All posts by blackfriar

healthcare, policy, rapid learning health systems

The inevitable evolution of medical care delivery…

  • medicine is an information intensive industry
  • HIT uptake is growing rapidly due to policy incentives
  • Healthcare looks similar to the retail sector from the 1980s
  • Retail worker productivity grew 4% per year since 1995
  • The biggest changes are likely to come from re-imagining the role of the patient – the single most underused person in healthcare, currently considered as close to a nuisance
  • Health care will be less frustrating when the power shifts from sellers to buyers
  • The Institute of Medicine suggests that inappropriate care, lack of adequate prevention, administrative waste, and prices that are too high account for nearly one-third of medical spending. Just the billing and collection operations in health care account for 25 percent of total costs; Walmart and Amazon spend an order of magnitude less on administration. Prices have fallen across the board in the retail sector.

Source: http://www.technologyreview.com/news/518906/why-medicine-will-be-more-like-walmart/

Why Medicine Will Be More Like Walmart

What health care will look like after the information technology revolution.

The idea that technology will change medicine is as old as the electronic computer itself. Actually, even older. In 1945, Vannevar Bush, the man with the vision for the National Institutes of Health, foresaw a Memex computer program that would allow access to past books and records. A lone physician searching for a diagnosis in far-flung case histories was one of the applications Bush imagined.

Medicine is an information intensive industry. Yet there’s still no medical Memex. Even though the Internet teems with health information, study after study shows that medical care often differs greatly from what the guidelines say—when there are guidelines. Doctors frequently rely on their own experience, rather than the experience of millions of patients who have seen thousands of doctors. Not only is the past lost, the present is missing. How many times has a patient received a drug that causes an allergic reaction, just because that information is not available at the time it is needed?

Bit by bit, this situation is changing. The 2009 American Recovery and Reinvestment Act (aka the stimulus bill), created the HiTech program, which allocates billions of dollars for doctors and hospitals to buy electronic health records systems. Since the program was enacted, rates of ownership of such systems have tripled among hospitals and quadrupled among physicians. In just a few years, it is reasonable to think that the entire medical system will be wired.

What will happen then? The introduction of information technology into the core operations of hospitals and doctors’ offices is likely to make health care much more like the retail sector or financial services. Health care will be provided by big institutions, in a more standardized fashion, with less overall cost, but less of a personal touch.

medicine Walmart chart

Health care today looks a lot like the retail sector did in the early 1980s, when clothes and household products were sold by many local stores and small chains. Quality was haphazard, prices were higher, and buyers’ experiences were mixed. Consumers had only the information they could see in the store or the Sunday paper.

Retail firms got larger when information technology became widespread. Walmart replaced the corner drug store and Amazon put the local book shop out of business because large firms can use information technology better than small ones—to manage inventories, create consistency, automate routine activities, and lower prices. Output per worker grew over 4 percent annually in the retail sector since 1995. Output per worker has fallen in health care over the same time period.

When the medical Memex finally arrives, look for health care to follow the retail track. The solo practitioner is likely to be the first to go. He or she will have to decide whether to try to become an IT manager as well as a doctor, or join a larger group of doctors. For most, the choice will be easy. The chance that a doctor over 65 works alone or in a two-person practice is about 40 percent. For young doctors, it’s less than 5 percent.

Small hospitals will suffer the same fate. Already, small hospitals that have seen the price tag of medical records systems—$20 million or more to purchase, then millions to maintain—are seeking shelter in the arms of their big neighbors. I suspect most cities will go from 10 to 15 independent institutions a decade ago to three to five large health-care systems a decade hence. These systems will do everything: checkups, nursing the elderly, treating heart failure, and dispensing allergy pills.

Who treats us, and where, will change as well. With an electronic backbone in place, one doesn’t need to see a doctor for every issue. There is little the primary care doctor does that can’t—and increasingly isn’t—being done by a nurse practitioner, perhaps at a clinic in a Walmart or CVS. Routine prescriptions for medication refills can be handled online, with an electronic doctor watching. Even high-end services can be spread widely, with specialized centers coördinating the treatment of patients far from its walls.

medicine Walmart chart

The biggest changes are likely to come from reimagining the role of the patient—the single most underused person in health care. Today, patients are thought of as close to a nuisance (“I told him to take his pills …”). But imagine that the patient was a participant and contributor to the medical Memex. Blood-pressure cuffs can be in the house of every person with high blood pressure; the daily pressure would be transmitted to the doctor’s electronic record and monitored by a computer for outlying values. Decision-support software might allow people with localized cancer to choose between surgery, radiation, and watchful waiting—decisions which are, today, heavily influenced by doctors (and none too objectively).

Information technology is going to change the game because it will affect how people view themselves, their illness, and the people who care for them. Amazon’s loyalty comes in no small part because it uses our past searches and the searches of people like us to predict what we will want. The customer is part of Amazon’s Memex. Health care will be less frustrating when the power shifts from sellers to buyers, and when patients are more in charge.

Some worry that a health-care system that’s concentrated like retail will drive up costs. But it’s also true that organizational changes are easier when more doctors work together in one system. According to the Institute of Medicine, inappropriate care, lack of adequate prevention, administrative waste, and prices that are too high account for nearly one-third of medical spending. Just the billing and collection operations in health care account for 25 percent of total costs; Walmart and Amazon spend an order of magnitude less on administration. Prices have fallen across the board in the retail sector.

Norman Rockwell’s classic painting, “Doctor and the Doll,” is memorable for how the doctor is comforting the little girl by listening to her doll’s heart. Norman Rockwell’s doctor knew everything about the girl and her family. The doctor of the future will not. Rather than being a living electronic record consulting an internal Memex, tomorrow’s doctor will be there to direct patients to the right specialized resources, to reassure those in need, and to comfort the terminally ill. This life may not be as exciting as the surgeons or diagnostic sleuths one sees on TV, but it is a noble calling nonetheless.

David Cutler is the Otto Eckstein Professor of Applied Economics at Harvard University and author of the forthcoming, The Quality Cure: How Focusing on Health Care Quality Can Save Your Life and Lower Spending Too.

entrepreneurship

Big Think: Everyone Wants to Create the Product of Tomorrow. You Also Need to Deliver on the ‘Today’.

http://bigthink.com/big-think-edge/everyone-wants-to-create-the-product-of-tomorrow-you-also-need-to-deliver-on-the-today

Like moths, we are attracted to light. In a company, that light is innovation. Everyone wants to be a part of the latest greatest thing. But that should not come at the expense of delivering on a product that has already been developed.

Stephen Miles argues that a balance must be maintained between optimization on one front and growing things on the other front. “I think a lot of times we optimize on one or the other which sub-optimizes the company,” Miles says.

He presents three key ways to maintain this balance.

  • To be successful, innovation requires both the planting of seeds and the pruning of buds.
  • Experimentation is a strategy that supports innovation without sacrificing optimization.
  • Leadership teams should contain a complementary mix of planters and pruners, or innovators and optimizers.
complex adaptive systems, data saving lives, entrepreneurship, healthy habits

Google’s Calico – extending health life years

  • Calico is about extending healthy life years, not just life
  • Larry Page’s view is that ageing is the cause and diseases are the consequence of this ageing
  • Google will use all data it has access to – from search terms, to location data and including genomic data when it becomes more readily available
  • Curing cancer is not as big an advance as you might think” saying it would only add about three years to average life expectancy.

Source: http://mashable.com/2013/10/24/google-calico/
Source: http://www.technologyreview.com/view/519456/google-to-try-to-solve-death-lol/

Google Wants You to Live 170 Years

BY DANI FANKHAUSER

Along the lines of self-driving cars and smart glasses, Google‘s newest venture promises to wow the tech scene. Only, it’s not quite tech, at least in the traditional sense. The venture is called California Life Company, or Calico for short, and its goal is to extend human life by 20 to 100 years.It sounds surreal, until consider that we already extended human life by 20 years over the past century. The average girl born today will live to be 100, a once outlying achievement.

Other research outlets have made relevant discoveries over the years, including worms thatdivide stem cells without aging and that resveratrol, found in red wine, seems to defend against diseases related to aging and could be manufactured as a more potent synthetic drug.

Meanwhile, companies such as Elixir Pharmaceuticals, Sirtris Pharma and Halcyon Molecular set out to extend human life, only to shut down (or be acquired, then shuttered by the buyer), many times running out of money before bringing a product to market.

Don’t be quick to assume Google’s involvement is strictly to benefit the common good, however. CEO Larry Page is pushing to spend on long term rather than incremental R&D. There’s money to be made here. The regenerative medicine industry is valued at $1.6 billion, and anti-aging products are virtually resistant to economic cycles. Therapies available today may be expensive,untrustworthy and could produce horrific results.

But one thing is true: The quest to live just a bit longer is in demand.

But living longer comes with its own challenges. One imagines doubling our elderly population and the strain that would put on their families and on resources in general. On the other hand, by allowing people to age slower, it’s possible a solution could extend our productive years, rather than the elderly years — so, an extra decade of being 30, rather than an extra decade of being 90 — a more attractive option for both individuals and culture as a whole.

Mashable spoke with experts in the space, who predict Calico will indeed approach the latter (Google declined to comment for this story). It won’t likely be one magic bullet solution, but rather, a group of solutions — a suite of products that will catch our imagination just as Google Glass and self-driving cars have.

The Problem With Aging

In a TIME profile, Larry Page said that solving individual diseases, even ones as pervasive as cancer, would not increase life expectancy by much. To reframe, cancer is the symptom; the true disease is aging itself. As we age and our cells wear down, it causes other old-age diseases.

Currently, much of our technology that extends life actually extends life in poor health, while thenumber of years lived in good health remains unchanged.

Our retirement age of 65 was originally set because hardly anyone ever reached that age.

“Today we spend an incredible amount [of money] out of keeping people alive in a bad state of health,”

“Today we spend an incredible amount [of money] out of keeping people alive in a bad state of health,” says Aubrey de Grey, chief science officer of the SENS Research Foundation, who presented a TED Talk on anti-aging.

This might explain why many people have no interest in living longer.A Pew study shows 56% of Americans would not choose to slow the aging process, even if such medical treatments were available.You may have read about the suicide of 60-year-old sports blogger Martin Manley. His website reveals his distaste for the physical and mental limitations of old age.But de Grey doesn’t expect a solution from Google to follow this trend, adding length to the “unwell” years of life while the number of healthy years remains the same.

“We will not be able to extend life without extending health,” he says. “Longevity is a side effect.”

Why Google?

For most of us, Google’s investment into longevity was a surprise (but note, Google will not be operating Calico, only backing it). Others already in the space were able to see the connection.

What Google brings to the table is data. “Not just one set of data, multiple forms,” says Harry Glorikian, founder of life sciences consulting firm Scientia Advisors. “Search data, GPS data, all sorts of other pieces, electronic breadcrumbs that you produce all out there to get a picture of you.”

This data could be paired with each person’s genome — a partial genome can be mapped today for $99 via 23andMe (another Google investment), but many are hoping a full genome will cost as much in the next few years.

Daniel Kraft, medicine and neuroscience chair of Singularity University, affirms that this will require people to relinquish some privacy, in hopes of helping others and themselves, but predicts it to be something many will do.

“Lot of folks will be happy to share elements of health history,”

“Lot of folks will be happy to share elements of health history,” he says.

For an example of how data can impact health, just look to Google’s Flu Trends, which predicted flu outbreaks based on search data, although it turned out to be accurate only in certain cases.

Finally, note that Google isn’t entirely new to this space. Singularity University has had a lot of cross-pollination with Google, Kraft says, and Ray Kurzweil, director of engineering at Google, is an advisor to Maximum Life Foundation, says founder David Kekich.

Glorikian notes that, much like how Google’s development of Glass inspired developers to create uses for it, the Calico announcement will bring further attention and energy to life extension.

“When one of these behemoths points to a certain place, everyone has to believe that there’s something there,” Glorikian says.

The Solution Won’t Be a Magic Pill

We won’t see an anti-aging product from Calico come to market in a year — it’s a long-term venture. The company is likely assembling a team (the announcement only mentioned leadership of Art Levinson, who is former CEO of biotech company Genentech) and deciding what kind of research to do. Of course, there are several types.

First, there is the idea of the engaged patient. You have the “ability to manage your prevention if you know the risk of certain diseases,” says Kraft. Again, think genome mapping.

Second, de Grey maintains that a medical solution will be discovered before a solution involving nanotechnology — and the medical solution will allow some of us to live long enough to also benefit from future solutions. A medical solution might involve cell therapy, gene therapy or injections. Nanotechnology could include tiny robots that repair our cells or assist organs.

Who Will Pay for It?

An early criticism of Calico was that it sounded like something that would increase the split between the rich and the poor, leaving millionaires to live as long as they like (a few extra years to spend all that money doesn’t hurt), while less privileged people would settle for traditional lifespans or shorter (many children in developing countries continue to die without lack of access to clean water).

The rich already have the option of cryonics, preserving their bodies after death in hopes future technology will revive them. It costs $200,000.

It is possible individuals will not need to cover costs of anti-aging treatments themselves? Much like health care today, it makes for a convincing job perk.

De Grey expects these solutions to be paid for by neither the individual or the employer, but rather, the government. Between social security and Medicaid, the government spends billions on treatment for old-age illnesses and providing for the aging population. Perhaps a product that slows aging will be seen as preventative care — over time, it may prove cheaper and could save government money down the road.

“These therapies will pay for themselves so quickly,” de Grey says.

Further Questions

An extra 100 years to live that you didn’t expect is a daunting idea. But because many of these solutions will piggyback over time, it’s not likely to be a sudden burden. As any technology comes to market, we as a culture must learn to use it both safely and with respect for others.

But still, asking the ethical questions is an important step. With an extra set of productive years, should people have second careers (or second marriages)? If you’ll be in this world for longer, does it reduce the drive to have children? Will a larger population mean more competition for resources?

A popular Steve Jobs quote communicates life’s brevity as a benefit to the human race:

“Death is very likely the single best invention of life. It’s life’s change agent.”

But even with increased lifespan, death is never too far away. When asked about the difference between solving death and solving aging, de Grey was quick to point out the obvious: “I’m not working on a solution to stop people from getting hit by cars.”

complex adaptive systems, data saving lives, healthy habits, nutrition

Thesis: Food composition is not as important as physical structure in determining satiety, and therefore overweight and obesity

vanishing caloric density: energy dense foods that meltdown rapidly in the mouth, often lack satiety (Dr. Drewnowski)

the problem with sugared soft drinks: energy consumed as fluid calories are not counted by the body as contributing to satiety, in the same way that energy consumed in solids.

Putting these two data points together, It would therefore seem that non-solid foods don’t satiate.

It makes sense that industry includes these forms of food in our diet, as the less satiety we experience, the more food we eat.

This also explains why fruit juice, but not solid fruit, leads to weight gain. It’s nothing to do with fibre slowing the absorption of calories in the gut, it’s to do with the satiating effects of calories derived from solids vs liquids.

This thesis makes sense in evolutionary terms, as the only pre-agricultural sources of liquid calories would have been honey – water being the mainstay.

recipe

Damn fine roast chicken

This is a riff on Jamie Oliver’s Perfect Roast Chicken, circa 1999. Really good with gravy, mashed potato, roast cauliflower and/or broccoli…

WP_20131116_008WP_20131116_009
Ingredients
1.8kg Chicken
2 Lemon quarters
5 Rosemary sprigs
1 Bunch Fresh basil
3 Sprigs Fresh oregano
5 Bay leaves
Chilli flakes
3 Garlic cloves
Olive or Macadamia oil
Salt & pepper
Roasting twine

Directions

  1. Wash chicken and pad dry with paper towel
  2. Fill bilateral pouches in the potential space between the breast meat fascia and skin with basil, oregano, oil, salt, pepper
  3. Place quartered half lemon, rosemary, bay leaves in body cavity
  4. Rub spare herbs, oil, salt, pepper over chicken
  5. Place rosemary and bay leaves between legs and wings and body then tie up chicken with twine
  6. Cut leg meat to aid thorough cooking
  7. Place the chicken breast down in heated heavy pot
  8. Place pot in 200 C degree pre-heated oven for 10 minutes
  9. After 10 minutes, turn chicken over and cook on the chicken’s base breast side up
  10. Cook chicken for another hour (total oven time 80-90 minutes)
  11. Take chicken out, let stand for 10 minutes
  12. Capture juices for use in gravy

 

entrepreneurship, healthcare, healthy habits, nutrition, policy

New Jamie Oliver ministry to open in Sydney

Good to see this, aligned with Riot Health mission… potential partnering opportunity?

Source: http://www.goodfood.com.au/good-food/food-news/new-jamie-oliver-ministry-to-open-in-sydney-20131022-2vz6i.html

New Jamie Oliver ministry to open in Sydney

  • October 22, 2013
Passionate about encouraging people to eat more healthily: Jamie Oliver.

On a mission … Jamie Oliver is opening a Ministry of Food in western Sydney.

For many years Jamie Oliver has been on a crusade to fight obesity and bad eating habits, with the aim to equip people the world over with cooking skills and a greater appreciation of fresh food.

Sydneysiders have witnessed his mission through numerous television shows, campaigns and cookbooks. Now it’s closer to home, with the announcement of the first Ministry of Food centre in NSW.

The British chef will open a cooking school in August to teach basic kitchen skills. It will be at the Stockland Shopping Centre at Wetherill Park in western Sydney, which is undergoing a $222 million redevelopment. It will be Oliver’s fifth Ministry of Food kitchen in Australia.

“Obesity is not just a diet-related disease. It’s the biggest killer in Australia and what the Ministry of Food is, it’s a fix and response that really does transform people’s confidence in the kitchens,” Oliver said.

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The cooking classes, funded by the not-for-profit arm of electrical goods retailer The Good Guys, will focus on basic cooking skills, nutrition, budgeting, meal planning and shopping tips.

Oliver said recipes would be healthy and tasty and would include desserts.

“We all love ice-cream. Life is about ice-cream and sometimes people get confused with some of my messaging,” he said.

“Of course we want to be as healthy as possible but we don’t want to edit out things in life. Life is about having beautiful treats and cakes and things like that.”

He said the problems began when parents gave in to their child’s requests for more soft drinks and desserts. “That’s the sort of repetition that gets us into trouble. Absolutely I give my kids ice-cream but my wife is fairly strict about when and how much.”

This year, the Australian Diabetes Council revealed that a diabetes epidemic had gripped the western suburbs of Sydney, with Liverpool in the south labelled as the suburb with the highest number of people with the disease.

Of the 10 suburbs with the highest incidence of diabetes, seven were in Sydney’s west, said head researcher, Alan Barclay. This includes Liverpool, Mount Druitt, Campbelltown, Westmead and Blacktown.

The high rates could be drastically reduced with a combination of improved primary healthcare and better knowledge of healthy cooking, he said in July.

“People need to know more about food and how to prepare it,” Barclay said. “We have to start doing more in schools and in the local community.”

The co-host of Channel Nine’s Today show, Lisa Wilkinson, will be the ambassador of the Ministry of Food centre.

healthcare, policy, politics

Diabetes set to become the largest epidemic in human history…

  • 600 million will suffer diabetes in 20 years, 2.3 million in Australia
  • Will kill one person every 6 seocnds (5.1 million people this year)
  • Affects developing economies just as much as developed economies
  • The US spends USD263 billion annually on diabetes
  • In 2013, AU will spend AUD11.4 billion, with 1 in 10 adults afflicted and 9500 deaths attributed.
  • Indigenous Australians have prevalence around 30%
  •  Western Pacific Islands have prevalence over 35%
  • Middle East (Saudi, Qatar, Kuwait) has a diabetes prevalence of 24%

 

Source: http://www.medicalobserver.com.au/news/largest-epidemic-in-human-history

‘Largest epidemic in human history’

DIABETES is likely to be “the largest epidemic in human history” with the number of people with diabetes predicted to surge to nearly 600 million in 20 years, including 2.3 million in Australia, experts say.

The latest edition of the International Diabetes Federation’s Diabetes Atlas, published today on World Diabetes Day, estimated that diabetes kills one person every six seconds and it will cause the deaths of 5.1 million people this year.

Professor Paul Zimmet, director emeritus of the Baker IDI Heart and Diabetes Institute, said the Diabetes Atlas group predicted 20 years ago that there would be 200 million people in the world with diabetes, but the predicted numbers for 2035 are almost double.

“Diabetes is likely to be the biggest health problem, the largest epidemic in human history,” he said.

The data showed that the majority of the 382 million people with diabetes today are aged between 40 and 59 and 80% of them live in low- and middle-income countries.

Professor Jonathan Shaw, associate director of Baker IDI Heart and Diabetes Institute, said the data debunked the historical idea that diabetes was a rich man’s disease.

“It really is not, when we look at the distributions across the world because the largest numbers of people with it are clearly in the developing world, particularly in our region with 138 million [in the Western Pacific] and 72 million in South Asia,” he said.

In contrast, around 37 million have diabetes in North America and 56 million in Europe.

However, health expenditure on diabetes in North American was 263 billion, higher than any other region in the world.

Australia spent $11.4 billion on diabetes care in 2013, with one in 10 adults now having diabetes, and more than 9500 people died from diabetes in Australia in 2013.

Comparative prevalence rates were highest in the Western Pacific Islands, where 37% of the population in Tokelau had diabetes, 35% in the Marshall Islands and 35% in Micronesia.

However, comparative prevalence rates had also surged in the Middle East where around 24% of the population in Kuwait, Saudi Arabia and Qatar have diabetes.

These prevalence rates were similar to that seen in Aboriginal and Torres Strait Islanders, where more than 30% of the population had diabetes, and high prevalence rates were common in indigenous people around the world.