In the Jurassic period of the information age, otherwise known as the late 1970s, there were no cable-ready TVs, electronic games or cell phones and of course there was no Internet. Times were good for TV marketers. They could reach 90% of US households with prime-time ads on just 3 networks.

In 2008, they would be happy to reach 30% with such a strategy, and DVRs mean viewers can skip the ads anyway.

But now things might be looking up for TV ad sellers. Researchers from the Carroll School of Management at Boston College have found that TV advertisements can influence brand preferences even when viewed in fast forward mode.

James Gips and Adam Brasel tracked the eye-movements and subsequent brand selections of participants watching a nature documentary on TV. The scientists showed that viewers focus intensely on the screen while fast forwarding commercial sequences so they don’t miss the start of normal programming.

In fact they’re paying closer attention than when ads are displayed at normal speed.

This explains why fast-forwarded brand images displayed for just a third of a second influenced future preferences, but only if they were centered on the screen and surrounded by little clutter. 

The scientists had inserted ads for Flake and Aero, two UK chocolate bars unfamiliar to most US viewers. Study participants fast-forwarding though ads in which the brand logo was displayed simply and on center screen were twice as likely to choose that brand during follow-up. Such preferences were not observed when ad lay-out deviated from the centered, uncluttered presentation.

So get ready to see brand images parked squarely and simply in mid-screen next time you’re leaning on fast forward.

Shhhh! If you speak about it you’ll jinx it, but it’s all good right now because something might get done in health care.

On Wednesday, two main trade associations representing America’s health insurers indicated they were ready to cut a deal with the Big O: we’ll cover everyone regardless of pre-existing conditions if you require that everybody gets coverage.

That’s the biggest trade since A-Rod to the Yankees for Soriano and a player to be named.

In 93-94 when Hil tried to get this done, the mere suggestion that such hurdles could be overcome would have drawn guffaws.

And there are other reasons to be optimistic.

Tom Daschle knows his way around the yard.

The private sector wants out from employee health care costs which oh by the way, foreign competitors never had to pay.

Big Pharma has even nodded assent. A little. We think. Maybe. 

Yep! That was Montel Williams on TV this week saying, “Early diagnosis and preventative treatment can save lives and lower health-care costs…that’s why everyone should have affordable health insurance.”

Way to go Montel!

So who’s left, doctors? They could kvetch about reimbursement, working conditions and whatever but if they play their cards right they get tort reform out of this and besides, doctors have been emasculated for so long, this one isn’t even going to hurt.

It’s hard to imagine physicians, who are fed up like no other with their career choice, wouldn’t go for the ride just on the chance things could get better.

A lot of people in South Korea had November 13 circled on their calendars. That was College Entrance Exam Day, an annual event that affects and perhaps reflects modern South Korean society as much as any on the calendar.

In South Korea, 80% of high school seniors attend college, and the results of last week’s 9-hour mostly multiple choice test will strongly impact the college they attend. Years hence, it will impact their success in securing desirable entry positions in large companies and the public sector.

So it was a big deal for the 600,000 students that took the Exam this year, and practically the whole country rose up, as it does every year, to help them do their best.

Offices and the stock market opened an hour late to assure the roads were open just when students needed a stress-free trip to the Exam sites. Non test-taking school children were given the day off to minimize noise. The nations’ national utility had 4,000 people on standby in case the power went out. Airplane take-offs and landings were halted during listening comprehension.

By 6pm though, it was over. Newspapers had published every question and the correct answer. Poorly performing students could hope for a better showing next year. The test prep industry began a new cycle and media outlets shelved their tip lines which had helped students improve concentration, study habits and dietary intake in the days before the test.

Many colleges and government officials feel it’s not right to have so much riding on a single test. They want to add essays, recommendations and related subjective material to college acceptance criteria.

But others like things as they are. They like a system that gives every student the same chance to succeed and the objectivity with which grades are assigned. 

No matter, everybody’s holding the date in 2009.

Big Pharma always had a special place in its heart for America. Why wouldn’t it? Americans spent a ton on health. Americans valued innovation and minimized regulation. Americans even let Big Pharma price its products.

And America generated half of Big Pharma’s worldwide profit.

But things change. Now, Big Pharma thinks its future lies in the developing world. Pfizer just reorganized itself to reflect that as a matter of fact. That move came after Pfizer began cultivating a presence in 130 Chinese cities. Heck, Pfizer just established a JV with a bank to develop rural markets for basic drugs in Bangladesh of all places.

Jean-Michel Halfon was describing Pfizer’s strategy when he told the Economist, ‘serving customers in developing countries is now “a business not a charity,’” but he might have spoken for all Big Pharma.

Why the change? Follow the money. Annual drug sales are expected to grow by 34% per year in emerging markets compared with 9% in the US and Japan, and 14% in Europe.  In less than a decade, drug sales in emerging markets should top $300 million, which is equal to total current sales in America and the 5 top European countries combined.

And frankly, Big Pharma doesn’t know what it’s got in the Big O. What if he were to permit the import of cheap Canadian drugs? What about his threats to have Medicare negotiate tougher price discounts? That could cut American sales by 3-10% right there, according to the Boston Consulting Group.

Meanwhile just because it’s a good idea for Big Pharma to focus on developing countries doesn’t mean it can execute. New marketing and sales strategies will be needed, not just recycled riffs designed for the American, Japanese and European markets. It can expect some tough sledding with distribution partners and regulatory complexity as well.

And what will it do about pricing?

The arteries of children that are obese or have high cholesterol look like they are 45 years old, according to the findings of a study presented last week at the American Heart Association meetings.

Dr. Geetha Raghuveer, a cardiologist at the University of Missouri Kansas City School of Medicine used a sensitive ultrasound device to measure carotid arterial inner wall thickness in such children, who were between the ages of 6-19.

Raghuveer found that the thickness of the inner 2 layers of these arteries (known as the intima and media) exceeded 0.5 mm in 52 of the 70 children tested. That’s what’s normally found in middle aged adults.

The ultrasound method used in this study is considered to be a more accurate measure of cardiac risk than cholesterol levels, blood pressure recordings and most other tests, but it is too expensive to be used in large populations.

“These findings are potentially consistent with predictions that obesity and its complications would result in cardiovascular disease becoming a pediatric illness,” David Ludwig told the New York Times. Ludwig is an associate professor of pediatrics at Harvard Medical School. He had published a study in 2005 predicting that obesity could cut short the lives of children by an average of 2-5 years.

“This is actually looking at the development of atherosclerosis, the process that we know will, if it is not dealt with, lead to heart attack or stroke,” Ludwig added.

About 16% of US children are obese, according to the CDC. Recently the epidemic had appeared to be stabilizing, but the Great Economic Crisis of 2008 may trigger a further expansion of kids’ waistlines, because inexpensive meals are often calorie-leaden.

Man-made Atmospheric Brown Clouds (ABCs or simply, brown clouds) are darkening Asian megacities from Tehran to Shanghai, reducing crop yields and killing hundreds of thousands of people each year, according to a report released last week by the United Nations Environment Program.

The report was compiled by a scientific team with research bases in China, India, Europe and the US.

Brown clouds are 2-mile thick layers of soot, black carbon, sulfates, toxic aerosols and carcinogens that result from burning fossil fuels and biomass. Coal-stoked power plants are the single biggest contributor.

Half the world’s population resides under one or another of the world’s 5 major regional brown clouds blanketing:
- East Asia, including eastern China
- South Asia including Pakistan, India, Bangladesh and Myanmar
- Southeast Asia including Cambodia, Indonesia, Thailand, and Vietnam
- Southern Africa from sub-Saharan Africa to Zimbabwe
- South America’s Amazon basin

Brown clouds reflect and absorb sunlight and have thus dimmed the skies over Tehran, Karachi, Beijing, Hanoi, Bangkok and hundreds of other major cities by 10-25% in just 30 years.

They also adversely affect food production, according to the UN report. In addition to the lost photosynthetic potential caused by dimming, brown clouds cut crop yields by 10-40% by trapping ground level ozone. Annual economic losses from crop damage exceed $5 billion in China, Japan and the Republic of Korea. 

In addition, the toxic components of brown clouds cause respiratory and cardiovascular disease. The UN report attributes 340,000 excess deaths per year in China and India to brown clouds, and estimates economic losses due to illness and disability at 3.6% of GDP in China and 2.2% in India.

And that’s not the half of it. It turns out that getting rid of the toxic clouds may accelerate global warming. Stay tuned for a post on this matter.

Federal regulators will soon swap out an antiquated medical coding system for a new one that describes modern health practices more precisely. But the transition is going to hurt.

ICD-10 is the new system. It increases by a factor of 10 the number of codes specifying medical conditions and procedures in the US health system. The increased specificity should allow insurers to assign payments that accurately reflect the complexity and intensity of medical services.

As a bonus, the improved data should facilitate quality improvement projects and retrospective studies like the one revealing an adverse interaction between heartburn drugs and Plavix.

But many worry that the transition will be costly and error-prone. Minimally, thousands of providers will have to purchase new software and train nurses, physicians and coders. In fact, the Centers for Medicare and Medicaid Services, the agency that oversees the system, expects implementation costs to top $1.5 billion.

This estimate doesn’t include waste associated with an inevitable increase in coding errors as people get used to ICD-10. It also doesn’t account for a likely increase in billing fraud and payment delays.

There’s also concern that CMS’ proposed 3-year roll-out is too aggressive.

CMS’ recent track record on large implementation projects is not reassuring. In the last two months alone it has been accused of bungling the transition to a new claims processor and called out by a US Senator for poor service on its 1-800-Medicare help line.

ICD-10 implementation dwarfs those challenges.

Heartburn drugs like Nexium, Prilosec and other so-called proton-pump inhibitors interfere with the heart-protecting function of Plavix, according to a study presented at last week’s annual meeting of the American Heart Association.

Among its many benefits, Plavix reduces the risk of future heart attacks in patients that have already sustained one. It also reduces the risk of life-threatening blood clots in patients that have undergone coronary stenting or balloon angioplasty.

But in its retrospective, claims-based study of nearly 17,000 people who received Plavix following stent placement or angioplasty, pharmacy-benefits giant Medco Health Solutions reported that the subset also taking heartburn drugs had a 50% higher risk of heart attacks and other cardiac events.

It’s a vexing problem for physicians because heartburn, stomach ulcers and gastritis are common side effects of Plavix, and nearly half of all Plavix users take Nexium, Prilosec or another proton-pump inhibitor to minimize these side effects.

And it’s a high-stakes problem for the pharmaceutical companies that market these drugs. Plavix, which is co-marketed by Bristol-Meyers Squibb and Sanofi-Aventis, topped $4 billion in sales last year. Astra-Zeneca’s Nexium was the 4th largest selling drug in the US last year, with sales of $5.5 billion. The percentage of Nexium users also taking Plavix is unknown.

A separate study presented at the AHA meetings added complexity to the matter because it seemed to show that proton-pump inhibitors increased cardiac risk all by themselves.

Larry Lesko, the FDA’s director of clinical pharmacology told the Wall Street Journal that his department will begin investigating the matter shortly.  Meanwhile, people who take Plavix and heartburn drugs should consult their physicians.

The Cleveland Clinic is test driving HealthVault, Microsoft’s Web-based personal health record.

Officials representing the prestigious health care provider indicated that the pilot began November 3. It’s the first one to track multiple diseases using multiple home-based medical devices.

The pilot will enroll 400 patient volunteers that have various combinations of diabetes, hypertension and heart failure. The multitasking volunteers will utilize HealthVault-enabled heart rate and blood pressure monitors, glucometers, weight scales and maybe even their kitchen sinks to monitor daily fluctuations in their health status (no word yet on which kitchen sinks are HealthVault-enabled, by the way).

Using their computers, volunteers will upload all that data into their HealthVault record and share it in secure fashion with their physicians at the Clinic.

The Cleveland Clinic already offers patients a home-grown personal health record known as MyChart. It claims that 150,000 patients use MyChart. Comparisons of the two systems are not available, nor were statements regarding the marginal value of HealthVault in MyChart users, the two systems’ interoperability, pilot costs etc.

It also remained unclear how the pilot would be evaluated and by whom. Financial terms and strategic objectives of the Microsoft-Cleveland Clinic hook-up were not disclosed.

“These kinds of innovative solutions have the potential to help physicians and patients save time, improve accuracy of health information and communicate more effectively,” said Christopher Hebert, MD, of the Clinic’s Nephrology and Hypertension Department.

“We expect to demonstrate that innovative, cost-effective technology solutions can empower patients to partner more effectively with their physicians and better manage their chronic conditions from where they live and play – in the home,” said Peter Neupert, corporate vice president of Microsoft’s Health Solutions Group.

In 1983, Ronald Reagan threatened to build a space-based laser defense system that could obliterate Soviet nuclear missiles before they left their own airspace.  Reagan called it the Strategic Defense Initiative, but Ed Kennedy derided it as a “reckless Star Wars scheme,” knowing full well the technology wasn’t there.

Kennedy was right and Star Wars never got built, but Reagan’s bluster may have nevertheless accelerated the implosion of the Soviet regime by forcing it to account for the billions of rubles it would take to maintain technology parity with the US at a time when its economy was going down the toilet.

Now, 25 years after Reagan’s Star Wars political checkmate, the US military appears to be back in the ray gun business. And this time, the early prototypes actually work.

At an undisclosed location probably in Iraq, an undisclosed branch of the military, probably the US Army has deployed Zeus, a “directed energy weapon” to destroy unexploded ordinance like roadside bombs from a safe distance.

Until now, the military completed this unsavory task with rocket propelled grenades, but RPGs are expensive and they have an annoying tendency to not go where they’re supposed to. Reportedly the laser goes where it’s aimed, and it works from 400 yards out so soldiers don’t have to expose themselves to sniper fire during the disarmament process.

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