Obesity Prevention: HBO, IOM, CDC, NIH and The White House Go Public May 14 and 15.

Posted on | May 11, 2012 | No Comments

Mike Magee

Health Commentary has been focused on the challenge of obesity for over a decade. The facts have been clear. But the will to deal effectively with this crisis has been spotty at best. The costs are rising – in financial, human, social and cultural capital – and weighing us down in a thousand different ways. What will it take to effectively respond?

Organization! And thanks to the very visible and tenacious leadership of First Lady Michelle Obama, we now are seeing a more coordinate approach coalesce from all sectors of our Society – an American approach. You need to be part of the action. The starting dates: May 14 and 15 (this coming Monday and Tuesday) join the HBO special described below. Note: it may be available even if you are not an HBO subscriber. Join me next week. The details are below.

“Bringing together the nation’s leading research institutions, The Weight of the Nation is a presentation of HBO and the Institute of Medicine (IOM), in association with the Centers for Disease Control and Prevention and the National Institutes of Health, and in partnership with the Michael & Susan Dell Foundation and Kaiser Permanente.

The films follow the IOM’s latest report, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation, which articulates the most promising solutions to our obesity crisis. These films document the state of the problem, including how we got here and what we must do to solve it.

  • Part I: Consequences and Part II: Choices will air May 14, beginning at 8 p.m. EDT.
  • Part III: Children in Crisis and Part IV: Challenges will air May 15, beginning at 8 p.m. EDT.

HBO has asked its carriers to open their channels, allowing the films to be viewed by non-HBO subscribers. The films will also be available May 14-15 at www.hbo.com/weightofthenation.

More Information >>

wotntrailer

Category: obesity
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Intergenerational Caring: When Caring Flows Up, Learnings Flow Down.

Posted on | May 2, 2012 | 4 Comments

Mike Magee

This afternoon I’ll be flying to Seattle to deliver a keynote tomorrow to the American Academy of Home Care Physicians at The American Geriatrics Society Annual Meeting. One of my messages will be to “reconnect the American family”. By that I mean to encourage multigenerational mutual caring, learning, and committment. Stated another way, I believe that we should foster the movement of learnings down the generational divide and caring up the generational divide.

Nothing could better capture the spirit and value of this approach than the true story below:

By Kent Nerburn

“We may not all live holy lives, but we live in a
world alive with holy moments.”
~ Kent Nerburn

Twenty years ago, I drove a cab for a living.

It was a cowboy’s life, a life for someone who wanted no boss.

What I didn’t realize was that it was also a ministry.

Because I drove the night shift, my cab became a moving confessional. Passengers climbed in, sat behind me in total anonymity, and told me about their lives. I encountered people whose lives amazed me, ennobled me, and made me laugh and weep.

But none touched me more than a woman I picked up late one August night. I was responding to a call from a small brick fourplex in a quiet part of town. I assumed I was being sent to pick up some partyers, or someone who had just had a fight with a lover, or a worker heading to an early shift at some factory for the industrial part of town.

When I arrived at 2:30 a.m., the building was dark except for a single light in a ground floor window.

Under these circumstances, many drivers would just honk once or twice, wait a minute, then drive away.

But I had seen too many impoverished people who depended on taxis as their only means of transportation.

Unless a situation smelled of danger, I always went to the door. This passenger might be someone who needs my assistance, I reasoned to myself.

So I walked to the door and knocked. “Just a minute”, answered a frail, elderly voice. I could hear something being dragged across the floor.

After a long pause, the door opened. A small woman in her 80?s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940s movie. By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets. There were no clocks on the walls, no knick-knacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.

“Would you carry my bag out to the car?” she said. I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb. She kept thanking me for my kindness.

“It’s nothing”, I told her. “I just try to treat my passengers the way I would want my mother treated.”

“Oh, you’re such a good boy”, she said. When we got in the cab, she gave me an address, then asked,

“Could you drive through downtown?”

“It’s not the shortest way,” I answered quickly.

“Oh, I don’t mind,” she said. “I’m in no hurry. I’m on my way to a hospice.”

I looked in the rear view mirror. Her eyes were glistening.

“I don’t have any family left,” she continued. “The doctor says I don’t have very long.”

I quietly reached over and shut off the meter. “What route would you like me to take?” I asked.

For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator. We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl. Sometimes she’d ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing.

As the first hint of sun was creasing the horizon, she suddenly said, “I’m tired. Let’s go now.”

We drove in silence to the address she had given me. It was a low building, like a small convalescent home, with a driveway that passed under a portico. Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.

“How much do I owe you?” she asked, reaching into her purse.

“Nothing,” I said.

“You have to make a living,” she answered.

“There are other passengers”.

Almost without thinking, I bent and gave her a hug. She held onto me tightly.

“You gave an old woman a little moment of joy,” she said. “Thank you.”

I squeezed her hand, then walked into the dim morning light. Behind me, a door shut. It was the sound of the closing of a life.

I didn’t pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk. What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away?

On a quick review, I don’t think that I have done anything more important in my life.

We’re conditioned to think that our lives revolve around great moments. But great moments often catch us unaware – beautifully wrapped in what others may consider a small one.

Category: caregiving
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Affordable Care Act: Remembering How We Got Here…And Where We’ll Likely Go Next If Rejected.

Posted on | April 30, 2012 | No Comments

Kathleen Sebelius

US Secretary, Health and Human Services

Several weeks ago the nation tuned into a renewed vigorous debate regarding health care reform fueled by the Supreme Court’s review of challenges to the constitutionality of the Affordable Care Act. While the final outcome of these deliberations are yet to be revealed, what we do know is that health care expenditures over the past year have flattened dramatically.

In light of these events, it is useful and instructive to reread an Wall Street Journal Op-Ed written by Kathleen Sebelius on September 28, 2010, because it reminds us all what we are dealing with here, and where we might have to go next if the Affordable Care Act is overturned.(1)

Secretary Sebelius says in 2010:

“In the last two weeks, my department has been accused of “thuggery” (this editorial page) and “Soviet tyranny” (Newt Gingrich). What prompted these accusations? The fact that we told health-insurance companies that, as required by law, we will review large premium increases and identify those that are unreasonable.

There’s a long history of special interests using similar attacks to oppose change. In the mid-1960s, for example, some claimed Medicare would put our country on the path to socialism.

But what is really objectionable about these comments is not who they’re attacking, but what they’re defending. These critics seem to believe that any oversight of the insurance industry is too much, and that consumers would be better off in a system where they have few rights or protections.

Over the past decade, Americans have seen what happens when insurance companies have free rein. The cost of health insurance has more than doubled, while millions of hard-working Americans lost their coverage or drained their savings to keep up with premiums. Employers—big and small—have struggled mightily to absorb these cost increases and have been losing the fight.

As insurance commissioner and governor of Kansas, I saw firsthand how these rate hikes burdened people. I spoke with families who watched their insurance go up 20%, 30%, even 40% a year without explanation. I met with small business owners who had stopped offering health insurance to their employees because they couldn’t afford the annual double-digit premium increases.

A woman who wrote to me recently summed up the frustration that many feel. “As a self-employed, hard-working person,” she wrote, “I have no good options for health coverage.”

Yet even as our insurance markets have failed Americans time and time again, special interests successfully blocked reform.

That’s changing with enactment of the new health insurance law. Under the Affordable Care Act, 46 states have already received grants to beef up their premium-review and oversight capabilities. And additional funding is on the way.

The law also gives clear instructions to the new state-based health insurance marketplaces called exchanges that will be created in 2014. As the exchanges decide what plans to include, they must incorporate recommendations from states about whether particular health insurance issuers should be excluded based on a pattern of excessive or unjustified premium increases.

We are already seeing this new level of accountability pay off. Last week, North Carolina’s largest insurer announced a ‘one-time refund that will return $155.8 million to more than 215,000 individual Blue Cross Blue Shield customers as a result of the Affordable Care Act.’ This rebate will put an average of $720 back into the pockets of each of those policyholders. In addition, thanks to diligent work by North Carolina’s insurance commissioner, they’ll see their premiums rise by less than 6% in 2011—the smallest rate increase in four years.

A day after Blue Cross Blue Shield’s announcement, seniors with private Medicare plans got some news that most Americans haven’t heard in years: Their premiums will actually go down 1% next year, even as many of them enjoy better benefits.

The Affordable Care Act is bringing some basic fairness to our health insurance market. So when I learned that a handful of insurers around the country are blaming their significant rate increases on the new law—even though the facts show that the impact of the law on premiums is small, just 1% to 2% declining over time—I let them know that we’d be closely reviewing their rate hikes.

It’s understandable that some insurance companies and their allies don’t welcome this change. They’ve made large profits from the status quo. And it’s not surprising—though still disappointing—that House Republicans have recently pledged to repeal the Affordable Care Act and get rid of these new consumer protections.

If critics really want to go back to the days when insurance companies ran wild with no accountability, they should have the courage to say so openly instead of hiding behind distracting attacks. In the meantime, we’re going to keep standing up for American families and small business owners who deserve a system that works for them.”

So here we are, nearly two years later, with health care spending holding steady at 17.9% of GDP. Is it just that many people are out of work, lack insurance, and are avoiding needed care?

David Cutler, Harvard Health Economist thinks not.“The recession just doesn’t account for the numbers we’re seeing. I think there’s much more going on.”  Karen Davis, the president of the Commonwealth Fund, agrees. “The tectonic plates might be beginning to shift. It’s hard to believe everything that’s been tried over the last decade to slow spending wouldn’t be making a difference.”(2)

New York Times reporter Annie Lowery provides this analysis, “…the slowdown was sharper than health economists expected, and a broad, bipartisan range of academics, hospital administrators and policy experts has started to wonder if what had seemed impossible might be happening — if doctors and patients have begun to change their behavior in ways that bend the so-called cost curve.”(2)

There are approximately 164 “accountable care organizations” in place already – attempting to balance quality with cost efficiency. Will these just go away if the Supreme Court registers a negative opinion? Unlikely.(3) Rather they may become the leading edge of a more straight forward “public option” which will address the very insurance industry Secretary Sebelius faced head on two years ago.

For Health Commentary, I’m Mike Magee.

References:

1. Sebelius K. Health Insureres Finally Get Some Oversight. Wall Street Journal. September 28, 2010.http://online.wsj.com/article/SB10001424052748704082104575515851336184716.html

2. Lowery A. In Hopeful Sign, Health Spending Is Flattening Out. NYT. April 28, 2012.http://www.nytimes.com/2012/04/29/health/policy/in-hopeful-sign-health-spending-is-flattening-out.html

3. Accountable Care Choices.http://www.accountablecarechoices.org/

Category: health reform
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Guest Blogger Megan Kashner on Poverty and Health

Posted on | April 27, 2012 | No Comments

Megan Kashner
CEO, Benevolent

Original Source:

I was doing some online research this weekend, looking for cite-able sources about the connection between improvements in people’s socioeconomic status and their health outcomes when I stumbled across a piece of scholarship I simply had to share with you.

Many of us might not know a great deal about Thomas Frieden, the head of the U.S. Centers for Disease Control. Dr. Frieden is responsible for providing the expertise and tools that people and communities need to protect their health.

Turns out, the guy is incredible – has turned the CDC around, shedding bureaucracy and replacing it with action and efficiency. He also happens to be the author of the brilliant piece I found in my searches yesterday: “A Framework for Public Health Action: The Health Impact Pyramid.”

So what was so brilliant about this article? Frieden clearly lays out the reality that “addressing socioeconomic factors has the greatest potential to improve health.”

Did you get that? The thing that we can do as a society to best improve health and health outcomes as a nation will be to reduce poverty which Frieden tells us will:

• Improve immunity

• Reduce crowding and exposure to communicable microbes

• Improve nutrition, sanitation and housing options

• Increase educational levels, and nutritional options

• Reduce cardiovascular disease, some cancers, and diabetes

• Reduce drug use and violence

• and Lower vulnerability to extreme weather conditions.

Well, ok then. We’re done. We’ve solved it. All we need to do is to reduce poverty and improve baseline socioeconomic status. Let’s all get on that.

Actually, we’re already on it. You’re already on it. Each need we meet on the Benevolent site is bringing that person – and his or her family – one step closer to economic stability and sustainability. Each time you read and share one individual’s story of striving, you’re meeting and introducing others to the real people behind the numbers and maybe, just maybe, we’ll build momentum to change the conversation about policies and supports.

So, next time you hear a conversation about health care in our country, or about entitlement programs or funding for safety net supports, remember that those are actually the same conversation. We cannot continue to put low-income families in impossible situations and expect them to succeed with less and less of a foundation from which to build.

We cannot hope to see improved health, decreased obesity, drops in diabetes and heart disease rates, or drop-offs in community violence until we address the underlying reality.It’s about poverty. It’s about resources. It’s about how our civic constructs promote or inhibit people’s progress towards their goals and out of hardship and risk.

Thanks to each of you for being part of the solution. Remember to share the stories of striving and challenge you see on the Benevolent site out to your friends and family overFacebook, through email, etc. The more we introduce people to the real people impacted by low-income and hurdles to taking their steps towards stability, the more we change people’s understanding of the issues, needs, and constructs surrounding poverty in our country.

Category: poverty
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Leaders From Health Care and Business to Discuss New Efforts to Achieve Better Care, Better Health, and Lower Costs in the United States

Posted on | April 27, 2012 | No Comments

Upcoming  Media Teleconference Draws on Examples from Newly Published Book, Pursuing The Triple Aim

WHAT: The Institute for Healthcare Improvement will host a media briefing on May 4th to describe groundbreaking new approaches to health care delivery in the US, many of which reflect a growing consensus among local and multiple stakeholders that “business as usual” in health care is no longer sustainable or acceptable.  The discussion coincides with publication of Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs (April 2012, Jossey-Bass) by IHI President and CEO Maureen Bisognano and leading health care author Charles Kenney. The book chronicles innovations currently underway in several states aimed at greater coordination of care and better outcomes for diverse populations. These new models, the authors suggest, are critical and deserve to be studied and built upon by other communities and the country as a whole.

WHO: Participants in the media briefing will include:

  • ·         Maureen Bisognano, President and CEO, Institute for Healthcare Improvement; co-author, Pursuing the Triple Aim
  • ·         Charles Kenney, leading health care author; co-author, Pursuing the Triple Aim
  • ·         Jack Cochran, MD, Executive Director, Permanente Federation
  • ·         George Kerwin, President and CEO, Bellin Health
  • ·         Richard Lopez, MD, Chief Medical Officer, Atrius Health
  • ·         Patricia A. McDonald, Vice President, Technology and Manufacturing Group, and Director, Product Health Enhancement Organization, Intel
  • ·         Michael O’Connell, Vice President, Planning and Marketing, Mount Auburn Hospital
  • ·         Rebecca Ramsay, CareSupport Manager, CareOregon
  • ·         Brian H. Rank, MD, Medical Director, HealthPartners Medical Group

WHEN: Friday, May 4th

2:00 – 3:00 pm (ET)

CONTACT: For more information or to register, please contact Liz Kidder, Goodman Media International,lkidder@goodmanmedia.com, (212) 576-2700 x239.

Category: healthcare reform
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Autism Advocacy Beginning To Pay Off: Will Others Benefit As Well?

Posted on | April 26, 2012 | No Comments

Mike Magee

We live in an age of advancing health consumerism. What began as a declaration of empowerment, has matured through direct and indirect education of the consumer public, and has been reinforced by active involvement, engagement and activism.

This growth and evolution has been spotty (more evident in those who are educated, insured, and wealthy – and less so in those who are not), as well as selective by condition. Breast cancer for example has been the subject of very prominent promotion and support, expanding resources for research and treatment, and leading to decreases in variability of diagnosis and treatment and increases in survival. This heavy visibility and explosion of pink is not without controversy (why this disease versus others and what’s with the politics of the Susan G. Komen Foundation?)

On the whole, however, publicity delivers results when it comes to a disease – as well as misinformation. A perfect example is autism. Latest US estimates are that 1 in 88 is affected by one or another of the autism spectrum disorders.(1) The numbers have increased dramatically in the past 30 years, mostly due to greater diagnostic acumen and vigilence. The narratives are profound and deeply troubling – a child developing normally suddenly and inexplicably reverses course. It’s more common in males than females by a 4 to 1 margin. And increasingly, genetics are felt to be the culprit, but we’re still fighting to correct tremendous damage that resulted when a now discredited researcher published a supposed link between childhood vaccines and autism.(2,3)

Messy business, as with the recent breast cancer scuffle. But, as with breast, on the whole, publicity delivers dollars, and dollars equal more focused research and breakthroughs. For example, just this week we have positive news on the autism front. The basic science insight has been profound. It had been thought that the defect (whatever it was) was hard-wired. It now seems clear this is not the case. Secondly, the conditon or conditions was not felt to be amenable to medical treatment. But this week’s research results in experimental animal models demonstrate that GRN-529, an experimental agent targeted at the brain chemical glutamate, tied to socialization and behavior, reversed repetitive and anti-social behavior in these animals.(4)

Lead author, Jacqueline Crawley of the National Institute of Mental Health noted, “Many cases of autism are caused by mutations in genes that control an ongoing process — the formation and maturation of synapses, the connections between neurons. If defects in these connections are not hard-wired, the core symptoms of autism may be treatable with medications.”(5) It seems then that the neurodevelopmental defects present intra-uterine are neither permanent nor hard wired. Rather, if left unaddressed, they destroy human potential. But if better understood and treated, there is significant reason for hope among the many, many families touched by this devastating problem. There activism is beginning to pay off. And the basic science learnings, in terms of the plasticity of the brain and moldability of ongoing synaptic connections could have a profound impact on a wide range of neuodegenerative diseases across the entire lifespan.

For Health Commentary, I’m Mike Magee

References:

1. CDC: Autism Spectrum Disorders, 2012. http://www.cdc.gov/ncbddd/autism/index.html

2. Freitag CM. The genetics of autistic disorders and its clinical relevance: a review of the literature. Mol Psychiatry. 2007;12(1):2–22. doi:10.1038/sj.mp.4001896. PMID 17033636. http://www.ncbi.nlm.nih.gov/pubmed/17033636

3. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ. 2011. 342:c7452. Retrieved April 2 2012. http://www.bmj.com/content/342/bmj.c7452

4. Silverman JL et al.Negative Allosteric Modulation of the mGluR5 Receptor Reduces Repetitive Behaviors and Rescues Social Deficits in Mouse Models of Autism.Sci Transl Med 25 April 2012:Vol. 4, Issue 131, p. 131ra51 http://stm.sciencemag.org/content/4/131/131ra51

5. Fox M. Drug helps treat autism symptoms in mice. National Journal. 4/25/12. http://www.nationaljournal.com/healthcare/drug-helps-treat-autism-symptoms-in-mice-20120425

Category: Research and Discovery, Uncategorized
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Open Advice to AAMC 51st RIMA Meeting Planners

Posted on | April 19, 2012 | No Comments

Will two college professors soon “eat your lunch”?

Mike Magee

On November 2, 2007, the Association of American Medical Colleges will convene the 51st National Research In Medical Education conference at its 123rd Annual Meeting. February 20, 2012 was the deadline for submissions which will shape the content for the meeting.(1) The 2012 lead initiatives of the AAMC include (2):

“Aligning and Educating for Quality (ae4Q)

The ae4Q initiative is designed to assist the continuing medical education units of academic medical centers to more effectively integrate with performance improvement goals.

Readiness for Reform (R4R)

The AAMC Readiness for Reform (R4R) initiative assists AAMC member institutions in assessing their readiness for responding to key provisions of the Affordable Care Act, and facilitates sharing member strategies and best practices for building capacity to address delivery reform.

Research on Care Community (ROCC)

ROCC is the research arm of the AAMC’s Best Practices for Better Care initiative, but is also open to all interested member medical schools and teaching hospitals.

Joining Forces

The AAMC is working with practitioners who care for our nation’s military members and their families.

Leadership and Talent Development

Working with our member medical schools and teaching hospitals, the AAMC is developing resources and tools to help institutions improve the process by which they search for and select institutional leaders.

Workforce

Current evidence suggests that the United States is headed toward an aggregate shortage of physicians. The AAMC’s Center for Workforce Studies conducts research that informs health workforce policy and compels the nation toward the right mix of physicians.”

…all of which is fine, much of which will be well represented in both submissions and final agenda, and none of which addresses significant transformative changes enveloping general education reform, consumer empowerment/professional partnering, and virtual bypass of historic power bases by new information technologies.

Are Medical Educators outliers in the general education arena when it comes to continuing to choose the status-quo over new risk-laden approaches to enveloping trends? A quick review would suggest the answer is yes. Let’s take a quick peak at what’s going on out there at higher education institutions.

1. Coursera: Stanford, the University of California, Berkeley, the University of Michigan, the University of Pennsylvania and Princeton just announced they have secured $16 million in venture capital and partnerships from two of Silicon Valley’s premier venture capital firms, Kleiner Perkins Caufield & Byers and New Enterprise Associates.(3,4) This the first step in creation of a Web portal to provide open access to a broad array of interactive courses in the humanities, social sciences, physical sciences and engineering. The brain child of Andrew Ng and Daphne Koller, two Stanford computer scientists, didn’t come out of nowhere. Last year, their online courses reached over 100,000 students.  Last year a highly publicized course in artificial intelligence topped out at 160,000 students from 190 countries. It was taught by former Stanford Professor Sebastian Thrun and  Peter Norvig, Google’s director of research. Participants didn’t receive university credits for the course, but rather certificates of completion. Thrun was apparently impressed. He resigned from Stanford and launched the new online university, Udacity.(4)

2. Free Is Good: The dual realities of open access and no fees apparently are not seen as obstacles amount savy investors. Says venture capitalist John Doerr, a Kleiner investment partner,  “Yes. Even with free courses. From a community of millions of learners some should ‘opt in’ for valuable, premium services. Those revenues should fund investment in tools, technology and royalties to faculty and universities.” As for the professors, they seem happy to pony up – what if you had the choice to reach 100,000 minds rather than 100?(4)

3. Flipping The Classroom: What investors in start-ups like Coursera, Udacity, Minerva, Udemy, MIT, and others are banking on is highly efficient learning centered on a concept introduced by educator, Salman Khan. He is the dynamic, youthful, almost naive creator of Khan Academy(5), who originally was simply doing a “nice turn” for his long-distance nephew by creating 10 minute interactive learning sessions on a wide range of topics. What he realized in the process was that it was easier to teach a person at home and problem-solve in the classroom than the other way around. Homework becomes schoolwork and vice versa.

All of which brings me back to the 51st RIME Meeting in San Francisco on November 2, 2012. Here’s how I see it. First, the physician job description hasn’t fundamentally changes in a century. Second, US medical education remains trapped in brick and mortar, hospital-centric, and focused on training physicians in highly traditional formats. Third, rapid advances in evolution of higher education may present individuals in the near future with opportunities to acquire more relevant medical education, faster and cheaper, through alternatives to medical schools. Fourth, these options will be open not only to potential new physicians and other health professionals, but also to their highly motivated patients.

Note to planners of the 51st RIMA Conference: Suggest a call to Salman Khan or Andrew Ng and Daphne Koller to see if they are available for a keynote at your conference.

For Health Commentary, I’m Mike Magee

References:

1 AAMC Annual Meeting: 2012.

2. AAMC 2012 Featured Initiatives. https://www.aamc.org/initiatives/

3. Coursera: About Coursera. http://www.cs101-class.org/hub.php

4. Markoff J. Online Education Venture Lures Cash Infusion And Deals With 5 Top Universities. April 18, 2012. New York Times.

5. Khan Academy.http://www.khanacademy.org/

Category: medical education
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