Health Business Blog

The next edition of the Health Wonk Review will be hosted next week on the Health Business Blog.

Please submit your post through the blog carnival submission website or via email.

Deadline is 9 am EST on Wednesday, November 4.

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Passing along this little nugget in case you want to nominate anyone:

Ashoka’s Changemakers is collaborating with the Pioneer Portfolio of the Robert Wood Johnson Foundation to launch a global search for “nudges” – innovative little pushes – that help people make better decisions regarding their own health and the health of others.

Nomination information is here.

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The massive stimulus bill, complete with health care IT provisions, is quickly working its way through Congress. Originally there was a provision to require that health IT spending be directed only to US-made products. Thank goodness that provision was stripped from the final version.

It’s worth noting that it was Republicans who insisted on this foolish requirement. Remember that next time you hear Republican criticism of Democrats’ trade policy.

It’s critical that the US implement the best health IT systems there are, whatever their country of origin. And we should be promoting free trade in order to achieve sustained economic growth, not protectionist measures that echo some of the worst policy errors of the Great Depression.

The best IT systems include US and foreign contributions. It’s inane to insist on “made in America” measures.

Unfortunately, similar “buy American” provisions remain in the broader stimulus package.

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From the Wall Street Journal: (FDA Warns on Dietary Product )

The Food and Drug Administration on Tuesday said consumers shouldn’t take the weight-loss pill “Venom Hyperdrive 3.0″ because it contains a potent chemical that can increase peoples’ blood pressure and heart rate.

The name of the product should have been enough to turn people away.

I wonder whether the 2.0 product is still ok…

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Health Business Blog welcomes you to Cavalcade of Risk #70!

Close enough for government work?

Healthcare Technology News wonders whether today’s electronic health record (EHR) systems are good enough to deserve government funding. MAeHC Blog complains that the health care IT bill working itself through Congress withholds 90 percent of the funding till 2011, under the assumption that today’s systems aren’t up to snuff.

Healthcare Economist says that a government-sponsored prevention-only health plan has merit, but overall he can’t endorse it.

Will they won’t they?

We might have major health reform this year if Pelosi and pals push it through, according to The Treatment.  Managed Care Matters is less sanguine –until and unless a broad consensus emerges.

When a worker is injured on the job, worker’s comp will pay for medical care and temporary wage replacement. Or will it? Check out Worker’s Comp Insider for details.

Risky schemes

High Variance explains the difference between risk and uncertainty. Conclusion: maybe the government should insure bad debts rather than nationalizing the banking system. Meanwhile Disease Management Care Blog differentiates “insurance risk” and “performance risk.”

Scott Wright’s Security Views suggests how to pose security questions to someone who calls you.

Quovax has a surefire method to spot companies that are ticking time bombs: outrageous comp for top execs.

Tribune is trying to stay together in bankruptcy to preserve a tax shelter, opines My Simple Trading System.

Issac Yassar says multi-level marketing schemes are scams and should be avoided. Funny that the context-specific ads on his site advertise free kits for instant government grants (“Get all the government grant money you need with this free grant kit!“)

Cars, pets and seminal analysis

Is pet insurance necessary? Insurance Toolbox says maybe. Bargaineering isn’t sure.

Want a reasonable car insurance premium? Skip the Hummer and go for the minivan, CrackInsurance advises.

If car makers have to suck up to Congress admitting that they screwed up and presenting plans to fix the mess, shouldn’t governors have to do the same for Medicaid? Some Republicans in Congress and Cato at Liberty think it’s perfectly logical.

Colorado Health Insurance Insider is not buying the argument that hair loss and infertility can be equated.

Good news and bad news

Coffee may help prevent Alzheimer’s, according to InsureBlog. After downing a cup, resist the urge to clean up your breath with mouthwash, an activity that may send your oral cancer risk skyrocketing, writes Raw Chef Dan.

A depression is a bad time to get cancer, especially if you’re counting on someone else to pay for treatment. Read all about it in The MedHealth Blog.

Thanks for listening!

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Check out the latest Grand Rounds at Chronic Babe.

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Pharmaceutical companies sponsor continuing medical education (CME) for physicians in order to boost the use of their own products. Pharma CME staff used to report to the marketing function within pharma companies. They justified their budgets by demonstrating a return on investment –which ultimately translated into the number of incremental prescriptions written. In recent years, most companies have shifted CME out of marketing in order to mollify regulators, but the intent to earn a return is still present.

Now the very concept of pharma-sponsored CME is under threat from those who are concerned about the extensive influence of the pharmaceutical industry on clinical practice.

A lot of physicians like pharma-sponsored CME. After all it’s free and nicely produced. A lot of companies (and universities) make a good living producing these materials. They don’t want to see the goose that lays the golden egg fly off.

Today PharmaLive reported on a survey of physician attitudes (Manhattan Research Survey Finds That Physicians Overwhelmingly Support Commercially-Funded Continuing Medical Education)

In an effort to better understand the positions of those who actually use continuing medical education, Manhattan Research surveyed physicians on their opinions with regard to their use and the potential bias of industry-funded programs. The Manhattan Research study reports that only 8% of physicians who participated in CME believe that it is biased…

If that’s really the case then it demonstrates that only 8 percent of physicians know what they’re talking about. Pharma-sponsored CME is definitely biased. For starters, it tends to be biased in favor of drug treatment, and in favor of treatment with newer, more expensive drugs that may not be better than older, cheaper ones. Not every single course is biased, but it’s silly to assert that bias isn’t present.

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I received this intriguing guest post submission and unlike a lot of the unsolicited stuff that comes my way this one struck a chord. I’ve heard some interventionists make some of the same points in unguarded moments and I definitely appreciate the radiation warnings.

One caveat: While the “progress road,” consisting of healthy eating and exercise habits is definitely a great idea, people have a tough time making the changes and sustaining them. In defense of the interventionists, at least they can be sure that their interventions actually occur!

The Great American Heart Hoax: Economic and Political Implications
By Michael Ozner, M.D.,
Author of The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will)

Cardiovascular care in America is spiraling out of control.  We are now spending more than one hundred billion dollars a year for treatment and management of cardiovascular catastrophes (heart attack, stroke and diseases of the vascular system).

In The Great American Heart Hoax I have outlined the problems of cardiovascular care in America that is draining our healthcare dollars and contributing to our financial collapse.  In addition, I point out key areas of wasteful spending on expensive and risky diagnostic studies and procedures that are of no benefit to the millions of Americans who fall prey to the cardiovascular intervention industry.

Examples of inappropriate cardiovascular care are summarized below:

1. Coronary angioplasty and stent insertion:  While coronary angioplasty (the opening up of a blocked artery with a catheter device) and stent placement can be indicated and potentially lifesaving in acute coronary syndromes such as heart attacks, utilizing this technology in stable patients who have coronary blockages is inappropriate and has never been shown to reduce the risk of future heart attack or prolong life as compared to more conservative therapy (lifestyle changes and medications as indicated).  Indeed balloon angioplasty and stent placement can often lead to an increase in cardiovascular morbidity and mortality compared to an intensive prevention approach.  Despite this fact the cardiovascular intervention industry continues like a freight-train out of control.  This year over one million stents will be inserted in patients across America and many of these procedures are clearly not indicated.

2. Heart bypass surgery (also called coronary artery bypass graft surgery): like catheter-based intervention, heart bypass surgery is clearly indicated in select unstable patients, however bypass surgery is over-utilized in the majority of  patients with obstructive coronary artery disease.  Major clinical trials have failed to show a benefit in clinical outcome in the vast majority of stable patients treated with bypass surgery.

3. CT-Scans:  While CT scans are often necessary in unstable patients in the emergency room as a diagnostic modality, the proliferation of this technology to screen Americans for coronary artery disease is inappropriate and leads to a depletion of our valuable health care dollars.    There is no evidence that subjecting yourself to a CT scan will lower your risk of having a heart attack or prolong your life.  Most disturbing is the fact that these procedures subject unsuspecting men and women to excessive radiation exposure which stays with them for a lifetime and increases their risk of cancer.  At the end of the day ask yourself the following question: do I need to pay a large sum of money and be bombarded with a significant dose of radiation just to be told to do what I should be doing anyway?   Follow a healthy-lifestyle with optimal nutrition, regular exercise, stress management and smoking cessation.

4. Avoid stress-nuclear studies:  As with CT scans, stress nuclear studies are expensive and lead to significant amounts of radiation exposure via intravenous radioisotopes.  These tests should be avoided in the stable population.  If a stress test is recommended with imaging why not choose a stress-echo study which is less expensive than a stress-nuclear study and utilizes harmless sound waves to provide similar information?

5. Cardiac catheterization:  Another expensive diagnostic tool that carries risk.  This risk is justified in unstable patients however this procedure should not be performed indiscriminately on stable individuals.

The Solution

There is a better road we can walk down that will provide us with a lifetime of heart health.   This road is called progress road and it costs a fraction of the journey down the dead-end road, with excessive interventions and diagnostic studies that don’t improve clinical outcome.  Progress road is truly the biggest bang for the buck!

Progress road utilizes prevention rather than intervention to keep us healthy and lowers our health care costs that cripple the financial health of America thereby impeding our ability to compete in a global economy.

It consists of:

1. A heart-healthy Mediterranean-style diet

2. Regular exercise:  30 minutes of walking should be considered a daily routine.

3. Stress management:  Simple techniques such as yoga, breathing exercise or relaxation response training can serve to lower our blood pressure and pulse and protect us from vascular insults such as heart attacks and strokes.

4. Control cholesterol:  Following a Mediterranean-style diet will significantly lower cholesterol levels in the majority of Americans.  Judicious use of medications such as generic statins could also be utilized if required.

5. Blood pressure control:  Blood pressure can be managed with lifestyle changes (Mediterranean diet, exercise, smoking cessation and stress management).  Blood pressure medication should be used in select patients if lifestyle changes do not achieve goal.

6. Avoid metabolic syndrome and diabetes:  again diet and exercise are key to prevent or reverse these conditions.

7. Achieve ideal body weight

8. Lower inflammation and oxidative stress: a Mediterranean diet, regular exercise, weight control, avoiding pollution and pesticides, good oral hygiene (daily flossing) all serve to lower inflammation and free radical induced oxidative stress that leads to cardiovascular disease.

9. Have a routine physical exam with comprehensive blood work: an ongoing relationship with your personal treating physician to discuss prevention strategies is key. Get the proper screening blood studies to uncover hidden risk of cardiovascular disease.

10. Avoid unnecessary procedures that increase the cost of medical care and do not lead to improved clinical outcomes.

At this critical juncture, we have to decide what is best for the health and wealth of the citizens of this country.  Will it be business as usual with indiscriminate utilization of diagnostic and interventional procedures that cost billions and don’t improve the overall health of Americans or do we want a health care system that is affordable and delivers preventive care that gives us the biggest bang for our buck?  I think the answer is clear.  The Great American Heart Hoax chronicles all that is wrong with our current health care system for cardiovascular treatment and it also delivers a concise, practical and clinically proven 10- step approach that can lead us to the promise land of affordable health care, fewer heart attacks and strokes and freedom from a misguided cardiovascular intervention industry that is sabotaging our financial and medical well-being.

Copyright  © 2009 Michael Ozner, M.D., author of The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will)

Author Bio
Michael Ozner, MD, FACC, FAHA,  author of The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will), is one of America’s leading advocates for heart disease prevention. Dr. Ozner is a board-certified cardiologist, a Fellow of the American College of Cardiology and of the American Heart Association, medical director of Wellness & Prevention at Baptist Health South Florida and a well-known regional and national speaker in the field of preventive cardiology. He is the medical director of the Cardiovascular Prevention Institute of South Florida and symposium director for “Cardiovascular Disease Prevention,” an annual international meeting highlighting advances in preventive cardiology. He was the recipient of the 2008 American Heart Association Humanitarian Award. Dr. Ozner is also the author of the BenBella Books title The Miami Mediterranean Diet.

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The health care IT section of the stimulus bill working its way through Congress looks pretty weak. The $20 billion number is big enough but unfortunately the timing and structure don’t make a great deal of sense.

Of the $20 billion, $18 billion is deferred until 2011, when it will start being offered as incentives to physicians who are already using EHRs. In other words, physicians have to invest their own money –and do so within the next few months– in order to be ready to start claiming the funds. It doesn’t strike me as realistic and it’s certainly not a near-term stimulus. It’s actually more like an unfunded mandate since it’s likely the availability of the $18B in 2011 on out will let Medicare and Medicaid pay lower rates than they otherwise would.

As Massachusetts eHealth Collaborative Micky Tripathi points out in his well-reasoned post, this is not a formula for success.

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Ezra Klein of The American Prospect was kind enough to link to my post on waiting lists in the US (Patient without a name, Waitlist without a number). (Maybe he was attracted by the literary reference.) In any case, Klein’s link proceeded to draw abusive comments and was then the subject of a post on Kayak2U Blog entitled Learning disabled. You will get some comic relief from reading the whole post, but here’s a taste:

Ezra Klein neatly encapsulates the sum total of his vapid incompetence in a single line link reference:

But I thought, in the U.S, we don’t have waiting lines!

Klein’s link goes to a David E. Williams, a medical biz consultant, who purports to undermine the argument that socialist health care leads to rationing and waiting lines by alleging that people in the U.S. already have to wait for health care.  (Briefly, let me point out that aside from any tangential arguments about whether socialist health care works better than free market care in some or any areas, the socialist model is morally wrong because it’s coercive at root and destructive of personal responsibility at the other end.  That it also, by most standards, fails, is merely ancillary.)  The trouble is, Klein either didn’t read past Williams’s shallow gloss, which seems like a stupid thing not to have done before shooting his mouth off, or he let bias cloud what little intellect he possesses, and failed to note the irony of trying to defend socialism by using examples of the failure of socialism, also not too smart.  Also, while it’s not preposterous to presume that Williams, whose business exists as a parasite of the health care industry, would stand to benefit from the institution of some sort of federally mandated health care scheme, Klein’s self-interest is a little harder to peg, but probably wells up out of that deep pool we call sheer ignorance.

The post is filed under “Commies” and “Incompetents.” At first that made me feel special, until I saw that many of the posts are tagged that way.

Kayak2U doesn’t seem to allow comments for some reason.

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