the healing process as well. And, age is undoubtedly a factor. Dogs are spayed when they are young whereas women generally have this surgery after age forty.

Nevertheless, Isabella’s recovery was 20 times faster than the average woman’s recovery.  And, even if I take into account that 1 dog year = 7 people years….the recovery was still 3 times faster. Why? Are there other considerations? (more…)

By Archelle Georgiou.

“Morning Glory” starring Rachel McAdams, Diane Keaton, and Harrison Ford is a wonderfully funny movie about the behind the scenes challenges in broadcast news. McAdams plays Becky Fuller, an executive producer charged with revitalizing a failing morning news program. The painfully accurate reality depicted in the movie is that news outlets live and die by their ratings so that we, the viewers, can get the news for free.

So who pays for it? Broadcast, print and web news media is supported by advertising revenue, and the basic business model is straightforward:

• News attracts viewers.
• Number of viewers is monetized.
• News outlet sells advertising space/time to marketers.
• The more viewers there are, the more a media outlet can charge for an ad.

The bottom line is that Viewers = Revenue.

Retaining viewers/readers ultimately requires that media outlets deliver information that is timely, accurate, well-balanced, and engaging. However, attracting them requires that outlets successfully break through the morass of news noise. How do they do that? By grabbing our attention with clever, dramatic headlines and teasing viewers/readers with lead-ins and headlines that are unexpected, outlandish, and extreme. It is a bait and hook strategy that works.

Here’s the problem: Too often, we don’t have the time to read or listen to an entire news clip or article. We merely rely on the headline and, subsequently, we become misinformed. And, when there is misinformation about health-related issues, this can lead to poor outcomes, higher cost, and, very commonly, patient confusion, frustration and disappointment.

Here a few examples:

Headline: “Study Pins Alcohol as More Dangerous Than Crack or Heroin”

Facts: This Lancet-published study evaluated 20 different drugs including cocaine, heroin, ecstasy and marijuana. Each was ranked on three dimensions: physical harm to the individual user, addiction potential, and the societal effect of the substance. The study clearly showed that an individual level, cocaine and heroine are most harmful. But, since alcohol abuse is so prevalent in the population, its high societal impact score inflated the overall score above that of all the other substances. Hence, the headline.

By the way, the author of the article is Professor David Nutt, a former U.K. drug czar who is using the study to argue that the regulatory classification of substances should use an evidence-based rather than a historical approach rather. This was a political article in drag.

The vast majority of online outlets including ABC, CBS, and FOX, had a headline similar to the one in Time, but kudos to The Boston Herald for their responsible but still eye-catching headline: “Dangers of Abuse Sobering.” (more…)

By Archelle Georgiou. “Maria’s Event” is how the insiders now refer to California’s annual Women’s Conference. They are referring to Maria Shriver who assumed responsibility for the event seven years ago when she became California’s First Lady. Oprah summarized it well when she said that Maria has transformed the event from a small, poorly attended meeting to the “hottest, hippest, highest attended women’s conference in the world.”

The overarching goal of the Conference event to inspire women to be “architects of change,” but Maria has also used the conference as a vehicle to work through some of her own challenges—from her reluctance to being a ribbon-cutting First Lady to enduring the sadness of her mother’s death. While she stacks the stage with a star-studded platform, the real magic of the Conference has been Maria’s willingness to be honest and transparent in front of thousands of people.  And, making herself vulnerable makes her real….and gives others the courage to do the same.

Shriver’s theme for the 2010 Women’s Conference was “It’s Time” which reflected that “its time” for her to transition this conference to California’s next governor. For each woman in the audience, the theme meant “it’s time” to make the personal and/or professional changes that moves each person toward a happier, more meaningful, life.  And yes, Maria said, change is scary.

Two weeks ago, I attended the Conference in Long Beach as part of EmpowHER, a health media company focused on helping women advocate for themselves. We were there to film a series of Web-TV shows from the exhibition hall floor on a variety of women’s health topics. Beyond conducting eight engaging interviews, my only other goal was to try to “bump into” a celebrity or two. (Matt Lauer would have been nice.) But, as the two-day event unfolded, at a personal level, I realized that “It’s Time.”

Day 1 was a “Night in the Village.”  The Long Beach Convention Center was overflowing with 14,000 people, hundreds of vendors, free samples, lots of bling, and a dizzying amount of noise. With each “Maria sighting,” crowds rushed through the aisles to catch a glimpse. Feeling overwhelmed, the introvert in me wanted to retreat to my hotel room, crawl into my PJs, and watch the events via webcast.  Had I done that, I would have felt a little safer, but I also would have missed the opportunity to experience the energy that is generated when women become a community and share their stories.

Fortunately, I reverted to my extroverted side. I took a break from our makeshift studio and wandered from booth to booth.  I was most inspired by the innovative products sold by small, women-owned businesses.  Some were simple but practical—like the clothes hangar labels designed to remind you of the date and location that you wore a certain outfit. Others were deeply moving—such as the intricately, hand-embroidered luggage from Afghanistan that uses micro-financing to promote women’s rights. Some were just incredibly creative—like Topsies…a flip-flop alternative that uses fun patterned stretch fabrics to create shoes that have all “flip and no flop.” Regardless of the size or scope of the business, each one was started by a woman who had a spark of creativity, believed in herself, and had the courage to take a risk.  It made me question whether I had approached the last 3 years, a new career chapter of my life, with the same zest and confidence as these women.   (more…)

By Archelle Georgiou. Aren’t movies a great value? In addition to offering two hours of entertainment, they often inspire us to wander into tangential questions and dilemmas that might otherwise remain unexplored and undiscussed. 

Disney’s Secretariat is a wonderful family movie about a racehorse who, in 1973, became the first Triple Crown champion in twenty-five years when he won the Belmont Stakes by 31 lengths. The movie is also about the his owner, Penny Tweedy.

Penny (Chenery) Tweedy is a Columbia Business School graduate turned housewife. She is married to a successful attorney and is the mother of four children. But, when she assumes responsibility for her father’s ranch, she shifts her focus away from her family and on to the horse and on to winning…at all costs. As usual, Disney glamorizes her passion and glosses over the family conflicts, but in a recent article by her Penny’s son, John Tweedy, he said, “In real life, we Tweedys were more riven and frayed…by the pressures of celebrity into which we were suddenly thrust. The wars between our parents were more bitter, the marriage more broken, and we kids were more alienated and countercultural than the movie depicts.”

During the scene when Penny turns down $8 million dollars for Secretariat and risks the family estate, David, my husband,  turned to me and said, “Archelle, even though I know how this movie ends, she is really being irrational.” Or, was she?

And, at that moment, my tangential thinking began….

• When should a “housewife” give up her dreams and what she believes in for the good of her family?
• Why should 6 men voluntarily descend 2041 feet into the San Diego Mine escape shaft to help save 33 others who were buried alive for 67 days.

These are questions of utilitarianism, a moral theory centered around the basic concept that “actions are right to the degree that they tend to promote the greatest good for the greatest number.” While I don’t fully understand all the nuances, the basic concept is one that’s been on my radar for a few weeks since Athena called me to brainstorm about an essay for her freshman Ethics class. “Mom, when do the needs of the community supercede the needs of the individual?”

Her question brings me to this blog topic:

When should a health care provider get the influenza vaccine (even when they don’t want it) to prevent putting vulnerable patients at risk? (more…)

By Archelle Georgiou. 10th grade Social Studies class. My first term paper. Typed on a Remington Select with bottles of White Out and typewriter correction tape by my side. The topic: The Equal Rights Amendment (ERA).

In case you haven’t read it lately, the language in the ERA simply states:
Section 1: Equality of rights under the law shall not be denied or abridged by the United States or by any state on account of sex.
Section 2. The Congress shall have the power to enforce, by appropriate legislation, the provisions of this article.
Section 3. This amendment shall take effect two years after the date of ratification.

The Amendment was originally introduced in 1923. In 1972, it finally passed in both the House and Senate but sits dormant, and is not part of the US Constitution since it has only been ratified in 35 of the necessary 38 states.

As you might expect, I took the position 30+ years ago that the Amendment should be passed. And, I still do. Not because women still need equal due process rights; the 14th Amendment takes care of that. Not because women still need equal opportunity for employment and compensation; the Civil Rights Act of 1964 and the Equal Pay Act (1963), theoretically at least, afford these protections.

The ERA needs to be passed so that women finally have an equal opportunity to achieve and maintain their health.

Two weeks ago, the Institute of Medicine published a report: Women’s Health Research: Progress, Pitfalls, and Promise. This report was commissioned by Health and Human Services to examine the status of women’s health research over the last 20 years and to determine how effectively findings have been put into practice. The report’s findings highlight that, indeed, there has been progress, particularly in the treatment of women with heart disease, breast and cervical cancer. There is a longer list of conditions for which progress has not been made.

Among the findings that I want to call attention to because, frankly, they are appalling, are those regarding the inclusion of women in clinical trials. Here is a brief synopsis…Comments in parentheses are my editorial comments. What are blogs for, anyway?
–Pre-1986: Women were not routinely included in clinical trials. There was an assumption that results of research on men could be extrapolated to women.
–1986: The NIH established a policy requiring the inclusion of women in clinical research.
–1990: A GAO audit identified that women were still not adequately represented in clinical trials. Why? The policy was vague, inconsistently applied and poorly communicated.
–1992: Another GAO audit found that while women were included in trials, they were underrepresented. (Oops..must have been another misinterpretation.)
–1993: The FDA issued new guidelines for requiring inclusion of women in clinical trials and required gender specific analysis of the data.
–2000: A GAO audit revealed that although women were included and adequately represented, studies were not adequately designed to permit analysis by sex.
–2001: A GAO audit of the FDA showed that 30% of studies failed to fulfill requirements for outcome data by sex. Clinical significance? Eight of 10 drugs withdrawn from the market caused more adverse effects in women.
–2001: The Institute of Medicine published Exploring the Biological Contribution to Human Health: Does Sex Matter?

Yes, Virginia…sex matters. But, it is 2010 and women are still under-represented and comprise only 39% of the participants in Phase 1 trials…the phase that assesses the safety, tolerability, and dosing of a drug.

Not outraged yet? What if you knew that:

During the height of the H1N1 vaccine shortage, researchers identified that women could be immunized with a lower dose of the vaccine and get adequate protection since we have a more pronounced immune response. Great news, right? Regulators were informed, but said they were too busy to consider this information in the vaccination guidelines
–Prominent researchers were recently discouraged from submitting any new grant proposals to the NIH for research on sex differences of mental health disorders. Does this make sense since science can’t yet explain why depression is twice as common in women, alcoholism is twice as common in men, eating disorders are three times more common is girls and autism is four times more common in boys? Nope. What are they thinking?
–Male mice, rats, and rodents are even preferentially used over females in basic clinical research!

What will it take to make women’s health a priority in clinical research? We have Federal laws, NIH policies, FDA guidelines, four separate Federal agencies with an “Office of Women’s Health,” and repeated GAO audits…but the status of women’s health research is abysmal for a nation that spends almost $3 trillion on health care. We’ve come a long way baby…but not far enough, and we may need a 28th amendment to the Constitution to finally have equal rights to a healthy life.

What can you do? Whether you are male of female…Read the report. Educate yourself on sex-based differences. Advocate for yourself..men are from mars, women are from venus, and sex matters, damn it!

*”Sexx Matters” is the creative brainchild of the Society for Women’s Health Research...an organization that works tirelessly to promote and advocate for sex-based differences research.

Originially posted on Archelle on Health, Tuesday, October 5th.