Monthly Archives: May 2014

business, data saving lives, entrepreneurship, management and leadership

Saturday Extra (Norman Swan): Retail Wars // Big Data Play

Robert Gottleibsen on Woolies vs Coles retail strategy, including commentary on Wollies big data play

http://www.abc.net.au/radionational/programs/saturdayextra/supermarket-wars/5397006

Retail wars

Saturday 3 May 2014 7:50AM
Creative: Generic online shopping (Thinkstock: Ablestock.com)IMAGE: CREATIVE: GENERIC ONLINE SHOPPING (THINKSTOCK: ABLESTOCK.COM)

The supermarket giants Coles and Woolworths have reported sales results that put them virtually neck and neck in the war for our trolleys and our wallets.

The battle for supremacy has been going on for five years, with Coles taking the lead since it was acquired by the Wesfarmers group in 2007.

But even with the retailers drawing closer in terms of results, there are some stark differences in business strategy that are being played out.

healthy habits, policy, politics

Steve Leeder on the shutting down of ANPHA

 

http://steve-leeder-better-health.blogspot.com.au/2014/05/anpha-lost-in-earthquake.html

Monday, May 5, 2014

ANPHA: LOST IN AN EARTHQUAKE

So. The seismic monitor suggests that ANPHA, the Australian National Preventive Health Agency, established in 2011, is likely to slip into Hades through a crack in the ground as the tectonic plates of the Commission of Audit and the Hockey budget shift and grind.  What a pity.  ANPHA began in 2011. Let’s be clear why it was a good idea, so that when it’s gone (assuming it goes) we can mourn its passing properly.

The major afflictions of our community are conditions such as heart disease. stroke, cancer, depression, and problems of bones and joints.  None of these things are as preventable as whooping cough or polio, but the decline in heart disease in Australia in the past half century is deeply encouraging.  Through a combination of better treatment, less smoking and dietary change we’ve more than halved – considerably more in the case of the under 65s – death rates.  These disorders have a major preventive element in them.

The risks for heart disease are fully described.  They relate closely to what we eat, how much we drink, our physical activity and more.  Yes, these behaviours are ultimately matters of choice: we are, as GW Bush would say, are the deciders.

But we’re not really.  The shopping environment influences what we choose to buy.  The advertising environment powerfully influences our purchases of alcohol.  The economic environment determines where we can afford to live.  Get real. These are shapers, the causes behind the causes.  And we must attend to these things if prevention is to work.

Without legislation, kiss goodbye to tobacco control.  Other countries label foods so that people – not just robots – can work out which are the healthiest.  New York has eliminated trans fats – by legislation from all prepared food.  More broadly in the US, man-made trans fat consumption fell by 600 million tonnes between 2005 and 2012 as Dow and other vegetable oil producers acceded to the expectations and legislative urging of American citizens and govenrnments that they would produce stuff that was health promoting and not damaging.

Set yourself a preventive agenda that seeks to achieve these lifestyle opportunity-promoters and you need strength including at a national level.  Individuals struggle to win these battles.  Groups such as the National Heart Foundation, cancer societies and others have been zealous.  But the thought behind ANPHA was that it could become a counterweight to the big-time, burly avarice that drives health-destroying profiteering.  No wonder the alcohol industry will declare drinks all rounds in celebration when the bulldozers demolish ANPHA!  Bewdy mate, drink up!

The politics of prevention are what made ANPHA so important to our health future and so hated by those who, like the tobacco barons of yore, want free rein to push their wares no matter the health costs.  Get rid of food labelling, they beseech the government!  It infringes our liberty as manufacturers to sell whatever we want.  Think of our civil liberties!  Make health a matter of choice but diminish the capacity of the consumer to choose intelligently! Please, Mr Government, DO it!

Yes, ANPHA could support more research in prevention.  From the perspective of big business research is pretty innocent stuff and usually has little commercial impact.  It’s safe.  But when research is translated into advocacy, that’s when trouble starts. That’s when those driven fundamentally by profit start worrying, and when the political tectonic plates start grinding in response. And advocacy is what a national agency with muscle could do.

So. When ANPHA goes that is what goes with it – the ability for an agency, with clout, to argue for changes that will help ensure a future in which it would be easier to choose to be healthy.  Shame.

cool, data saving lives, entrepreneurship, nutrition, quantified self, technology

Extremely cool $150 smartphone spectrometer

 

http://gigaom.com/2014/04/29/consumer-physics-150-smartphone-spectrometer-can-tell-the-number-of-calories-in-your-food/

https://www.kickstarter.com/projects/903107259/scio-your-sixth-sense-a-pocket-molecular-sensor-fo

Consumer Physics’ $150 smartphone spectrometer can tell the number of calories in your food

by 

SCiO-In-Hand---900px

SUMMARY:The SCiO is a handheld molecular analyzer, developed by Consumer Physics, which pairs with a smartphone through Bluetooth LE. The Kickstarter launched Tuesday morning and a fully operational SCiO starts at $149.

Would you like to be able to look up the calorie content of the specific apple you’re eating? You could take it to a lab and run it through a spectrometer, but accurate spectrometers are huge, expensive machines that are often only owned by institutions and require training to use. A new startup, however, wants to make iteasy as running an app and pairing a bluetooth dongle.

SCiO

The SCiO is a handheld device that pairs with a smartphone through Bluetooth LE being developed by Consumer Physics, an Israel-based startup funded by Kholsa Ventures. It’s based on near-infrared spectroscopy, which means it reflects light onto an object, then collects and analyzes the light reflected back. The Kickstarter launched Tuesday morning with several funding levels: a fully operational SCiO starts at $149, but Kickstarter backers pledging over $300 will receive two years of guaranteed app upgrades.

While scientists and researchers use near-infrared spectroscopy on a regular basis, there are lots of consumers that would love to know more about the chemical composition of the world around them, whether it’s identifying the pills left in the back of the medicine cabinet or figuring out whether the fruit at the farmer’s market is ripe. Consumer Physics will offer both Android and iPhone apps, and also hopes to develop a platform upon which third parties can build their own apps.

Using the SCiO is simple: shine its blue light onto an object you want to analyze. In a few seconds, the associated smartphone app will take the spectrometer reading, send it to SCiO servers, analyze it and compare it to a database of known spectral signatures, and display the information in an easy-to-understand manner. In turn, the readings provided by users will make the spectral signature database more complete.

Consumer Physics has developed three different applications for identifying food, medicines, and plants. During a short demo, I saw the module return the percentage of fat and number of calories per 100 grams of cheese. The SCiO was also able to identify a number of different over-the-counter drugs and could distinguish between a Tylenol and a Tylenol PM. I did not see the plant application, but eventually, it should be able to measure leaf hydration and soil hydration and provide hydroponic solution analysis.

While the SCiO prototype is about the size of a large keyring, the actual module is much smaller. It’s closer to the size of a smartphone camera module, and could one day be included in a variety of forms, including wearables. Developer kits available through the Kickstarter for $200 offer bare-bones SCiO modules and come with CAD designs for 3D printers.

Although Consumer Physics, in addition to developing the hardware, is also populating the first databases and apps that work with the SCiO, hopefully other companies will build their own apps, using the developer kit available from Kickstarter. Personally, I’d love to see apps that would identify if a drink has been spiked with drugs. However, you might have to pay, especially for specific professional use-cases. Spectography is often used to identify gems, and CEO Dror Oren adds, “If someone wants to offer an application for diamonds that costs $1,000, that’s the kind of platform we want to build.”

Other companies working in the portable spectrometer space have also used the technology to track calories eaten and nutritional intake through a user’s sweat.

The first SCiO prototypes will ship in October and the Kickstarter is live now.

healthy habits, nutrition, silly

Severed heads in coca-cola

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

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

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

06-05-14

coke425

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

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

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

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

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

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

Orthopods come clean on prostheses and care quality… sort of

 

 

Australian Orthopaedic Association research shows best artificial joints

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

###

healthcare, policy, politics

Terry Barnes on Commission of Audit

But why does he leave private health insurers untouched?

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

The audit missed healthcare costs

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

TERRY BARNES

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

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

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

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

HEALTHCARE SHOULD FOCUS ON INDIVIDUALS

 

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

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

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

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

AMERICANISING OUR HEALTHCARE SYSTEM

 

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

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

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

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

The Australian Financial Review

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

PHI dysfunction starting to gel…

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

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

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

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

My back-of-envelope rationale:

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

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

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

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

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

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

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

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

Let me know your thoughts?

Cheers, Paul

 

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

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

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

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

Regards,

Am

 

 

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

Australian Healthcare & Hospitals Association
the voice of public healthcare

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

 

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