A post by Andrew Barna

So we are all on board with price transparency in healthcare, right? Well maybe it is not so simple. Apparently, a John’s Hopkins study has found that specialized cancer facilities have higher costs at the time of service, but they “yield lower cost per quality-adjusted life year” in the long-run. That is a mouthful, but in a nutshell, it means you are going to pay more for cancer treatment at a Sloan Kettering or a M.D. Anderson, but you will probably live longer and with a better quality of life. I think this would make sense to most Americans – you get what you pay for – but the picture is not so clear when you look at hospital/physician comparison websites.

Most of the websites I have seen have been pulling quality data from the CMS quality demonstration project. This is not a bad start. The CMS measures cover some of the highest volume procedures and they draw attention to practices that promote better outcomes. And by “better outcomes,” they mean you are more likely to leave the hospital alive. I am not knocking the CMS measures. I think the CMS Demonstration project, as well as the IHI campaign, have created systematic improvements in patient safety and outcomes… but…these measures do not necessarily give consumers an indication of the long term value of the services they are purchasing.

Let’s go back to our health economics class. The value of a healthcare intervention is measured in terms of lengthened life or improved quality of life. Indeed, this is how a lot of medical research is done. One treatment is shown to have better long term impact than another. But by their very nature, the CMS measures focus on short-term outcomes that can be measured during your hospital stay. So on one of the hospital comparison websites you could find out that the in-hospital mortality rate for your heart procedure is lower at Hospital A rather than Hospital B. OK, easy choice go with Hospital A. But what does that outcome mean relative to cost. Are you willing to pay an extra $5,000 for less of a chance to die? Or could you save a $1,000 and take a tenth of a percent in additional risk? Now the decision is not so clear. We aren’t typically equipped to make such a call.

Americans are expert consumers and we want to know every detail about what we are buying. I won’t even buy a CD until I know how other people who like similar music like that CD. When we have the right information about what we are purchasing, we make better choices (I should say that we make choices that we are happier with). Granted that purchasing healthcare is not equivalent to purchasing a CD, but it is not different on this point. The more that hospitals can demonstrate their overall and long-term value, the more consumers will make better choices.

Post Script: I just received the spring copy of Frontiers of Health Services Management and the featured topic is “Price Transparency: Meeting the Market Demand for Clarity”. So as I read the articles, I am sure I will be writing posts retracting the comments above. Hey Tony, your old boss Richard Clarke wrote the lead article. It looks good from the summary.

by Nick Jacobs

Colonoscopies are no joke, but these comments during the exam were quite humorous.... A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:

"Find Amelia Earhart yet?"

"Can you hear me NOW?"

"Are we there yet? Are we there yet? Are we there yet?"

"Any sign of the trapped miners, Chief?"

"Hey! Now I know how a Muppet feels!"

And the best one of all... "Could you write a note for my wife saying that my head is not up there?"

by Tony Chen

When we think of "wellness programs," we probably typically think of weight loss programs, smoking cessation programs, and the like. Now, many employers are focused on the healthy employees, too - keeping them healthy is has a high ROI. Check out this article at healthdecisions - there are several examples of employers getting $2, 3, 4 dollars "back" for every $1 spent in wellness. Employees are joining in masses.

We are a funny bunch, aren't we? We won't change our lifestyle to save our life. But for a couple of bucks, we'll do it...

by Jared Johnson

I came away from a recent networking luncheon with more than just a couple of business contacts and a good meal. We listened to an engaging presentation from Ketchum, one of the nation's top public relations agencies, about the findings of a recent study called Media Myths and Realities. Ketchum partnered with the University of Southern California to dispel myths about how we reach people through mass media. If you haven't been in a room full of PR gurus when someone starts showing media usage data, it's much akin to the way Wall Street hounds crave earnings reports. In other words, we were glued to the PowerPoint as if we were caught in a tractor beam.

At any rate, we heard three conclusions that I found particularly insightful in a health care setting. The application is simple. If we truly are to make hospitals the best-run organizations in the country, we must know how to communicate our message. We must be united in how we present health care to the masses because the masses have no problem lumping us all together as part of the health care hustle.

The first conclusion is that blogs are far from superseding traditional media , i.e. local television news and daily newspapers. Blogs are being read increasingly across all age groups, but not nearly as much as we think. Even 18- to 35-year-olds read local newspapers nearly three times as often as blogs. This doesn't spell doom for HospitalImpact; it just means we should be aware of how blogs fit into the public perception of hospitals.

The second, which was a surprise to me, is that social networking sites like MySpace and Facebook are no longer just for kids. They are growing more popular among professionals. These sites are often deemed hangouts for pre-teens, but the data shows that usage continues to increase among those 35 and over. More than 30 million moms are online and 70 percent visit social networking sites like NewBaby.com. The proliferation doesn't stop there; in fact, there is now a social network devoted exclusively to baby boomers. If so many consumers are making connections this way, it seems there is value to exploring these sites rather than dismissing them as child's play.

Finally, you're not alone if you see the need for improvement in the way your hospital communicates internally. The Ketchum study showed that, across the board, corporate communicators rely too heavily on their company Web site. Hospitals are unique in that clinical staff members generally doesn't spend time sitting behind a computer while on shift. So posting important corporate announcements on the intranet or even sending out an e-blast won't necessarily reach a majority of workers.

Ketchum posted a news release about the study for anyone who is interested.

by Nick Jacobs

Most of my days are spent in meetings with M.D.’s, PhD’s, V.P.’s, and all of the C’s; CFO, CMO, COO, and CPO (chief people officer) . . . Well, you get the idea. Last week, though, we filled the room with the PhD’s and a different group of C’s; the Colonels, Lieutenants Colonels, Full Bird Colonel, Doctor Colonels, Administrative Colonels and the like.

At one point during the meeting, our heart, lung and blood specialist, a PhD recruited from the NIH, was reporting on a study that he had recently completed with two prestigious universities from a neighboring state where the participants donated blood, ate a very high fat meal and then donated blood again for testing. It was called a brachial artery study.

The result of the test was exactly what the doctor had been concerned about. The fat irritates the lining of the blood vessels. They swell up and cause the arteries to be smaller which causes your heart to pump harder. Now, let me be clear, I am not clinical and definitely not scientific. So, I am not going to try to explain it in any more inappropriate detail. I am sure he will be publishing these results soon, or, you can wait for the movie.

But one of the physicians present in the room jokingly said, “You ought to try this test again, and this time you need to add a cigarette and a set of stairs.” Everyone got a kick out of that suggestion, but my concern was that this test should first be administered to some high profile enemy of the State because it should be called “The Last Supper.”

go over to the Running a Hospital blog or the best of healthcare jokes. Good to know that folks like Paul and Nick Jacobs who run hospitals have a good sense of humor.

by Nick Jacobs

A few weeks ago, it was my pleasure to have lunch with a 68 year old, retired CEO who had, in fact, seen it all. Let me begin by cautioning you that his suggested management decisions might not fit very well in the hospital setting, but, as you will read, they are just FUN.

Example Number One: A group of PhD's assigned to create specific technology that would change the face of imaging were occupy a beautiful, new building in the middle of a wooded industrial park. Our veteran CEO is called to the task of straightening up what appears to be a hopeless situation, a total lack of productivity.

He enters the conference room filled with superior talent and queries them as to their accomplishments. After about 45 minutes of unsuccessfully attempting to uncover some project that they have brought to fruition, something that is useful, he leaves the room, goes to the master mechanical room and pulls the main circuit breaker. All power is now off in the building. At this point he goes to his office and begins to work with paper and pencil.

Within a few minutes there are several PhD's asking him what they are supposed to do without computers, lights or air conditioning. His reply was, "Whatever you want to do, you're not accomplishing anything here anyway." To which they continued to query him. He explained that, "As long as they weren't coming up with anything that was productive, he couldn't afford to keep the electricity on, and, for all he cared, they should go outside and sit in the grass."

The power was not reinstated until two days later, and it was about ten minutes after that the group revealed some meaningful ideas that resulted in such progress that they eventually landed literally hundreds of millions of dollars worth of contracts.

Example Number Two:

He was called into a company filled with engineers who did not talk to each other. There was a long hallway with engineers on both sides, but, except for an occasional bathroom stop or a nod at the coffee pot, there was no conversation between offices. Our CEO observed that situation for about two days, went to the main server area and had the local e-mail turned off. Almost immediately the engineers emerged from their dens and began to talk to each other. It took him six months, but the discontinuation of the e-mail was the tipping point that allowed progress to begin.

My Inspiration: On Friday I called a group of managers together, handed each of them an envelope with their name typed on the front and a pink piece of paper inside. I asked them to hold the envelope up to the light. One sheepishly responded that, "It looks like a pink slip." To which I replied, "It is." Then I said, "It's a pink slip of blank paper, but consider this a dress rehearsal for next month. If we, as leadership, do not get our act together regarding our perceived productivity, we will all be replaced."

I'll let you know how that one turns out, but it certainly created some serious flow of conversation.

by Nick Jacobs

Dad hated garlic. Seriously, an Italian who HATED garlic was like a Catholic who hated incense. Well, okay, maybe that’s a bad comparison. It always had seemed strange to me that he hated garlic. As it turns out, dad hated garlic because his mother made him wear a little bag around his neck to ward off vampires and other evil things like sore throats, and that bag contained a clove of garlic.

Now, Mom was English and hated garlic, but my English food experience would tell me that, no offense, the English hate most spices. So, when I got married at the tender age of 21, one of my first discoveries was that my in-laws had 13 containers of garlic salt in their spice rack, that the ice cream in their freezer tasted like garlic as did the jello, the milk and the bread. In fact, because this was the only flavor he had ever known, my son once sent a suggestion to Ben and Jerry to make garlic flavored ice cream with chunks of kielbasa for Orthodox Easter.

So, not long into the relationship, I developed high blood pressure and high cholesterol, which is another story. Actually, one part of the story was, when I met my first Bishop, I said to him, “Bishop, that’s a tough job. Do you have high blood pressure and high cholesterol?” He smiled and said, “No, I give high blood pressure and high cholesterol.” Some people are carriers of these maladies. Anyway, back to the story.

The Ukrainian side of the new family always treated high blood pressure and cholesterol with garlic. In fact, Uncle Mike used to put cloves of garlic between his toes when he slept at night. Mike never had high blood pressure or cholesterol because no one would get close enough to him to have contact of any kind. Consequently, he was exposed to very little conflict.

Maybe because of Dad, garlic was not one of my favorite sources of medication, and when garlic tablets became the rage, I avoided them like the plague, but it kept appearing in my food. In fact, I think it gave me high blood pressure and high cholesterol because, as a teacher and then a business person, garlic for breakfast, lunch and dinner tended to slow down my ability to make and close deals, and it usually made me mad when someone said, “Hey, eat a little garlic for breakfast today?” Granted, to my knowledge, none of the bites that I’ve experienced ever came from a vampire, but the blood pressure and cholesterol continued to climb to new heights.

Lindsey Tanner, however, has changed my life. I’m not sure if Lindsey is a guy or a girl, but I assume she’s female, and, I have to admit that I love her. Lindsey wrote an article a few weeks back for the Associated Press entitled: “Study: Garlic doesn’t lower cholesterol” where she reports that the quintessential study is complete. It was performed on people who ate it in sandwiches, pills, powder and raw, and the report was that it had NO EFFECT on cholesterol. None. Zero.

Break out the horns and hats. It’s over. My forced consumption of garlic in all forms is finally going to be OVER.

Christopher Gardner said of the study that “If garlic was going to have a chance to work, it would have worked in this study.” For you doubting Thomas types, the study appeared in the “Archives of Internal Medicine.”They must have had a lot of pressure, however, because “The Archives” said in an editorial that “the jury is still out” on the question of cardiovascular disease. Ahhhhh.

by Tony Chen

The $5.1B (+$1.7B debt) acquisition of Triad by Community Health Systems (CHS) was approved yesterday by Triad stockholders. This is an interesting acquisition for a number of reasons:

- This creates the largest public hospital company in the U.S. The combined company will operate 130 hospitals (for now).

- This CHS offer trumps the previous offer of $4.7B by a group of investors to take Triad private. CHS saw a lot of value in Triad even though there is some overlap in the hospitals that they serve.

- For Community Health Systems, this is a blatant departure from their strategy to focus on (read: dominate) rural areas. I've heard that in some markets, they will buy two hospitals in a particular market, eventually consolidate services, and close one of the hospitals. In their corporate fact sheet (PDF), they say their strategy is to purchase 3-4 hospitals/year (and that 400 hospitals fit their profile for purchase). With this acquisition, they're content in being a player in both rural and mid-sized markets.

- Yesterday was the last day for Triad to tell the investor group if they had found a better deal. CCMP Capital Advisors LLC and Goldman Sachs Capital Partners were just hours away to closing the deal, and then BAM! the deal is gone. CHS took their bride from the altar. Don't feel too bad for CCMP & Goldman, though, they still receive a "break-up fee" to the tune of $40MM. Not bad for some due diligence and legal work. (isn't it ironic? Incidentally, CHS CEO noted that year-one cost savings of the merger would be $40-50MM.)

- This has got to be the first time I've ever seen a hospital stock go up 80% over 5 months.

- Will the FTC approve this? Will CHS be required to divest in some areas for this deal to be approved?

- Triad CEO may be looking for a job. Maybe Tenet is looking for him?.

- All these buyouts in healthcare! HCA went private, don't forget USPI did too, and now Triad+CHS are hitched. What's left? According to one hospital analyst, LifePoint is attractive, HMA's got a poison pill, UHS stock is controlled by UHS mgmt, and Tenet's got too much debt.

- Up until this past year, CHS was consistently the darling hospital stock among a lot of ugly ducklings and their management viewed as the most disciplined. 2006 was the first year that they didn't grow EBITDA in their company's history. Makes you wonder, huh?

- All this buying makes us ordinary hospital folk wonder - lots of smart people are spending lots of money to get into the business of what we do. And they do so because they think they can do it better. What value do they see? What strategies are they employing that we haven't thought up yet?

By Nick Jacobs

In 1960, according to Adrienne Lewis of USA Today, the Federal Government's share of domestic spending and tax breaks was 22.1% of the federal budget on adults and 20.1% of the budget on children. That percentage has dropped to 15.4% today and is going on down to 13% by 2017. As a share of the total economy of the nation, kids are going from 2.6% to 2.1% and adults are rising from 7.6% to 9.5% of the economy.

The report by the Urban Institute states that "Despite frequent rhetoric from policymakers on the priority given to children, the federal budget makes fairly clear that children are less of a priority and more of an afterthought."

Why, you might ask? AARP with its 36 million members spent, $105,000,000 on lobbying, more than any other organization in the United States except the U.S. Chamber of Commerce.

Marian Wright Edelman, president of the Children's Defense Fund states that, "Children are a voiceless, voteless constituency."

Here's the kicker. Bill Hoagland, a former top budget advisor to Senate Republicans said, "I know for a fact, first-hand, that ballots are distributed at nursing homes on Election Day, and they're not distributed at the kindergarten level."

As former Colorado Richard Lamm said, ". . . you cannot make fiscal sense out of the future of our children without taking on entitlements."

Where is your heart on this topic?

Go over the Paul Levy's Running a Hospital Blog and read his thoughts about the decision to become the official hospital of the Boston Red Sox. And no, it wasn't a "downstream revenue" business case at all.

by Tony Chen

My inbox (virtual and physical) is piling up way too fast. With our schedules, does anyone actually keep up with all the various publications and newsletters that are sent to us. Let's take a quick inventory:

Healthcare Executive
HFM
Frontiers
FierceHealthcare daily news
FierceHealthIT weekly news
Advisory Board Daily briefing
HFMA Weekly News
Sg2 weekly briefing
McKinsey on Health Care and McKinsey Quarterly
Fast Company
Business 2.0
Trends Newsletter
SHSMD weekly
Blogs (Health Affairs, healthcareblog, HIStalk, Running a Hospital, WindberCare, others)
ModernHealthcare
MH Daily Dose
Crain's Chicago Business
The May Report
Hospital Impact (of course!)

Too much! Question for you: what are the three most important things you read every week? If you are a forward-thinking hospital innovator, where do you go to find the top 5 things you need to know for the week?

The other thing that's missing is the synthesis of all this info. I don't just want news or tidbits, I need to tease out implications, contexts, and creative linkages. What President Lincoln is still true today - we have enough information, we just don't have enough wisdom.

By Nick Jacobs

If you discuss the current Emergency Room situation in the United States with anyone in the business responsible for keeping the doors open, you most likely will be given some very distressing information. The numbers of patients have been growing exponentially as other avenues previously used for care are no longer available. The reimbursement for UrgiCare centers reached such low levels that most of the quasi-emergency rooms were closed down or discontinued in many regions of our country.

As the graying of America continues, we see less and less emergency room physicians available to work and more and more who are attracted to the very lucrative world of locum tenem care where you spend a day or a week or a month doctoring somewhere and move on to your next assignment.

An article featured in MSN Money on March 1, 2007 entitled "10 Things Your Hospital Won't Tell You," quotes a new study from the Institute of Medicine that found that "hospital emergency departments are overburdened, under funded and ill-prepared to handle disasters as the number of people turning to ER's for primary care keeps rising."

It goes on to say that "an ambulance is turned away from an ER once every minute due to overcrowding, and the situation is further exacerbated by shortages in many of the 'on call' backup services for cardiologists, orthopedists and neurosurgeons." According to the article "things are getting worse." Finally, it says that "73% of ER directors report inadequate coverage by on-call specialists, versus 67% in 2004, according to a survey conducted by the American College of Emergency Physicians."

The advice that the article spells out for the potential patient is that "if you can avoid the ER between 3 p.m. and 1 a.m., the busiest shift, and go there between 4 a.m. and 9 a.m. your chances of a shorter wait is your best bet."

What the article doesn't say is what exactly are we going to do about this situation? How are we going to address the health care crisis in this country, and when will we finally acknowledge publicly that this country "Has no health care policy." As the gap between the very rich and the middle class widens, we are faced with the fact that more and more people will be falling through the net.

just got back from two days of presentation/communications skills training. In 20 hours of instruction, I made 6 presentations (all of which were videotaped), critiqued 36 presentations made by my classmates, was made to stand on pieces of paper, and was made to "punch" the screen with big gestures. We learned about the 6 types of evidence we should give in support of our points: experience, expert, example, fact, analogy, and statistic - more on these later.

As I get back to the office tomorrow morning after this intensive training & my trip to san fran, I'm sure the blogging will be light for the rest of the week as I catch up on work & try to absorb all these new realities/insights.

by Tony Chen

Well, I'm about to get on a plane back to lovely Chicago after 4 days here enjoying the above-freezing weather in San Fran. A few things I heard in the last few days:

"Steve Case launching RevolutionHealth is like Napoleon invading Russia"

"The Bayh-Doyl act has made universities like crack addicts getting their crack using those small-minded tech transfer offices" - Former Senator Bayh quoting some criticism about his landmark legislation.

Overall, the conference was a blast. There is definitely better ways for me to do the tech transfer part of my job - more thoughtful marketing, more informed patenting decision-making, better relationships with industry, and more innovative thinking about new modes of collaboration.

For me, the most crucial time at these conferences is immediately after. After receiving mountains of more generic information, the trick is to boil it down, connect the dots, and synthesize seemingly-unrelated information to change my day-to-day approach and tactics. more on that later...

by Tony Chen

You know those conferences you go to where the seminars are kinda stale, the networking is okay, and you end up having dinner by yourself? Well, this AUTM conference is NOT one of those (or maybe it's because I'm sincerely interested in this stuff!)

It has been a very enlightening day listening to industry giants (Cisco, Intel, Genentech, etc), small-start ups (Nanosys), and Angel investors talk about how they want to work with universities and hospitals. They inherently realize (maybe more than we do) that there is genius within our walls, and they need to mine it.

What I am enjoying the most is the variety of people here. Normally, you go to something like this and it's groupthink galore. Everyone's the same. Some are ahead of others a bit, but overall everyone's basically in the same world. Today I've talked to someone at Genentech about how they review their incoming licensing proposals. I talked to an angel investor who's turned 4 IPOS and is interested in healthcare wikis and blogging (will be meeting up with him tomorrow morning). I talked to this BD guy at a company that does a few licensing deals a day. I spoke to a fellow Kellogg Alum who's part of the 80-person tech transfer office for the NIH.

It's true that tech transfer probably only applies to a handful of hospitals. Nonetheless, I counted (and emailed) about 50 attendees who are from hospitals, AMCs, and clinics. It's a world completely separate and far off from our world of DRGs, capitation, and bad debt. But in many ways, it's the same - understanding need & meeting it in sustainable way.

A couple of uncategorized insights that I picked up today:
- This one angel investor who's funded 30 successful start-ups asks 4 simple questions in funding a new biz: does the science work? can I protect it (IP or otherwise)? Can I find people who feel the pain that the biz will solve? Can I attract a motivated management team?
- There are a lot of deals that have gone bad out there, and a lot of bad feelings about it. When the industry panel spoke candidly about terms, agreements, requirements, the university folks were getting pretty riled up. Imagine a conference in which payors were the speakers and they told you what they need to survive. Hey ACHE, at your next Congress, why don't you have a session with payers. How about a session with a patient panel!? a physician panel?
- Too many people treat tech transfer marketing like a shotgun. We need to tailor/customize each communication for each potential partner, speaking to their strategy/needs.
- Companies like Cisco have more money to spend on licensing than they can spend. The issue isn't a lack of funds, the issue is finding the ideas & not letting terms stop the show

by Tony Chen

I'm here in San Fran for a technology transfer conference. Will be trying to soak up as much as possible about this mysterious art of "technology transfer". How do we best leverage the patents, inventions, and discoveries coming from our physicians and researchers? On the one hand, it's relatively straightforward - it's like selling real estate. Get the marketing together, target likely buyers, highlight the best/unique features, get a signed contract. On the other hand, there is a whole set of strategies and thought processes that are based on legal, intellectual property, pharma industry, and patenting considerations. Most inventors don't realize that the work done to get the patent is probably only 3-5% of the work.

I finally got to meet fellow Hospital Impact blogger Andrew Barna face-to-face. Yes, the power of blogging. Two random hospital administrators 2,000 miles away. Through this thing thing called the blogosphere, we are colleagues and friends. It really is a real, living community - and now we have a lunch at a nice Cuban restaurant to prove it.

Anyway, probably light blogging for the rest of the week. Be back in full force next week.

by Nick Jacobs

This is neither the first nor the last time that my passion regarding hospice and palliative care will be iterated here. Hospice is the RIGHT WAY for the transition to occur in an impending death situation. It is about dignity, healing for the families and the patient, and, most importantly, it is about providing the bridge to help us move to the next reality.

Every physician should be encouraged or better still, required to participate in continuing medical education directed toward end of life considerations. Death is not wrong. It should not be considered failure when a patient reaches the beginning of the end of their life.

Each family should be given concrete information regarding the actual probability and statistics of the effectiveness of any exceptional treatments, treatments that typically reduce the quality of life for the patient and their family and rob the loved one and the family of their chance to have lucid, meaningful transitional interactions. It is up to the primary care physician to be open, honest and forthright with each family. Your loved one should not be tucked away in a semi-private hospital room with a stranger's family, limited visiting hours, and continuous interruptions for meaningless tests that no longer warrant the time, attention, or the uncomfortable disruption that accompanies them.

We are born, we live and we leave our earthly bodies. Regardless of your religious belief, it is as significant a transition as birth. Death should be appropriately recognized. It should be thoughtfully acknowledged. It should be a time of positive transition for the family and their loved one.

Look into hospice. Support hospice. Volunteer for hospice. It is beautiful. It is noble, but most of all, it is the right thing to do.

Perhaps the soul does not die but moves on,

And just as a newborn child is welcomed into this world,

So should a soul be welcomed into its death.

Whatever the health-care provider believes,

By caring for a dying patient in this way,

Using familiar smells and gentle touch,

The transition from life as we know it,

Is celebrated in the most supportive and holistic way possible.

Health-care providers are privileged to be midwives and facilitators of this transition.

Dorothea Hover-Kramer 1993

By Nick Jacobs

In the article, Dueling Therapies: Is a Shotgun Better Than a Silver Bullet? By Nicholas Zamiska of the Wall Street Journal, dated Friday March 2, 2000, a wonderful announcement appears that, for many of us may be the beginning of a period of healing and enlightenment like we have never before seen in Western Medicine. On the other hand, it just may represent one tiny pee pee step forward in our sometimes ludicrously regulated world.

Mr. Zamiska opens by contrasting the Chinese medicine philosophy of experimentation with combinations of herbs to cure diseases and the Western approach of finding that one molecule that that cures a disease, or as he describes it, “the elusive blockbuster therapy,” which is constantly being pursued by the major drug companies.

His fundamental question: Is it better to attack disease with one substance whose potency has been pinpointed? Or should treatments be administered, as the Chinese profess, by aiming a group of agents at the problem?

It has always been interesting to me that the chemo therapy mind-set and approach to Western medicine does not seem to be hampered by the number of abnormalities being treated. For example, if you have high blood pressure, high cholesterol, low HDL, stomach distress caused from those medicines which requires a prescription inhibitor, Plavix to protect you from your coated stents, aspirin, etc., when combined in your body in a pill cocktail, everyone admits there will be varying degrees of interactivity between and amongst those meds.

In other words, conventional wisdom is that the probability that there is some type of interaction between as few as five prescriptions when they are mixed in your body is 100 percent. Yet, the FDA had not permitted herbs to be introduced through our pharmacies until the particular molecule that makes it work has been identified? Degrees of caution or degrees of prejudice?

The announcement is that the FDA’s policy has evolved into one that is more accommodating to the Chinese approach. In June 2004 new guidelines were released that make it easier for drug companies to turn herbal remedies into Western medicine. I’m not quite sure just yet that I want the pulverized deer penis mixed with green tea that is used as an example in this article, but, what the heck, maybe we will be entering a new era of approval for known cures that here-to-fore has been even more intimidating than the 13 pills that some of us mix together each day in the name of health!

by Tony Chen

I recently read this article written by a starving artist. The only thing is this starving artist quit his six-figure comfy corporate job to pursue his dream of being an actor/screenwriter. After the article, someone posted a message asking people to share their stories of leaving six-fig jobs to pursue "real happiness." In just a few hours, there's been hundreds of folks sharing their stories - so, for all those people who are doing what they love (or for those who need that extra motivation to go for it), read through these!

I can't tell you how many people I've met in hospital management who (despite all the regulations, politics, and difficult people) love what they do.

By Tony Chen

Da wife is working night shift this week, which means I'm flying solo taking care of the little one at night. That translates to no more than 3 consecutive hours of sleep at a time for 7 days, and thus significantly lower brainpower. ie I can only give you tidbits instead of something actually thought out (it took me 5 tries to spell "consecutive")

So now that I've made it appetizing to read on, here are some interesting tidbits from this sleep-deprived healthcare-saturated dad.

Wellness is kicking it up a notch, and mostly cuz employers are fed up of paying 15% more for healthcare each year. Read this Yahoo article - one 30-year-old man was fired for "drug addiction" - nicotine. Then, there's the story of the "healthy" superfit exec who reluctantly went to go have his heart checked after constant nagging from his company-paid health coach. Good thing he did, a few hours after the test, he had 2 stents installed.

Speaking of the new "prevention," the much-acclaimed RevolutionHealth portal has been officially "launched." I was hopeful that it would grow exponentially, but so far it hasn't. Nonetheless, it's still only a few weeks old. Last time I posted on them, they had 1,500 doctor ratings. Now, a few weeks later, they have 4,500. Yes indeed, the jury is still out - the true value comes only if people use it, but people will only use it if it's valuable - this is the name of the game of social media/tech.

Regarding tech, the techie conference is finally over. Matthew Holt's lovely HIMSS wrap-up includes some commentary on Colin Powell, new healthcare blogs, and EMR. Or you could go to Tim Gee's Medical Connectivity Blog. The "buzz" theme for HIMSS this year? Depends on who you talk to. Some folks have mentioned EHR and connectivity. HISTalk thinks the theme was that there wasn't one, but he names 5 companies that really impressed him (a mix of usual and unusual suspects) with their booth humor and/or their strategy.

Strategy is the name of the game as both Strategy+Business and McKinsey (reg req) recently wrote articles on fixing the healthcare mess. S+B comes closer to practical solutions - warning providers and heralding the coming of consumer-based retail-type medicine. Both bring up strategically sound but practically impossible principle of payors, consumers, and providers collaborating instead of competing. Nonetheless, both of these are worth the read.

by Nick Jacobs

Let me begin this week’s post with a disclaimer. On the anniversary of my father’s death, I decided that I would take one shot at our readers to help me help the people that I love. Consequently, this is not a light column, but please continues to read it.

It started with a pesky cough. The cough came from what everyone thought was the remnants of a nagging chest cold. My parents were on their first extended vacation to Florida with her brother and sister in law. Dad had just turned 56 years of age, and both of their kids were out of college, married and doing just fine. For the first time since 1941, my folks had both freedom and a few extra dollars to enjoy life a little.

Dad had stopped smoking at or around 1964, ten years earlier, when the new surgeon general had the backbone to declare that smoking was “bad for your health.” Dad had smoked since he was a teenager, and, because his life had been filled with numerous unexpected challenges; a terrible accident that resulted in a broken back, the job challenges created by a collapsed economy, the loss of twin sons and some very unsophisticated and difficult bosses in a number of impossible jobs, he had hung onto those cigarettes as his 20 best friends each day.

I was only about 26 when he returned from his vacation and was diagnosed with a tumor, an unknown tumor in his lung. Over the next few months he went through various tests, but finally, he was urged to have an exploratory surgery on that lung. We followed him to the hospital for his surgery. It was scheduled for 6:30 AM, and when they wheeled him out, we all hugged and smiled and knew he would be okay. Four and a half hours later, we were told that, indeed, he was not okay. He had a very rare type of lung cancer that was extremely aggressive. They had removed his lung.

We were shocked. We were horrified. We were devastated. The journey to his death took us through 18 months during which we experienced, sorrow, depression, misery, hopelessness and desperation mixed with deep love, hope and strength.

He was a wonderful man. As his cancer spread first to his bones and then to his other lung, he looked me in the eyes time after time and said, “If only I had known, I would never have smoked, ever. I want to stay here with all of you.”

He left us about two months after my daughter was born. He did get to hold her, and love her, but he never got to influence either her or my son. He wasn’t there to provide his knowledge, kindness, guidance, love and his emotional support for any of us. He was not there to help anyone, and, most importantly, he was not there to enjoy our family as it grew and prospered. Why? Because the tobacco companies had mastered the art of combining just the right mixture of ingredients to contribute to an addiction that some have said is worse than that of heroin.

So why did I write this? I wrote this because I have friends and family members who, thirty two years later, are smoking. Holding my father in my arms as he died from an addiction that was manifested upon mankind by corporate America was sad, wasteful, and painful, but watching it happen to people who I love who, unlike my father, know without a doubt that more men and women die from lung cancer than any other type of cancer each year is unbearable.

In 2002, lung cancer accounted for more deaths than breast cancer, prostate cancer, and colon cancer combined. In that year, 100,099 males and 80,163 females were diagnosed with lung cancer, and 90,121 males and 67,509 females died from lung cancer. We also know that tobacco smoking is by far the leading cause of lung cancer. More than 87% of lung cancers are caused directly by smoking. Don't quit out of fear. Quit because of love. We love you.