by Nick Jacobs

False security is something that typically comes from a lack of information or, conversely, an abundance of misinformation. As a young college student, we were taught about semantics, the study of the relationship between words and meanings. If you ever doubt that various national media outlets present things differently, watch the contrasts between the same news stories as presented on the numerous cable news networks and then watch the same story on the international news network. It is sometimes amazing how convoluted the actual facts can become from the interpretation of the stories by the different media sources.

Sometimes we just need to determine what the connection is behind the scenes. For example, I recently saw a newsletter called Environment & Climate News that was published by the Heartland Institute. The first article that caught my eye was entitled, Hybrid Vehicle Owners Report Adverse Health Effects. Because my family has two hybrid vehicles, I immediately immersed myself in this article. After paragraphs of fear mongering (my use of semantics to make a somewhat opinionated and prejudiced point), it quoted H. Sterling Burnett, senior fellow at the National Center for Policy Analysis who said, “There is no research definitively linking hybrid batteries to adverse human health effects.” When I googled the Heartland Institute, this is what I found, “The database contains 22,000 documents from 350 U.S. right-wing think tanks and advocacy groups.” Title vs. facts? Your call.

This article, however, is about at risk women and the various modalities that should be considered for ascertaining their risk levels. As a disclaimer, both local hospitals have MRI’s and will be performing MRI breast exams at centers near you. With that knowledge in mind, read this and decide for yourself.

Anne Wilde Mathews in the Personal Journal Section of the Wall Street Journal wrote a persuasive article that should be required reading for any woman at risk for breast cancer. The basic thrust of the article is a very clear revelation that mammography alone is absolutely not foolproof. Not unlike the accuracy or lack thereof of cardiac stress tests, mammograms can miss as high as 30 percent of malignancies, and, if you happen to be one of those unlucky, high risk patients, a clean bill of health after a mammogram is not always a reason for celebration.

As new and more refined modalities come to the forefront, the efficacy of these diagnostic tests is also continuously being substantiated. Ms. Matthews writes, “For those women whose family background, genetic, or other factors signal a high level of concern, a growing number of physicians are suggesting that MRI breast screening be recommended as the most sensitive form of screening.”

Some physicians regularly recommend ultrasound as well. Although ultrasound is much less sensitive; it still helps to identify sometimes missed lesions. According to the article, “MRI could detect cancers missed by mammography.” In higher risk patients, MRI’s detected over 70 percent of breast cancers while mammograms detect only about 40 percent.” The combination of mammography, physician examinations, and MRI resulted in a 90+ percent find rate.

One of the cautions expressed in the article from a study that appeared in the Journal of the American Medical Association, JAMA, was that both ultrasound and MRI’s can lead to false positive findings which, although disconcerting, are far better than false negatives which can be lethal.

One physician quoted in the article, Wendie Berg, a radiologist, said, “It’s a judgment call. The denser the breast, the more difficult the mammogram is to read, the more likely I am to recommend ultrasound.” Another physician, Constance Lehman, said that she never advises ultrasound for patients. “It’s not even in the same ballpark” as MRI.

My objective take on this one is, if you or your family member is an at risk patient from either family history or genetic propensity, seek further diagnostics. What you don’t know can kill you.

(Mr. Jacobs is not a medical profession - this blog is for educational purposes only and should not be construed as medical advice in any way. Please consult your medical professional)

by Tony Chen

I don't know about you, but I'm drooling over the new iPhone. I'm not a big gadget guy, nor am I one of those Mac enthusiasts. But I am someone that loves great functionality packed into great design, and this thing is the one gadget that I feel like is made "just for me."

This also got me thinking. What applications will the iPhone have for healthcare? Especially now since Apple opened up the floodgates for developers to create new apps. Here's 10 being talked about right now.

For Physicians
- Integrate all your other beepers/phones/PDAs, etc?
- Access medical files, charts, and mini-versions of clinical decision support systems?
- Download comprehensive drug information from drugs.com
- Use the camera to take pictures to send to specialists?
- See heart imaging with this software.
- refresh your CMEs or pick up medically-related videos/media? Read MEDLINE journals.
- Make the X-ray light box obselete?

For Consumers
- People with diabetes, Download your blood glucose levels right from the attachment.
- Track fitness? I've previously written about a wellness phone being tested in Japan
- Interface with your medical record. Looks like Life Record does this already. And I'd be surprised if someone isn't working on an interface between Google Health and the iPhone.
- Reduce anxiety/pain for kids during hospital stays?

Honestly, I probably could have made the same statements about many of the smartphones on the market today. But the iPhone just looks so darn nice, too. And the processing power is a plus.

What do you think will be the greatest healthcare use of the iPhone?

by Tony Chen

Now you can get your local map with color-coded hospital ratings. See below for an example.

Go to NetDoc to draw up your own. This is a nice little tool for patients, but as always, it's only as good as the underlying data.

(HT: Warren Johnson)

by Tony Chen

This just goes to prove again my conspiracy theory about Minnesota being the undiscovered hotbed of health care innovation. Check out this press release from Allina Hospitals & Clinics - a $100MM "living laboratory" to innovate new care models & treatments.

by Tony Chen

Remember's Google's big announcement when they launched Google Health? Their partners included the likes of Cleveland Clinic, Quest, CVS, among others? These were the partners that had built interfaces to the Google Health platform, and patients could choose to import data from those sources into (and out of) their Google Health record.

Got this in my email today:

Today Microsoft and Kaiser Permanente announced a pilot program between Kaiser Permanente’s My Health Manager personal health record and the HealthVault consumer health platform at the Microsoft HealthVault Solutions Conference. Connecting My Health Manager to the HealthVault platform will allow users to combine personal health information from Kaiser Permanente and a wide range of health and wellness management applications and devices, such as blood pressure monitors. Also at the conference, a wide range of health technology companies introduced more than 40 new online health applications and devices.

While Microsoft is probably nobody's favorite company, you have to commend them for landing such a strategic partnership covering xx millions of lives right off the bat?

by Nick Jacobs

Last month, I was invited to speak for the American Hospital Association in Phoenix, Arizona. One of the speakers who preceded me, Ian Coulter, PhD of the Samueli Institute and RAND Corporation provided a compelling analysis of healthcare around the world. He described his countrymen from Scotland as “Unarmed Americans with health insurance.”

Even more chilling was the fact that, “America is the only major economic power where, if you lose your job, you literally can fall into medical oblivion without health insurance until the age of sixty five.”

Another major problem identified by Dr. Coulter is that the food producers of America provide enough food products for every adult to consume 4000 calories each and every day. Unfortunately, we only need about 2000 calories per day. The more is not better theory works here as well as we overeat, become morbidly obese, develop diabetes, high blood pressure and high cholesterol.

Interestingly, in the rest of the industrialized world, the ratio of specialists to primary care physicians is approximately 40 percent specialists to 60 percent primary care. In the United States, that ratio is exactly the opposite; 60 percent specialists to 40 percent primary care physicians. This fact was very interesting as well. In the United Kingdom, primary care physicians earn approximately 130,000 pounds a year or nearly $260,000, significantly more than primary care physicians in the U.S. There is also a 30 percent pay for performance opportunity in the U.K. compared to a 6 percent pay for performance opportunity in the United States. Our primary care physicians are under incentivized while we may have too many specialists in some areas of the country.

Dr Coulter also corrected a previous set of facts that we have all read numerous times; 30 percent of all healthcare dollars are not spent on the last thirty days of life. Thirty percent of all Medicare dollars are spent on the last thirty days of life. What is not stated is that these expenditures typically do not improve the quality of those last thirty days of life.

If you aren’t too tired of facts and figures yet, how about this one from his presentation? Two thirds of Republicans and only one third of Democrats think that we have the best health system in the world, and 58 percent of Republicans and only 20 percent of Democrats are satisfied with the quality of our health care. These statistics may indicate that money does influence your perception of what you can buy in the health care system.

Finally, 20 percent of all American are consumers of complimentary and alternative medicines. On the other hand, 40 percent of the population or nearly 120,000,000 people are fully open to trying integrative medicine alternatives. Unfortunately, only about 30 percent of physicians embrace the various modalities offered through these alternative medicine approaches.

In closing, maybe we should consider this very broad interpretation of health as stated by the World Health Organization’s, "Health is relatively simple; if you feel better, that is health.”

by Christopher Cornue

Through an email distribution I receive from the RWJF, I was led to this article in the Washington Post from last week. It's an interesting read and a positive spin on what has been a difficult challenge for US Health Care - a total reform of our health care system and politics. If you get a chance, take a gander ... and feel optimistic about the future of healthcare!!