Category Archives: politics

Healthways…

http://www.healthways.com  || http://www.healthways.com.au

Christian Sellars from MSD put on a terrific dinner in Crows Nest, inviting a group of interesting people to come meet with his team, with no agenda:

  • Dr Paul Nicolarakis, former advisor to the Health Minister
  • Dr Linda Swan, CEO Healthways
  • Ian Corless, Business Development & Program Manager, Wentwest
  • Dr Kevin Cheng, Project Lead Diabetes Care Project
  • Dr Stephen Barnett, GP & University of Wollongong
  •  Warren Brooks, Customer Centricity Lead
  • Brendan Price, Pricing Manager
  • Wayne Sparks, I.T. Director
  • Greg Lyubomirsky, Director, New Commercial Initiatives
  • Christian Sellars, Director, Access 

MSD are doing interesting things in health. In Christian’s words, they are trying to uncouple their future from pills.

After some chair swapping, I managed to sit across from Linda Swan from Healthways. It was terrific. She’s a Stephen Leeder disciple, spent time at MSD, would have been an actuary if she didn’t do medicine, and has been on a search that sounds similar to mine.

Healthways do data-driven, full-body, full-community wellness.

They’re getting $100M multi-years contracts from PHIs.

Amazingly, they’ve incorporated social determinants of health into their framework.

And even more amazingly, they’ve been given Iowa to make healthier.

They terraform communities – the whole lot.

Linda believes their most powerful intervention is a 20min evidence-based phone questionnaire administered to patients on returning home, similar to what Shane Solomon was rolling out at the HKHA. But they also supplant junk food sponsorship of sport and lobby for improvements to footpaths etc.

Just terrific. We’re catching up for coffee in January.

MJA Insight: Hard choices – Will Cairns

  • We cannot continue on our current course without depriving other societal domains that are essential to the long-term wellbeing of our community, such as education, physical infrastructure, aged care, environmental protection, the arts and recreation
  • When we eventually do act we will realise that there are a limited number of ways to constrain the proportion of community resources expended on health care.

    One is for funders to pay less for the things that are done.

    The second, and perhaps the simplest, is to not do things that are of little or no benefit. We could also ensure that, when there is a choice, the less expensive options are used. This is primarily a task for doctors but everyone is responsible.

    The third is to make sure that people do not have treatment that they do not want. This merely supports the right of people to make a choice not to start or persist with treatment that will not bring them sufficient benefit in terms of a quantity of a life of quality as they define it. This also requires community acceptance that individuals have the right to make such choices.

While thoughtful medical practice, systemic support of the right to individual choice and improved efficiency can buy us some time they are unlikely to be sufficient.

Perhaps the complex ecology of gridlocked self-interest means that struggling health systems must collapse and fail before they can be rebuilt, and we will just have to watch while it happens.

Surely a better outcome would be to work towards spending only what we can afford. These are not simple issues and the process might begin with an open discussion of our community values and the goals of health care. The sooner we start that discussion the better.

From: https://www.mja.com.au/insight/2013/47/will-cairns-hard-choices

BMJ: Can behavioural economics make us healthy

  • BE policies are by design less coercive and more effective than traditional approaches
  • It is generally far more effective to punish than to reward
  • Sticks masquerading as carrots – simultaneous, zero-sum incentives and penalties
  • References to policies which have and have not worked – but why can’t policy be research?
  • Conventional economics can therefore justify regulatory interventions, such as targeted taxes and subsidies, only in situations in which an individual’s actions imposes costs on others—for example, second hand cigarette smoke. But the potential reach of behavioural economics is much greater. By recognising the prevalence of less than perfectly rational behaviour, behavioural economics points to a large category of situations in which policy intervention might be justified—those characterised by costs which people impose on themselves (internalities), such as the long term health consequences of smoking on smokers.
  •  Is it fair to say that in a universal health care system, any preventable ill health imposes costs on others, as it is the tax payer who picks up the cost of treatment?
  • present bias: the tendancy for decision makers tend to put too much weight on costs and benefits that are immediate and too little on those that are delayed. Present bias can be used to positive effect by providing small, frequent (i.e. immediate) payments for beneficial behaviours e.g. smoking cessation, medication adherence, weight loss
  • “peanuts effect” decision error: the tendency to pay too little attention to the small but cumulative consequences of repeated decisions, such as the effect on weightof repeated consumption of sugared beverages or the cumulative health effect of smoking.
  • competition and peer support are more powerful forms of behaviourally mediated interventions

Care of Nicholas Gruen.

PDF: CanBehaviouralEconomicsMakeUsHealthier_BMJ

Similarly in Health Affairs: http://content.healthaffairs.org/content/32/4/661.short

On maps

Geraldine cracked out this terrific interview with Jerry Brotton on his book “A history of the world in twelve maps” covering everything from the folly of the perfect map (take note avid health informaticians) to the consequences of Google’s “cartographic power”.

Program source: http://www.abc.net.au/radionational/programs/saturdayextra/is-there-ever-a-realistic-map/5141292

Local compressed interview recording:

 

Economist Intelligence Unit – Rethinking Cardiovascular Disease Prevention

 

Source: http://www.economistinsights.com/healthcare/opinion/heart-darkness%E2%80%94fighting-cvd-all-mind

CVD prevention at population level, such as a “fat tax” or smoking ban, relies heavily on regulation. This is its greatest strength – it can compel healthy behaviour (or seat belt wearing) – but also its greatest potential weakness. It inevitably involves some degree of coercion, which runs the risk of paternalism.It need not involve regulation, however. The same human flaws that are exploited by the food industry to persuade us to buy certain items at the check-out can also be used to persuade us to act in the interests of our own health. The current UK government is attempting to turn psychological weakness into an advantage outside of the legislative framework.

Its Behavioural Insights Team, commonly referred to as the “nudge unit”, is designed to seek “intelligent ways” to support and enable people to make better choices, using insights from behavioural science and medicine instead of increased rulemaking. Many of these goals overlap with CVD prevention, from smoking cessation to encouraging kids to eat healthier foods and walk to school more often. Early successes have brought them to the attention of the Obama administration in the US.

Besides the difficulties of making positive lifestyle changes, non-adherence to treatment is another significant obstacle to effective CVD prevention. Even after suffering a CVD incident, some patients forget to take their medication; other patients opt not to complete a course of treatment for other reasons, ranging from concerns about costs, the inconvenience involved with travel, to feelings of despondency caused by depression and anxiety. At its most anodyne, individuals frequently stop taking drugs prescribed for prevention after they feel better and think themselves cured.

This is part of a much wider medical problem: in the rich world adherence to treatment for all diseases is around 50%. Recognising the commercial opportunities here, private enterprise is looking to play a greater role. Earlier this year a US company called WellDoc launched a smartphone product aimed at giving type 2 diabetics better management of their treatment, through tailoured advice and motivational coaching. In the UK, meanwhile, a start-up calledImpact Health is developing a similar health psychology smartphone product to increase adherence to treatment among sufferers of Crohn’s disease.

CVD patients stand to benefit from such development in medical technology, although they may have to wait a little while yet. Impact Health’s online platform requires patients to have a smartphone. For this reason the start-up is targeting Crohn’s first and not CVD. As David Knull, one of its directors, explains, the profile of the average sufferer is generally around 30 years old—far younger than the average CVD patient, and much more likely to have a smartphone.

Report source: http://www.economistinsights.com/healthcare/analysis/heart-matter

Report PDF: The heart of the matter – Rethinking prevention of cardiovascular disease

The heart of the matter: Rethinking prevention of cardiovascular disease is an Economist Intelligence Unit report, sponsored by AstraZeneca. It investigates the health challenges posed by cardiovascular disease (CVD) in the developed and the developing world, and examines the need for a fresh look at prevention.

The report is also available to download in German, French, Italian, Spanish, Portuguese (Brazilian) and Mandarin—see the Multimedia tab

Why read this report

  • Cardiovascular disease (CVD) is the world’s leading killer. It accounted for 30% of deaths around the globe in 2010 at an estimated total economic cost of over US$850bn
  • The common feature of the disease across the world is its disproportionate impact on individuals from lower socio-economic groups
  • Prevention could greatly reduce the spread of CVD: reduced smoking rates, improved diets and other primary prevention efforts are responsible for at least half of the reduction in CVD in developed countries in recent decades…
  • …but prevention is little used. Governments devote only a small proportion of health spending to prevention of diseases of any kind—typically 3% in developed countries
  • Population-wide measures like smoking bans and “fat taxes” yield significant results but require political adeptness to succeed. There is no shortcut for the slow work of changing hearts and minds
  • The size of the CVD epidemic is such that a doctor-centred health system will not be able to cope. Innovative ways for nurses and non-medical personnel to provide preventative services are needed
  • A growing number of stakeholders are involved in CVD prevention, sharing the burden with governments. Now, greater collaboration across different sectors and interest groups should be encouraged
  • Collaboration works when incentives of stakeholders are aligned, including business. Finland’s famed North Karelia project suggests better alignment of interests is crucial to a successful “multi-sectoral” approach

Cardiovascular disease is the dominant epidemic of the 21st century. Dr Srinath Reddy, president of the World Heart Federation

We know a lot about what needs to be done, it just doesn’t get done. Beatriz Champagne, executive director of the InterAmerican Heart Foundation

Action at the country level will decide the future of the cardiovascular epidemic. Dr Shanthi Mendis, director ad interim, management of non-communicable diseases, WHO

I have no idea, I just write…

Punchy interview with Bill Gates’ favourite author. Alignment on food. Other things interesting, but unrelated.

http://www.wired.com/wiredscience/2013/11/vaclav-smil-wired/?mbid=synd_gfdn_bgtw

This Is the Man Bill Gates Thinks You Absolutely Should Be Reading

Author Vaclav Smil tackles the big problems facing America and the world.   Andreas Laszlo Konrath“There is no author whose books I look forward to more than Vaclav Smil,” Bill Gates wrote this summer. That’s quite an endorsement—and it gave a jolt of fame to Smil, a professor emeritus of environment and geography at the University of Manitoba. In a world of specialized intellectuals, Smil is an ambitious and astonishing polymath who swings for fences. His nearly three dozen books have analyzed the world’s biggest challenges—the future of energy, food production, and manufacturing—with nuance and detail. They’re among the most data-heavy books you’ll find, with a remarkable way of framing basic facts. (Sample nugget: Humans will consume 17 percent of what the biosphere produces this year.)His conclusions are often bleak. He argues, for instance, that the demise of US manufacturing dooms the country not just intellectually but creatively, because innovation is tied to the process of making things. (And, unfortunately, he has the figures to back that up.) WIRED got Smil’s take on the problems facing America and the world.

You’ve written over 30 books and published three this year alone. How do you do it?

Hemingway knew the secret. I mean, he was a lush and a bad man in many ways, but he knew the secret. You get up and, first thing in the morning, you do your 500 words. Do it every day and you’ve got a book in eight or nine months.

What draws you to such big, all-encompassing subjects?

I saw how the university life goes, both in Europe and then in the US. I was at Penn State, and I was just aghast, because everyone was what I call drillers of deeper wells. These academics sit at the bottom of a deep well and they look up and see a sliver of the sky. They know everything about that little sliver of sky and nothing else. I scan all my horizons.

Let’s talk about manufacturing. You say a country that stops doing mass manufacturing falls apart. Why?

In every society, manufacturing builds the lower middle class. If you give up manufacturing, you end up with haves and have-nots and you get social polarization. The whole lower middle class sinks.

You also say that manufacturing is crucial to innovation.

Most innovation is not done by research institutes and national laboratories. It comes from manufacturing—from companies that want to extend their product reach, improve their costs, increase their returns. What’s very important is in-house research. Innovation usually arises from somebody taking a product already in production and making it better: better glass, better aluminum, a better chip. Innovation always starts with a product.

Look at LCD screens. Most of the advances are coming from big industrial conglomerates in Korea like Samsung or LG. The only good thing in the US is Gorilla Glass, because it’s Corning, and Corning spends $700 million a year on research.

American companies do still innovate, though. They just outsource the manufacturing. What’s wrong with that?

Look at the crown jewel of Boeing now, the 787 Dreamliner. The plane had so many problems—it was like three years late. And why? Because large parts of it were subcontracted around the world. The 787 is not a plane made in the USA; it’s a plane assembled in the USA. They subcontracted composite materials to Italians and batteries to the Japanese, and the batteries started to burn in-flight. The quality control is not there.

Bill Gates’ actual bookshelf. We count six books by Smil in this section alone.   Ian Allen

Can IT jobs replace the lost manufacturing jobs?

No, of course not. These are totally fungible jobs. You could hire people in Russia or Malaysia—and that’s what companies are doing.

Restoring manufacturing would mean training Americans again to build things.

Only two countries have done this well: Germany and Switzerland. They’ve both maintained strong manufacturing sectors and they share a key thing: Kids go into apprentice programs at age 14 or 15. You spend a few years, depending on the skill, and you can make BMWs. And because you started young and learned from the older people, your products can’t be matched in quality. This is where it all starts.

You claim Apple could assemble the iPhone in the US and still make a huge profit.

It’s no secret! Apple has tremendous profit margins. They could easily do everything at home. The iPhone isn’t manufactured in China—it’s assembled in China from parts made in the US, Germany, Japan, Malaysia, South Korea, and so on. The cost there isn’t labor. But laborers must be sufficiently dedicated and skilled to sit on their ass for eight hours and solder little pieces together so they fit perfectly.

But Apple is supposed to be a giant innovator.

Apple! Boy, what a story. No taxes paid, everything made abroad—yet everyone worships them. This new iPhone, there’s nothing new in it. Just a golden color. What the hell, right? When people start playing with color, you know they’re played out.

Let’s talk about energy. You say alternative energy can’t scale. Is there no role for renewables?

I like renewables, but they move slowly. There’s an inherent inertia, a slowness in energy transitions. It would be easier if we were still consuming 66,615 kilowatt-hours per capita, as in 1950. But in 1950 few people had air-conditioning. We’re a society that demands electricity 24/7. This is very difficult with sun and wind.

Look at Germany, where they heavily subsidize renewable energy. When there’s no wind or sun, they boost up their old coal-fired power plants. The result: Germany has massively increased coal imports from the US, and German greenhouse gas emissions have been increasing, from 917 million metric tons in 2011 to 931 million in 2012, because they’re burning American coal. It’s totally zany!

What about nuclear?

The Chinese are building it, the Indians are building it, the Russians have some intention to build. But as you know, the US is not. The last big power plant was ordered in 1974. Germany is out, Italy has vowed never to build one, and even France is delaying new construction. Is it a nice thought that the future of nuclear energy is now in the hands of North Korea, Pakistan, India, and Iran? It’s a depressing thought, isn’t it?

The basic problem was that we rushed into nuclear power. We took Hyman Rickover’s reactor for submarines and pushed it so America would beat Russia. And that’s just the wrong reactor. It was done too fast with too little forethought.

You call this Moore’s curse—the idea that if we’re innovative enough, everything can have yearly efficiency gains.

It’s a categorical mistake. You just cannot increase the efficiency of power plants like that. You have your combustion machines—the best one in the lab now is about 40 percent efficient. In the field they’re about 15 or 20 percent efficient. Well, you can’t quintuple it, because that would be 100 percent efficient. Impossible, right? There are limits. It’s not a microchip.

The same thing is true in agriculture. You cannot increase the efficiency of photosynthesis. We improve the performance of farms by irrigating them and fertilizing them to provide all these nutrients. But we cannot keep on doubling the yield every two years. Moore’s law doesn’t apply to plants.

So what’s left? Making products more energy-efficient?

Innovation is making products more energy-efficient — but then we consume so many more products that there’s been no absolute dematerialization of anything. We still consume more steel, more aluminum, more glass, and so on. As long as we’re on this endless material cycle, this merry-go-round, well, technical innovation cannot keep pace.

Yikes. So all we’ve got left is reducing consumption. But who’s going to do that?

My wife and I did. We downscaled our house. It took me two years to find a subdivision where they’d let me build a custom house smaller than 2,000 square feet. And I’ll test you: What is the simplest way to make your house super-efficient?

Insulation!

Right. I have 50 percent more insulation in my walls. It adds very little to the cost. And you insulate your basement from the outside—I have about 20 inches of Styrofoam on the outside of that concrete wall. We were the first people building on our cul-de-sac, so I saw all the other houses after us—much bigger, 3,500 square feet. None of them were built properly. I pay in a year for electricity what they pay in January. You can have a super-efficient house; you can have a super-efficient car, a little Honda Civic, 40 miles per gallon.

Your other big subject is food. You’re a pretty grim thinker, but this is your most optimistic area. You actually think we can feed a planet of 10 billion people—if we eat less meat and waste less food.

We pour all this energy into growing corn and soybeans, and then we put all that into rearing animals while feeding them antibiotics. And then we throw away 40 percent of the food we produce.

Meat eaters don’t like me because I call for moderation, and vegetarians don’t like me because I say there’s nothing wrong with eating meat. It’s part of our evolutionary heritage! Meat has helped to make us what we are. Meat helps to make our big brains. The problem is with eating 200 pounds of meat per capita per year. Eating hamburgers every day. And steak.

You know, you take some chicken breast, cut it up into little cubes, and make a Chinese stew—three people can eat one chicken breast. When you cut meat into little pieces, as they do in India, China, and Malaysia, all you need to eat is maybe like 40 pounds a year.

So finally, some good news from you!

Except for antibiotic resistance, which is terrible. Some countries that grow lots of pork, like Denmark and the Netherlands, are either eliminating antibiotics or reducing them. We have to do that. Otherwise we’ll create such antibiotic resistance, it will be just terrible.

So the answers are not technological but political: better economic policies, better education, better trade policies.

Right. Today, as you know, everything is “innovation.” We have problems, and people are looking for fairy-tale solutions—innovation like manna from heaven falling on the Israelites and saving them from the desert. It’s like, “Let’s not reform the education system, the tax system. Let’s not improve our dysfunctional government. Just wait for this innovation manna from a little group of people in Silicon Valley, preferably of Indian origin.”

You people at WIRED—you’re the guilty ones! You support these people, you write about them, you elevate them onto the cover! You really messed it up. I tell you, you pushed this on the American public, right? And people believe it now.

Bill Gates reads you a lot. Who are you writing for?

I have no idea. I just write.

Chronic Disease Fear Factor Ageing Messaging

Governments won’t be able to afford you if you are over 70 and can’t work
You will need to be productive
The current health market can only extend your life, but not your productive life
The new health system will have to do both if we are to preserve our standard of living
Sure, people will need to die sometime, but it’s the when, how and why they die that needs to evolve
This health system aims to deliver on this
Australia is well positioned to lead the world on this
Excitement

MedObs: Govt changed food label system after industry lobbying

It’s clear the algorithm that DoHA established was stuffed if what they say about a glass of water vs chicko rolls is true.

The fact that dairy has held sway indicates the project has been undermined.

Never mind if it ever gets adopted, which is unlikely given AFGC’s mutterings at the press club recently.

Then finally, how much of an impact will food labeling actually have, given all the other drivers of the problem of fundamental overeating. I suspect industry is using food labelling as a straw man to keep the bureaucrats and academics tied up while industry marches on its merry way.

This is a classic case of policy development driven by obsessions with process rather than focus on outcome.

Source: http://www.medicalobserver.com.au/news/govt-changed-food-label-system-after-industry-lobbying

Govt changed food label system after industry lobbying

THE Department of Health and Ageing has admitted it changed how it rated dairy products under a radical new food labelling scheme following lobbying from the industry – but staunchly defended its assessment methods.

In Senate estimates this week, department secretary Professor Jane Halton said the dairy industry had complained about how its products fared in the new star system designed to combat obesity.

“The concern that was raised in respect of the algorithm in respect of dairy was that it didn’t give dairy the right prominence,” she said.

“The [department’s] project group considered in great detail how dairy might be recalibrated. We’ve pulled dairy out and we’ve got different categories now.”

But Professor Halton rejected “in the strongest possible terms” suggestions the formulae were wrong after the Senate heard a glass of water would be rated as less healthy than some junk food products.

“It is highly robust and it has been tested across a large number of foods,” she said of the system.

Other industries had told the department they wanted their products rated “better” but she would not say which.

In a statement, Senator Bridget McKenzie said the new scheme risked sending the message that healthy products like milk and cheese were unhealthy.

“The fact that under this scheme a glass of water is less healthy than a Chiko Roll calls into question the whole basis of the front-of-pack labelling scheme,” she said.

Research showed healthy amounts of dairy were linked to reduced risk of several chronic diseases, including heart disease, hypertension, stroke and type 2 diabetes, she said.

The scheme is expected to have the star ratings on food packaging by mid-2014.