All posts by blackfriar

healthy habits, nutrition, policy, storytelling

DH getting serious on healthy food policy

  •  getting rid of guilt lanes at supermarket checkouts
  • removal of confectionery and soft drinks from gondola ends
  • voluntary code to limit marketing (incl. use of cartoon characters) of HFSS to children
  • Lidl trials of juices and fresh fruit in checkouts attracted 20% higher footfall
  • a new pilot scheme in a Morrisons store in Salford, using cardboardboard cut-outs of local GPs in the fresh produce aisles delivered a 20% rise in the sales of fresh fruit and a 30% uplift for frozen fruit.

Tip: http://www.foodpolitics.com/2014/01/how-to-get-people-to-buy-healthier-food-cardboard-cutouts/

Source: http://www.thegrocer.co.uk/topics/dh-wants-new-deal-to-tackle-unhealthy-food-promotions/353654.article

DH wants new Responsibility Deal measures to tackle unhealthy food promotions

18 Jan 2014 | By Ian Quinn

Health cutout

Cardboard cut-outs of local GPs convinced Salford shoppers to buy 20% more fresh fruit

The government has given retailers and suppliers a “short window of time” to agree a voluntary clampdown on the promotion of foods high in fat, salt or sugar as it prepares to launch a new strategy to fight childhood obesity in the spring.

The DH claims supermarkets and suppliers can supply the final piece in the jigsaw in its Responsibility Deal if they support a raft of proposals, including getting rid of “guilt lanes” at checkouts and the removal of sweets and sugary fizzy drinks from gondola ends. It is also planning a new voluntary code to limit the marketing of HFSS products to children. Talks before Christmas between health secretary Jeremy Hunt, health minister Jane Ellison and CEOs of suppliers and all the major supermarkets focused on protecting children from obesity and Ellison said she was “hopeful” they would result in a “package of measures”. Dr Susan Jebb, chair of the Responsibility Deal food network, who was central to the talks, said: “We’ve challenged them to think what they might do from a long and wide-ranging list of ideas. We’re giving the industry a short window of time to come back with a response.” She said pressure was growing on the government to regulate if companies failed to respond to the calls. With pressure on the DH reaching fever pitch in the wake of this week’s alarmist reports, it wants a commitment to guarantee a minimum level of price and loyalty promotions for healthier options, the banning of cartoon characters on packaging of HFSS foods and restrictions on online promotions. This week, discounter Lidl promised to roll out its ‘Healthy Checkouts’ concept – an initiative first trialled last year – replacing unhealthy items with fresh fruit and juices at tills, claiming the trial stores attracted a 20% higher footfall. “I think it’s a bold move,” said Jebb. “What I find very encouraging is that they’ve done it in response to what their customers want and I think it sends a powerful message to other retailers.” “This is a huge opportunity for the industry to show that a voluntary strategy is the way to deal with the obesity crisis,” she added. “We’re tackling satfats, calories and salt, and the thing that would wrap it all up is something around promotions.” Meanwhile it was revealed this week that a new pilot scheme in aMorrisons store in Salford, using cardboardboard cut-outs of local GPs in the fresh produce aisles delivered a 20% rise in the sales of fresh fruit and a 30% uplift for frozen fruit.

data saving lives, quantified self, startup

Apple raid Sano

  • Apple have started raiding software startups like Sano Intelligence (the blood monitoring patch):

The needle-less, sensor-laden transdermal patch is painless (I handled a prototype, which felt like sandpaper on the skin) and will soon be able to monitor everything you might find on a basic metabolic panel–a blood panel that measures glucose levels, kidney function, and electrolyte balance. Already, Sano’s prototype can measure glucose and potassium levels. There are enough probes on the wireless, battery-powered chip to continuously test up to a hundred different samples, and 30% to 40% of today’s blood diagnostics are compatible with the device.

 

http://9to5mac.com/2014/01/17/apple-continues-hiring-raid-on-medical-sensor-field-as-it-develops-eye-scanning-technology/

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9to5Mac: Apple iPhone, Mac and iPad News Breaking All Day

Example of biomedical industry's work on blood sensors

Example of biomedical industry’s work on blood sensors

Apple is moving to expand its personnel working on wearable computers and medical-sensor-laden devices by hiring more scientists and specialists in the medical sensor field. Apple began work in earnest on a watch-like device late last decade, and it has worked with increasing efficiency and more dedicated resources on the project over the past couple of years. Last year, we published an extensive profile that indicated Apple has hired several scientists, engineers, and managers in the field of biomedical technologies, glucose sensors, and general fitness devices…

 

Smartening the iWatch team

Over the past couple of months, Apple has been seeking even more engineering prowess to work on products with medical sensors. Earlier this year, two notable people from the medical sensor world joined Apple to work on the team behind the iWatch’s hardware vision. Apple has hired away Nancy Dougherty from startup Sano Intelligence and Ravi Narasimhan from general medical devices firm Vital Connect. In her former job, Dougherty was in charge of hardware development. Narasimhan was the Vice President of Research and Development at his previous employer.

Unobtrusive blood reading

sano

Sano Intelligence co-founders introducing their work (image)

Dougherty’s work at Sano Intelligence is incredibly interesting in light of Apple’s work on wearable devices, and it seems likely that she will bring this expertise from Sano over to Apple. While Sano Intelligence has yet to launch their product, it has been profiled by both The New York Times and Fast Company. The latter profile shares many details about the product: it is a small, painless patch that can work on the arm and uses needle-less technologies to read and analyze a user’s blood.

The needle-less, sensor-laden transdermal patch is painless (I handled a prototype, which felt like sandpaper on the skin) and will soon be able to monitor everything you might find on a basic metabolic panel–a blood panel that measures glucose levels, kidney function, and electrolyte balance. Already, Sano’s prototype can measure glucose and potassium levels. There are enough probes on the wireless, battery-powered chip to continuously test up to a hundred different samples, and 30% to 40% of today’s blood diagnostics are compatible with the device.

With the technology for reading blood able to be integrated into a small patch, it seems plausible that Apple is working to integrate such a technology into its so-called “iWatch.” For a diabetic or any other user wanting to monitor their blood, this type of innovation would likely be considered incredible. More so if it is integrated into a mass-produced product with the Apple brand. Just like Apple popularized music players and tablets, it could take medical sensor technology and health monitoring to mainstream levels.

Earlier this week, Google entered the picture of future medical devices by announcing its development of eye contact lenses that could analyze glucose levels via a person’s tears. This technology is seemingly far from store shelves as keeping the hardware in an eye likely poses several regulatory concerns. By putting similar technology on a wrist or an arm, perhaps Apple will be able to beat Google to market with this potentially life-changing medical technology.

Screen Shot 2014-01-17 at 4.33.55 PM

While the aforementioned work by Dougherty occurred at Sano Intelligence, the fact that she “solely” developed this hardware means that her move to Apple is a remarkable poaching for the iPhone maker and a significant loss for a small, stealth startup. She notes her involvement at Sano on her LinkedIn profile (which also confirms her new job at Apple):

– Hardware Lead in a very early stage company designing a novel system to continuously monitor blood chemistry via microneedles in the interstitial fluid. Brought system from conception through development and board spins to a functioning wearable pilot device.

– Solely responsible for electrical design, testing, and bring-up as well as system integration; managing contractors for layout, assembly, and mechanical systems

– Building laboratory data collection systems and other required electrical and mechanical systems to support chemical development

Dougherty’s work at Sano Intelligence was not her first trip in the medical sensor development field. Before joining that company, she worked on “research and development for an FDA regulated Class I medical device; a Bluetooth-enabled electronic “Band-Aid” that monitors heart rate, respiration, motion, and temperature” for another digital health company, according to her publicly available resume.

Patent portfolio

Screen Shot 2014-01-17 at 5.21.07 PM

At Vital Connect, Narasimhan was a research and development-focused vice president. As Vital Connect is a large company, it is unclear how responsible Narasimhan actually was for the hardware development, but it is clear that he has expertise in managing teams responsible for biosensors. Their sensor can be worn on the skin (usually around the chest area) and is able to monitor several different pieces of data. As can be seen in the description from Vital Connect (above), their technology can measure steps, skin temperature, respiratory rate, and can even detect falls. These data points would be significant compliments to a wearable computer that is already analyzing blood data.

Besides his management role at Vital Connect, Narasimhan comes to Apple with over “40 patents granted and over 15 pending,” according to his LinkedIn profile. Many of these patents are in the medical sensor realm, and this demonstrates how his expertise could assist Apple in its work on wearable devices. Narasimhan has patents for measuring the respiratory rate of a user, and, interestingly, the measurement of a person’s body in space to tell if they have fallen. The latter technology in a mass-produced device would likely improve the quality of life for the elderly or others prone to falling.

Of course, it is not certain that the work of either Narasimhan or Dougherty will directly appear in an Apple wearable computer or other device. What this information does indicate, however, is that Apple is growing its team of medical sensor specialists by hiring some of the world’s most forward-thinking experts in seamless mobile medical technologies.

Silicon Valley

Apple is not the only company boosting its resources for utilities that can measure blood. According to sources, other major Silicon Valley companies are racing Apple to hire the world’s top experts in blood monitoring through skin.

Other biometric technologies

CEBIT SENEX

In addition to focusing on sensors that could monitor a person’s activity, motion, and blood through the skin, sources say that Apple is actively working on other biometric technologies. As we reported in 2013, Apple is actively working on embedding fingerprint scanners into Multi-Touch screens. It seems plausible that in a few years down the roadmap, Apple’s Touch ID fingerprint scanners could be integrated into the iPhone or iPad screen, not into the Home button.

Perhaps more interesting, Apple is also actively investigating iris scanning technology, according to sources. This information comes as a Samsung executive confirmed that Samsung is developing iris scanning technologies for upcoming smartphones. It is currently unknown if iris scanning to unlock a phone will arrive with the Galaxy S5 this year.

Apple is also said to be studying new ways of applying sensors such as compasses and accelerometers to improve facial recognition. These technologies could be instrumental in improving security, photography, and other existing facets of Apple’s mobile devices. It does not immediately seem intuitive to have new facial and iris recognition technologies on wearable devices, so it is unlikely that those technologies will make the cut for the future “iWatch.”

Big plans

While 2013 focused on improvements to Apple’s existing software and hardware platforms, Apple CEO Tim Cook has teased that 2014 will include even bigger plans. “We have a lot to look forward to in 2014, including some big plans that we think customers are going to love,” Cook told employees in December of 2013. These plans likely include larger-screened iPhones and iPads, updates to iOS and OS X, and sources are adamant that Apple will revamp its television strategy this year. But is an iWatch in the cards of 2014? Only time will tell. Regardless of when the product is planned for launch, it appears that Apple is stacking up its resources to create a wearable computer that is truly groundbreaking for the medical world, and that the company will not introduce it until it is ready.

healthcare, healthy habits, policy, politics, quotes & aphorisms

2014 AMA Health Priorities

Steve Hambleton
– population health
– reduce unwarranted clinical variation

Chris Baggoley
– dementia

Lesley Russell
– value-based payment

 

The five most pressing health priorities in 2014

21/01/2014

Trying to identify just five top priorities in an area as complex and ethically fraught as health care is a tough challenge, but that was the task Australian Medicine set for seven of the nation’s leading health advocates and thinkers, including AMA President Dr Steve Hambleton, the nation’s Chief Medical Officer Professor Chris Baggoley, health policy expert Dr Lesley Russell and World Medical Association Council chair Dr Mukesh Haikerwal. Here they provide their thought-provoking and insightful responses.

AMA President Dr Steve Hambleton

1.  Make population health a cross-portfolio priority for all levels of government
Population health is not just about treating illness. It’s also about keeping people well, and all portfolios (Agriculture, Defence, Education, Employment, Environment, Finance, Foreign Affairs and Trade, Health, Immigration and Border Protection, Industry, Infrastructure and Regional Development, Social Services, Treasury etc) need to do their part to fight the threat of non-communicable diseases which stem from tobacco, alcohol, over-nutrition and under- exercise.

2. Continue the investment in closing the life expectancy gap between Aboriginal and Torres Strait Islander peoples and all Australians
All governments need to keep up the investment, but not just in the health portfolio. There is stark evidence that investing in the social determinants of health and a good education, starting at birth, are major predictors of health outcomes.

3. Fix e-health and the PCEHR
We must be able to talk to each other in the same language -general practice, hospitals (public and private), public outpatients, private specialists, aged and community care. Too often the right message just does not get through. Let’s get the (e) rail gauge right and use it.

4. Reduce unwarranted clinical variation
The fastest way to save health dollars and achieve better outcomes is to (as Professor Lord Ari Darzi advised at the 2012 AMA National Conference) “close the gap between what we know and what we do”.  We know we are doing a good job and are very cost effective. If we embrace the move of learned colleges toward clinical audit and self-reflection we can make best practice even better.

5. Invest in research
The human papillomavirus vaccine will save millions of lives. Research delivered and refined the place of statins, also saving millions of lives. We need new ways of treating infections, perhaps more antibiotics or better ways to use the ones we already have.

Professor Chris Baggoley, Australian Government Chief Medical Officer

It is not easy to nominate five priority areas for action, given that there are so many deserving areas that require our ongoing attention. Of course, in my role there are a number of areas where my direct involvement is needed to help made a difference.
Understanding that this list excludes other equally deserving priority areas, my list is:
1. Antimicrobial Resistance, where concerns we are facing a post antibiotic era are widely shared across the globe. Australia is taking a leading role: we have adopted a One Health approach, a safety and quality approach (via the National Standards), and we are increasing our surveillance of resistant microbes and antimicrobial usage.

2. Emerging Infectious Diseases. The appearance of avian influenza H7N9 in China in 2013, and the Middle East Respiratory Syndrome Coronavirus in 2012-13, has redoubled the focus of all areas of the health system to prepare to manage emerging infectious diseases, and this must remain a focus for 2014.

3. Immunisation coverage. Public interest in the benefits of high levels of childhood immunisation was a particular feature of 2013, especially following the National Health Performance Authority report breaking coverage down to Medicare Local and postcode areas. Vaccine-preventable diseases should be prevented, and our attention to this aspect of health care in all areas must remain a priority.

4. Dementia. While the first three areas are part of my daily work, this is not the case for dementia. Nonetheless, the case for research into the causes and prevention of dementia is apparent to all of us.

5. Improving the nation’s mental health. Much work is underway to improve our mental health. Improved community and professional understanding and reduction in stigma will assist sufferers of mental health illness to seek help, and assist their recovery.

Dr Lesley Russell, Visiting Fellow, Australian Primary Health Care Research Institute, Australian National University

National

1. Addressing health disparities

Prime among these is the need to Close the Gap on health disparities for Indigenous Australians, but we should not forget the disparities suffered by people with mental illness, people with disabilities, the homeless, and those who are isolated, both geographically and socially. These gaps will only be closed by a broader focus on the social determinants of health through a whole-of-government approach.

2. Changing the way we pay for healthcare services

It’s time to move away from fee-for-service to a financing system that is (1) focused on value rather than volume; (2) rewards improved health outcomes and cognitive services as much as procedures; (3) encourages effective teamwork and collaboration; and (4) recognises time dedicated to education, mentoring, research, essential paperwork and communication.

3. Reworking the healthcare workforce

If we are to address the health and healthcare needs of the 21st century in a country as large and diverse as Australia, then we need an appropriate workforce and a system that enables every healthcare profession to work to full scope of practice. That means widening who can prescribe and who can work independently. The new workforce must include more Aboriginal and Community Health Workers to assist with outreach, education, care coordination and cultural sensitivity.

International

4. Antibiotic resistance

The growing threat of multiple resistance requires a major international effort involving the agriculture, food and health sectors and an increased focus on research to deliver solutions and new antibiotics.

5. Climate change

Everyone’s way of life and even national security is under threat from climate change. Developed nations like Australia must show leadership in tackling both the causes and the impacts. In the absence of government action, communities must step in to lead the way.

Professor Stephen Leeder, Professor of Public Health and Community Medicine, University of Sydney

1. National data collection and evaluation – the collection of national hospital safety and quality data is critical to monitoring the use of drugs and controlling the rise of drug-resistant infections. Information is also needed to track progress in preventive health, such as in addressing obesity. Repeated surveys, done by the same people using the same survey instruments, are needed to judge our progress.

2. We need to tell the story of what we are achieving in health care for the tens of billions we invest in it. The community who pays deserves to hear. Health Ministers need to enunciate what the goal of providing health care is, backed by stories that illustrate what is achieved every day in caring for people. These stories are needed to keep compassion alive in our democracy.  “Look where my Medicare tax dollar goes!” would be a great thing to boast about, and would enable ordinary taxpayers to see that their tax contributes to something of immense social value.

3. Fixing IT. We are 20 years behind best practice. We can see what it looks like in the US. It requires a huge investment, but the pay-off in quality is immense.

Martin Laverty, Chief Executive Officer, Catholic Health Australia

1. Causes of ill health need to constantly inform both health policy and practice. Two-thirds of Australians are overweight, 16 per cent of Australians smoke, and 13 per cent drink at levels of risk. Implementing Senate recommendations on social determinants of health would revive efforts to prevent Australians, particularly the most disadvantaged, from suffering avoidable chronic illness.

2. Coordination of health services around a person’s unique needs must become more of a priority, to improve patient outcomes and reduce waisted expenditure. Ideally, any person with an ongoing health complaint would have a health plan worked out and appropriately managed to focus on right treatment in the right place, ongoing medication management, avoidance of duplicated service, and prevention of further disease.

3. Health workforce constraints and industrial barriers still haven’t been resolved to ensure Australia will have enough medical, nursing, and allied health staff to meet Australia’s growing and ageing population. Role redesign of who does what in the health system remains essential, but as a nation we’re no closer to being able to solve workforce constraints because of entrenched industrial perspectives.

4. Consumer choice underpins the new National Disability Insurance Scheme, and is being introduced into home care for the aged. Better choice in health and aged care also needs attention, so that competition and contestability can drive improvements in financial and clinical outcomes.

5. End of life care needs the entire community’s attention. Health professionals and health consumers need to give new consideration to talking about, determining, and then implementing future care plans. Pastoral care for those in the final stages of life, indeed for any person dealing with significant illness, needs elevation as a priority for health and aged care providers.

Dr Mukesh Haikerwal, Chair of Council, World Medical Association, former AMA President

With a new federal administration in place, a fiscal Armageddon heralded and the health settings for Australia being less favourable, the usual troupe of kite-fliers have been showing their wares in the ‘silly season’. What I think we need is to secure the fundamentals and enhance and support sensible collaborative work practices.

1. Support more care out of hospital – don’t penalise quality holistic care in general practice.

Embed the notion of general practice as the bedrock, not only of primary health care and all out of hospital care, but also for health care delivery across the nation. The costs of the same care out of hospital, when appropriate, are a fraction of the cost in hospital.

2. Enhance hospitals and support the care provided there, and stop perverse penalties.

Support the existing hospital infrastructure that is struggling with the burden of increased demand and expectation from patients and from governments, which absurdly see them penalised for trying their hardest to cope with this. There needs to be a move from blame to re-setting costs and targets based on realistic care need evaluations, allowing for inevitable variation.

3. Embolden and formalise clinical leadership in health in a meaningful way.

Use clinical Senates – groups of cognisant, focussed individuals suggesting and supporting innovation in health care delivery. Enhance their work by trialling and evaluating changing concepts before whole-of-system adjustments, so that unforeseen consequences are outed and adjusted for in real situations with real doctors treating real patients.

4. Use e-health and telehealth logically in clinically safe and acceptable forms over and above the PCEHR, especially secure messaging delivery and web-based videoconferencing.  

Use innovative technologies in health (e-health and telemedicine) for clinical purposes, with clinical needs and drivers at the forefront. We do have potential technology to support and enhance (but not replace) trusted, proven good clinical methods. This is over and above, but could include, the PCEHR. Secure email to connect information is the key element.

5. Innovate with translational research in real clinical situations, proving concepts before rolling them out.

In care settings, sequential work across disciplines and health care establishments, with clinical participants nutting out how to best to innovate. Use just one set of agreed best practice guidelines that promote translational research that have been promulgated to, and agreed by, relevant medical groups. Make sure the economics and medicine are understood: it may cost more to implement in the beginning, but it will save on costs down the track.

Dr Brian Morton, Chair, AMA Council of General Practice

1. End of life care – There is an expectation that modern medical technology and care will extend life, but at what cost to the quality of life? The preparation of an Advanced Care Directive when competent will bridge this gap.

2. Lifestyle health issues – The genesis of many health issues are related to poor lifestyle choices which then require medical solutions. We need brave governments to implement public health interventions to de-medicalise preventive management.

3. Obesity – a whole-of-community response is required to manage the obesity “epidemic”, including responsible marketing and labelling of foods, appropriate food helping sizes, ready access to exercise programs, dietetic advice and legislative recognition that obesity is a risk factor for multiple chronic diseases.

4. Prostate cancer – A rational evidence-based and consensus approach is needed regarding screening and management.

5. Alcohol – A multifactorial societal approach is fundamental to alcohol management.

healthcare, policy, politics

PHI GP cover threatens budget and universality

“Aside from equity issues and potential distortions in the allocation and delivery of health services*, critics warn Medibank-style arrangements could drive a surge in the Government’s Medicare bill and the cost of its private health insurance rebate while forcing down the extent of GP bulk billing and raising doctor fees.

In addition, because the initiative would likely boost private health insurance membership, the Government would also be liable for a $400 million increase in the private health insurance rebate, and GPs would likely reduce the extent to which they bulk billed patients.”

*HAH!!!

https://ama.com.au/ausmed/medibanks-gp-cover-threatens-universal-health

Medibank’s GP cover threatens universal health

21/01/2014

A Medibank Private scheme to give members privileged access to a range of GP services threatens to create a two-tier health system and could fracture the relationship patients have with their family doctor, the AMA has warned.

As the Federal Government proceeds with preparations for the sale of Medibank Private, it has been revealed by The Australian that in November the insurer commenced a trial with medical centre operator IPN in which its members are bulk-billed for GP consultations and get access to several service “enhancements”, including guaranteed appointments within 24 hours and after-hours home visits.

The arrangement is so far being trialled at six IPN clinics in south-east Queensland (including one at which AMA President Dr Steve Hambleton practises), and it circumvents a Private Health Insurance Act prohibition on insurers paying for services that are eligible for Medicare rebates by limiting Medibank Private funding to assistance with covering the administrative and management costs of the trial.

But AMA Council of General Practice Chair Dr Brian Morton said the scheme violated the spirit of the law, and corroded basic principles regarding equity of access to care.

Dr Morton said that although the AMA wanted to see health insurers more involved in primary health care, the approach being trialled by Medibank Private was flawed.

“We do want to involve private health insurers in general practice, but we don’t really see this as the best way of doing it,” Dr Morton told The Australian, adding that any provision to allowed funds to cover primary health services should be open to all patients and GPs.

Anticipating that private funds might seek to give their members privileged access to GP services, the AMA in 2006 released a Private Health Insurance and Primary Care Services Position Statement(https://ama.com.au/position-statement/private-health-insurance-and-primary-care-services-2006) setting out the parameters for the expansion of health fund into primary health care and the dangers that needed to be avoided.

In its Statement, the AMA said that a “limited” expansion of private insurers into primary care may be of some benefit, but only where it provides or pays for services not covered by Medicare.

“There are inherent risks in supporting an expansion of health insurance fund services into primary care,” the Position Statement said, noting especially that “limiting certain services to those who can afford private health insurance, particularly those related to preventive health measures, represents the establishment of a two-tiered system.”

Other concerns identified by the AMA included the potential for the focus of health services to shift from quality and continuity to cost cutting; for insurers to develop models for rationing care; for the development of imprecise patient selection techniques; for a shift away from the provision to patients of information and education “related to their health needs”; and for patients being encouraged to visit participating GPs, who may or may not be their regular family doctor.

In its Position Statement, the AMA warned that any scheme or arrangement that created such risks or undermined the universality and equity of Medicare “will be rejected by the medical profession”.

But so far the Federal Government has adopted a hands-off approach to the Medibank trial.

Health Minister Peter Dutton told The Age that he saw no evidence that the arrangement contravened the legislation, and appeared to give some encouragement to the initiative in a statement to The Australian Financial Review.

“I want every Australian to have a good relationship with their GP, so I wouldn’t rule out any changes,” Mr Dutton said. “Like the Australian Medical Association, I am open to greater involvement of the insurers, who cover 11 million Australians, to keep those people healthy and getting more regular access to primary care.”

Aside from equity issues and potential distortions in the allocation and delivery of health services, critics warn Medibank-style arrangements could drive a surge in the Government’s Medicare bill and the cost of its private health insurance rebate while forcing down the extent of GP bulk billing and raising doctor fees.

In a note obtained by The Australian Financial Review, the Health Department in 2008 estimated the scheme would spur a 5 per cent increase in demand for GP services and GPs would increase their fees, adding a massive $3.4 billion to the Government’s Medicare rebate bill over five years.

In addition, because the initiative would likely boost private health insurance membership, the Government would also be liable for a $400 million increase in the private health insurance rebate, and GPs would likely reduce the extent to which they bulk billed patients.

The nation’s second largest health fund, Bupa, has joined the criticism, warning that although insurance cover for GPs charges would likely be a boon for providers, it would drive up the Government’s health bill.

The trial arrangement, and a suggestion that Medibank could assume responsibility for helping to administer the National Disability Insurance Scheme, has prompted speculation the Government is trying to boost the interest of investors in the purchase of the health fund, whose possible privatisation is currently the subject of a scoping study.

The pilot of private health cover for GP services has also come as the National Commission of Audit ponders a proposal for a $6 charge for GP visits [see also, $6 co-payment an illusory health saving].

Adrian Rollins

healthcare, healthy habits, meaning, musings, nutrition, policy, storytelling

Eternal youth for just $43K per day – or just exercise and eat well????

This is funny, only because for the super rich, this seems like a feasible way forward… instead of eating well and exercising. A really interesting insight into how broken our thinking on health truly is.

https://ama.com.au/ausmed/eternal-youth-may-be-yours-just-43000-day

Eternal youth may be yours, for just $43,000 a day

21/01/2014

Like a bad fairy tale, scientists believe they have developed a way to stop people getting older, but at a cost that puts it out of the reach of all but the super-rich.

A team of researchers at the University of New South Wales, working in collaboration with geneticists at Harvard Medical School, claim to have unlocked the secret to eternal youth, and to have developed a compound they say not only halts the ageing process, but can turn back the years.

The catch is, the treatment is prohibitively expensive, with estimates it would cost the average 86 kilogram man $43,000 a day, and the average 71 kilo woman $35,500 a day.

The compound was developed based on an understanding of how and why human cells age.

A series of molecular events enable communication inside cells between the mitochondria – the energy source for cells, enabling them to carry out key biological functions – and the nucleus. The researchers found that when there is a communication breakdown between the mitochondria and the nucleus of the cell, the ageing process accelerates.

As humans age, levels of the chemical NAD (which initiates communication between the mitochondria and the nucleus), decline. Until now, the only way to arrest this process has been through calorie-restricted diets and intensive exercise.

But the researchers, led by University of New South Wales and Harvard University molecular biologist Professor David Sinclair, have developed a compound – nicotinamide mononucleotide – that, when injected, transforms into NAD, repairing broken communication networks and rapidly restoring communication and mitochondria function.

In effect, it mimics the results achieved by eating well and exercising.

“The ageing process we discovered is like a married couple. When they are young, they communicate well but, over time, living in close quarters for many years, communication breaks down,” Professor Sinclair said. “And just like a couple, restoring communication solved the problem.”

In the study, the researchers used mice considered equivalent to a 60-year-old human and found that, within a week of receiving the compound, the mice resembled a 20-year-old in some aspects including the degree of muscle wastage, insulin resistance and inflammation.

Professor Sinclair said that, if the results stand, then ageing may be a reversible condition if it is caught early.

“It may be in the future that your age in years isn’t going to matter as much as your biological age,” Professor Sinclair said.

“What we’ve shown here is that you can turn back your biological age or, at least, we think we have found a way to do that.”

The problem is, the compound is prohibitively expensive, at least at the moment.

It costs $1000 per gram to produce, and in tests so far it has been applied at a rate equivalent to 500 milligrams for every kilogram of body weight, each day.

Professor Sinclair admitted the cost was major consideration, and said the team was looking at was to produce the compound more cheaply.

As part of their research, the scientists investigated HIF-1, an intrusive molecule that foils communication but also has a role in cancer.

It has been known for some time that HIF-1 is switched on in many cancers, but the researchers found it also switches on during ageing.

“We become cancer-like in our ageing process,” Professor Sinclair said. “Nobody has linked cancer and ageing like this before, and it may explain why the greatest risk of cancer is age.”

Researchers are now looking at longer-term outcomes the NAD-producing compound has on mice, and suggest human trials may begin as early as next year.

They are exploring whether, in addition to halting ageing, the compound can be used to safely treat a range of rare mitochondrial diseases and other conditions, such as cancer, type 1 and type 2 diabetes, muscular dystrophy, other muscle-wasting conditions and inflammatory diseases.

The research was published in the journal Cell.

Kirsty Waterford

healthcare, policy

US doctors not happy or satisfied with career

 

 

http://www.cbsnews.com/news/1-million-mistake-becoming-a-doctor/

$1 million mistake: Becoming a doctor
ByKATHY KRISTOF  MONEYWATCH September 10, 2013, 1: 43 PM

 

ISTOCKPHOTO

(MoneyWatch) If you are brilliant, ambitious and gifted in science, you may consider becoming a doctor. If so, think twice. According to a new survey by personal finance site NerdWallet, most doctors are dissatisfied with the job, and less than half would choose a career in medicine if they were able to do it all over again.

There are many reasons for the dissatisfaction, said Christina Lamontagne, vice president of health at NerdWallet. Most doctors enter the field thinking they’ll be able to spend most of their time healing the sick. Yet the paperwork burden on doctors has become crushing, and could become even more complicated under the Affordable Care Act.

“Administrative tasks account for nearly one-quarter of a doctor’s day,” Lamontagne said. “With additional liability concerns and more layers in health care, we can understand the drain this takes.”

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Doctor: Patients should take active role in care

Worse, the cost of becoming a doctor has soared, with higher education expenses leaving the average newly minted physician with $166,750 in medical school debt, while average salaries are declining. Nearly one-third of doctors — 28 percent – saw a cut in pay last year, according to NerdWallet’s research.

To be sure, pay is still high, with of six-figure positions in the country, according to government data. But it also takes between 11 and 14 years of higher education to become a physician. That means the typical doctor doesn’t earn a full-time salary until 10 years after the typical college graduate starts making money.

That lost decade of work costs a cool half-million dollars, if you assume this individual could have earned just $50,000 annually, and the typical medical school candidate is smart and successful enough to earn considerably more. Add in the time and cost it takes to pay off medical school debt and a dissatisfied physician may well consider pursuing medicine a $1 million mistake. (This assumes the average $166,750 medical school debt  takes 30 years to repay at 7.5 percent interest — a total cost of $419,738.)

Moreover, primary care physicians — those who go into pediatrics, family and internal medicine — earn barely more than the amount they accumulated in medical school debt, between $173,000 and $185,000, according to the study that looked at data from George Washington University’s School of Public Health, the American Association of Medical Colleges and Medscape.

The least satisfied physicians are those who go into internal medicine, according to the study. On average, these doctors see two patients every hour while spending 23 percent of their time on paperwork. They work an average of 54 hours per week, take home about $185,000 annually, and a fifth have seen a decrease in pay. Just 19 percent would choose the same specialty, and only one-third would choose a medical career if they had to do it over.

“The frustrations that patients have about not getting enough time with their doctor is mirrored by the frustration their doctors have with not having enough time to spend with their patients,” LaMontagne said.

The best paid doctors are orthopedic surgeons, who take home an average of $405,000 annually. The most satisfied appear to be neurologists, who earn an average of $216,000, while working an average of 55 hours per week. Sixty-percent would choose the same specialty, and 53 percent would go into medicine again. Oncologists — the doctors who treat cancer patients — are also generally satisfied with medicine and their jobs, with 62 percent saying that they would go into medicine and 57 percent reporting that they would choose oncology as a specialty.

Radiologists are the physicians most likely to have suffered a pay cut in the past year, with 42 percent reporting a decline in salary. However, they’re also among the best-paid doctors, earning an average of $349,000. More than half would both choose to be doctors again and choose the same specialty.

The doctors who work the longest hours are cardiologists, who report being on the job 60 hours per week. Some 54 percent would choose the same medical specialty, but only 44 percent would go into medicine again if they did it over. The average cardiologist earns $357,000 annually, though 39 percent have seen a cut in pay in the past year.

Those least likely to have suffered a pay cut are emergency doctors, who earn an average of $270,000 and work an average of 46 hours per week. Just 19 percent of emergency doctors suffered a cut last year, but only 41 percent would go into medicine or emergency medical care again.

Across all specialties, physicians see roughly 13 patients per day, work 52 hours per week and earn an average of $270,000. However, family and emergency doctors see nearly 75 percent more patients than anesthesiologists.

© 2013 CBS Interactive Inc.. All Rights Reserved.
facts & data points, healthy habits, nutrition

Diabetes and the brain

  • Good summary on the state of understanding the strengthening relationship between glucose metabolism and dementia
  • Type 2 diabetes is a very strong risk factor for dementia – Alzheimer’s disease is sometimes referred to as “Type 3 diabetes”
  • It also results in brain atrophy
  • Metabolic syndrome is also implicated in dementia
  • High insulin in the body means lower insulin in the brain due to a reduction in BBB insulin receptors, and insulin helps clear toxic beta-amyloid from the brain
  • The key to lowering blood sugar and insulin is lose excess weight and exercise more
  • a diet high in high GI carbs and saturated fat is associated with higher unbound beta-amyloid fragments in their CSF. Subjects on lower GI carbs and low saturated fat had less

http://www.nutritionaction.com/daily/diabetes-and-diet-cat/the-effect-of-diabetes-on-the-brain/

The Effect of Diabetes on the Brain

Can high blood sugar lead to brain atrophy?

 • January 16, 2014
“Type 2 diabetes is a very strong risk factor for dementia,” says Jae Hee Kang, assistant professor of medicine at Harvard Medical School and the Brigham and Women’s Hospital in Boston. “Some people call Alzheimer’s disease type 3 diabetes.”

(In type 1 diabetes, blood sugar soars because the body makes no insulin, the hormone that acts like a key to allow sugar into cells. In the more common type 2 diabetes, blood sugar soars because insulin no longer works properly—that is, people are insulin resistant.)

Act now to download your FREE copy of Diabetes and Diet: Decoding Diabeteswithout cost or obligation.

“There’s no question that diabetes damages small blood vessels,” says David Knopman, professor of neurology at the Mayo Clinic in Minnesota.

It may also shrink parts of the brain. A recent study found more brain atrophy in 350 people with diabetes than in 363 people without the disease.

It’s not just those with diabetes who are at risk. People who have what doctors call “metabolic syndrome” also have a higher risk of cognitive decline. That’s roughly one out of three U.S. adults.

Their blood sugar levels are higher than normal, but not high enough to be diabetes. That gives them an increased risk of dementia.

And they may have high blood insulin levels because obesity—especially an oversized waist—has made them insulin resistant. (When insulin doesn’t work well, the pancreas responds by pumping out more.)

That may also spell trouble for the brain. Men with high blood insulin levels declined more on cognitive tests over three years than those with lower levels.

Why would high levels of insulin in the blood matter?

“High insulin in the body means lower insulin in the brain,” says Angela Hanson, a physician and senior fellow at the University of Washington School of Medicine.

That’s because, over time, high levels of insulin in the blood may shrink the number of receptors for insulin in the blood-brain barrier, allowing less to enter the brain, says Hanson. And insulin may help keep the brain healthy.

“Insulin helps clear toxic beta-amyloid out of the brain,” Hanson explains. “So if you put someone on a diet that increases brain insulin, you might have less of the toxic amyloid around.”

The key to lowering sugar and insulin in the blood—and presumably raising insulin in the brain—is to lose excess weight and exercise more.

But one pilot study suggests that it’s not just how much, but what you eat that matters.

Hanson and her colleagues assigned 20 older adults without mild cognitive impairment and 27 older adults with MCI to eat one of two diets. The LOW diet was low in saturated fat, and its carbs had a low glycemic index—that is, they didn’t cause a bump in blood sugar. The HIGH diet was high in saturated fat, and its carbs had a high glycemic index.

The HIGH diet was unusually high in saturated fat and sugar, but it wasn’t off the charts. “If you look at a fast-food combo meal, it’s got a sugary soda and a high-fat burger,” notes Hanson.

After four weeks, people who got the HIGH diet had higher levels of unbound beta-amyloid fragments in their cerebrospinal fluid (which bathes the brain and spinal cord), while people who ate the LOW diet had lower levels.

“The theory is that the beta-amyloid that’s not bound to fats or other lipids is free, and it’s free to wreak havoc, if you will,” says Hanson. “We believe it’s a more toxic form of beta-amyloid because it’s less likely to be cleared. But that’s hard to test in humans.”

The results seemed to fit with a finding from a similar, earlier study: the LOW diet raised insulin levels in cerebrospinal fluid (and presumably the brain), while the HIGH diet lowered insulin levels.

“A Western diet or obesity or other things that cause high blood insulin may decrease brain insulin,” says Hanson. “If you make someone less insulin resistant with weight loss or a diet, they may have more brain insulin.”

Until more studies are done, it’s too early to know if a diet lower in saturated fat and sugars can protect the brain. But the research is encouraging.

“The most striking finding from these studies was that you could change the brain chemistry of people who have mild cognitive impairment,” says Hanson.

“When I’m in my clinic, I can tell patients with MCI that if they eat a healthier diet and exercise, things might get better. That’s the message that keeps me going.”

Sources: J. Am. Geriatr. Soc. 56: 1028, 2008; Exp. Gerontol. 47: 858, 2012; Diab. Care 36: 4036, 2013; JAMA 292: 2237, 2004; N. Engl. J. Med. 369: 540, 2013; Eur. J. Pharmacol. 719: 170, 2013; Neuroepidemiol. 34: 200, 2010; JAMA Neurol. 70: 967, 972, 2013; Arch. Neurol. 68: 743, 2011.

healthy habits, nutrition, policy, politics

Tobacco, Firearms and Food

“But the job of government is not to encourage profitable businesses at the cost of public health; it’s to regulate them so that the public is served. Who is this country for, anyway?”

http://www.nytimes.com/2014/01/15/opinion/bittman-tobacco-firearms-and-food.html

The Opinion Pages
Tobacco, Firearms and Food

Mark Bittman Jan 14, 2014

Let’s say your beliefs include the notion that hard work will bring good things to you, that the golden rule is a nice idea though it may occasionally have limits, and that it’s more or less every person for him or herself. Your overall guiding force is not altruism, but you’re not immoral; you’re a good citizen, and you don’t break any major laws. This could describe many of us; most, maybe.

Now suppose you’re in the business of producing, marketing or selling tobacco or firearms — products known to sometimes kill others. You need not be a corporate executive or a criminal arms dealer; you might be a retailer of cigarettes, a person who sells them along with magazines, a marketer, a gun shop owner. In any case, your conscience is clear: you’re selling regulated legal products and, as long as you’re obeying the regulations, you’re doing nothing illegal. (“Wrong” is a judgment call.)

You sleep well, believing that the government would further regulate your product if it were necessary. And if regulations were to change, you’d change with them. But to act otherwise — to hold back your energy from production or sales just because of moral or social pressure — would be foolish, and put you at a competitive disadvantage.

For many years after knowing about the lethal nature of tobacco, our government did little or nothing to limit its consumption. That’s changed gradually in the last 50 years, and more dramatically since 1998, because of successful lawsuits and because the Food and Drug Administration often tries to pursue its mission. (For a variety of reasons not worth going into, firearms are more challenging to regulate. Let’s leave it at that for now.)

O.K., so suppose we pass legislation that discourages you from producing or selling tobacco or firearms while at the same time actively encouraging you — supporting you — to change to producing apples or cotton or washing machines or screwdrivers; as long as you could see a way to increase profit, you’d probably look at the new opportunity. After all, it’s not as if you wantto produce agents of death. You want to make the best living you can selling stuff that’s legal and that people want. Markets change, and flexibility is important, and the government can and does affect your business, even if it’s by inaction.

Now let’s apply this same way of thinking to the major food categories — and for the purposes of this discussion there are only three — and what it’s like to be a farmer or producer, or a manufacturer, processor, distributor, retailer of this stuff. Again, you’re agnostic about what you sell, but you’re profit-conscious. And the government can and does affect your business; it can help your business (“you didn’t build it yourself”) or hurt it, as it should if your business is harming others.

Let’s call the first food group industrially produced animal products. Producing and selling as much as possible is the way to go here, since the penalties for damage your product does to human and animal health and to the environment (including climate) are virtually nonexistent. You can treat the animals as you like and damn the consequences, from salmonella contamination to antibiotic resistance to water contamination to, of course, cruelty. There are even incentives, in the form of subsidized prices for animal feed.

The next group is most easily labeled junk food; you might call it “hyperprocessed.” This comprises aisles and aisles of “edibles” sold in supermarkets and restaurants, and is often “food” that’s unrecognizable as such, ranging from soda and other sugar-sweetened beverages to things like chicken nuggets and Pringles and tens of thousands of other examples. These are mostly made from commodity crops, especially corn, soybeans and wheat. Federal subsidies abound in many forms here, from direct payments (in theory, these are ending, to be replaced by a bizarre form of crop insurance) to the ethanol mandate to virtually unregulated land use that permits toxic overapplication of fertilizers and other chemicals. There is also that same failure to recognize the public health and environmental costs of what is probably the least healthy diet a wealthy nation could devise. You could even say that the Supplemental Nutrition Assistance Program (SNAP, usually called food stamps) acts as a subsidy to junk food, since nothing limits using food stamps for food that promotes disease. It’s worth noting that for the past century the bulk of university research, much of it paid for with tax dollars, has gone into figuring out how to increase the yield of the crops and processes that turn out this junk that sickens.

Then, in the third group, there’s everything else, from fruits and vegetables — absurdly called “specialty crops” by the Department of Agriculture — to animals raised in sustainable and even humane ways. But here, disincentives abound: farmers may be encouraged to allow some land to go fallow, but not to be planted in specialty crops, and research money, subsidies, insurance, market promotion and access to credit are directed toward industrial food production, distribution and sales. These inefficiencies make most of this real food, which is health-promoting and closer to environmentally neutral, appear to be more expensive. (Only “appear,” though. If you account for the costs of environmental and public health damage, industrially produced junk food and animal products actually cost more.)

One could imagine a government that encourages more life-giving (and less disease-causing) agriculture just as one can acknowledge that sanity prevails when government steeply taxes tobacco and encourages its farmers to move on to something else. (I’m not saying, by the way, that tobacco farmers have been treated fairly; much more could have been done — and still could be done — to help them transition to other profitable crops.)

Of course this is disruptive; change the status quo, and someone is hurt. But the public health disaster created by our commodity-pushing agricultural policies is only getting worse, and calls for the same kind of action in industrial agriculture that we’ve seen in tobacco and, to a lesser extent, in guns. That kind of action will happen only when we have political representatives who care about food, health and the environment.

We can pressure corporations all we want, and what we’ll get, mostly, is healthier junk food. Really, though, as long as sugar is profitable and 100 percent unrestricted (and subsidized and protected!), marketers will try to get 2-year-olds hooked on soda and Gatorade.

But the job of government is not to encourage profitable businesses at the cost of public health; it’s to regulate them so that the public is served. Who is this country for, anyway?

healthcare, policy, rapid learning health systems

Commonwealth Fund 2013 Annual Report

Blumenthal is a top shelf operator and its terrific to see him leading the Fund on new work which includes constructive disruption of the US health system. His opening lines carry a finely crafted, powerful and persuasive message:

“Like every American, like every person on this globe, I treasure the access I have to health care. I know I’m privileged, but every time my family members or I are sick, we are taking risks, that we are entering a system that doesn’t function as well as it should. As a primary care provider, as a scholar, as a professor, I’ve been interested in the same things the Commonwealth Fund is interested in. A high performing health system and vulnerable populations.

We have a system that’s excessively costly, inadequate in quality. Poor results with many other countries on quality metrics. We spend far too much on health care – $2.7 trillion when no other country comes close to that.

It’s important that the most vulnerable access care, because in some ways, they are the canary in the mine. Their vulnerability highlights a general vulnerability.

The Commonwealth fund is dedicated to producing the right information at the right time to make decisions better and make our health care system better.

A high performing health system will be a health system in which the providers of care, the clinicians, doctors and nurses, enjoy their work. It matters to me not just as a policy maker, and a scholar, but as a father, as both my children are physicians in training, and I hope we can leave them a system they can truly enjoy working in.

[….]

The last area, and somewhat new, is what we’re calling breakthrough innovations, which are opportunities to fundamentally transform the system through innovative approaches to health care delivery”

 

http://www.commonwealthfund.org/Annual-Reports/2013-Annual-Report.aspx?omnicid=20