Health Business Blog

I’m hosting the upcoming Grand Rounds. Please submit your favorite post to me via email. The deadline is Sunday at midnight EDT. There is no theme.

Michael D. Parkinson, MD, MPH has had an interesting career. In this podcast interview, Dr. Parkinson describes how his experience as an Air Force physician taught him about how personal health behaviors and organizational culture impact health and health care costs. He explains why he left government service to become Chief Health and Medical Officer with consumer-directed health plan startup Lumenos, where he emphasized prevention and chronic care management. He also discusses his current role as President of the American College of Preventive Medicine.

Parkinson and I discussed the interaction between prevention and costs, the positioning of consumer directed plans as “high deductible” plans for the wealthy and well (something Parkinson doesn’t care for) and the role health care is likely to play in the general election.

 Interview with Dr. Michael Parkinson: Play Now | Play in Popup | Download

I interviewed Dr. Jason Yap at Consumer Health World in Las Vegas. He is Director of Healthcare Services at the Singapore Tourism Board and part of the multi-agency Singapore Medicine Initiative, the goal of which is to promote, develop and maintain Singapore as an international medical hub.

I first met Jason a year ago and he hosted me on a tour of hospitals in Singapore last summer. We’ve spoken in the past about medical tourism, but in this interview I focused on Singapore’s health care system and the potential lessons for the US.

Singapore spends less than 4 percent of its GDP on health care yet has universal access and produces outcomes that are as good or better than the US and other wealthy countries. Singapore’s health care financing bears some resemblance to consumer directed health care plans in the US, which should lend encouragement to those who see consumerism as a way out of the health care thicket.

One of the more interesting elements of the Singaporean system is free-market pricing. Providers set their own prices –just like providers of other services. The government focuses on making sure that the market mechanism is working well, but doesn’t dictate what the prices should be.

I’m not saying that the US should adopt the Singaporean model (and neither is Jason) but I do find it an intriguing case study.

 Podcast interview with Dr. Jason Yap: Play Now | Play in Popup | Download

Check out the latest edition of Grand Rounds, hosted at Suture for a Living. I’ll be hosting next week so feel free to email your submissions.

I’m at the Consumer Health World Conference in Las Vegas where I spoke today with Don Powell, PhD, President and CEO of the American Institute for Preventive Medicine, a for-profit wellness and demand management company that is celebrating its 25th year in business.

Don and I spoke about how the wellness field has evolved over time, how employers think about the benefits of wellness programs, and about the kinds of customization and integration that are required to achieve success.

 Interview with wellness expert Don Powell, PhD: Play Now | Play in Popup | Download

I’m at Consumer Health World in Las Vegas where I spoke today with David Hom, chairman of the board of the Center for Health Value Innovation.

David and I spoke about value based insurance design and health care consumerism. Hom would like to see consumers become CEOs of their own care and he believes we are at the cusp of using information technology effectively to enable consumers to adhere to their therapies.

The Center’s approach represents a clear departure from business as usual, but the concepts are strongly rooted in improving the existing employer-based model rather than overthrowing it.

 Interview with Center for Health Value Innovation's David Hom: Play Now | Play in Popup | Download

I’m at the Venetian Hotel in Las Vegas where I chaired a session entitled Facilitating the Patient Experience in International Medical Travel as part of Consumer Health World.

At the hotel I noticed an amusing twist on the usual no smoking sign. It read: “Please refrain from smoking except in gaming areas.” I guess one good habit deserves another.

Thanks to Mickey for this guest post.

I’ve had a salty taste in my mouth on and off for years, but in the past week it has gotten much worse. I thought this was a perfect subject for “Google Diagnosis”. Google Diagnosis doesn’t work very well for combinations of different complaints, but it can work well for a single complaint that hasn’t yet been collected into databases if the person has time to wade through a bunch of search results. This seemed perfect for figuring out a salty taste, and the logical starting point was to search the Web for “salty taste”. This leads to a variety of results, with #1 being from the Mayo Clinic, which noted several causes of salty taste, including “Side effect of certain medications, such as anti-thyroid medications and chemotherapy drugs.” However, my physicians haven’t recommended any medications for me in years except Vitamin D, but I’d noticed the salty taste before that. The Mayo article also suggested postnasal drip as a cause of salty taste, and since this is an allergy season that seemed timely, though implausible.

Search result #2 was a YourTotalHealth item written by a Stanford-educated doctor, but it didn’t offer much help.

A patient support site seemed perfect for such a problem, and result #3 was a SteadyHealth thread that went on for three years and was so long it was terminated with an announcement that “This topic is closed due to the having too many posts”. However, it offered no answer. The thread did have great descriptions of the salty taste: “when I took a big sip of water and thought that someone had tricked me by putting razy [sic] amounts of salt in my bottle”. The thread also had reports from many people that eating sweets worked temporarily to mask the salty taste, something noted on the Health Business Blog previously, that may be important for obesity research . However, it raised all sorts of unlikely causes of salty taste such as seizures and spinal fluid leaks from brain tumors, and described people getting all sorts of diagnostic tests, almost all negative. Many posters raised the possibility of common conditions associated with salty taste such as gastroesophageal reflux or postnasal drip, but people usually notice if such fluids are entering their mouth, one of the good points made in the YourTotalHealth item.

But a prominent salty taste in the mouth that keeps worsening over a week has a way of focusing the mind. It occurred to me that I’d been taking loratadine (the now-generic over-the-counter medication also sold as Claritin) for the past week. I searched for salty Claritin but only found descriptions of people taking Claritin to treat seasonal postnasal drip, including the protracted SteadyHealth thread in which someone wrote “It IS allergy season and I take Claritin every morning but still have the salty taste”. Others in the SteadyHealth thread reported snorting salty water to treat postnasal drip.

This didn’t seem to finger Claritin as the culprit, so I cast a wider net, searching for loratadine “side effects” taste, and found many entries referring to “altered taste”, apparently originating from the Claritin package insert, though curiously that warning was not found at Claritin.com.

This was not much to go on, but the obvious experiment to try was stopping the loratadine and seeing what happened. The salty taste went away. A lot of the taste went away the first day I didn’t take loratadine, and over the next two days it went away completely and allergic symptoms reappeared.

Loratadine is a very common medication and I wouldn’t be surprised if others with salty taste have the same problem. Since the drug is sold over-the-counter and people take it in spurts without consulting a physician, many would not even list it if their physician was evaluating them for salty taste and asked about their medications. Or worse, as suggested in the SteadyHealth thread, some people will think of the possibility of postnasal drip and take loratadine to treat the problem and end up making it worse.

Assuming that loratadine indeed turns out to be a common cause of salty taste, the Internet didn’t do very well. But clearly it will do better soon; I bet searches for “salty taste” in the future will include this post or information derived from it.

Health 2.0 is a hot topic, so no wonder a variety of companies are jumping on the bandwagon. Yesterday, iHealthBeat.org ran the story Social Networking Site Lets Patients Share Stories of Misdiagnosis based on an article in Wednesday’s HealthcareIT News Company launches ‘medical misdiagnosis’ social networking site. According to the HealthcareIT News piece:

Patients who have endured medical misdiagnoses have another social networking Web site where they can share their experiences.

Premerus, a Nashville, Tenn-based company that claims to be the nation’s only “diagnostic management” firm, has launched a Web portal - www.yourmisdiagnosis.com - as a way to help patients and their families address the impact of medical misdiagnosis.

Norman Scarborough, MD, Premerus’ medical director, said the company hopes visitors to the site will post their own experiences as a way of sharing insights about the impact of diagnostic errors on themselves, their families and the public…

He said yourmisdiagnosis.com offers opportunities to learn about several categories of misdiagnosis, read submissions from other consumers and submit anecdotes.

“Premerus has pioneered this online community to educate the public about misdiagnosis and provide support for patients and families,” said Scarborough. “It is often helpful to connect with others who may have encountered similar circumstances.”

It’s pretty obvious that the author didn’t bother to visit the so-called social networking website. If he had he would have seen that there is a total of 1 post, Misdiagnosed — Metastasized to Lung dated April 3, 2008. There are no comments or trackbacks (maybe this post will hit it!). Despite what Scarborough says about “several categories of misdiagnosis” there is in fact only one, “Misdiagnosis Experiences.” The Post Your Stories link is simply a link to an email address that a user can send a story to. There are no social networking features. It’s your basic, vanilla blog template with essentially no content.

Of course there is a big display ad linking to the Premerus website, which I guess is the whole point.

But before Premerus takes this criticism to heart and transforms the site into a real social networking site (or at a bare minimum gets some employees or PR people to post some stories, which you’d think they would have done already), let me be clear that I don’t think a social network for people who’ve been misdiagnosed is worthwhile in the first place.

I asked SimulConsult CEO Michael Segal, MD, PhD for his opinion:

From my experience, if people have been mis-diagnosed they identify with the smaller community of people who have the disorder that they actually have, not with the larger community of people who have been mis-diagnosed. A good example of such smaller communities is the Save Babies Through Screening foundation, which has all sorts of horror stories of mis-diagnosis, some of which I used in my article on the Differential Diagnosis of Child Abuse.

It would be great if there were a forum for the general class of mis-diagnosed people, but it seems more likely that one could be successful with a federation of smaller sites about particular disorders. Such disease-specific groups tend to work with professional societies to educate doctors to prevent mis-diagnosis in the future. We’ve seen some interest by such groups in providing cases for the Child Neurology Society’s case-based education program for residents.

Change of Shift, the nursing blog carnival, is up at Life in the NHS.