btw2.net

I’m doing my blogging at PortfolioLife.

ScienceRoll has a post titled Web Directories of Medicine and Web 2.0 which links to several other medical 2.0 blogs. And they note:

What is the difference between medicine 2.0 and health 2.0? Walter Jessen has the perfect answer:

Medicine 2.0 is science of maintaining and/or restoring human health through the study, diagnosis and treatment of patients utilizing web 2.0 internet-based services, including web-based community sites, blogs, wikis, social bookmarking, folksonomies (tagging) and rss, to collaborate, exchange information and share knowledge.

Health 2.0, a new concept of healthcare, also utilizes web 2.0 internet-based services but is focused on healthcare value (meaning outcome/price). Patients, physicians, providers and payers use competition at the medical condition level over the full cycle of care as a catalyst for improving safety, efficiency and quality of healthcare delivery.

The part worth noodling on:

…The U.S. health-care system has two distinct parts — financing and delivery. The financing system is how we pay for health-care services. It is composed of employer-based insurance, the individual insurance market, Medicare, Medicaid, SCHIP, the veterans health system and other programs. Today, the private part — employer-based coverage and individual insurance — accounts for just under 55 percent of all payments for health care, while government contributes about 45 percent.

The delivery system consists of about 850,000 doctors, 5,000 acute-care hospitals, 39,000 pharmacies and 8,100 home health agencies, as well as hospices, surgical centers, radiological centers, laboratories and other outlets that provide the actual health-care services Americans need.

To the extent that any health insurance scheme involves spreading among members of society the financial risk of getting sick, all insurance “socializes” the risk. This is, of course, not what people mean when they level charges of “socialized medicine.” This term is never used in reference to police protection, fire departments or highways — all of which are provided by government.

Properly speaking, socialism is when the state owns or controls the means of production. Thus “socialized medicine” is when the doctors are state employees; when the hospitals, drugstores, home health agencies and other facilities are owned and controlled by the government.

Only one part of the U.S. system really is socialized medicine: the veterans’ health-care system, which is wholly owned and operated by the federal government. Veterans love the system and vigorously oppose any suggestions of dismantling it and integrating them into civilian health care. By many measures, this bastion of socialized medicine may constitute the highest-quality and most efficient part of American health care….

It is absurd to call an expansion of government payments for health care in the existing private delivery system socialized medicine. Politics may be full of hype, exaggeration or partisan bickering, but there should be no place for overt deception. A serious debate about whether and how to reform the American health-care system requires that we eliminate comments whose only purpose is to mischaracterize and misinform….

‘Socialized Medicine’ Quackery
By Ezekiel J. Emanuel, The Washington Post, October 8, 2007
Ezekiel J. Emanuel, an oncologist and
the author of “No Margin, No Mission: Health Care Organizations and the Quest for Ethical Excellence,”
chairs the Department of Bioethics at the National Institutes of Health.
The views expressed here are his own.

The Arizona Republic has an article this morning about world weather records and who investigates them and arbitrates what are real records.
It’s not a weather record until he says it is
U.N. taps professor at Arizona State to create global archive

The purpose is to establish an authoritative tracking and record of weather extremes, which will help scientists understand weather patterns and climate shifts over time. A sharp increase in record-setting extremes could provide clues to the Earth’s climate shift.

How’d he get into this? “Cerveny got interested in weather as a child in Nebraska. His family’s hilltop farm was on the edge of town, and the sheriff would drive to their house in bad weather to watch for tornadoes. If the sheriff saw one, he would radio in so the town could sound warning sirens.”
His thoughts on On global warming:

“I don’t think it’s going to be catastrophic. We’re going to have to change and develop sustainability ideas to handle the change. But I was once asked by students, ‘Are we going to be around in 20 or 30 years?’ Well, yes, we’re going to be around. It’s going to be a different place, but we’re going to be around.

The World Meteorological Organization recently launched a Web site that archives world weather/climate extremes. Here are some examples from the site, wmo.asu.edu/….

Indicators of change

…As Cerveny considers such data, he ponders whether extreme events are an indicator of global climate change. No one can point to a new record rainfall or heat spell and declare it’s a sign of global warming, he says. But if more records occur, they could indicate a climate change. Any determination depends on their accuracy….

Today The Health Care Blog has a post - The Perpetual Health Care Crisis By Jeff Goldsmith.
It begins:

I began teaching health policy almost thirty years ago with Odin Anderson at the University of Chicago Graduate School of Business. Like me, Odin was a sociologist, and one of his hobbies was tracking the sociology of our nation’s “healthcare crisis”. He found that the health care “crisis” waxed and waned (as measured by press mentions and journal articles), but never disappeared. It had been going on for twenty years by then, so I guess we’ve now been in “crisis” for fifty years. The American health care “crisis” is not acute illness - rather it is like a chronic disease which flares up periodically, accompanied by fresh prophecies of impending doom and calls for someone on a white horse to fix the problem.

From 1970 to 1993, health costs roughly doubled as a percentage of GDP. All the way along, prophets of doom forecast that the country would simply fall apart when health costs exceeded 8%, then 10%, etc. . Our economy somehow continued growing and innovating, and the health system got steadily more capable at managing our illnesses the entire time. No-one I know would trade our present, very expensive health system for the cheaper one we had in 1965 or 1980….

There are several things to keep in mind as we delve into our “crisis”:

1. Medical care is not the same as health care. Health care involves illness avoidance as well as the treatments of medical care.
2. Many leaps have been made in both medical care and health care.  And, like Jeff Goldsmith, I wouldn’t got back to 1965 or 1980 for cheaper health care.
3. Some folks rely on their doctor to keep them healthy. The doctor can help but the “patient” does much of the health benefit effort by managing their lifestyle. (yes, heredity can short circuit all of that. but try anyway.)
4. While the cost of health care has gone up, the practice of medicine has changed dramatically. Some doctors are still trying to manage their practice like its 1980. The doctor and their patients are ill served by that lact of a progressive effort.

And I’ve found value in the ideas in this book.

ScienceRoll has a post - Personalized Medicine: The Future is Now
which links to several news and announcement links.

Hannah Seligson blogs about how “the Siruis radio show Be Happy, Dammit gathered a dynamite panel to talk about work-life balance and how women can often be their own obstacle in the workplace.” One quote is “that women magnify the importance of things. Her advice is to reprioritize.” She links to the radio post.

The graying of the Web
By Matt Richtel, The New York Times, September 11, 2007
via Cnet news.com

Older people are sticky.

That is the latest view from Silicon Valley. Technology investors and entrepreneurs, long obsessed with connecting to teenagers and 20-somethings, are starting a host of new social networking sites aimed at baby boomers and graying computer users.

The sites have names like Eons, Rezoom, Multiply, Maya’s Mom, Boomj and Boomertown. They look like Facebook–with wrinkles.

And they are seeking to capitalize on what investors say may be a profitable characteristic of older Internet users: they are less likely than youngsters to flit from one trendy site to the next….

Social networking has so far focused mainly on businesspeople and young people because they are tech-savvy and are treasured by Madison Avenue.

But there are 78 million boomers–roughly three times the number of teenagers–and most of them are Internet users who learned computer skills in the workplace. Indeed, the number of Internet users who are older than 55 is roughly the same as those who are aged 18 to 34, according to Nielsen/NetRatings, a market research firm….

They are sticky. And the older they get, the stickier they get. One thing that will slow this down is that as they age they tend to lag on technology. They tend to have slower devices and connections.

I think the new sites take that into account some but perhaps not enough.

Kaiser Foundation study: Americans paying more for health care
By Mark Schwanhausser, The Mercury News, 09/11/2007

There’s only a bit of good news for workers and employers when it comes to rising health care costs: Premiums for employer-sponsored health insurance rose just 6.1 percent in 2007, according to the Kaiser Family Foundation’s prominent national survey, being released today. This marks the fourth consecutive year that the rate of increase has slowed, and the rate is less than half the 13.9 percent mark set in 2003.
Despite that slight relief:
• Premiums still have vaulted 78 percent since 2001 - rising four times faster than wages or inflation….

“What this says to me is that health insurance is increasingly becoming unaffordable for many working people and small- and medium-size businesses,” said Drew Altman, the Kaiser foundation’s chief executive in Menlo Park. “They’re getting nicked whatever they do, and they have fewer choices.”…

The New York Times, Smaller Rise in Health Premiums
By Milt Freudenheim, September 11, 2007

The cost of employer-sponsored health insurance premiums has increased 6.1 percent this year, well ahead of wage trends and consumer price inflation, but below the 7.7 percent increase in 2006, the Kaiser Family Foundation reported today.

Because doctor and hospital costs continue to rise at an even faster rate, the modest slowdown in insurance inflation mainly reflects cutbacks in coverage by many health plans, which have found ways to make employees pay more for their care. Industry experts said that without those measures, premium costs would have risen by 9 percent or more.

The total average annual cost for family coverage premiums rose to $12,106.

World Health Care Blog has a post about A Chicken vs. Egg Issue in Medicine

A report yesterday indicated that there is a strange chicken or egg question about how at least one medical diagnosis is made. The issue is: Does the diagnosis precede the choice of treatment, or does the choice of treatment come first, then cause the diagnosis in order to justify the treatment?

It has long been known that physicians are idiosyncratic in their approach to diagnosing patients. In some cases, they prescribe a treatment in the hopes that it will show what the diagnosis was by either working or not working. The character “House” in that eponymous TV show is fond of this approach. And it makes sense when the risks and side effects of the treatment are minimal, and no other approach to diagnosis has worked….

He goes on to discuss how that can affect cycles in medication use as they work or don’t work for treating the symptoms.

As patients, we non-physicians may expect, and even prefer that diagnoses come first, and are based on something other than the need to justify a presumption or guess about the diagnosis. The fact that diagnoses of depression decreased so markedly, so fast, after increasing so dramatically before the FDA warning, at least suggests that diagnoses were being made on less than model criteria and using a variety of processes that may not fit “evidence-based medicine”.

Meanwhile Health as Human Capital has a post about Medical service coding and billing: a complicated system in need of nosy consumers.

Corporations often use health claims data to describe and understand the important health issues faced by their workforce. But medical services coding and billing have a business purpose: how doctors and hospitals get paid. We also recognize that claims data are powerful indicators of how reimbursement policies affect consumer and provider behavior. Depending on who pays, and what is paid for, the behavior of both consumers and providers changes, regardless of the actual health issues being treated.

The Wall Street Journal’s Health Blog posts Treat the Patient–Not the Computer

Sure, there are lots of efficiencies offered by computerized medical records. But the computer can also present an unwelcome barrier between doctor and patient, Michael Hochman, a medical resident in Boston, writes in this morning’s Globe.

Which has a comment that begins:

I think this article is representative of a major misconception about modern EMR’s. Not all EMR’s require typing in order to enter discrete data. One that I am familiar with can take points and clicks and turn them into common english sentences. The other issue that the industry struggles with is the following….