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…)

FutureMed, the first program of its kind, is an executive program for physicians, healthcare executives, innovators and investors that focuses on exploring the impact of rapidly developing technologies. FutureMed will be held May 10-15 at Singularity University on the NASA-Ames Research Park in Silicon Valley.

Few fields have the potential to evolve more dramatically through disruptive, exponential technologies than healthcare. Low cost genomic sequencing and proteomics, ever-faster and higher-resolution imaging, artificial intelligence, telemedicine, stem cells, robotic surgery, smaller and more capable implantable and wearable devices, ubiquitous mobile applications, nanotechnology and synthetic biology–these and other game-changing technologies and innovations have tremendous implications for medicine, healthcare and the biomedical industry in the decade ahead, including the potential enablement of better, more accessible care at lower costs.

The five-day, intensive FutureMed program includes lectures, workshops and site visits that are led by notable faculty from the fields of medicine, biotechnology and innovation. CME credit is available for clinicians. In attendance will be world-class innovators and thought-leading faculty across multiple disciplines.

Some of the FutureMed faculty include:

• Peter Diamandis MD, Chairman of the X-PRIZE and co-founder of Singularity University
• Tim O’Reilly, Founder and CEO of O’Reilly Media
• Dean Ornish MD, Founder and President, Preventative Medicine Research Institute
• Thomas Goetz MPH, Executive Editor WIRED, Author of ‘The Decision Tree’
• Dan Barry MD PhD, 3 time Space Shuttle NASA Astronaut and Roboticist
• Catherine Mohr MD, Director of Medical Research, Intuitive Surgical
• David Ewing Duncan, Author of ‘Experimental Man,’ and the ‘Personalized Medicine Manifesto’
• Randy Scott PhD, Founder and Chairman of Genomic Health
• Roni Zeiger MD, Chief Health Strategist, Google
• Christopher Longhurst MD, Chief Information Officer for Packard Children’s Hospital, Stanford Medical School
• Michael Gillam MD, Director of the Microsoft Medical Media at Microsoft Health
• Allan May, CEO of Life Sciences Angels
• Michael West PhD, Founder of Geron and BioTime Pharmaceuticals

A full list of faculty is on the FutureMed web site.

Core tracks include those which will explore the exponential trends in Information & Data-driven and Internet-Enabled Health Care, Genomics and Personalized Medicine, Regenerative Medicine, Robotics & Future Interventional Approaches, NeuroMedicine, Device & Drug Development, and Entrepreneurship.

Click here for more information or to register. Follow FutureMed on Twitter @futuremedtech and at facebook.com/futuremed.

The following was published online by Nature on April 21st.

By Anu Acharya. With careful due diligence, help from financiers and a keen eye, even small companies can grow through mergers and acquisitions.

The word ‘merger’ often is associated with a big company buying a smaller one or two large companies coming together. But it is not only large companies that can succeed through acquisitions—even startups can use mergers as an effective way to grow their businesses. As a small team leading the startup Ocimum Biosolutions, based in Hyderabad, India, a decade ago, my colleagues and I could have opted to grow the company internally. But early on, we decided to take the path of mergers and acquisitions (M&As) to expand our company.

We had difficult choices to make as our business grew, and we learned invaluable lessons. Here, I share some of my experience and show how Ocimum evolved from a small company into a globally integrated genomics firm.

Ocimum’s long evolution

Ocimum Biosolutions currently offers informatics solutions, wet lab genomic services and products for sample storage, processing and visualization of gene expression data, sequence data organization, small interfering RNA (siRNA) design, genome analysis, gene patterns, in silico gene optimization and customized biological databases. But a decade ago when Ocimum was just getting started, biological research had not yet comprehensively embraced ‘omics-based approaches, and our business was based on a different model.

We started by collaborating with pharmaceutical and biotech research organizations, solving their challenges and increasing the productivity of their R&D efforts through the application of our in-house informatics expertise. While doing this, we unearthed several places in the R&D value chain that could be streamlined with informatics, but in our first few years, we grew organically. We maintained a positive cash flow by licensing bioinformatics and enterprise software solutions like laboratory information management systems and by providing bioinformatics training.

Within a few years, we had built a thriving business with a steady pipeline. Money was coming in, and it would have been easy to be content with the direction of the company. However, Ocimum aspired to be more than a bioinformatics company—we wanted to be a ‘lab next door’ that could provide a researcher with services across the spectrum in a timely and cost-effective manner. To do this, we knew we would have to break out of our comfort zone and expand beyond the perceived limitations of our small team and startup company. We looked at our goals—a strong presence in the US, expansion of our portfolio of services to include biomarker discovery, and a customer base in Europe—and realized growth through acquiring assets seemed like a great way to build a large, scalable and sustainable company, so long as the pieces fit with our proprietary Research-as-a-Service (RaaS) business model. Ultimately, we achieved these goals through a combination of organic growth and three mergers (See table). (more…)

By Jane Sarasohn-Kahn. Wellness and disease prevention were the meta-themes at Health 2.0′s Spring Fling held earlier this week in San Diego. where the discussions, technology demonstrations, and keynote speakers were all-health (as opposed to health care), all-the-time. Dr. Dean Ornish told the attendees in the standing-room-only ballroom space that the joy of living is a greater motivator than the fear of death. And the 1.0 version of managing health risks has been more the latter than the former. As a result, Ornish’s two decades of research have shown that health is more a function of lifestyle choices than it is drugs and surgery. In fact, people have a “spectrum” of choices to make based on their personal preferences — not a one-size-fits-all “diet,” Dr. Ornish has learned.

While genes are our predisposition, they are not our Fate: good news for every human being. Furthermore, he said that, “healthcare needs more connection and community. It’s as important as food and water.” He and other researchers have learned that a person’s greater social connectedness (friends, family, community) contributes to better health. People who are lonely and depressed have 3 to 7 times greater mortality, Ornish told us. The largest unmet need is for intimacy and connection.

While Dr. Ornish’s research continues to demonstrate the power of lifestyle changes on health and longer, more joyful living, sponsors of health plans are now getting into a next generation of wellness and prevention in the context of value-based benefit design. With health premium increases that now have a family of four’s coverage indexed at nearly $20,000 per year based on the Milliman Medical Index, fewer employers are confident they’ll be able to cover employee health benefits a decade from now as the chart’s declining red line illustrates.

Thus, employers in 2011 are looking to link benefits with health and productivity, based on the Towers Watson and National Business Group on Health’s survey  into employer-based benefits in the post-reform era. While companies will continue to offset increasing health costs to employees (with a 45% increase in employees’ share of health costs since 2006), they’re also using incentives more aggressively to motivate lifestyle behavior changes in a new-and-improved approach to wellness and prevention. (more…)

By Glenna Crooks. Over a decade ago, researchers noticed an interesting finding: women who believed they were subject to heart disease were four times more likely to die than women with similar risks who did not hold similar fatalistic views.

Some people called this a ‘nocebo’ effect. The Washington Post called it the ‘evil twin’ of the ‘placebo’ effect, which most everyone knows by now is a treatment that produces a positive effect for patients even when it shouldn’t because is isn’t real.

Nocebos, like placebos, are ‘self fulfilling’ prophesies at work. Apparently, the brain (and body) cooperates with the deception.

A study just published in Science Translational Medicine takes this to new levels.

Healthy people agreed to participate in a pain experiment. Heat applied to their leg caused pain and a baseline of their tolerance determined. On a scale of 0-100, the average pain rating was 66. Placed in an MRI with an IV inserted, they were administered a powerful pain-relieving drug…but not told so. Pain levels dropped to 55, so apparently the drug had some effect. That was Stage One of the study.

Stage Two started when the research subjects were told the drug was now being administered. Average pain dropped to 39, mmmmmm.

Stage Three came next. Even though the drug was administered still, the researchers lied… subjects were told it was stopped. Average pain intensity rose to 64. Very close to the baseline. Wow. Tell the person – the patient – there is no help on board and the nocebo takes over.

These were not just subjective reports. The MRI’s confirmed that the brain’s own pain networks responded in ways that matched the subjective ratings.

Change the expectations…change the response.

So what does this have to do with politics and media? Plenty maybe. You decide.

I’ve been thinking about this for a long time. Here’s why: Long ago and far away, I trained for the Olympics. My sport was Karate. There’s more.

In a training accident, a sparring partner kicked me in the head, bones in the left side of my face were fractured and reconstructed. After successful surgery, for nearly six months I spent the first hour of every morning in a dental chair to get the refining, pain-relieving work done. 

How might other patients be like me?

What if I had not liked my dentist? What if I had not trusted him?  Could I have gotten up every morning and made the drive to see him? Would I have shown-up? Or not? Cancelled my appointments? Not been adherent to the regimen? Walked away angry and disappointed? Litigious?

I can’t even remember his name today, except he was a really nice, funny, skilled, terrific guy. Eventually there was no more pain. I went on my way.

Sometimes, as I watch the anti-healer drumbeat from politicians and the media (old and new) I wonder about other people who need help.

What would it be like to be admitted to the hospital and believe that the surgeons, nurses or hospitalists there were uncaring, incompetent and likely to cause my death, not my recovery?

What would it be like to have a chronic condition and believe that my doctor had no interest in me and my health but only her own selfish interests and income? That she lacked the intelligence or ethics to stave off the influences of the many forces that make it hard to put my interests first? To believe that a pizza for lunch would influence her choice of therapeutic option?

What would it be like to get up every morning to take a medicine and believe that the company who discovered and developed it employed people only in it for the money? And that it was probably poison to boot, likely to cause bad – even fatal – side effects?

While those of us who are patients and those of us who are healers are trying to make healing  happen it seems to me there are others whose interests are not about healing.

It seems to me there are those - politicians – with interests to drive a wedge between patients and their healers in order to get media attention. It makes for flashy hearings.

Likewise it is in the interest of the media to drive that wedge to sell news.

You decide. For yourself. For those you love.

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 Robin Strongin. I am thrilled to annouce our four newest Disruptive Women bloggers. Through their work these women demonstrate an unrelenting passion to improve the health and well being of everyone – men, women, and children. Take a few minutes to look over their bios. Also, stay tuned for future posts from them, which I can promise won’t disappoint.

	Bernadette Melnyk, PhD, RN, CPNP/NNP, FAAN, FNAP is currently Dean and Distinguished Foundation Professor in Nursing at Arizona State University College of Nursing and Health Innovation. She is a nationally and internationally recognized expert in evidence-based practice as well as in child and adolescent mental health.
	Constance Garner, PhD, EdS, MSN, RN is the Policy Director in the Government Strategies Practice Group, and Executive Director for Advance CLASS, Inc at Foley Hoag, LLP. Her areas of expertise include health care, disability, long term care, and education.
	Dr. Margaret “Muggy Do” Dickinson, Ph.D. (Dr. Do) co-founded the Art and Drama Institute, Inc. (ADTI) and serves as the company’s CEO, president, and program director. Dr. Do and the Art and Drama Therapy Institute’s Inspirational Choir and Moroccan Ensemble participated in the Disruptive Women’s December Holiday event.
	Dr. Sirkku M. Sky Hiltunen, Ph.D., Ed.D., RDT-BCT, ATR-BC, BCPC, MT, BCPC, LPC (Dr. Sky) co-founded the Art and Drama Institute, Inc. (ADTI) and as executive vice president, and executive arts director.

I was excited to learn of the newly proposed National Center for Advancing Translational Research (NCATS) at the National Institutes of Health (NIH) because it offers an unparalleled opportunity to advance translational medicine and improve human health.

Last year, despite more than 100 billion dollars in research spending, only 20 drugs came to market. This is much too slow and needs to be vastly improved. Further, fewer than 200 of the 7,000 rare diseases have any available therapy options. The current system of therapeutic development has been failing patients and consumers for far too long and the time to transform translational medicine is upon us. Our network at Genetic Alliance includes more than 10,000 health related organizations, 1,200 of which are disease-specific advocacy organizations representing the millions of Americans suffering from diseases and conditions. For us there is an urgent need to bring the promise of translation to fruition.

I think that NIH has both the potential and the responsibility to leverage its existing and emerging programs and resources to accelerate translational medicine. The passage of the Cures Acceleration Network highlights that both the American public and Congress share this expectation that NIH will play a leading role in improving human health outcomes through translational research. The establishment of Therapies for Rare and Neglected Disease is another example. There is a gap in our ability to create therapies, and we need to be working to fill it now.

I’ve worked for a number of years with all of the Federal agencies charged with promoting the nation’s health. There are enormous silos preventing the coordination essential to developing timely and robust diagnostics and therapies. The NCATS is essential for this mission. We also work with academia, biotech and pharmaceutical companies and understand the limitations of each of them, and of NIH. A coordinated effort, among academia, biotech and pharmaceutical companies, and advocacy organizations, is critical to overcome the problems inherent in drug development, particularly in these early years of precision (personalized) medicine. NIH is upping the ante – haven’t we all heard, in every meeting: “Someone has to lead, someone has to step up!” This is it. We must all step up to help put the pieces together for a new system of translation.

We all know numerous ways in which the health care system is broken. Right now, so is the pipeline trickling into it. It is time to put aside turf, territoriality and all the man-made obstacles to these already complex scientific challenges. It is time to work together, and here’s hoping this new center has a radically open and innovative culture.

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 Robin Strongin. Even Disruptive Women can be quiet. But not for long. I have a lot to say about the horrific events that unfolded in Tucson this weekend.  And it goes without saying that my thoughts and prayers are with all the shooting victims and their families. 

We need to take a hard look at the lessons learned from such senseless violence.  Tragically, these are not new lessons:

• When are we going to learn that tougher gun laws are absolutely essential
• When are we going to learn that we must do more to address mental illness
• When are we going to realize that our sophisticated health care system, with its highly trained personnel (first responders, surgeons, nurses, interns who learn first aid), and life saving technology, can be the difference between life and death

Some say this is a wake up call. Is anyone listening?

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 Glenna Crooks. Robin has already wished everyone a Happy New Year. To those wishes, I add mine: a Healthy New Year, too!

Got plenty to clean off your desk? Probably.

A pile of papers, postponed ‘to do’ list items and accumulated emails? Likely.

Is that competing with New Year’s resolutions to exercise more?

Is it stressing you beyond your promises to remain calm, unruffled and Zen through 2011?

Are you already planning to postpone the workout (for just one day) and have some high fat, high calorie comfort food to relieve that stress (just for today)?

Tempting, even for me, trying to practice what I preach about prevention.

Maybe this will help: a reminder that health has a number of important contributions for us and the people we care for in the work we do. It brings them not only longer, better quality lives but also the ability to create economic security for themselves, their families and their nations.  Good health for us means likewise and helps us stay ‘on the job,’ addressing the challenges of working in today’s health care sector — piles of papers, unanswered emails, stress and all.

This is worth the time – piles of papers and all! It’s a wildly entertaining, short presentation on a value of health we rarely discuss…that of creating wealth.

Hans Rosling is a master – of data and communication about the value of health.

http://www.flixxy.com/200-countries-200-years-4-minutes.htm

If you like this one, though this next link will take you to earlier versions, you’ll find them additionally entertaining and informative….

http://www.ted.com/index.php/talks/view/id/92.

Happy and Healthy 2011 to you!

By Robin Strongin. 2010 was a very exciting and disruptive year in the world of health care. On March 23^rd the historic Patient Protection and Affordable Care Act was signed into law by President Obama.  Disruptive Women was right in the middle, weighing in on the debate and conversation.  We also kicked up some dust on other health care issues, framing, commenting, and providing insights and perspectives. We hope you found our blog a useful resource.

Stay tuned to us in 2011, we’ve got more ebooks and events planned. As always, we love to hear feedback from our readers. Don’t be shy about letting us know what topics you want us to cover.

On behalf of all the Disruptive Women best wishes for a healthy, happy and prosperous new year.

By Robin Strongin. From all of the Disruptive Women…