Category Archives: musings

data saving lives, entrepreneurship, healthy habits, musings, policy, quantified self, rapid learning health systems, technology

Location-based prevention services

OK, so here’s the idea:

Our physical environment is loaded with cues capable of triggering healthy and unhealthy behaviours…

  • walk past any take-away, and you might succumb to the call of a chicko-roll (or bottle of water)
  • approach the supermarket, and you might feel the urge to purchase a tub of ice cream (or bag of oranges)
  • do you take the escalator (or the stairs)

Rather than leaving it to fate, why not use a location-triggered message to steer away from temptation, and towards a healthy future.

The danger areas can be configured individually, crowd-sourced or pre-loaded, as can the messages.

complex adaptive systems, healthcare, healthy habits, musings, nutrition, policy, politics, rapid learning health systems, storytelling

Katz smashes it again… it’s the culture, stupid.

“Bariatric surgery is effective and should be available to those who need it. I have referred patients for such surgery over the years. But our culture will be defined by what we learn and share. We could learn and share the skill set for losing weight and finding health, and make that our cultural norm.”

…but how do we operationalise culture change…. it is massive task, but it needs to happen. Purpose perhaps?

http://www.linkedin.com/today/post/article/20140121144506-23027997-obesity-and-oblivion-or-what-i-ve-learned-under-general-anesthesia

Director, Yale University Prevention Research Center

Obesity and Oblivion- or- What I’ve Learned Under General Anesthesia

David L. Katz, MD, MPH

January 21, 2014  

I am going to tell you what I’ve learned under general anesthesia, but I ask you to bear with me kindly and wait a few paragraphs for that revelation.

I am a rambunctious guy, pretty much always have been. I have always loved active recreation and was one of those kids who had to be reeled in for dinner from outside play with a winch and a cable. As an adult, I placate the restlessness of my native animal vitality with about 90 minutes of exercise every day. In addition, I hike whenever I can, and pretty much share my dogs’ attitude about it: the more miles, the better. I studied the martial arts for years. I am a lifelong, avid alpine skier, and an ardent equestrian– privileged to share that latter brand of rambunctiousness with my beautiful horse, Troubadour, who seems to enjoy running and jumping as much as I do, and is far better at it.

This is all part of family tradition. Women in the family are generally quite active, and some have their share of perennial restlessness. But the guys are a case apart. My son’s rambunctiousness is, quite literally, famous of song, story, and program. The ABC for Fitness™ program Gabriel directly inspired is now reaching hundreds of thousands of kids around the country and world, and paying forward the benefits of daily exercise in schools. Gabe helped me appreciate the importance of asserting that the proper remedy for rambunctiousness in our kids is recess, not Ritalin.

And then there’s my father, whose restlessness is the granddaddy of all, and the stuff of legend, or at least family lore. We celebrated his 74 birthday last summer with a hilly, 56-mile bike ride.

By and large, the effects of this rambunctiousness are extremely positive. My animal vitality is spared the constraints of leash or cage, and rewards me reciprocally with energy, stamina, and productivity. But everything has a price. My particular brand of rambunctiousness has involved pushing limits, and limits have a tendency of pushing back. The result is several concussions (I am now a consistent helmet wearer), too many stitches to count, roughly 20 broken bones, and general anesthesia to restore the mangled anatomy of some joint or other not fewer than a half dozen times.

Which leads, at last, to what I’ve learned under general anesthesia: Nothing. Nada. Zip.

Nobody learns anything under general anesthesia. General anesthesia involves unconsciousness; oblivion.

And on that basis, I consider it a societal travesty that hyperendemic obesity and the metabolic mayhem that often follows in its wake are treated ever more frequently, in ever younger people, under general anesthesia. Our answer to obesity is, it seems, oblivion.

True, bariatric surgery is effective. But it is also expensive, and subject to all of the potential complications of surgery. We don’t really know how long the benefits last, particularly for the children and adolescents who are candidates in growing multitudes. We do know that lasting benefit requires ancillary lifestyle change, and that there is often some, and sometimes a lot, of weight regain despite the rewiring of the gastrointestinal tract.

And we know as well that we are relying on scalpels in the hands of others to do what forks in our own hands (and feet in our own shoes) could do better, at dramatically lower cost and risk, if our society committed to empowering their more salutary use. We have evidence to suggest that schools and aptitudes acquired there could do for weight what scalpels applied under anesthesia do. But in my experience, they could do so much more. As a medical advisor at Mindstream Academy, a boarding school producing weight loss to rival bariatric surgery, I have been far more impressed with what the kids find than what they lose, impressive though the latter may be. They find pride and proficiency; confidence and competence; skillpower and self-esteem. They learn, in other words- as nobody ever does under general anesthesia.

Our society’s tendency to “over-medicalize” has been chronicled by others. The consequences extend to expecting from our clinics what only our culture can deliver. Among the most vivid illustrations of this is the lifelong work of my friend, Dean Ornish. Dr. Ornish was involved in groundbreaking work that showed the capacity for a lifestyle overhaul to rival the effects of coronary bypass surgery. With evidence in hand that feet and forks (and a short list of other priorities attended to) could do for coronaries what scalpels could do, Dr. Ornish set out to make his lifestyle program a reimbursable alternative to surgery. He succeeded, earning Medicare reimbursement after – wait for it- 17 years! I don’t know that Dean has the patience of a saint, but he apparently does have the patience of a cicada.

It took 17 years to gain reimbursement for lifestyle as a cost-effective treatment of coronary artery disease, whereas surgery was reimbursed from the get-go. That’s how we roll, and then wring our hands about the high costs of health care.

With that in mind, I ask my fellow parents reading this column; I ask the grandparents, godparents, aunts and uncles to contemplate this: How many of our sons and daughters, nieces, nephews, and grandchildren will have passed through the O.R. doors if it takes us two decades to establish lifestyle intervention as a culturally sanctioned alternative to bariatric surgery? However many that is, I can tell you exactly what they will all learn while under general anesthesia: Nothing. Nada. Zip.

Knowledge and experience are the foundational elements of culture itself. Culture derives from the capacity of our species to learn, and pay forward our learnings to our contemporaries and our children. Among the impressive manifestations of effective school-based approaches to adolescent obesity is the capacity, and proclivity of the kids to pay their newly acquired skillpower forward. When last I visited Mindstream Academy, one of the young girls there, who had lost some 80 lbs, was most proud to tell me about her father back at home who, courtesy of her long-distance coaching, had lost about 40. There is nothing to pay forward following the oblivion of general anesthesia.

Bariatric surgery is effective and should be available to those who need it. I have referred patients for such surgery over the years. But our culture will be defined by what we learn and share. We could learn and share the skill set for losing weight and finding health, and make that our cultural norm. That remains unlikely so long as we put our money preferentially where our medicalizations are. The AMA has proclaimed obesity a disease, but that’s just symptomatic of our culture tendencies. It is more a disease of the body politic than of the often healthy bodies that succumb to it in a culture that propagates its causes.

The healthiest, happiest, leanest, longest-lived populations on the planet do not attribute such blessings to the proficiency of their surgeons or the frequency of their clinical encounters. They attribute them to the priorities and prevailing norms of their culture.

Nobody learns anything under general anesthesia. General anesthesia is oblivion. If we keep prioritizing the medical over the cultural, oblivion over enlightenment, my friend Dean Ornish will remain a lonely pioneer. And the cicadas, when next they emerge, will see nothing new. They will have cause to roll their protuberant eyes at us and trill out: same as it ever was.

It doesn’t have to be that way. We could choose oblivion a bit less often, and stay conscious instead. Conscious, we would have a chance to think outside the box of surgical gloves- and perhaps thereby perceive a new world of opportunity.

-fin

Dr. Katz was recently named one of the most influential people in Health and Fitness (#13) byGreatist.com. His new book, DISEASE PROOF, is available in bookstores nationwide and at:

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

http://www.facebook.com/pages/Dr-David-L-Katz/114690721876253
http://twitter.com/DrDavidKatz
http://www.linkedin.com/pub/david-l-katz-md-mph/7/866/479/

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

musings, words

Cherish

I was reflecting on my time in the Minister’s office over dinner with BN and riffing on the idea that I in no way enjoyed it but nonetheless found it a profound and important thing. BN came back to me with the word that completely encapsulated the idea – that I “cherished” the time. Spot on, thanks.

complex adaptive systems, cool, file note, meaning, musings, politics

Notes: Antifragile (from flight)

Commerce and small business (though not large markets and corporations) are activities and places that bring out the best in people, making most forgiving, honest, loving, trusting and open minded… Like antifragile tinkering, mistakes are small and rapidly forgotten [17].
On errors. In the fragile category, the mistakes are rare and large when they occur, hence irreversible; antifragile mistakes are small and benign, even reversible and quickly overcome. They are also rich in information. So a certain system of tinkering and trial and error would have the attributes of antifragility. If you want to become antifragile, put yourself in the situation of “loves mistakes” [21].

cool, data saving lives, healthy habits, musings, quantified self

Jawbone health report: what kept us up late…

This is the first wave of publicity generated from aggregating data from health  trackers.

At some stage we’re going to have their data incorporated into weather reports to see how well we slept, how much weight we put on and how inactive we were.

Cant wait for that…

Jawbone’s health report highlights key events where people stayed up late.

Serena Chu Serena Chu on December 19, 2013.
As a means to better understand people’s sleep patterns, the Data Science team at Jawbone compiled a list of major world events and correlated it to specific outlier findings. The study shows that people lost an average of 6 minutes of sleep on the night of the Oscars. And back when Barack Obama was re-inaugurated, 29 minutes were lost.While some events directly affected the amount of sleep, other events, like the George Zimmerman trial and Miley Cyrus twerking at the VMA’s, made no impact. Jawbone’s sleep cycle analysis lets us view our habits and anomalies from a birds-eye view perspective.

In order to come to these conclusions, Jawbone collected over 47 million nights of sleep log from thousands of UP wearers in 2013. So what is an UP device? It is a system that tracks and organizes your movement and sleep data into an holistic report. You can purchase one here.

Take a look at the researcher’s results, some of the findings might catch you by surprise.

DataArt_Year-in-review-FINALSource: Jawbone 

cool, healthcare, musings

Facebook as the template for a shared EMR

As naive as it sounds, this actually makes a lot of sense and couldn’t be any worse than current arrangements. The doctors would hate it on account of it being too easy, but then again, it might not be up to them in the end…

Source: http://qz.com/161727/wed-all-be-better-off-with-our-health-records-on-facebook/

THE DOCTOR IS ON

We’d all be better off with our health records on Facebook

By Melissa McCormack December 27, 2013

Melissa McCormack publishes reviews and writes buyers’ guides on electronic health records for Software Advice, a medical software company.

For doctors, Facebook could be a revolutionary tool. AP Photo/Kingman Daily Miner/JC Amberlyn

A Facebook user’s timeline provides both a snapshot of who that user is and a historical record of the user’s activity on Facebook. My Facebook timeline is about me, and fittingly, I control it. It’s also one, single profile. Anyone I allow to view my timeline views my timeline—they don’t each create their own copies of it.

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Intuitive, right? So why don’t medical records work that way? There is no unified, single patient record—every doctor I’ve ever visited has his or her own separate copy of my records. And in an age where we can conduct banking transactions on my smartphone, many patients still can’t access or contribute to the medical records their doctors keep for them.

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My proposal? Medical records should follow Facebook’s lead.

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Cross-industry innovation isn’t new. BMW borrowed from the tech world to create its iDrive; Fischer Sports reduced the oscillation of its skis by using a technologycreated for stringed instruments. So I asked myself: Who has mastered the user-centric storing and sharing platform? The more I thought about it, the more I decided a Facebook timeline approach could be just what medical records need.

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To see what I mean, let’s explore some of Facebook timeline’s key features to see how each could map to features of the ideal medical record.

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“About” for Complete, Patient-Informed Medical History

On Facebook: The “about” section is the one that most closely resembles the concept of a user profile. It includes a picture selected by the user and lists information such as gender; relationship status; age, political and religious views; interests and hobbies; favorite quotes, books and movies; and free-form biographical information added by the user.

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In medical records: The “about” section would be a snapshot of the patient’s health and background. It should include the patient’s age, gender, smoking status, height, weight, address, phone number, and emergency contact information; the patient’s primary care provider; and insurance information. This section would include a summary list of the patient’s current diagnoses and medications, as well as family history. And importantly, both the doctor and the patient would be able to add details.

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FACEBK about-patient

“Privacy Settings” and “Permissions” for Controlled Sharing

On Facebook: Privacy settings allow users to control who can see the information they post or that is posted about them. For example, in my general privacy settings I can choose to make my photos visible only to the people I’ve accepted as “friends.” However, if I post a photo I want the entire world to see, I can change the default setting for that photo to be visible publicly instead.

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Facebook also allows users to grant “permissions” for outside applications to access their profiles. For example, let’s say I use TripAdvisor to read travel reviews. TripAdvisor lets me sign in to its site using my Facebook account, rather than creating a separate TripAdvisor account. But, to do this I must grant TripAdvisor “permission” to access my Facebook account.

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In medical records: Patients could use “privacy settings” to control whether all or part of their information can be seen by a family member or caregiver. For example, if my aging mother wanted to give me access to her “events” (upcoming doctor’s appointments), she could do so. If my college-aged son who is still on my health plan wanted to give me access to his knee X-rays, he could.

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facebook privacy

Additionally, a patient could grant “permission” for other doctors to access their records. When I visit a new doctor, rather than signing a form granting my previous doctor permission to fax over copies of my records, I could simply grant permission electronically within the record–and presto! The new doctor would have instant online access.

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And doctors could use “permissions” in lieu of the paper forms patients typically have to sign during office visits today–to get patient signoff on the sharing of their information with insurance providers or other doctors, in compliance with thelatest HIPAA regulations for patient privacy.

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“Status Updates” to Document Diagnoses and Treatments

On Facebook: “Status updates” let Facebook users broadcast what’s going on with them at a given moment. (For example, my status update might say: “I just had a great idea for improving medical records.”) A user’s latest status update appears toward the top of the timeline; older statuses can be viewed by scrolling through the timeline.

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In medical records: Doctors could post “status updates” to log new diagnoses, medications or treatments. For example, if a doctor prescribes a patient Lipitor, a status update would be posted automatically to note the new prescription. These types of new prescription updates would also generate drug interaction alerts. Think of those drug commercials that warn, “Before using our drug, tell your doctor if you have any of the following conditions.” Similarly, the timeline medical record would prompt a doctor prescribing that drug to ask the patient about those conditions before prescribing.

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facebook status

“Photos” for the Online Delivery of Test Results

On Facebook: Users can upload pictures they’ve taken. Photos are organized into albums that are visible on the user’s timeline. There’s also a special “photos” section where viewers of the timeline can go to see all of a user’s photo albums.

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In medical records: Doctors could upload scans, X-rays, and other test results to a patient’s medical record timeline. When uploading the images, the doctor would be prompted to select the type of image being uploaded, the applicable body part and the date, which would create an album titled with those details–for example, “X-ray-Left foot-11/17/2013.” The timeline record would serve as a single repository for all such “photos,” rather than each doctor or facility having their own copies. The patient or any doctor granted permission to access the record would be able to view past test results.

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facebook photos

“Tagging” to Involve Other Parties and Track Common Themes

On Facebook: Users can “tag” other users to indicate their involvement with the content being posted. For example, when I post a picture of myself with a friend, I can “tag” the friend in that photo. This ties the photo to both our timelines instead of just mine. It also triggers a “notification” to the friend that she’s been tagged. She can remove the tag if she doesn’t wish for the photo to be tied to her timeline.

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In medical records: Providers can use tagging to alert other providers involved in a patient’s care of pertinent updates. For example, let’s say my primary care physician refers me to a specialist for some tests. When the specialists posts the tests results as “photos,” she could “tag” my primary care physician to ensure he’s notified of the test results as well.

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facebook tagging

“Notifications” for Test Result Alerts, Medication Alerts, or Preventive Care Reminders

On Facebook: Users are alerted by red “notification” messages when another user writes them a message, posts a picture of them or otherwise interacts with their profile. These notifications are a way to make the user aware of interactions or information involving them.

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In medical records: Patients would be notified when a provider uploads “photos” of them–i.e., lab results or scans. Notifications should also be triggered when patient vitals are out of normal range at an appointment–for example, when blood pressure is low or temperature high. The medical record timeline should also notify both patients and providers when a patient is due for a preventive care visit or screening.

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facebook notification

“Check-Ins” to Denote Office Visits

On Facebook: Users can “check in” to places they’re currently visiting. For example, I could “check in” to the concert I’m at on a Saturday night. This would serve as both a status update and a record of my attendance of the concert. Photos can also be marked with places to record where they were taken.

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In medical records: Patients literally check in when arriving for doctor appointments. When medical staff check the patient in, this would automatically generate a note on the patient’s timeline recording the date and which provider the patient is visiting. Visits to a specialist would trigger a “notification” to the primary care provider, allowing that physician to better track a patient through the continuum of care.

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facebook check-in

“Friendships” to Track New Provider Relationships

On Facebook: Users can create “friendships” with other users when one party electronically requests a friendship and the other party electronically accepts. These friendships are marked on the user’s timeline (“Jane Doe is now friends with John Smith”) along with the date the online friendship was created.

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In medical records: “Friendships” in medical records would really be relationships with medical professionals and caregivers. For example, when a patient checks in to an appointment with a doctor he’s never visited before, the timeline would automatically note the new relationship with that doctor. All providers could be accessed via a list of providers, similar to Facebook timeline’s “friends” list. This would serve as a record of all touch-points for care.

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facebook providers

“Events” to Track and Remind for Upcoming Appointments

On Facebook: Users can create online “events” to manage attendance and other details for in-person events. For example, I might create an event for the New Year’s party I plan to host, and I might invite my Facebook “friends” to that online event, where they could RSVP and receive reminders as the event date approaches.

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In medical records: “Events” in a medical record would represent upcoming doctor appointments or scheduled tests or procedures. Events would be created automatically when a patient schedules an appointment, and as the time of the appointment gets closer, patients would receive online reminders about the upcoming event.

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facebook events

It’s Time(line) for a Patient-Centric Medical Record

Dr. Rob Lamberts–a practicing physician, speaker, blogger, and health IT evangelist–tells me his biggest complaint with today’s digital record: “It’s not a patient-centered [medical record]; it’s payment-centered.” This he credits to the way the US health system has historically paid for healthcare, which is based on the volume of treatments rather than the quality of outcomes, requiring doctors to log complex medical codes into their EHRs.

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Lamberts voices support for a timeline-like record, but he points out that the right incentives must be in place: “An improved record system like this would have to go hand-in-hand with a business model of medicine that benefited from it.” In other words, a business model which is patient-centric.

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facebook whole timeline-medical-record

Luckily, this looks more like the direction the US health system is starting to take. Healthcare reimbursement models are slowly but surely shifting to reward physicians for better care instead of more care, and as that happens, technology providers will be incentivized to create solutions that align with that goal. Mine is to bring the magic of Facebook to medical records. But I’m open to other ideas that solve the patient-centric needs of tomorrow’s health ecosystem.

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You can follow Melissa on Twitter at @ProfitPractice and read her reviews atSoftware Advice. We welcome your comments at ideas@qz.com.