For centuries, health providers have focused on the prevention, diagnosis and treatment of disease. This time-honored paradigm has generated phenomenal advances in medicine, especially during the last 60 years. It has also created a bit of an image problem for providers. That’s because the paradigm encourages consumers to perceive health care as a negative good; an economic term describing a bundle of products and services that we use because we must, not because we want to. Recent trends towards empowered consumers are a symptom of this problem more than a solution to it, as I described here.

Recently, the concept of Positive Health has emerged as a possible antidote for the malaise.

Pioneered by University of Pennsylvania psychologist Martin Seligman, Positive Health encourages us to identify and promote positive health assets—which Seligman describes as strengths that contribute to a healthier, more fulfilling life and yes, improved life expectancy as well. According to Seligman, “people desire well-being in its own right and they desire it above and beyond the relief of their suffering.”

Proponents of Positive Health have proposed that several social and functional factors are positive health assets. These include optimism, connectedness, a stable marriage and so forth. Scientists, often supported by the Robert Wood Johnson’s Pioneer Program, have begun studying these proposals. Their results have been compelling to say the least.

This post is the first of a series on Positive Health. In each post, I’ll review scientific studies of the matter and as the series unfolds, I’ll  discuss the relationship between this emerging paradigm and the traditional disease-oriented paradigm favored by today’s health providers.

Heart Health Linked to Satisfaction with Life
Most people know that negative psychological states like stress, anxiety and depression are linked to poor health outcomes, including a slew of adverse cardiac outcomes. Does it follow that a state of emotional and cognitive well-being can have a protective effect on cardiovascular health?

To answer this question, Harvard’s Julia Boehm and colleagues reviewed data from the Whitehall II study, which involved nearly 8,000 British civil servants. As part of that study, each participant had assessed his or her satisfaction with several dimensions of life experience including leisure activities, standard of living, job, health, family life, sex life, marital or love relationships and overall feelings about themselves as a person. Participants also provided yes/no answers regarding negative aspects of their lives including the presence of depression, anxiety and so forth. (more…)

The Internet has transformed every aspect of health care. Online communities provide new forms of support for people with a thousand different medical conditions. Email has streamlined communication between stakeholders in the system. Electronic medical records and social networking sites hold a wealth of data that can be leveraged to study the effects of various treatments.

The most significant advance however, has been the ease with which people can access information about their health. As many as 74% of all people search for information about their symptoms and treatments online, and many of these information-empowered people now see physicians as guides to and interpreters of this information, a far cry from the era in which passive patients presented symptoms and relied on paternalistic physicians to act in their best interests.

But there are problems with the new paradigm, just as there were with the one it replaced. Online health information can be incomplete, biased, lacking for proper context or flat-out inaccurate. And not everyone, especially those without a medical background, can sort through these deficiencies in a way that assures they are properly informed.

A recent study by Alexander van Deursen and Jan van Dijk of the University of Twente has quantified these problems. The scientists used performance tests to assess health-related Internet search and other online skills in a representative sample of the people in the Netherlands.

Their tests focused on four types of skills:
Operational-These included basic internet skills like opening a health website, saving a PDF file and adding a website to a list of “favorites.”
Formal-These included navigating health-related menus and websites, and surfing a list of websites.
Finding Information-These included accessing specific information regarding medical conditions and answering specific questions like whether it is appropriate to begin a treatment after being infected with a particular germ.
Strategic-These included extracting information from different sources and making decisions based on the information. For example, “find out whether it is wise to give a 3-year-old boy Vitamin A and D.” (more…)

“IPAB is the latest whipping boy for those who object to the implementation of healthcare reform.” Margaret Dick Tocknell, a writer for Health Leaders Media, who recently attended as 2 Congressional committees discussed the Independent Payment Advisory Board, a panel tasked by the Affordable care Act to recommend ways to control Medicare costs.

“We can give people all the information and advice in the world about healthy eating and exercise, but if parents can’t buy the food they need to prepare those meals because their only options for groceries are the gas station or the local minimart, then all that is just talk.” First Lady Michelle Obama, announcing national commitments to provide millions of poor people access to healthy, affordable food.

“My argument against circumcision of children and infants is no more and no less than that it’s a human rights issue. All people, male as well as female, are entitled to bodily integrity, and nobody — for any reason — has the right to cut off part of another person’s body when that person is too young to understand and to consent.” Georganne Chapin, executive director of Intact America.

“Circumcision…reduces the risk of HIV and penile cancer in men. It reduces the risk of several other sexually transmitted infections in men and women, including syphilis and herpes, and of cervical cancer in women. Urinary tract infections in infants are about 10 times less likely if the boy has been circumcised.” Daniel Halperin, a lecturer in international health at Harvard. This November, voters in San Francisco are expected to decide whether parents should be allowed to circumcise their baby boys.

“This is not where we wanted to be, and it’s not where we deserve to be. In the best tradition of Fleet Street, we are going to the pub.” Colin Myler, editor of News of the World, after the British tabloid closed down for good, a casualty of the phone-hacking scandal involving Rupert Murdoch’s News Corporation.

I thought I read the final chapter in the tale of Pfizer’s shady marketing practices for Neurontin years ago. Sadly, there’s at least one more chapter to go.

Recall that in in 2008, leaked documents from a US District Court revealed that Pfizer had covered-up the results of a clinical trial which showed the drug didn’t work for chronic nerve pain, even as it promoted off-label use of the anti-seizure drug for that purpose. The next year, it was revealed that Parke-Davis (now a subsidiary of Pfizer) took advantage of lax disclosure policies by certain medical journals to publish 13 articles promoting off-label use of Neurontin that were ghostwritten and funded by the company without disclosing such arrangements.

Now, it has come to light that Parke Davis’ marketing department sponsored a Seeding Trial of Neurontin back in the day—that is, a trial portrayed deceptively as a patient study but whose real aim was to encourage prescribers to use the drug.

The trial was STEPS, the ‘Study of Neurontin: Titrate to Effect, Profile of Safety’ trial. More than 772 physician ‘investigators’ and 2800 patients participated in STEPS.

The stated objective of STEPS was to study the safety, efficacy and tolerability of Neurontin. However, after reviewing documents compiled for a pair of lawsuits against Pfizer and its subsidiaries, Joseph Ross and colleagues concluded that the actual objective was to increase prescribing rates by ‘investigators’ in the study. Neither the ‘investigators’ nor their patients were informed about the real purpose of STEPS.

The trial worked, from Parke-Davis’ point of view. Physician ‘investigators’ prescribed 38% more Neurontin as a result of their participation in the trial.

The drug company also leveraged the patient recruitment process to market Neurontin to ‘investigators,’ Ross’ group found. Company representatives asked ‘investigators’ to set-aside certain days on their schedule in which epilepsy patients comprised the bulk of the appointments, thereby permitting the reps to be present and promote Neurontin at the moment of truth. The reps even helped collect patient data for the trial.

The smoking gun though, was uncovered in the company’s marketing plans, which cited the trial itself, not its anticipated results, as central to the promotion of Neurontin. For example, a 1995 report listed STEPS as a deliverable under the strategy “Solidify Neurontin’s position with neurologists and select primary care physicians as the safe and easy add-on for refractory patients.” Another document stated that “the rapid growth of Neurontin depends on the ability to influence the large population of community neurologists that see the majority of nonrefractory seizure patients. The STEPS trial…was a strong start to this…” (more…)

African-American Men More Likely to Stay Alive In Prison than Out. A study of North Carolina inmates found that African-American males are half as likely to die in prison as out of prison. The study, in the Annals of Epidemiology, found that African-American inmates were protected against drug and alcohol-related deaths, fatal accidents and some chronic diseases.

Injuries of Veterans, Football Players Linked to Dementia Later in Life. Two studies provide new evidence that head injuries such as concussions are linked to dementia later in life and may make the brain more vulnerable to the development of symptoms characteristic of Alzheimer’s disease.

A Wife May Shorten Time to MI Care. Married men arrive at a hospital quicker than age-matched single men after developing chest pains suggestive of a heart attack, researchers found.

FDA Issues Draft Document on Mobile App Regulations. The 30-page draft provides guidance outlining how mobile medical apps should be regulated as medical devices, targeting an issue that has long plagued physicians looking to adopt apps and vendors wondering how far they can go without incurring the regulations.

Reddit Cofounder Charged With Hacking MIT Computer. Federal prosecutors have accused Aaron Swartz of stealing 4 million documents over a 3-month period in 2010. He faces charges of wire fraud, computer fraud, unlawfully acquiring information and recklessly damaging a protected computer. If found guilty, Swartz could spend 35 years in jail and be fined $1 million.

Budget Impasse Unlikely To Affect EHR Incentive Payouts. Despite the ongoing stalemate in federal budget negotiations, it is unlikely that Congress will eliminate future funding for incentive payments for the meaningful use of electronic health records, according to David Roberts, VP government relations at HIMSS.

Greenway Medical Files to Go Public. The vendor of integrated physician practice management/electronic health records software has filed for a $100 million initial public offering of stock.

Tobacco Use in Movies Continues Dramatic Drop. The number of onscreen tobacco incidents in youth-rated (G, PG, or PG-13) movies continued a downward trend, decreasing 71.6% from 2,093 incidents in 2005 to 595 in 2010, the CDC reported. The rate of decline varied substantially by motion picture company.

Kids Safer With Granny Behind the Wheel. Grandma may be better behind the wheel than mom when it comes to injuries from car crashes involving children, an insurance database showed.

Supply of Essential Medicines Falls Short in US Hospitals. Shortages of common medicines have reached a record high and are a nearly universal problem for community hospitals in the US, where the problem is leading to rationing and higher costs for care.

Gain Fitness Launches iPhone App. Gain Fitness, a startup that creates personalized workouts based on certified trainers’ expertise, has launched an iPhone app that allows fitness enthusiasts to access to personal trainer quality exercise without having to research workouts or book expensive trainers.

Web Changing How People Recall Facts. Access to a wealth of information on the Internet is altering what people remember, prompting us to retain fewer facts but more information about how to find those facts, say scientists at Harvard and Columbia.

Second-Hand Smoke Tied to ADHD. Researchers found that of more than 55,000 US children younger than age 12, 6% lived with a smoker. Those kids were more likely to have attention-deficit hyperactivity disorder (ADHD) than children living in smoke-free homes.

Florida Pain Doctor Suspended; 34 Patients Dead. Dr. Joseph Hernandez was suspended earlier this month by the Florida Department of Health for overprescribing opiate painkillers. Of the 761 patients Hernandez saw between January and April 2011, 34 have died.

When Medicaid Paid Better, Kids Had More Dental Visits. When dentists were reimbursed more for preventive visits, kids on Medicaid ended up in their chairs more often, probably because the increased compensation made them more willing to accept those patients, a government researcher said.

Top Quotes of the Week: Federal Deficit Edition

“Come on, you and I, let’s lock arms and we’ll jump out of the boat together.” House Speaker John Boehner (R-Ohio), in May, urging President Obama to do a ‘big deal’ on the federal deficit.

“I want to get there, but it takes two to tango, and they’re not there yet.” Boehner, speaking about the Democrats last Sunday. Boehner then blew-up talks surrounding a $4 trillion ‘big deal’ he had been discussing with President Barack Obama.

“I’m prepared to take significant heat from my party to get something done. And I expect the other side should be willing to do the same thing.” Obama, responding to Boehner.

Inaction on the debt ceiling “would be catastrophic for the economy…no responsible leader would say the United States of America, for the first time in its history, should not pay its bills, meet its obligations.” Treasury Secretary Timothy Geithner.

“This is a misnomer that I believe that the President and the Treasury Secretary have been trying to pass off on the American people, and it’s this: if Congress fails to raise the debt ceiling by $2.5 trillion, somehow the United States will go into default and we will lose the full faith and credit of the United States. That is simply not true.” GOP presidential candidate Michele Bachmann.

“The astonishing feature of the federal fiscal position is that revenues are forecast to be a mere 14.4% of GDP in 2011, far below their postwar average of close to 18%. Individual income tax is forecast to be a mere 6.3% of GDP in 2011. This non-American cannot understand what the fuss is about: in 1988, at the end of Ronald Reagan’s term, receipts were 18.2% of GDP. Tax revenue has to rise substantially if the deficit is to close.” Martin Wolf, chief economics commentator at the Financial Times, London.

Opioid Implant Cuts Positive Urine Screens. An implantable formulation of the opioid addiction drug buprenorphine (Probuphine) kept more patients “clean” over six months than did a sham implant, according to drug maker Titan Pharmaceuticals.

AIDS Drugs Can Prevent Infection, Studies Show. Two new studies show that AIDS drugs can prevent heterosexuals from acquiring HIV, adding to a growing number of methods to slow the spread of the virus. Many researchers now believe that we have developed sufficient tools to contain the pandemic, though tight budgets may limit their deployment.

Antipsychotic Drugs Used Commonly for Parkinson’s Disease. Despite warnings about the risks of using antipsychotics to treat older patients at risk for dementia, the powerful drugs are routinely prescribed to elderly Parkinson’s patients.

Stinky Foot Odor May Prevent Malaria Deaths. Researchers at the Ifakara Health Institute in Tanzania are developing traps using natural and artificial foot odors to lure mosquitoes and prevent them from spreading diseases like malaria, in a project funded by the Bill & Melinda Gates Foundation.

Small Physician Practices Not Using Key EHR Features. Few small and midsize physician practices use electronic health record system functions that are seen as essential components of patient-centered medical home model of care, according to a study. Features include care coordination, electronic disease registries, e-prescribing and online communication with patients.

Docs Averse to Sharing Patient Data, Even for Public Health. When it comes to disclosing identifiable patient information, family doctors are reluctant to do so – even for public health purposes such as tracking influenza, according to a recent study.

The Hype on Hypoallergenic Dogs Is Just That, Study Warns. So-called hypoallergenic dogs do not produce fewer allergens like dander and fur, and are hence are no less likely to make you sneeze than other dogs, a new study says.

Fitview Gives Personal Trainers A Comprehensive Fitness And Coaching Platform. The new startup launched yesterday, hoping to help personal trainers better connect with their clients and the general public.  Fitview is launching as a comprehensive SaaS for fitness trainers to upload a fitness curriculum, keep track of client progress and more.

Tennessee’s Telehealth Program in Disarray amid Fraud Investigation. A non-profit charged with managing Tennessee’s telehealth network is shutting down amid claims that two former executives stole or misused more than $1 million in grant funding.

Survey Finds High Rate of Spanking in Kids under Age 2. Thirty percent of North Carolina mothers of children less than 2 two years old say they have spanked their children in the last year, a concern since being spanked is associated with poor self-esteem, mental health problems and substance abuse.