Social Determinants Impact Health More Than Health Care

Jane Sarasohn-Kahn

imageToday’s post first ran on Health Populi on November 9.

The factors of where people are born, live, work and age — social determinants — shape human health more than health care. Yet in the U.S. much more resource per capita is funneled into healthcare services than into social ones.

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity was published by The Kaiser Commission on Medicaid and the Uninsured in November 2015, calling attention to the opportunity and wisdom of baking health into all public policy.

The social determinants of health (SDOH) include economic stability, the physical environment and neighborhood, education, food, community and social context, and the health care system, shown in the second exhibit. (more…)

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A Thoughtful Discussion on Drug Pricing and Innovation

Mary R. Grealy

This post first appeared October 5 on the Prognosis Blog.

There has been a lot of talk of late about the price of prescription drugs.  Most of it, unfortunately, has come in the form of 30-second sound bites, largely driven by one hedge fund investor’s decision to significantly raise the price of a single product.

Determining the correct price for an innovative, life-changing product to achieve both consumer accessibility as well as a return on investment, which is vital to fund future research and development, is a complex topic that warrants a thoughtful discussion, not glib attack lines.

Credit, then, goes to the Washington Post for its lengthy question-and-answer article with Joseph Jimenez, the CEO of Novartis, one of the world’s leading pharmaceutical companies.  In the interview, Jimenez made, I believe, several striking and instructive points.  Among them: (more…)

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PSA Serum Testing: To Test or Not to Test?

Terri Prof Headshot 0412Lewis W. had everything going for him. Recently remarried to the love of his life with a job he enjoyed and was good at it. He had so much to look forward to. But about a year into his new marriage, something didn’t feel right. He wasn’t as interested in sex as a newlywed might usually be and he was struggling to be the husband he wanted to be. His wife, thinking he had lost interest, moved on, leaving Lewis alone again at 53. During the following year he dealt with a divorce and during that time went to the doctor for a checkup. During the visit he mentioned his marital difficulties, not thinking that they were relevant to his health, other than the stress that a divorce carries. His doctor surprised him a few days later with the news that his PSA (Prostate Specific Antigen) levels were very high. The normal range, his doctor told him, is below 4.0 ng/mL, but the normal, baseline range for each man varies so Lewis’s PSA serum level was not necessarily a danger signal, but really a trigger for additional testing.

PSA serum levels can provide an indication of one’s risk of prostate cancer, but alone, are not enough to diagnose cancer. When levels rise above 10.0 ng/mL the probability of cancer increases dramatically. Accompanied by a digital rectal exam, PSA levels can be used to make a decision regarding whether additional testing and/or a biopsy is needed. (more…)

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Opportunities in the Connected Health Market

rania nasisThe connected health market has been growing exponentially, resulting in the consumerization of healthcare. Connected devices are increasingly becoming a routine part of lives with roughly one-fifth of the smartphone and tablet owners using a health app on a monthly basis, according to research from Parks Associates. If there’s any doubt of the role connected devices will play in our lives, check out Apple’s recent special event. Following Tim Cook’s welcome address, Airstrip, a veteran in the connected health space, took the stage to showcase their Sense4Baby app, which allows doctors to remotely monitor a mom and her baby during pregnancy.

The recent Connected Health Summit in San Diego brought together a panel of investors to discuss opportunities in the growing connected health market. The investors highlighted key areas of opportunity and provided sage advice for entrepreneurs in the space. Panel participants were Casper de Clercq of Norwest Venture Partners, Jason Russell of Citi, Euan Thomson of Khosla Ventures, Jeannine English of AARP, and David Schulte of McKesson Ventures. (more…)

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Hormone Imbalances and Testing: Which Test is Right for You?

Terri Prof Headshot 0412As we age, one of the first things to go is often our hormone balance. Hormones are the critical chemicals that keep our bodies in alignment, help us get enough sleep and maintain our energy levels. As we get older our hormone levels change. Throw in the stress that many of us feel from raising children, managing careers, taking care of ill or aging parents, and the result? Low energy and an overall feeling of exhaustion!

Lori Van Popering, a Certified Holistic Practitioner and Coach, has been there! She knows what it’s like to feel exhausted, foggy and just “not herself”. Her hot flashes, weight gain, difficulty sleeping, lack of motivation and low energy left her feeling miserable and stuck. The surprising results of a saliva hormone test showed that her hormones were out of whack. As a Holistic Practitioner, she knew that hormone imbalance could be causing her symptoms.

Hormone tests can offer valuable insight into the current state of the body. (more…)

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American Hospitals Need to Stop Offering Fast Food, Quick!

heather farthingBan on Hospital Smoking: A Model

In the 1950′s the Journal of the American Medical Association (JAMA) published what was, at the time, an incredibly surprising finding: smoking is detrimental to health1. By 1964, the Surgeon General had publically acknowledged the linkage between smoking and cancer and, by the seventies, the smoking-cancer relationship was standard curricula in U.S. medical schools 2. Despite both medical and public awareness, however, hospital policy lagged behind the science; most healthcare centers had little to no official regulation regarding smoking in their facilities2. Reducing Smoking in Hospitals. A time for Action, published in a 1985 issue of the JAMA, declared a forceful criticism of this oversight:

Six years later, the Joint Commission: Accreditation of Healthcare Organizations (JCAHO) ordered that all American hospitals be smoke free by the end of 19934. Today, American hospitals are plagued by a bad case of déjà vu. This time the paradox is not the presence of the cigarette at the bedside, but rather the burgers, the fries, and the soft drinks.

What’s Wrong With Fast Food? (more…)

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Confronting Scandalous Physician Behavior: The Annals Of Internal Medicine Takes The First Step

Val Jones, MD

This post first appeared on Better Health.

If you have not read the latest essay and editorial about scandalous physician behavior published in the Annals of Internal Medicine (AIM), you must do so now. They describe horrific racist and sexist remarks made about patients by senior male physicians in front of their young peers. The physicians-in-training are scarred by the experience, partially because the behavior itself was so disgusting, but also because they felt powerless to stop it.

It is important for the medical community to come together over the sad reality that there are still some physicians and surgeons out there who are wildly inappropriate in their patient care. In my lifetime I have seen a noticeable decrease in misogyny and behaviors of the sort described in the Annals essay. I have written about racism in the Ob/Gyn arena on my blog previously (note that the perpetrators of those scandalous acts were women – so both genders are guilty). But there is one story that I always believed was too vile to tell. Not on this blog, and probably not anywhere. I will speak out now because the editors at AIM have opened the conversation. (more…)

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When Great Healthcare Is Served With A Large Helping Of Unnecessary Mental Anguish

Val Jones, MD

Better Health first ran the post below on August 5.

I watched helplessly as a dear friend went through the emotional meat grinder of a new cancer diagnosis. Her  husband was found to have melanoma on a recent skin biopsy, and she knew that this was a dangerous disease. Because she is exceptionally intelligent and diligent, she set out to optimize his outcome with good information and the best care possible. Without much help from me, she located the finest specialists for her husband, and ultimately he received appropriate and state-of-the-art treatment. But along with his excellent care came substantial (and avoidable) emotional turmoil. The art of medicine was abandoned as the science marched on.

First came the pathology report, detailed and nuanced, but largely uninterpretable for the lay person. She received a copy of it at her request, but without any attempt at translation by her physician. In his view, she shouldn’t be looking at it at all, since it was up to him to decide next steps. She brought the report to me, wondering if I could make heads or tails out of it. Although I am not trained in pathology, I did know enough to be able to translate it, line-by-line, into normal speak. This was of great comfort to her as the ambiguity of prognosis (rather than certainty of metastasis and or mortality, etc.) was clearly outlined for the trained eye. (more…)

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New initiative focused on mental health in the workplace

MHFA_Facebook_AThe National Council for Behavioral Health in collaboration with Aetna, a major health insurance provider, has launched a new initiative to create healthier work environments through Mental Health First Aid training. The purpose of this initiative is to raise awareness of mental health issues in the workplace and to change the perceptions of mental health and substance use problems for employees.

Mental Health First Aid is a skills-based, in-person training that helps increase literacy around mental illness and substance use and better equips managers and employees to safely, respectfully and effectively address mental health and substance use concerns before they become performance problems. It also provides resources so employees know where to go for help for themselves or a colleague. (more…)

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Over-Reliance on Tests: Why Physicians Must Learn to Trust Themselves & Their Patients

Val Jones, MD

The post below ran yesterday on Better Health.

I met my newly admitted patient in the quiet of his private room. He was frail, elderly, and coughing up gobs of green phlegm. His nasal cannula had stepped its way across his cheek during his paroxsysms and was pointed at his right eye. Although the room was uncomfortably warm, he was shivering and asking for more blankets. I could hear his chest rattling across the room.

The young hospitalist dutifully ordered a chest X-Ray (which showed nothing of particular interest) and reported to me that the patient was fine as he was afebrile and his radiology studies were unremarkable. He would stop by and check in on him in the morning.

I shook my head in wonderment. One look at this man and you could tell he was teetering on the verge of sepsis, with a dangerous and rather nasty pneumonia on physical exam, complicated by dehydration. I started antibiotics at once, oxygen via face mask, IV fluids and drew labs to follow his white count and renal function. He perked up nicely as we averted catastrophe overnight. By the time the hospitalist arrived the next day, the patient was looking significantly better. The hospitalist left a note in the EMR about a chest cold and zipped off to see his other new consults. (more…)

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Direct Access Testing: Putting Consumers in the Driver’s Seat

Terri Prof Headshot 0412Angela Young knew something was wrong. She hadn’t felt well for months but didn’t know what was going on. Her doctor ran tests for immune problems and endocrine issues. They all came back normal. Finally, Angela went to an independent direct access testing (“DAT”) laboratory and had them run some additional tests, including a test for something she suspected, but her doctor didn’t want to test her for: Lyme disease. When the Lyme disease test came back positive, she was relieved, because finally she knew what was wrong, could seek treatment and begin to get healthy again.

Michael S. is a typical 55 year old American man. He knows he doesn’t eat that well, too many quick stops at the McDonald’s on the way home from work and too much time sitting on the couch. He really should start working out, but life kept getting in the way. He felt OK, not great, but there wasn’t any reason to get to a doctor. His wife kept pushing him to get to the doctor, so to save time he just went into a direct access testing laboratory for some basic tests to get his wife off his back. He was shocked to discover that his cholesterol levels were in the upper 200s. He knew it was really time to lose weight and get moving. (more…)

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Consumer Engagement through Patient Portals and Innovative Care Delivery Models

connectedThe upcoming Connected Health Summit: Engaging Consumers, September 9-10 in San Diego, will examine the growth of the connected health market through analysis of new devices, technologies, and integrated platforms and its consumer-oriented focus.

2014, the first year of the conference, was a significant year in the evolution of this market. A record number of ACOs formed to deliver accountable care, and it was also the maiden year for health insurance exchanges, which are now attracting more private insurers as the current healthcare model solidifies. Large CE companies, including Apple, Google, and Samsung, officially entered the consumer health and wellness market, leading to record sales of connected fitness trackers, the emergence of Fitbit as a market leader, and an influx of new consumer brands in the wearables market targeting health and wellness applications. Parks Associates’ consumer research finds nearly 30% of U.S. broadband households now have a connected health device.

To have value in the connected healthcare market, technology must demonstrate its worth for both consumers and healthcare industry stakeholders. (more…)

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Newly Minted Doctors Begin Their First Jobs In July: Should You Be Afraid?

Val Jones, MD

Today’s post first ran on Better Health on July 4.

The short answer, in my opinion, is yes.

The long answer is slightly more nuanced.  As it turns out, studies suggest that one’s relative risk of death is increased in teaching hospitals by about 4-12% in July. That likely represents a small, but significant uptick in avoidable errors. It has been very difficult to quantify and document error rates related to inexperience. Intuitively we all know that professionals get better at what they do with time and practice… but how bad are doctors when they start out? Probably not equally so… and just as time is the best teacher, it is also the best weeder. Young doctors with book smarts but no clinical acumen may drop out of clinical medicine after a short course of doctoring. But before they do, they may take care of you or your loved ones.

It has been argued that young trainees “don’t practice in a vacuum” but are monitored by senior physicians, pharmacists, and nurses and therefore errors are unlikely. While I agree that this oversight is necessary and worthwhile, it is ultimately insufficient. Let me provide an illustrative example. (more…)

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  • July 6th, 2015 Pope Francis’ Visit and Philadelphia Healthcare
    By Glenna Crooks
  • July Man of the Month: Farzad Mostashari, MD

    Casey Quinlan

    July 4 is Independence Day in the United States. Every year, we celebrate an unruly bunch of guys – the ones we now call the Founding Fathers – who, fed up with draconian rule from far away, decided to plant a new American flag and say “we’re running this show from here on out!”

    farzad_mostashariThere are plenty of analogies that can be drawn between the patients’ rights movement, healthcare reform, and our Founding Fathers. One of the champions of “data liberación” – the battle cry of healthcare open data efforts – Dr. Farzad Mostashari has consistently called for people, the ones commonly called “patients” by the healthcare system, to have equal rights within the system purportedly designed to help them maintain or achieve health.

    From the stage of Health Datapalooza 2015, Farzad threw down a gauntlet to the entire healthcare industry, encouraging every American to declare #dataindependenceday this July 4 by accessing their medical records online.

    “We believe that right now is the moment when patient demand for their records will be the ‘unknotter’ of the problem that we have — of the lack of access for patients to take their data and do what they want with it.” ~ Farzad Mostashari, MD (more…)

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