“People can send a text to vote for the next American Idol, but they can’t send one to report the East Coast Rapist in Prince William or anywhere else.” Theola Labbe-DeBose, a reporter for the Washington Post, in an article on the nation’s anachronistic 911 systems.

“How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers’? ‘Consumer-based’ medicine has been a bust everywhere it has been tried.” Nobel Prize winning economist Paul Krugman, in an Op-Ed piece for the New York Times.

“Female college students having unprotected sex were less depressed than those whose partners used condoms…so there’s a deeper bond between men and women than St. Valentine suspected and there’s a better gift for that day than chocolates.” Lazar Greenfield, president-elect of the American College of Surgeons, in an article for Surgery News that cited a study in Archives of Sexual Behavior. Greenfield subsequently resigned. The Surgery News piece was retracted.

“I once asked a professor to explain the solution to a problem so I could understand it more intuitively. He said, ‘You can’t understand it intuitively. Just learn the formula so you’ll get the right answer.’ That was it for me.” Joi Ito, the newly appointed Director of the MIT Media Lab, explaining why he never graduated college.

“I’m a fan of Republicans. They are just so damn entertaining. They’re the best reality show — ever. Forget the Kardashians, I want to know what the Bachmanns are up to.” Elon James White, a comedian, during a stand-up routine at a New York City club. 

Vermont Senate Approves Single-Payer Health Care. The state is on track to become the first one in the nation to offer a single-payer system and universal health coverage.

Wolters Kluwer in Deal to Acquire Lexi-Comp. Drug information provider Lexi-Comp is the latest of several WK acquisitions that have focused on providing decision support at the point-of-care. 
 
Apple Responds to the Furor over iPhone Data Tracking. The company states unequivocally that it has never, and will never track the location of a customer’s iPhone.

Guantanamo Docs Neglected, Concealed Medical Evidence of Torture. The evidence includes bone fractures, lacerations, and symptoms of post- traumatic stress disorder, according to Physicians for Human Rights.

Convicted Rapist Next in Line for a Heart Transplant. New York taxpayers would pick up the $800,000 tab.

New Health Wonk Review is Posted! ‘Spring Has Sprung and Mud Still Flung’ edition, created by the folks over at The Incidental Economist. Features @Pizaazz post on Alzheimer’s guidelines.

Today, consumers can purchase dozens of medical tests without a prescription–tests that tell them whether they are pregnant, have a urinary infection, their cholesterol is too high, and so on.

Should direct-to-consumer (DTC) genetic tests be as readily available? These are the mail-in saliva tests that tell consumers about their genetic susceptibility to Alzheimer’s disease, type 2 diabetes, heart disease and other conditions.

DTC genetic tests are different from the genetic tests that have been used for decades in prenatal and newborn screening, and more recently in predictive testing (like the BRCA test for breast cancer risk).

The difference is not the substrate being tested. In both cases, it’s DNA. Rather, it’s who owns the testing process.

For the legacy DNA tests, health professionals own the process. As per protocol, they obtain permission (informed consent) from patients before ordering the test. Then, they consult with and support the patient once the results are known.

In contrast, DTC genetic tests transfer ownership of the genetic testing process to consumers. A person can decide for herself whether to get a DTC genetic test. She doesn’t need permission from a provider, and has no obligation to share the information with her provider.

This bothers many physicians, bioethicists and consumer advocates. They point out that DTC genetic test reports can be difficult to interpret (for physicians as well, I might add, despite claims that they are universally qualified to do so). They decry the lack of regulatory oversight of testing facilities which might help assure the accuracy and reliability of the information. Furthermore, reports of “egregious…deceptive marketing” by some DTC genetic testing vendors suggest that consumers maybe harmed, they say.

These people call for regulatory oversight of DTC genetic testing. The FDA has in certain limited instances, already begun to do just that.

Physician organizations tend to support the regulation of DTC genetic testing. In particular, they favor rules that transfer ownership of DTC genetic testing to (guess who?) physicians who can then serve as custodians of the information, just as they do for the traditional genetic tests mentioned above.

Set the Data Free
I disagree. People who want access to their genetic-risk information should be free to pay their own money to obtain it, period. The only place where regulation has a role in DTC genetic testing is to assure the quality of the results being generated. That’s it.

(more…)

Supreme Court Questions Vermont’s Restrictive Data Mining Law. The justices expressed concern that free speech rights may be violated by the law, which limits the use of prescription drug records for marketing.

Friendster To Erase All User Photos, Blogs and More On May 31. Launched in 2002, the social network pioneer attracted tens of millions of users over the years, but never grew into the juggernaut it could have been.

ACP Calls for National Strategy on Healthcare for Immigrants. The professional society responds to a South Carolina bill that would make it illegal to transport undocumented persons to a hospital, and other legislative efforts to deny medical care to immigrants.

iMPak Debuts At-Home Sleep Analysis System. Unlike currently available sleep tracking apps which require users to enter data about sleep habits, ‘Sleep Trak’ actually measures the amount and quality of the users’ sleep.

$1.26 Trillion Shortfall in Funds Used To Pay Retiree Benefits. State funds that pay pension and health-care benefits to retired teachers, corrections officers and millions of other public workers faced a cumulative shortfall of $1.26 trillion at the end of fiscal 2009, a new report says.

ScrubdIn Announces Winners of 2011 Best Medical Apps Contest. Best medical app for health care professionals: Medibabble. Best medical app for patients: iHealth Blood Pressure Monitor. Most innovative Medical app: Webicina.

ALS Study Shows Social Media’s Value in Research. The study leveraged PatientsLikeMe to expedite patient enrollment and reduce the time required to complete a trial of lithium therapy for Lou Gehrig’s disease.

Adults Claiming to have ADHD May Be Faking It. 22% of adults who said they had the disorder tried to skew test results to make their symptoms look worse, according to a new report.

Outpatient Care Provided by Hospitals Is No Bargain. Although hospital outpatient care makes up only 5% of all outpatient visits in the U.S., it accounts for more than one-fifth of outpatient costs.

AHRQ Reviews Therapy for Autism Spectrum Disorders. The report says that certain behavioral and developmental interventions are associated with improved outcomes in affected individuals. But for many other interventions, the science remains inconclusive.

For the first time in 30 years, an expert panel has updated guidelines for the diagnosis of Alzheimer’s disease. The long overdue facelift should favorably impact care for millions and accelerate badly needed research on the disease.

The guidelines were produced by representatives from the National Institute on Aging and the Alzheimer’s Association. They portray Alzheimer’s for the first time as a three-stage disease. In addition to ‘Stage 3,’—the full-blown clinical syndrome that had been described in earlier versions of the guidelines—the new guidelines describe an earlier ‘Stage 2,’ of mild cognitive impairment due to Alzheimer’s, and a ‘Stage 1, or preclinical’ phase of the disease. The latter can only be detected with biochemical marker tests and brain scans.

The guidelines legitimize years’ worth of observations by the family members of Alzheimer’s patients, who recognize in retrospect that Grandpa had a slowly progressive cognitive disorder long before he was diagnosed. The guidelines also reflect progress on the research front, where it has now been established that the disease begins years before patients become symptomatic.

Alzheimer’s patients and their families, and the teetering US health system that supports them, would have been better served by the publication of these guidelines 2-3 years ago.

The science was compelling enough back then, and a 2 to 3 year lead-time on research could have had an enormously positive impact on our economy and our health system. In a report last summer for example, the Alzheimer’s Association concluded that unless disease-modifying treatments are found quickly, the number of Americans with Alzheimer’s disease will jump from 5.1 million to 13.5 million by 2050. The total costs of caring for these folks will have exceeded $20 trillion, in today’s dollars, by then. A lions’ share of these expenses will be borne by government entitlement programs, Medicare and Medicaid.

The New Guidelines Will Improve Care
Meanwhile, several commentators have criticized the new guidelines as confusing and stress-provoking. ‘Why should we rush to tell people they have something we can’t treat?’ is the crux of their argument.

These people have it wrong. Denial is not the way to go with Alzheimer’s. The sooner patients and their families find out they have it or are at risk to develop it, the more time they have to develop care plans that reflect their preferences. Mildly affected individuals get to decide for themselves how to enjoy what may be a limited number of years-worth of relatively unimpaired mental functioning. They also get to decide whether to participate in clinical trials and which ones to participate in. They and their families can access counseling and support groups more quickly, a benefit that can improve the quality of life for everyone involved. Even providers themselves can use the enhanced lead-time to implement a patient support plan that respects the needs of the patient and his family.

Today, full-blown Alzheimer’s affects 5.1 million Americans. In all likelihood, at least that many have mild cognitive impairment due to Alzheimer’s (the new ‘Stage 2′). These are the people that will benefit immediately by the expanded definition.

The New Guidelines Will Improve Research
By formally recognizing that Alzheimer’s is slowly progressive and establishing criteria for each stage of the disease, the guidelines facilitate scientific inquiry into various diagnostic and therapeutic options. They allow patients to be grouped by stage of illness (a breakthrough similar to what tumor staging has done for cancer research). Most importantly, they encourage patients to enter clinical trials at a time in the natural history of their disease when treatment success is more likely. (more…)

Amazon’s Trouble Raises Cloud Computing Doubts. Problems with the cloud-based service are likely to prompt startups like Foursquare, Quora, Reddit and BigDoor to reconsider their reliance on such systems. 

How Harvard Medical Manages Students’ Mobile Applications. Of note, the most frequently downloaded clinical applications by the students were Dynamed, uCentral, VisualDx, Epocrates Essentials, and iRadiology.

The Furor over Apple’s Location Database. Though you might not know it, Apple stores your location data in a file on your iPhone. Someone can access this data (from a stolen phone, say) and use it to determine where you’ve been, and when.

Rx for Secondary Prevention May Not Save Money. Statins and anti-hypertensives may, or may not be cost-effective in patients with known cardiovascular disease. We need studies to find out.

How Social Media Will Change Mental Health Care. The quality of care will improve in myriad ways, and the stigma and isolation of mental illness will lessen, according to a psychologist.

“The best minds of my generation are thinking about how to make people click ads.”
Jeff Hammerbacher, an early employee and research scientist at Facebook, and a mentor @RockHealth. Hammerbacher was profiled as part of a Bloomberg Businessweek piece on the tech bubble.

“If you wouldn’t talk about it with a colleague in a coffee shop, then it’s not appropriate to talk about it online.”
Susan Giurleo, a psychologist and business consultant, who was interviewed for an article concerning a physician that posted a patient’s confidential medical information on Facebook.

“If he is man, he text you.”
Anonymous Bay Area taxi driver, to ChickRx co-founder Stacey Borden during the normal course of conversation.

“The hard part of doing genetic studies has been identifying enough people to get meaningful results. We’ve shown you can do it using data that’s already been collected in electronic medical records.” 
Abel Kho, on the results of his recent study in which his group combined patient information from 5 different kinds of EMRs to quickly identify large cohorts of people that had specific diseases.

“We’re redefining Alzheimer’s disease, looking at this in a different way than has ever been done. I think we’re going to start to identify it earlier and earlier.”
Creighton Phelps, director of the National Institute on Aging’s Alzheimer’s Disease Centers Program, after his team updated diagnostic guidelines for the disease for the first time in 30 years.

A federal panel advised the FDA last week that menthol cigarettes are more harmful to the public health than regular cigarettes. However, it did not recommend or endorse any actions the FDA should take to act on the advice.

According to the panel, menthol cigarettes drive-up cigarette smoking rates among youth and African-Americans because its minty taste attracts people to try cigarettes and makes it harder for them to quit. In addition, its mild anesthetic properties mask the harsh taste of cigarettes. That sensation might otherwise deter some from the habit before they get hooked. The report also cites evidence that consumers believe (incorrectly) that menthol provides some health protection or medicinal benefit.

“Removal of menthol cigarettes from the marketplace would benefit public health in the United States,” the panel’s report concludes.

The panel’s official name is the Tobacco Products Scientific Advisory Committee. Its report will likely trigger a lengthy test of the FDA’s ability to promulgate and enforce restrictions on cigarettes, nicotine and menthol. The FDA will review the report and other information before deciding what to do. It has no obligation to do anything.

Reaction to the report was mixed. Some saw it as a necessary first step toward an outright ban on menthol. Others were disappointed that the advisory group shied away from recommending steps the FDA might take to deal with the problem it identified. (more…)

Nowadays, a lot of folks pursue happiness as if it were their primary mission in life. But what is happiness?

Philosophers tell us there are at least 2 kinds. There is so-called “hedonic well-being” which is short-term pleasure derived from things like a tasty meal, great sex or a day in the amusement park.  Then there’s “eudaimonic well-being” which comes from living with a sense of purpose, which is usually actualized by participating in meaningful activities like volunteering for a worthy cause, raising children or caring for others.

Scientists have recently joined their philosopher brethren in the analysis of happiness. Remarkably, they have produced evidence which suggests that people who are driven to achieve eudaimonic  happiness actually have better health outcomes than those motivated to achieve hedonic happiness. They are more likely to remain intact cognitively, for example. They even tend to live longer.

For example, in a cohort study of 7,000 people known as MIDUS (the Mid-Life in the US National Study of Americans), Carol Ryff and colleagues at the University of Wisconsin have tried to identify social and behavioral factors that predict one’s ability to maintain good health into old age. The team has focused on sociocultural sub-populations known to be associated with poor health outcomes…things like low education level.

Ryff’s group showed that people with low education levels and high levels of eudaimonic well-being had lower blood levels of interleukin-6, a bio-marker of inflammation that has been linked to cardiovascular disease, Alzheimer’s disease, even after accounting for hedonic well-being into account. Their write-up appears in Health Psychology.

As well, a study of 950 community-dwelling elderly folks linked eudaimonic well-being to a lower risk of developing Alzheimer’s disease. During their 7-year follow-up of this cohort, David Bennett and colleagues at Rush University Medical Center found that participants who reported having less of a sense of purpose in their lives were at least twice as likely to develop the debilitating condition as those who reported a greater sense of purpose. Their write-up appears the journal Archives of General Psychiatry. (more…)