All posts by blackfriar

healthy habits, nutrition, silly

Severed heads in coca-cola

i think this is a prank, but I’m not sure, from John Butter’s feed…

http://www.thedailymash.co.uk/news/business/coca-cola-admits-natural-flavors-include-a-severed-head-2014050686280

Coca-Cola admits ‘natural flavors’ include a severed head

06-05-14

coke425

DRINKS maker Coca-Cola has admitted using severed human heads to add a touch of piquancy.

After withdrawing a flame retardant from some of its products, the corporation also revealed the horrifying nature of the enigmatic ‘natural flavors’ mentioned on its cans.

A spokesman said: “We drop a man’s head into the distillation vats, that’s where coke gets its unique spicy flavour from.

“We fish the severed head out at the end, as if it were a cinnamon stick.

“It depends what’s lying around the factory really, the basic principle is to just lob anything in and then sweeten the living shit out of it.”

health market quality, healthcare, policy, politics, rapid learning health systems

Orthopods come clean on prostheses and care quality… sort of

 

 

Australian Orthopaedic Association research shows best artificial joints

  • SUE DUNLEVY NATIONAL HEALTH REPORTER
  • NEWS CORP AUSTRALIA NETWORK
  • OCTOBER 21, 2013 8:00PM

A model of knee bones and joint. Source: News Limited

HIP and knee replacement joints that are close to foolproof have been identified, in a breakthrough which will help tens of thousands of Australians fitted with dodgy devices.

Faulty joint replacements force 8000 Australians every year back on the operating table, butNational Joint Replacement Registry research has found four devices with lower rates of problems.

Even when novice surgeons implant these devices they have the same risk of needing revision as when an experienced surgeon uses them.

The National Joint Replacement Registry which has been tracking the performance of hip and knee replacements inserted since 1999 has for the first time reported on whether surgeon experience affects the outcome.

While it found surgeons with more than eight years experience had a lower rate of revision operations it found that with some devices surgeon experience did not matter.

The two most commonly used hip replacements – Exeter V40/Trident and Corail/Pinnacle combinations – show no difference in rates of revision regardless of the experience of the surgeon.

With knee replacements there was no difference in the revision rate when comparing surgeon experience for two commonly used LCS/MBT and Nexgen CR Flex/Nexgen combinations.

“We believe this is a very reassuring finding for the public,” Australian Orthopaedic AssociationPresident Peter Choong said.

While he said it was certain that there are many other prostheses that have similar results in the hands of inexperienced and low volume surgeons, the registry did not have sufficient numbers of procedures for these prostheses to undertake the analysis.

More than 800,000 Australians have a joint replacement and each year another 90,000 devices are inserted at a cost of around $1 billion.

But hundreds of thousands of patients have been fitted with dodgy devices that loosen, get infected, erode and have to be replaced, in a hidden medical scandal which has previously been revealed by News Corp.

The National Joint Replacement Registry’s annual report has identified more than 100 hip and knee replacements have higher than average rates of revision.

Of these eight hip and six knee prostheses have been reported for the first time.

Disturbingly 31 devices that have been identified more than once as having high revision rates are still being used by surgeons, the registry reports.

It was important to understand some devices were in the “still used” category because of a time delay in reporting, Dr Choong said.

The registry’s annual report found with hip replacements a head size of 32mm had the lowest rate of revision, while those with smaller head sizes had the highest rate of revision.

Using cement to fix hip replacements reduced revision rates in older age groups but cementless fixation worked better in those younger than age 75.

Having a device that was constructed from cross linked polyethylene also reduced the rate of revision.

With knee replacements the report found unicompartmental knee replacements had a higher rate of revision than primary total knee replacement.

Using a knee replacement constructed from cross-linked polyethylene may reduce rate revision, the report found.

The Australian Othopaedic Association says it is mindful that the better informed patients are – the better the outcome. The AOA has made attempts to make this information more accessible to patients, Dr Choong said.

 

###

healthcare, policy, politics

Terry Barnes on Commission of Audit

But why does he leave private health insurers untouched?

http://www.afr.com/p/business/healthcare2-0/the_audit_missed_healthcare_costs_pDVkJjKdrNlkAWzF1vuFGP

The audit missed healthcare costs

PUBLISHED: 07 MAY 2014 02:38:00 | UPDATED: 07 MAY 2014 05:38:26

TERRY BARNES

There’s a well-worn joke about a lost traveller standing at a crossroads and asking a grizzled old Irishman for directions. “To be sure,” the Irishman replies. “I wouldn’t start from here.”

Prime Minister Tony Abbott, Treasurer Joe Hockey and Finance Minister Mathias Cormann established the National Commission of Audit to give directions on more sensible, structured and sustainable Commonwealth and federal-funded programs and services. But if the commission’s report is the starting point to a better healthcare future, like the Irishman I wouldn’t start from here either.

Overall, an unavoidable impression is that the commission, headed by then-Business Council of Australia chairman Tony Shepherd, didn’t fully grasp Australia’s complex, often economically irrational, and, above all, highly political healthcare infrastructure. Rather than do much original policy thinking, it sought largely to put its own stamp on policy debates already under way, including Medicare co-payments; widening the roles of private health insurance and health professionals other than doctors in primary care; and improving federal-state and public-private co-ordination of effort.

The commission’s narrative attempts to connect the dots between various elements of the Australian healthcare picture – public and private, federal and state, and acute, primary and preventive care. In doing so, however, it misses the reality that the Australian healthcare system is not a system at all. Instead, there’s a tangle of loose and fractious associations of providers, funders and consumers, all competing aggressively for resources and dominance, all believing they know best and those wearing white clinical coats, typified by the Australian Medical Association and Pharmacy Guild of Australia, bully anyone who opposes their agendas

HEALTHCARE SHOULD FOCUS ON INDIVIDUALS

 

In its naivete, the commission recommended that Health Minister Peter Dutton should “identify a framework that brings together all aspects of the health system – public and private, hospital and community-based – to support the organisation and delivery of healthcare in a way that tightly focuses on individuals”. Sounds easy, but the problem is Dutton, as minister, is not the supreme controller of an ordered system but herder-in-chief of a multitude of feral, rent-seeking cats, including the states and territories and their ravenous public hospitals. Dutton may have the Commonwealth’s immense political and funding leverage, but like King Canute, he cannot command the tempest of interests.

In 2008-10, former prime minister Kevin Rudd sought to do exactly what the Commission of Audit recommended, by way of his National Health and Hospitals Reform Commission. Rudd’s raising health reform expectations so high, coupled with his subsequent failure to deliver, is a major reason why he is a former prime minister. Abbott and Dutton are very mindful of his hubristic lesson.

Indeed, a political fact of life is that there is a broad national consensus that Medicare, as a universal public health insurance scheme, is reasonably fair and effective. As the overheated debate about a modest $6 co-payment on bulk-billed GP services shows, the slightest proposed adjustments to Medicare’s fabric bring outraged howls not only from healthcare ayatollahs, but from voters fearing change to a beloved institution. Even incremental Medicare reform requires considerable political courage.

Dutton, Abbott and Hockey bravely have flagged Medicare and wider health structural reform as a high priority for their government. But such structural reform must be measured and gradual, delicately balancing entrenched Australian notions of a fair go with the philosophical and economic goal of encouraging individuals to take greater personal responsibility for their own healthcare consumption and choices. As the Abbott government now knows, it is tough enough selling economically self-evident concepts, like modestly increasing pay-as-you-go in Medicare and the Pharmaceutical Benefits Scheme, in the teeth of ferocious opposition.

AMERICANISING OUR HEALTHCARE SYSTEM

 

This is why the commission’s showstopper recommendation, that higher income earners be compelled to take out private health insurance in place of Medicare, will gather dust. Most Australians see private health insurance as complementing Medicare, not replacing it. Labor and the Greens haven’t hesitated to demonise the commission as Americanising Australian healthcare, and no sane government will go there.

There are, however, some gems in the report. Besides supporting Medicare co-payments (although proposing a ridiculously high $15 figure and inadequate protections for the less well-off), the commission’s recommendations on partially risk-rated health insurance for unhealthy voluntary behaviours such as smoking; taming the health bureaucracy beast; revamping the Pharmaceutical Benefits Scheme; and breaking the Pharmacy Guild’s ownership and location cartels, are timely and welcome. But on health policy generally, the report falls short. Nevertheless, and as did John Howard and Peter Costello in 1996, on budget night Abbott, Dutton, Hockey and Cormann will declare that what they announce isn’t half as bad as the commission of audit’s more radical recommendations. That’s the basic truth of this exercise: it gives political and policy cover to a new government striving to sell a difficult, inherited fiscal repair task to a bruised, wary and sceptical public.

Terry Barnes runs consultancy Cormorant Policy Advice, and wrote the Australian Centre for Health Research’s proposal to reintroduce co-payments on bulk-billed general practitioner services

Visit afr.com/healthcare2-0 for more health coverage.

The Australian Financial Review

file note, health market quality, healthcare, management and leadership, musings, policy, politics, rapid learning health systems

PHI dysfunction starting to gel…

Email from me to Anne-marie regarding PHI and Commission of Audit ideas…

Thanks Anne-marie… last week was so busy, but at least it was a good busy, filled as it was with so many excellent events and conversations, quite often featuring you! Glad to hear that the club delivered on expectations… maybe Steve will be up for some insurrection? Or maybe not.

[the following early morning rant is off-the-record on account of my current employment and it still being a bit rough, but am happy to explore it further with you as required J]

On the modelling question, that’s more on the economic modelling side – something we’re tooling up for with Federico Girosi and Jane Hall, but haven’t quite started on. Ian McAuley and John Menadue have been presenting solid thinking about PHI for a while and would be worthwhile speaking with, particularly if you were looking to confirm your suspicions? Off the top of my head, I can’t think of anyone who could actually back-in the COA’s assumptions, as I’ve never heard anyone credible (with the potential exception of Paul Gross – though unsure how credible he is) put forward that point of view, mainly because it is ideologically driven, rather than evidence based. Indeed, the closer I get to the PHI data, the PHI businesses and the people who run them, the more certain I am that PHI can only ever be inflationary – especially when positioned as a duplication of a public insurance scheme (as per that graph from the SMH that Jim Gillespie spoke to at the event last week), as it allows clinicians to select whichever system suits their interests best, making them the customer rather than the patient.

My back-of-envelope rationale:

PHIs market themselves as honest brokers in the health system, but in reality, benefit directly from health inflation, acting as hemi-bureaucracies which take a 13% clip of disbursements that pass through them. In Australia, this dynamic is emphasised by their mutual structure, as the lack of profit motive leads to a lack of interest in containing anyone’s costs, especially when the Minister mandates premium increases based on demonstration of increased costs!!?? The smaller PHIs have no market power, so aim to please hospitals and doctors, thus making providers the customers, rather than their patients. This all has the effect of distancing patients from value the market generates, despite the fact they are the ones who fund it. I can’t think of a more diabolical arrangement than the one we’ve got. I’m disappointed that conservatives are willing to trade this downside for the illusory benefits of choice (which don’t actually exist because the basis on which we might choose are health service have nothing to do with the quality of that service). In reality, the choice argument is just a smoke screen for queue jumping, something conservatives aren’t to keen on when it came to asylum seeker policy.

As a footnote, it’s interesting to see the behaviour of the non-mutual PHIs – Medibank and NIB. They tend to be far more innovative and disruptive towards conventional health service models, mainly in an attempt to position themselves as the customers served by doctors and hospitals, while still being funded by their members. Unfortunately, their business model still ultimately relies on cost containment AND premium growth, and so also ends up also being inflationary – the main reason the US is the situation it’s in.

Wrapping the diatribe up, ideally a health market should be singularly focused on improving the health of the population that funds it. I’d estimate the current ranking of value captured by various actors looks something like this:

  1. insurers
  2. hospitals
  3. bureaucrats
  4. politicians
  5. doctors
  6. patients
  7. nurses
  8. allied health professionals

Under the previous administration, it probably looked more like this:

  1. bureaucrats
  2. politicians
  3. insurers
  4. doctors
  5. hospitals
  6. nurses
  7. patients
  8. allied health professionals

Ultimately, all forms of private health insurance make the providers the customers while the population carries the can. Interventions which position the population as customers should be the preference. Medicare was a big, necessary but not sufficient step in that direction.

I reckon some of this can inform some interesting health market design that could support a far more advanced and efficient health system. We’ve previously discussed that we’ve got 6 years to bring this to maturity, though if things keep tracking like they have been, it could be sooner.

Let me know your thoughts?

Cheers, Paul

 

From: Anne-Marie Boxall [mailto:ABoxall@ahha.asn.au]
Sent: Monday, 5 May 2014 6:08 PM
To: Paul Nicolarakis (paul.nicolarakis@outlook.com)
Subject: Modelling

No, not the fashion kind (although I am sure you would be great).

A curiosity question – are you and your people able to model something along the lines of the means-tested Medicare scheme proposed by the Commission of Audit? Not sure what data you have, or what is needed to model such a proposal, but it strikes me that the idea rests heavily on the assumption that a market for health insurance would drive down health costs (hospital and primary care and therefore premiums prices). Not quite sure what evidence underpins this assumption (other than economic theory) as Fraser era experiment suggests that it would not work. Just wondering….

Hope you made it to your many subsequent events last week. Dinner at the gentleman’s club was interesting. I think they might also have an age criteria for membership there. 70 plus only.

Regards,

Am

 

 

Dr Anne-marie Boxall
Director, The Deeble Institute for Health Policy Research
Managing Editor, Australian Health Review

Australian Healthcare & Hospitals Association
the voice of public healthcare

T: 02 6162 0780 | F: 02 6162 0779
Post: PO Box 78, Deakin West, ACT 2600
Location: Unit 8, First Floor, 2 Phipps Close, Deakin West, ACT
E:aboxall@ahha.asn.au
W: www.ahha.asn.au
Twitter: @DeebleInstitute

 

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healthy habits, nutrition, policy, rapid learning health systems

Katz in the SMH

Good to see Dr Katz in the SMH

http://www.smh.com.au/lifestyle/diet-and-fitness/blogs/chew-on-this/do-you-need-tastebud-rehab-20140501-37k6a.html

Do you need tastebud rehab?

Date: May 5, 2014 – 8:03AM
Paula Goodyer is a Walkley award winning health writer

View more entries from Chew on This

Illustration: Judy Green.

Illustration: Judy Green.

On the face of it the cause of weight gain is simple: we eat too many kilojoules. What’s less simple is fixing the reasons that encourage overeating – a complex mix of factors like the need for comfort, the power of food marketing and inflated portion sizes, none of which have anything to do with hunger.

On top of this is a food supply loaded with amped up flavours that make it easy to overeat. Traditional foods that used to be simple now come with extra layers of flavour and kilojoules – plain yoghurt has been almost kicked out of the chiller cabinet by sweetened yoghurt; scones and hot cross buns come flavoured with chocolate, there’s pizza made, not just with cheese and ham, but ham and bacon and peperoni and barbecue sauce – and we’re embellishing a cup of coffee with caramel syrup.

“What was once a survival advantage in an age when the only sweet foods were breast milk, honey and fruit makes us easy targets for an industry flogging food with more-ish flavours.” 

It’s what Dr David Katz, director of Yale University’s Yale-Griffin Prevention Research Centre in the US, calls the hidden challenge to eating well in the modern world.

This over-flavouring of food can be hard on the waistline, says Katz, explaining that we’re  hardwired to crave sugar and salt, a hangover from our hunter gatherer days when sweet, salty or fatty foods were hard to find but important for survival in a time when the food supply was unpredictable. But what was once a survival advantage in an age when the only sweet foods were breast milk, honey and fruit makes us easy targets for an industry flogging food with more-ish flavours.

“Manufacturers of processed foods are counting on this,” Katz says. “Their goal is nothing short of wanting to profit from our inability to control ourselves when their irresistible food product is in our hands.”

We’re not entirely helpless though. Reliance on very sweet and salty flavours is reversible and inDisease Proof, a new book that provides practical skills for preventing chronic disease, Katz  devotes a chapter to  retraining overstimulated taste buds so that we can appreciate the natural flavours of healthier foods, widen our food preferences and tame food cravings.

It starts with cutting down on added salt and sugar by reducing reliance on processed foods. Making foods like pasta sauce or salad dressing at home rather than buying them off the shelf, for example, gives us more control over the ingredients and flavours we consume. It also helps to get to know the different names that sugar hides under on the labels of packaged foods such as sucrose, fructose, maltose and lactose.  (Katz also fires a shot at one sweetener with a health halo – agave syrup which he describes as a highly concentrated source of fructose with little, if any, health benefits even though it’s promoted as a healthier option to sugar.)

“Your taste buds will adjust to lower thresholds of these flavours, feeling satisfied with lower amounts of sugar, salt and fat,” he says. “Over time, the sweet and salty flavours you used to eat by the handful may taste too sweet or salty.”

As for food cravings, these are less likely if you eat healthy meals and snacks at regular intervals to keep hunger under control, says Katz who also points out that – like nicotine cravings – a food craving will often pass if you can wait it out for a few minutes.

“Research from the University of Exeter in the UK found that a 15 minute brisk walk reduced urges for chocolate among regular chocolate eaters. If you must give in to a craving, have a small portion, then wait. Researchers at Cornell University recently found that hedonic hunger (eating for pleasure) is satisfied by a handful of a tasty food and tends to disappear after 15 minutes so long as the memory of indulgence remains,” he adds.

It’s also possible to tame cravings with healthier foods – if you want something sweet, try something naturally high in sugar like fruit, or try turning the sweet craving off by eating something with a sour or palate cleansing flavour like citrus or mint.

Speaking of sour flavours, Katz also points out that some of the healthiest foods on the planet – like kale, grapefruit, spinach and plain yoghurt have a naturally bitter flavour and if we shun them we miss out on their benefits.  His tips for making them easier on the tastebuds: sweetening the flavour of Brussels sprouts or broccoli by roasting them with a little olive oil to bring out the natural sugars in these vegetables; serving sautéed kale with a little balsamic vinegar and mixing berries and a dash of vanilla extract into plain Greek yoghurt.

Disease Proof by David Katz is published by Penguin, $29.99

entrepreneurship, management and leadership

rude sales people make you buy luxury goods

 

http://www.psmag.com/navigation/health-and-behavior/condescending-salespeople-make-buy-fancy-things-80452/

QUICK STUDIES

bags

Rude Salespeople Make You Buy Fancy Things

BY PAUL BISCEGLIO • April 30, 2014 • 4:53 PM

(Photo: Karkas/Shutterstock)

Being snubbed by a luxury store only increases your desire for its goods, according to a new study.

•

If you venture into high-end stores like Gucci or Burberry on shopping trips, you probably know their salespeople aren’t famous for their kindness.

“When I went to Louis Vuitton … the salesgirls were so [unfriendly]—I could not believe it,” writes a commenter on The Fashion Spot. “I was just dressed normally … and when I walked in they stopped talking and stared at me. It was like walking into a freezer, they were so cold towards me.”

“Social rejection motivates individuals to conform, obey, change their attitudes, work harder and generally try to present themselves in a favorable manner in order to gain acceptance.”

In a forthcoming study in theJournal of Consumer Research,Morgan Ward of Southern Methodist University and Darren Dahl of the Sauder School of Business use this quote to highlight an unsettling discrepancy between how we want salespeople to act and what actually gets us to buy things.

It’s no secret that salespeople at upscale shops can be a little snobbish, if not outright rude, the researchers note. Consumer complaints recently have pressured some luxury retailers to train their staffs to be more approachable; Louis Vuitton even went as far as decorating the entrance of its Beverly Hills store with a smiling cartoon apple in 2007. But if luxury retailers want to continue to rake in the dough, they actually should do the exact opposite, the study found. The ruder the salesperson the better.

In four online surveys, Ward and Dahl had participants imagine interactions with different types of salespeople under a bunch of different conditions. Variables included the imagined store’s level of luxury, the extent of the salesperson’s haughtiness, how well the salesperson represented the store’s brand, and how closely participants themselves related with the brand. The results:

  • Rejection makes people want to buy luxury goods. A salesperson’s condescending attitude has little effect on consumers’ desire to buy more affordable brands like Gap and American Eagle, though.
  • Rejection is stronger when salespeople convincingly embody brands in the way they act and dress. Sloppy salespeople aren’t as intimidating. 
  • People who really want to own a particular brand are even more influenced by rejection. Instead of switching their loyalties, customers just become more attached.
  • Rejection works best in the short term. While great at pressuring people into buying something in the moment, dismissive staff may still alienate customers in the long run.

The results fall into a long line of research that demonstrates the extent to which rejection can jar our fragile self-conceptions. “People have an innate need to belong to social groups that define and affirm their identities,” the researchers write. “Social rejection motivates individuals to conform, obey, change their attitudes, work harder and generally try to present themselves in a favorable manner in order to gain acceptance.”

The next time you’re snubbed, maybe wait a day or two before any big purchase. Or just shop online, Ward and Dahl recommend. “While many customers may purchase online for convenience, shopping online also may enable customers to avoid threatening encounters with intimidating salespeople,” they conclude.

Fellow Paul Bisceglio was previously an editorial intern at Smithsonianmagazine and a staff reporter at Manhattan Media. He is a graduate of Haverford College and completed a Fulbright scholarship at the University of Warwick in Coventry, United Kingdom. Follow him on Twitter @PaulBisceglio.