Don’t have a hot attack: Framingham Heart Study carries on

fhsWhat is up with the Framingham Heart Study? That long-running research project has been tracking the cardiac health of hundreds of local folk for decades.  (The algorithm used to estimate the 10-year risk of heart disease is called the “The Framingham Risk Score.”)

A story and a blog post recently reported woefully about a 40 percent sequester cut to the study’s National Institutes of Health funding.  Neither quoted anyone from NIH.

So, both pieces failed to note that the cut is to the study’s administrative grant from the National Heart Lung and Blood Institute, not its research grants.  According to BU, the study receives an estimated $5.4 million in NIH grants for research. This funding is not impacted by the 40 percent cut.

In other words, the cuts come from the money used to run the program – office staff, data collection and the management of study subjects, not the scientific research projects that fall under the program’s umbrella. The data collected from the locals helps researcher understand the mechanics and, more recently, the genetics of heart disease as it impacts the rest of us.

In total, NIH says it will spend $21 million this year contracts for the FHS study infrastructure – including a study looking for biomarkers for heart disease. In addition to funding the BU research, NIH says its grants cover 17 FHS related studies at eight different organizations and universities. In addition to the Heart Lung and Blood institute, that money comes from five other NIH institutes and centers, including the National Institute on Aging, The National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Neurological Disorders and Stroke.

None of this was clear in this first, July 20 story from the Metro West Daily:

The Framingham Heart Study expects to lose $4 million in funding as part of the federal budget cuts known as sequestration, study officials confirmed Friday in a statement. The $4 million cut takes effect Aug. 1 and represents 40 percent of funding it receives from the National Heart, Lung and Blood Institute (NHLBI), a division of the National Institutes of Health, the statement said.

 The story quotes a spokeswoman from Boston University, which is home to the study.

The cut with “result in a reduction in workforce affecting 19 staff from a variety of clinical and administrative areas, as well as reductions in clinic exams and lab operations.”

Then it quotes from a statement about NIH cuts in general from new Sen. Ed Markey:

“Slashing critical federal investment in medical research jeopardizes the health of many Massachusetts residents, while putting at risk tens of thousands of jobs in the commonwealth’s innovation economy and the industries they support,” Markey said. 

Then it quotes from Karen LaChance, a Framingham resident and president of the Friends of the Framingham Heart Study.

“We just hate to see any cut. It delays hopefully finding whatever the magic bullet might be to prevent heart disease.

Then it doesn’t quote anyone from NIH.

In a post on the Metro West Daily story,  WBUR’s CommonHealth blog offers the headline “Famed Framingham Heart Study Faces Deep Cuts From Federal Sequester.”

It was a “Say it isn’t so” moment this morning when I saw this MetroWest Daily News headline: Framingham Heart Study Faces $4 Million Cut. “Heart disease is the country’s number 1 killer, and chances are whatever you do to prevent it or treat it was influenced by the Framingham Heart Study, a venerable epidemiological gem right here in our own Boston suburbia….”

But, you could argue that it ain’t so.

As far as the impact of the cuts, Metro West Daily quote  BU as noting that “This loss of funding will result in a reduction in workforce affecting 19 staff from a variety of clinical and administrative areas, as well as reductions in clinic exams and lab operations.”

BU tells us that approximately 80 people work at the FHS. “The affected staff will see a reduction in hours beginning Aug. 19; if alternative funding sources are not identified, a layoff would occur Nov. 1. “

The FHS site was a little clearer on all this, with note on its home page:

New Information for FHS Participants edited July 20 2013

Q. Is the FHS closing?
A. No. The current Offspring and Omni Group 1 exams are continuing to Oct. 31, 2013. Ancillary studies are continuing as planned. Medical history updates are being collected on the regular schedule. Please respond to calls for FHS participation as usual.

By Wednesday August 1, BU had posted its own story on the BU Today website with the headline: “Framingham Heart Study Carries on, Despite Budget Cuts: 65-year-old core contract loses 40 percent of funding.”

NU prof in NYTimes: Can meditation teach manners?

Update 7/18 :The folks at WGBH’s Boston Public Radio took calls after an interview with David DeSteno, the author of this meditation study. Note:  Jim Braude does not mediate: his co-host Margery Eagan does.

7/7: This piece in the NYTimes magazine, “The Morality of Meditation” is of interest for two reasons. It was written David DeSteno is a professor of psychology at Boston’s Northeastern University. And, this reporter has spent the past five weeks in a brace and on crutches with a fractured tibia plateau — top of the shin bone. Anecdotally, that 16 percent of people would give up a seat for a person on crutches seems about right.

bll-leg-pix-web Buddha: “I teach one thing and one only: that is, suffering and the end of suffering.” For Buddha, as for many modern spiritual leaders, the goal of meditation was as simple as that….

Here’s how they tested that concept:

When a participant entered the waiting area for our lab, he (or she) found three chairs, two of which were already occupied. Naturally, he sat in the remaining chair. As he waited, a fourth person, using crutches and wearing a boot for a broken foot, entered the room and audibly sighed in pain as she leaned uncomfortably against a wall. The other two people in the room — who, like the woman on crutches, secretly worked for us — ignored the woman, thus confronting the participant with a moral quandary. Would he act compassionately, giving up his chair for her, or selfishly ignore her plight?

The results were striking. Although only 16 percent of the nonmeditators gave up their seats — an admittedly disheartening fact — the proportion rose to 50 percent among those who had meditated.

BHN Report: On MV, Berwick takes a break from his break to comment on Ryan Medicare plan, new film

                Former Medicare chief Donald Berwick was present both on and off the screen for a Thursday Martha’s Vineyard showing of a new film on the health care system. Berwick, who spends part of his summer in Chilmark, was fresh off an interview with WBUR’s On Point call-in show. So, he was ready to comment on the Medicare voucher plan proposed by Republican Vice Presidential candidate Paul Ryan.

            Berwick thinks the addition of Ryan to the ticket will be good for the debate over the Medicare budget.

            “You see Romney trying to explain the Ryan plan. I think it will help clarify the difference in viewpoints,” between the two parties, he said.

            At the same time, Berwick noted that issues surrounding Medicare are complicated – he admited that he had study up on some technicalities when he took over the national health plan for the elderly for a year.  So, voters are already hearing a lot of “irresponsible rhetoric” and one-liners, he said.

            As it turns out Romney and Ryan were also in New England this week– talking about Medicare during yesterday’s campaign stop in New Hampshire. The Boston Globe reported that Ryan said he invites a debate on the plan. He characterized Obama’s approach this way:        

            Mitt Romney and Paul Ryan, campaigning in a state with a median age higher than Florida’s, criticized President Obama on Monday morning for his health care law and said the Republican ticket would be more likely to put Medicare on sounder financial footing.

     “Medicare should not be a piggybank for Obamacare!” Ryan said.

      Romney and Ryan charge that the health reform law takes $750 billion from Medicare to pay for the new health law.  Berwick said that’s “not really true.” The changes in payment are designed to promote changes in the way care is delivered, he said. “It doesn’t take a nickel away from beneficiaries. The Ryan plan is the one that takes money away from beneficiaries by putting them at risk. “

      The Ryan plan cuts Medicare by setting up a voucher system, he said. Instead of a guaranteed benefit, the approach would become a guaranteed payment in the form of a voucher. It cuts the budget, Berwick noted, by telling beneficiaries – “It’s your problem now.”

     Interest in the topic drew a full house to see Escape Fire: The Fight to Rescue American Health Care in a small viewing room in Edgartown’s Harbor View Hotel. (The title refers to a method firefighters use to avoid being burned by a wildfire.) The movie offers a beginner’s overview of the problems facing the health system, as well as three engaging stories of people coping with them.   The subjects – interspersed between talking heads — include a doctor, a soldier and a victim of grossly excessive treatment for heart disease. Judging from the gasps from members of the audience, familiar facts about problems like medical errors were new to them.  “Disturbing,” one woman leaned over and whispered to the companion.

            Besides Berwick and Steve Nissen of the Cleveland Clinic, the commnetators in the  film did not represent the usual suspects. Most people associate Andrew Weil and Dean Ornish with healthy lifestyles, not systemic change. Still, they spoke to the need from more preventative care. (The audience seemed to agree. A heart attack patient opening a can of Vienna sausages and smoking a cigarette generated the loudest groans.)

             Berwick also offered something different. Instead of demonizing doctors and drug companies, he doesn’t blame any of the players, who are working within the system as it stands.   

            “They’re just doing what makes sense,” he said. “We have to change what makes sense.”

FDA says – Ask yourself, your doc: Should I take drugs for #osteopenia, #osteoporosis or bone loss?

Twelve years ago, a Boston Globe story raised doubts some Canadian researcher had about bone scans for the diagnosis of osteoporosis. It was a scary story to write.  Doctors, some patient advocacy groups, researchers and drug makers were enthusiastic about the new-found ability to measure bone density and the development of bisphosphonates like Fosamax to treat it.  Osteoporosis was under-treated, they said. Still, it seemed the concerns needed to be explored.

Now comes this from the FDA, which rarely uses The New England Journal of Medicine as a forum .

The long-term safety and efficacy of bisphosphonate therapy for osteoporosis are important concerns for the Food and Drug Administration (FDA). In response to postmarketing reports of rare but serious adverse events associated with bisphosphonates, such as atypical femur fractures, osteonecrosis of the jaw, and esophageal cancer, the FDA performed a systematic review of long-term bisphosphonate efficacy. The findings, summarized here, were presented at a joint meeting of the FDA Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Committee.1 The committees jointly recommended that bisphosphonate labeling be updated, although there was consensus that the data did not support a regulatory restriction on the duration of drug use.

In an unusual move that may prompt millions of women to rethink their use of popular bone-building drugs, the Food and Drug Administration published an analysis that suggested caution about long-term use of the drugs, but fell short of issuing specific recommendations.

Specialists differ on the value of tests for bone density

By Tinker Ready Globe Correspondent 4//25/00

When Winchester gynecologist Robert Shirley does an ultrasound bone scan of a patient’s heel, the news he delivers  is often less than comforting.      Based on the heel scan, which measures bone density in the foot, Dr. Shirley diagnoses 1 in 3 of his older patients with either osteoporosis or osteopenia, the bone-thinning disease that is common in aging women and
also affects some older men.

“It’s a very helpful tool to make them realize that osteoporosis is real, and they need to think about it,” said Shirley.

Certainly, few women will fail to take notice when they hear they have a disease that may lead to brittle bones, a hunched back or “Dowager’s hump,” and painful, disabling fractures. As frightening as the diagnosis sounds, however, it does not always lead to serious fractures _ the most severe of which is  hip fracture _ and the bone scan itself cannot  accurately predict who will get hip fractures, or even fully measure bone strength.       Still, osteoporosis is now defined by bone density, even though density only accounts for about 70 percent of bone strength. Other factors _ such as the actual shape, structure and size of a bone, and the presence of tiny cracks know as “microdamage” _ seem to factor in as well.       But these things are not measured by bone scans. And, when it comes to hip fractures and the elderly, a person’s risk of falling seems to play as much of a role in fracture risk as does bone density.

So, when a group of scientists convened by the National Institutes of Health met for three days in late March to review the most current data on the diagnosis and treatment of osteoporosis, they declined to endorse the bone scan as a screening test for osteoporosis. In its March 29 consensus statement, the panel noted that the risks for osteoporosis _ as reflected by low bone density _ and the risks for fracture, overlap but are not identical.

In addition, the panel expressed concern that different bone scanning devices and techniques produce conflicting results. A committee of scientists is working on a plan to standardize the tests, but right now, an ultrasound bone scan of the heel might indicate osteoporosis, while an x-ray scan of the spine may not. And even though bone loss can accelerate at menopause, tests in women under the age of 60 are particularly weak at predicting hip fractures.

“There are other things outside of bone density that we may want to measure to better improve our prediction of fracture risk,” Mary Bouxsein, an instructor in the Orthopedic Biomechanics Laboratory at Beth Israel Deaconess Medical Center told the panel.

This is in stark contrast to what many doctors and advocacy groups say about bone scans and osteoporosis. Many see the disease as a silent epidemic that goes undiagnosed in millions of women.  The National Osteoporosis Foundation cites an alarming list of statistics to drive that point home: 28 million people either have the disease or are at risk, and half of all women will suffer a fracture of the spine, hip or    wrist during their lifetime.

The group recommends bone scan screening for all women over 65, has lobbied Medicare to cover the test, and is now pushing for mandatory private insurance coverage.

Bone scans are not perfect, but they are the best tool available to identify women with the disease, said Conrad Johnston, director of the Bone Studies Laboratory at Indiana University, who is the current president of the National Osteoporosis Foundation.

“Everybody who has high cholesterol doesn’t have a heart attack, and everyone who has low bone mass doesn’t have a fracture.   But for many women, he said, “low bone density is the single best predictor of who will    fracture.”

So should women just ignore this? The pharmaceutical industry certainly isn’t. The makers of bone building drugs are active in promoting bone scans. Merck, which makes Fosamax, recently ran ads in magazines like Good Housekeeping and Parade encouraging healthy women to seek testing. Warning that undiagnosed osteoporosis can lead to broken bones or the disfiguring Dowager’s hump, the ad equates the simple, painless bone density test with mammography to detect breast cancer.

Osteoporosis is serious business for many who have it. According to the National Osteoporosis Foundation, the disease causes 1.5 million fractures annually, about half of them in the spine. Spinal fractures can cause a range of symptoms; some people may feel nothing at all, others may have back pain, and yet others may develop the Dowager’s hump.      The scientific data on the incidence and severity of spinal fractures is incomplete. But, all agree that the hip fracture, which strikes about 300,000 people per year in their 70s and 80s, can be a devastating and sometimes deadly event.  About 30 percent of older people who fall and break a hip end up in a nursing home.      Bone density contributes to hip fractures, but so does a long list of other factors including age, low body weight, smoking, mobility, exercise habits, and poor eyesight, which can make someone more vulnerable to falls, says Dr. Arminee Kazanjian, the director of the British Columbia Office of Health Technology Assessment.

After reviewing years of research into bone mass and fracture, her agency released on of the most scathing critiques on the use of bone scans. It concluded that as many as 70 percent of the women who eventually break a hip will not be diagnosed at menopause with osteoporosis, if that diagnosis is based on a bone scan alone. And, only half of the 30 percent of women identified as having osteoporosis or osteopenia will go on to have a fracture.

“The important health outcome is bone fracture,” said Kazanjian. “Bone mineral density is a minor factor. Any other combination of factors is much more important.”  Rather than rely on the bone scans alone to diagnose osteoporosis,    Kazanjiam and others suggest that doctors focus on the other factors that contribute to fracture risk.     For example, a woman with low bone density, but who doesn’t smoke (which contributes to thinning bones) and has good eyesight, may be less likely to break a hip than a woman with high bone density who uses a walker and has a family history of fractures, she said.
Amy Allina of the National Women’s Health Network, a Washington,  D.C.-based advocacy group, says that women who are told they don’t have  osteoporosis based on a bone scan alone may not take steps to prevent the  falls that cause hip fractures, even though they may be at risk. And those  whose bone scans indicate that they have osteoporosis may spend years on medication, even though they may never have broken a bone.

That’s a problem, Allina said, because the treatments for osteoporosis themselves come with risks. Hormone replacement therapy, which millions of women take to both treat and prevent osteoporosis, can increase a woman’s odds of developing breast cancer. And Fosamax, a non-hormone drug that builds bone,  irritates the throat and its long-term effects are unknown.

A 1993 decision by a World Health Organization panel set the stage for the bone scan to inadvertently become a routine diagnostic test for osteoporosis. The panel established a scale _ based on the average bone density of a premenopausal woman _ that allows doctors to measure bone loss, diagnose osteoporosis, and establish fracture risk.     The average 55-year-old woman has a 15 percent chance of breaking her hip someday. If her bone density is 1 point below the WHO average, she is defined as having osteopenia, a level of bone thinning that increases the lifetime risk of hip fracture by 20 to 45 percent. Osteoporosis is diagnosed when bone density falls 2.5 points below the WHO average. This, by some measures, raises the risk of hip fracture to greater than 45 percent.         Brigham and Women’s Hospital in Boston recently produced a detailed set of osteoporosis diagnosis and treatment guidelines for its patients and doctors. The guidelines don’t endorse bone scans to be used as screening tools alone, but they advise doctors to recommend bone scans to all women over the age of 65.
Dr. Robert Barbieri, chairman of the Department of Obstetrics and Gynecology at Brigham and Women’s, sees the bone scan as a useful tool but  he emphasized that a diagnosis of osteoporosis should not be based on the test alone. He says he is confident that doctors are considering other factors when assessing a patient’s bone strength and risk of a fracture.
“They use history and physical exams and laboratory tests in an integrative way and pull them all together,” he said.

But Mark Hefland, a researcher at the Oregon Health Sciences University, told the NIH pane that doctors are relying too heavily on bone scans, even though many of them admit that they don’t understand how bone scan scores relate to fracture risk.

“However we may like it, this is how diagnosis is occurring in everyday practice,” said Hefland, the director of the school’s Evidence-Based Practice Center.

Dr. Shirley of Winchester says he relies on bone scans to diagnose osteoporosis, but said that he also spends a lot of time with patients talking about fracture risk and alternatives to drug therapy like increasing weight-bearing exercise and boosting calcium intake.     But according to Diane Saparoff, who runs a monthly support group for women with osteoporosis at the Jenks Senior Center in Winchester, Dr. Shirley’s approach differs greatly from that of other doctors.

“Many of  the doctors order these tests but there is no follow up,” she said. The
doctors often don’t explain the test scores or help women come up with a fracture prevention plan, she said. “They just throw Fosamax at them.”

Dr. Johnston of the National Osteoporosis Foundation acknowledges that some doctors may be relying too much on bone scans to diagnose
osteoporosis. “I think that’s probably happening but it shouldn’t be,” he said. “This is a reasonably new area. Bone mineral measurements have only been around for about 10 years. Its takes a while for people to get up speed.”

Report lists ways to avoid injuries

A recent report from the National Institutes of Health offers advice on how to build and maintain strong bones:

*Get adequate calcium and vitamin D both early in life and throughout adulthood.

* Engage in regular exercise; it contributes to the development of peak bone mass and may reduce the risk of falls in older individuals.

*As needed, use drugs that enhance bone mass; medications have been been shown to reduce the risk of osteoporotic fractures.

In addition to regular exercise, there are several steps seniors can take to avoid falls, according to the National Center for Injury Prevention and Control:

* Use non-slip rugs and bath mats. Put grab bars in the  bathroom and handrails on the stairs.

* Ask your doctor to review medicines that may cause drowsiness or
confusion when combined with others you may be taking.

*Stay current with eye exams.

–Tinker Ready

This story ran on page D01 of the Boston Globe on 4/25/2000.

What are #Harvard docs and #medical school students reading? Countway tweets tell all #library

The Countway Library at Harvard Medical School has a twitter account listing the books Harvard students, docs and profs return. Here are a few samples.  “Cooper:Therapy dog” seems popular, as do books by Paul Farmer of Partners in Health. For more see @HMSreturns.

History, memoir and colons

Medieval technology and social change by  Lynn Townsend White http://bit.ly/cuu1A8

Alfalfa to ivy : Memoir of a Harvard Medical School dean by  Joseph B. Martin http://bit.ly/wh12DD

Alice Hamilton: Pioneer doctor in industrial medicine by  Madeleine P. (Madeleine Parker) Grant http://bit.ly/IorK5q

The puzzle people : Memoirs of a transplant surgeon by  Thomas E. (Thomas Earl) Starzl http://bit.ly/v7zyjw

The mentally ill in America : A history of their care and treatment from colonial times by  Albert Deutsch http://bit.ly/IpxTlb

Power, sex, suicide : Mitochondria and the meaning of life by  Nick Lane http://bit.ly/iMoUZh

On the pill : A social history of oral contraceptives, 1950-1970 by  Elizabeth Siegel Watkins http://bit.ly/mJgZpX

Subjected to science : Human experimentation in America before the Second World War by  Susan E Lederer http://bit.ly/GWc9jq

Secrets?

Ophthalmology secrets in color http://bit.ly/ioWQHk

Trauma secrets http://bit.ly/Iqm91S

Dental secrets http://bit.ly/qlDxjJ

Med School

Assessment measures in medical school, residency, and practice : the connections http://bit.ly/Iqaikk

So you want to be a brain surgeon? http://bit.ly/ItC6oo

The Washington manual internship survival guide by  Grace A Lin http://bit.ly/A2JnkM

Iserson’s getting into a residency : a guide for medical students by  Kenneth V Iserson http://bit.ly/z47UNY

Diversity

Shattering culture : American medicine responds to cultural diversity http://bit.ly/GDhmrq

Health issues in Latino males : a social and structural approach http://bit.ly/zBRdWe

Race, ethnicity, and health : a public health reader http://bit.ly/dbx8jT

Not too medical

Gold: recovery, properties, and applications by  Edmund M. (Edmund Merriman) Wise http://bit.ly/JeDPM7

Hair transplantation http://bit.ly/JdZoiA

Etc

[Cooper : therapy dog] http://bit.ly/k7raF1

Better than well : American medicine meets the American dream by  Carl Elliott http://bit.ly/rGjxBK

How to

Electroconvulsive therapy : a guide for professionals and their patients by  Max Fink http://bit.ly/IofP7E

Schmidek & Sweet operative neurosurgical techniques : indications, methods, and results http://bit.ly/Io6L2C

Fundamentals of clinical trials by  Lawrence M. Friedman http://bit.ly/xGnSoF

Pocket medicine http://bit.ly/Io5DMl

Introduction to anesthesia; the principles of safe practice by  Robert Dunning Dripps http://bit.ly/HZwUXf

Janeway’s immunobiology by  Kenneth (Kenneth M.) Murphy http://bit.ly/rumf5h

Good general practice http://bit.ly/z56Nuq

Next generation microarray bioinformatics : methods and protocols http://bit.ly/HtuRsP

Bethesda handbook of clinical oncology http://bit.ly/qjBZ8M

The breath, and the diseases which give it a fetid odor : with directions for treatment by  Joseph W. (Joseph William)  http://bit.ly/ItDmrD

Sapira’s art & science of bedside diagnosis by  Jane M Orient http://bit.ly/tMxL9g

Outdated?

Callous disregard : autism and vaccines — the truth behind a tragedy by  Andrew J Wakefield http://bit.ly/HWH0vw

New York Times profiles Harvard cognitive psych prof Elizabeth Spelke and BHN baby enrolls in one of her experiment

The Times’ “Profiles in Science” feature seems to favor Harvard types. Today’s offers a video and story on cognitive psychologist Elizabethe Spelke. If you’ve had a baby in the Boston area any time in the past 15 years or so, you probably got a letter from a lab like hers asking if scientists could use your tot for research. (We took her up on it — more on that later.)

From the Times:

Dr. Spelke studies babies not because they’re cute but because they’re root. “I’ve always been fascinated by questions about human cognition and the organization of the human mind,” she said, “and why we’re good at some tasks and bad at others.”       

But the adult mind is far too complicated, Dr. Spelke said, “too stuffed full of facts” to make sense of it. In her view, the best way to determine what, if anything, humans are born knowing, is to go straight to the source, and consult the recently born.       

Decoding Infants’ Gaze

Dr. Spelke is a pioneer in the use of the infant gaze as a key to the infant mind — that is, identifying the inherent expectations of babies as young as a week or two by measuring how long they stare at a scene in which those presumptions are upended or unmet. “More than any scientist I know, Liz combines theoretical acumen with experimental genius,” Dr. Carey said. Nancy Kanwisher, a neuroscientist at M.I.T., put it this way: “Liz developed the infant gaze idea into a powerful experimental paradigm that radically changed our view of infant cognition.”       

Note that the story includes a comment from Steven Pinker – another Harvard prof  profiled by the paper — who famously debated Spelke over the whether gender differences are learned or, to some degree, innate. Also note that The New Yorker profiled Spelke in 2006.  

Bombarded with letters from Spelke and other researchers after my son was born, I decided enroll my son in one of her studies. He got a shirt and a tippy cup. I got a story, which ran in The Boston Globe.

Health Wonk Review: Wearing the Green for the St. Patrick’s Day Edition

Here in Boston, researchers have looked into that most pressing of St. Patrick’s Day health questions: Is Guinness really good for you? Red wine gets all the press, but Tufts researchers found a positive association between beer and bone density.

For this edition of the Health Wonk Review, we take a a look at the Irish Times and find that even with a national health plan, Ireland has to deal with barriers to care. One story details slow progress in the establishment of promised primary care centers, and another story, asks “Is the EU good for your health?”

So, while we refight the battle over birth control, the Irish health ministry – of the largely Catholic country — is releasing a “sexual health” app.

Back here in the new world, the great grandchildren of Irish immigrants celebrate their heritage as Linda Leu at the Health Access Blog writes about a report that “highlights the need for cultural competency and language access, to welcome all ethnicities from California (and America’s) diverse communtiies….The Importance of Equity in the Bridge to Reform: As St. Patrick’s Day celebrates Irish ethnic pride, we need to take note of the full diversity of our states and nation. As we get ready for 2014, remember the communities that will be newly served may not look (or speak) the same as those that the current system serves.” 

For the once-a-year step dancers,Gary Schwitzer at Health News Review answers questions about outcomes data on knee replacement surgeryAlso see posts on the JGIM paper on  data on  shared decision-making in prostate cancer surgery & coronary stents decisions   and an online “Daily Deal” coupon for preventive MRI scan – disease-mongering du jour

Boston’s own David Williams notes: “Profits are up at Massachusetts health plans –should you be upset? On his Health Business Blog, he writes: The Globe reports higher profits and CEO compensation at Massachusetts health plans. But profit margins are low and if anything the CEOs are underpaid.”

More of the best of recent health policy posts

At The Hospitalist Leader, Brad Flansbaum examines physician pay,fairness, and how it relates to the reinvigoration of primary care. Specialty physicians take note.”

Another post on health care providers — and their support teams – notes: “There’s been much discussion of the potential impact of health reform, aka Obamacare, on employment”  Joseph Paduda at ManagedCareMatters.com writes: “Most has referenced employers cutting jobs to avoid the mandate or save dollars for premiums.  What hasn’t received much attention are the new jobs – mostly high-paying ones- that will be created as more Americans are insured and seek coverage and care.”

Julie Ferguson of Workers’ Comp Insider asks “If you had to guess what workplace experienced most assaults by customers/patrons what would you guess? If you guessed healthcare, you would be right.” She informs us that 61% of all workplace assaults are committed by healthcare patients, according to a recent report issued by NCCI.

Two posts came in on shady practices.

Colorado Health Insurance Insider offers: Colorado AG Files Lawsuit Against Discount and Mini-Med Health Plan:  “It’s a pretty typical website for that sort of product, with lots of great-sounding claims and sample cases where members have supposedly saved thousands of dollars.  But they also have a link for people who want to “become a reseller”.  And their process of getting recruits enrolled to sell the product is what has come under the watchful eye of the Colorado AG.”

 Calling it “The latest example of misbehavior by a large health care corporation,”  Roy M. Poses at Health Care Renewal writes : Gentiva’s Odyssey Healthcare Settles Again, Signs Yet Another Corporate Integrity Agreement and gets “little more than a financial wrist slap.  The case was about allegations that a for-profit hospice enrolled patients who did not meet the regulations for federal reimbursement for hospice care.  In particular, they were alleged to be patients who really did not seem to have extremely limited life expectancies.  It is true that enrolling such patients lead the government to pay more for their care than might otherwise be the case.  But the real problem is that patients may have been denied treatments that could have improved, or even lengthened their lives. 

Two on workplace wellness:

Wellness Program Implementation at WCS Looks a Lot Like Dating” says Kat Haselkorn Corporate Wellness Insights. This post details the similarities between customer satisfaction and romantic relationships. Although wellness program implementation and dating do not seem to have much in common, we have found that the process of making a client happy mirrors the act of keeping a romantic prospect satisfied. When it comes to setting up a wellness program, we do whatever it takes!

Henry Stern, LUTCF,  at the CBC InsureBlog writes about “Health vs Common $ense, challenging “the conventional wisdom that workplace health promotion programs work.”

And two on HIT:

“Competition today in healthcare encourages care providers to hoard patient data.”  says Vince Kuraitis of the  e-CareManagement blog in a post called “Stage 2 MU Rules : The proposed Stage 2 Meaningful Use rules support moving competition in healthcare to the right bases — sharing and adding value to patient health record data.

Health Affairs offers a post by Danny McCormick, of Harvard Medical School and the Cambridge Heath Alliance, and coauthors David Bor, Stephanie Woolhandler, and David Himmelstein. The title of the post is  “The Effect Of Physicians’ Electronic Access To Tests: A Response To Farzad Mostashari

The four authors of the post are also the authors of an article in the March issue of Health Affairs. The article reported that electronic access to computerized imaging results (either the report or the actual image) by physicians was associated with a 40% -70% increase in imaging tests, including sharp increases in expensive tests like MRIs and CT scans; the findings for blood tests were similar. The article prompted a critical blog post by national health IT coordinator Farzad Mostashari.

Jason Shafrin writes: “Americans are a litigious culture.  The malpractice claims that make it to court, however, are not many as you may think.The Healthcare Economist explains why.

Finally, how does health care In the U.S. compare to other countries?  On the Disease Management Care Blog  Dr. Jaan Sidorov tests our knowledge of and finds: We’re not so bad after all!

So, our days of drinking black — or green  — beer are over. But, on Saturday I’ll boil up some cabbage and — sorry Walter Willett – and a hunk of  corned beef in honor of my Irish nanny and the Readys and Gradys  and Murphys who left their green shores and made their way across the sea to settle in Boston and New York.  Happy St. Patrick’s Day from BHN.

 

Occupy Health Care: Boston protesters say Wall Street makes them sick

While health reform may not be at the top of their agenda, some of the Occupy Boston protesters down at Dewey Square had no problem linking the high cost of medical care to their complaints about Wall Street.  Some support Obama’s reforms; others called for a single payer system. But, nearly everyone interviewed had universal health care on his or her list of demands.

Even MIT professor Noam Chomsky said  the health care system is tainted by what he described as a government dominated by private corporations. Speaking on Saturday night, he told the crowd that the  federal budget deficit could be eliminated if the US had a health care system like other countries in the developed world — presumably single payer.

Medicare itself is not the problem, he said.

“It’s a problem because it goes through the privatized, unregulated system,” he said. “It is totally dysfunctional. You can’t talk about this in Washington because of the power of the financial institutions. “

More from the rank and file below.

Report: Heroin overdose deaths down in Massachusetts

The Globe offers an advance on a Boston substance abuse survey that reports a decline in city heroin overdose deaths from 2007 to -2008.  The state also reports a drop in the same period, after a two-year spike in overdose deaths.

Click below for a 2010 radio report from Boston Health News on the program that distributes overdose prevention drugs to users. Both the city and the state credit the program for the drop in fatalities.

For more on the Narcan program, listen to this September 2010 report:

http://www.prx.org/pieces/54390

or

http://tinkerready.files.wordpress.com/2011/06/troverdose.mp3

From the Globe

Deaths from heroin and  opiate abuse plunged in Boston after the city launched a controversial program in 2006 that supplies addicts with medicine to reverse their overdose, according to a report to be released today by the Boston Public Health Commission.

The report says the death rate dropped by 32 percent between 2007 and 2008, the most recent year for which data are available – a decrease that specialists said bucks the national trend.

Since 2006, the city has distributed the overdose drug Narcan to 2,080 people and has recorded 215 cases in which overdoses were reversed, a city health official said yesterday.

Opioid overdose  deaths were down statewide over the same time period, 2007 to 2008. From the state Bureau of Health Information, Statistics, Research, and Evaluation:

Opioids, including heroin, oxycodone, morphine, codeine, and methadone, continue to be the agent most associated with poisoning deaths (69%). This year there was a drop in the number of opioid deaths—43 fewer deaths, from 637 to 594. While this change did not achieve statistical significance, it is important to note that this drop may reflect the effectiveness of the Departments focused efforts to reduced opioid overdoses, including the OpioidOverdose Prevention and Reversal Program, which began in 2008.

June 2011 Health Wonk Review: Hockey, hoodlums and hot rod angels

Welcome to the Big Men edition of HWR. Congratulations to the Stanley Cup winning Boston Bruins. Good-bye to Big Man Clarence Clemons, Springsteen’s sax player and side man, who died last week after a stroke. And hello to Whitey Bulger, the Boston crime boss captured last night after 16 years on the run.

Wingers: Politics

Joe Paduda explains: Why health reform will not be repealed at Managed Care Matters.  He writes: “Once people again actual real-life experience with a government program, they abandon their fear of the unknown, see its benefits more clearly, and become invested in its future.We’ve seen that with Medicare, which consistently pleases its beneficiaries. Part D has similar traction, and now we’ve learned that the citizens of Massachusetts are increasingly happy with that state’s health  reform.”

Jared Rhoads interviews Sally Pipes on doctors, students, and activism at The Lucidicus Project. A free-market advocate, Pipes, head of the Pacific Research Institute, says medical students are being ”indoctrinated by their professors who constantly tell them that a government-run system would bring about affordable, accessible, quality care for all.”

Avik Roy at Forbes argues that “The McKinsey Health Insurance Survey Was Rigorous, After All”  Supporters of the new health care  law “have worked themselves into a tizzy” over a survey that concluded 30 percent of responding employers would likely cut coverage for their workers. “Because McKinsey had refused to release details of the methodology… Democrats and left-of-center writers accused the company of having something to hide.”

Assist: Shared Decision Making

Gary Schwitzer offers: Telling the story of variations in health care and shared decision-making in a TV news story posted at HealthNewsReview Blog. A model for how journalists – even those on local TV – can cover shared decision-making stories. Also see his side note on the decision making process re: implantable heart devices.

Jessie Gruman asks: Check-In-The-Box Medicine: Can the Blunt Instrument of Policy Shape Our Communication with Clinicians? posted at Prepared Patient Forum: What It Takes Blog. One example: counseling at the pharmacy, which she says has been” transformed into the time-saving strategy of asking us to check the box and sign the book or screen pad…(T)he vast majority of us now add our signature, pay the bill and walk away, oblivious to the substantial benefit we have rejected.”

Jonena Relth responds to a CNN blog, on ”dumb things” patients do at the doc’s office with 10 Things Docs and Clinicians Can Do, posted at Healthcare Talent Transformation, Her version offers advice for docs and staff so they can be a little smarter when it comes to dealing with patients.

Stick Handling: Quality of Care

David Williams presents Readmissions: Hard to predict who it will be and why posted at Health Business Blog, saying, “Reducing readmissions is hard, especially when no one can predict who will bounce back and why.”

Don’t Just Count Heads, Weigh Them! at The John A. Hartford Foundation blog, Health Agenda, discusses a recent JAMA article on the importance of making sure physicians are trained to provide proper care to older patients.

Glenn Laffel offers another installment in a series about online interventions designed to foster healthy behavior: Posted at Pizaazz.

Slashing: Costs

Jason Shafrin note the Share of Federal Budget Spent on Health Care Jumped in 2009  at Healthcare Economist, saying, “In 2009, 54 percent of federal revenues were spent on health care. The Healthcare Economist reviews other interesting healthcare statistics from the California Health Care Foundation’s Report.”

Jon Coppelman writes about Managing Chronic Pain at Workers Comp Insider, saying, “With chronic pain being a major cost driver for many workers’ comp claims, payers are looking to control costs. He comments on the Chronic Pain Treatment Guide issued by the Mass Department of Industrial Accidents (DIA) Health Care Services Board.”

Joseph White offers The Mixed (De)Merits Of ‘Bending The Cost Curve’ on the Health Affairs Blog. He traces…” the development of the phrase ‘bending the cost curve’ and argues that the risks of the now ubiquitous metaphor outweigh its benefits.”

Slap Shot: HIT

Shahid N. Shah offer a  Guest Article: How to sell your EHR and other health IT products into clinics and physician practices posted at The Healthcare IT Guy. “Healthcare IT is a hot topic these days and lots of new people are starting new ventures in the field. Developing your product is the easy part; the hard part is commercializing and selling it into a fragmented, diverse, and increasingly skeptical healthcare industry”

Jane Sarasohn-Kahn comments on a study that foundU.S. patients are looking for from their doctors: more self-service options, more online access, and more self-health care tools in patient portals in a post at Health PopuliIn HHS, Privacy, and Your PHI  Henry Stern, at InsureBlog, reports on newly relaxed privacy rules, and wonders if they’re a good thing.

 

Checking: Health law

Health Care Renewal reports: The First Contaminated Heparin Case Verdict: Making Money by Giving Patients “the Cheap Stuff” “Since the case of the contaminated heparin that allegedly killed over 80 patients began in 2008, this is the first legal case about it that has been resolved.  Documents revealed during the litigation referring to the heparin from China that apparently was deliberately contaminated with a potentially deadly chemical as “the cheap stuff” suggested how the current management of supposedly “ethical” pharmaceutical companies has allowed cost-cutting to trump their core mission.”

Finally, Dan Diamond at California Health Line allows us to mix our sports metaphors, by noting that lawyers defending the new health law in the lower courts are like minor league ball players getting ready for the majors: “Opponents of health reform rushed to challenge the law in court — but the flurry of anti-overhaul cases may have helped the government build its own case to defend it. Lawyers explain the Obama administration’s rare approach to the unprecedented legal battle.”

We’ve filtered out all the spam, so you’ll have to look elsewhere for reports on weight loss miracles, cures for bipolar disorder, personal trainer classes and DNA testing (“Did Jason Sudeikis Admit to Being the Father of January Jones’ Baby?”)

And, the dramatic events of the past two weeks led us to abandon our  original theme – Thanks anyway for the birthday wishes. We had art for the Bruins and they nailed Whitey just last night. (See The Departed for a character inspired by the Boston gangster.)  And we had to squeeze in Big Man. Clarence used to step out of the shadows and into the spotlight for his soulful “Jungleland” solo. Now he’s stepped back, and those of us who worship at the House of Bruce will miss him in a big, big way.

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