Archive for August, 2011

Father of the Bride Speech: #LaffelKaufman11

August 15th, 2011 | 1 Comment | Source: Commentary

Ladies and gents, I’m Glenn Laffel, the father of the bride. On behalf of my wife Lori and Mindy and Roy Kaufman, I welcome you to our celebration of Nikki & Ben’s wedding. Many of you have come a long way to join us. We’re honored and thankful that you came.

NikBen4 300x225 Father of the Bride Speech: #LaffelKaufman11Off the bat, I want to say how proud I am to have accompanied Nikki today.

Nikki, I have never seen you more beautiful then you are right now. I am amazed at what you have achieved already. You were a 2-time state champion swimmer in high school. You got into Princeton when you were 16 years old. And you’ve managed a dozen different projects in a dozen different factories—on the ground, in China—to get the world’s coolest products to market, on time.

I look at your remarkable productivity, and what I see is your mother, who has had her share of success over the years, as well. I am proud that you take after her in areas that matter to me.

Every dad hopes his daughter will find a reliable, sensible, considerate partner and although you try not to interfere in their decisions, you do hope your children will make the right choices in life. Nikki chose Ben.

Nikki, in Ben you have found a perfect partner. He does the driving. He takes you shopping. He sets up your Wi-Fi and your iPhone. He even folds laundry, though he does put it on the couch where he just napped, buck naked!

Beginning today, Ben is the most important person in your life, Nikki. Mommy and I, your sisters, grammy and grampy, we are always here for you, but Ben is the last person you see before you close your eyes for sleep every night. So before you do that every night, Nik, look at this man. Remind yourself that he is Ben Kaufman, your husband and the most important person in your world. Now and forever.

And Ben, you are as amazing as your bride, and I admire you. You were named one of the nations’ top entrepreneurs under the age of 30, when you were barely 20! You sold a company to Carmelo Anthony. You were invited to the White House because of your success as an entrepreneur. You have lectured at Stanford, MIT and RISD, and there’s more where that came from.

NikBen21 300x225 Father of the Bride Speech: #LaffelKaufman11So just one quick story. I said that Ben does all the driving with Nikki. So he and I have this little thing in which, whenever he and Nik go for a drive, and when it’s safe for him to do, Ben texts me to say that Nikki has fallen asleep in the car. It never takes Nikki more than 3 minutes to pass out when Ben is driving! I love getting this text from Ben because – first of all – Lori falls asleep like that in my car too, but more importantly, it comforts me to get that text from Ben. That’s because what he’s really saying is, he’s taking care of my daughter. Ben will always do that, I know. That’s a big reason why I’m so happy tonight.

OK so that’s it from me! Just please let me propose a toast to the new couple. Ben, Nikki, I wish you a lifetime of happiness together. May you fulfill all the hopes and dreams you have for yourselves and each other. And may your bond as a married couple gain strength, each and every day.

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Positive Health III: Well-Being, Fitness and Survival

August 11th, 2011 | 1 Comment | Source: Commentary

Martin Seligman is the originator of an increasingly mainstream theory of health and behavior known as Positive Health. His theory suggests that we should cultivate and maintain ‘positive health assets’ – things like optimism, connectedness, a stable marriage and so forth – because they contribute to a healthier, more fulfilling life and improved life expectancy as well.

In earlier posts on the matter, I reviewed 2 studies that support Seligman’s theory. In the first, Harvard scientists showed that emotional and cognitive well-being was associated with a reduced rate of coronary events.  In the second, University of Michigan scientists showed that optimism was an independent predictor of short term stroke risk.

howwillImakefriends 300x223 Positive Health III: Well Being, Fitness and SurvivalWhile both studies suggest that the presence of certain positive health assets can be protective, they do not look at whether the absence of certain negative attributes can be similarly helpful.

Recently, scientists at the Karolinska Institutet undertook to study this aspect of Positive Health. Once again, the findings support Seligman’s concept.

As was the case for the first 2 studies, support for the new study was provided by the Robert Wood Johnson’s Pioneer Portfolio.

In the new study, Francisco Ortega and colleagues set-out to study the association between psychological well-being and cardiorespiratory fitness, and their combined effects on survival.

The scientists used data from the Aerobics Center Longitudinal Study (ACLS), a prospective epidemiologic investigation of more than 5,000 volunteers that began in 1988. At the time of enrollment, participants had a thorough clinical evaluation including a history, physical exam, blood chemistry tests and an exercise test. Participants ranged in age from 20-81. They were followed annually until they died or the study ended, in 2003.

In ACLS, psychological well-being was evaluated at the time of enrollment using negative and positive emotion subscales from the Center for Epidemiologic Studies depression (CES-D) test. Questions in this test asked about how frequently respondents experienced certain feelings in the preceding week. The negative emotion subscale included things like ‘my life had been a failure’, ‘not able to shake off the blues’, and ‘depressed’. The positive emotion subscale included things like ‘feeling as good as other people’, ‘happy’ and ‘hopeful’.

What Did They Find?
After adjusting for traditional cardiovascular risk factors, the scientists found that participants with low levels of negative emotion had a 34% lower risk of death than peers reporting high levels of negative emotion. The protective effect was localized to those with high levels of cardiorespiratory fitness (CRF): high levels of CRF were themselves associated with a 46% reduction in mortality risk, but in the subset of participants that had both high levels of CRF and low levels of negative emotion, there was a 63% lower mortality risk. (more…)

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Positive Health II: Optimism and the Risk of Stroke

August 10th, 2011 | 1 Comment | Source: Commentary

Way back in 1946, the chartering documents of a new UN agency—the World Health Organization—defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

We have made astounding progress in medicine and public health since the WHO charter was crafted, yet we have actualized only part of its comprehensive vision for health. What we call health care today is really just illness care. Even our disease prevention and health promotion programs focus on reducing risk factors for disease. It is the rare initiative indeed that encourages good health for its own sake.

thumbsup 201x300 Positive Health II: Optimism and the Risk of StrokeNew initiatives focused on the concept of Positive Health are changing that by helping us understand what it means to be healthy in a comprehensive sense, beyond the simple absence of symptoms and illnesses. The initiatives focus on health assets, which are biological, psychological, social and other characteristics that are associated with prolonged life, reduced morbidity and health care costs, and improved quality of life.

The initiatives have been triggered by the seminal contributions of Martin Seligman. Many are funded by the Robert Wood Johnson Foundation’s Pioneer Program. They have already produced provocative results, one of which I discussed last week.

In this post–the second in a continuing series–I review another initiative in the field of Positive Health. This one examines how optimism impacts the risk of stroke, the nation’s third leading cause of mortality and disability after heart disease and cancer.

The Study
The classic risk factors for cardiovascular disease (including stroke) include high blood pressure and cholesterol levels, cigarette smoking and diabetes. ‘Negative’ psychosocial factors like depression, anxiety, work stress, low socioeconomic status and poor social support also predict cardiovascular events. More recently, a few studies have filtered into the literature suggesting that health assets like life satisfaction are also predictive.

However, as the National Heart, Lung and Blood institute recently emphasized, essentially none of these factors are all that good at predicting near term (that is, 1-2 years) cardiovascular events, especially in asymptomatic adults. Furthermore, almost no studies have examined whether positive health assets can impact the risk of stroke, per se. (more…)

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Positive Health and the Heart

August 9th, 2011 | 4 Comments | Source: Commentary

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 an image problem for providers, because the paradigm encourages consumers to perceive health care as a negative good - that is, a product or a service 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.

greatbigbeautifultomorrow 300x199 Positive Health and the HeartRecently, 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…)

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IPAB: Fix It, Don’t Repeal It

August 8th, 2011 | 1 Comment | Source: Commentary

In recent weeks, several Democrats and some health reform advocates including the AMA have joined Republicans in calling for a repeal of provisions in the new health law that create the Independent Payment Advisory Board (IPAB). For these people, IPAB represents the worst aspects of the new law–an unelected, centralized planning authority empowered by government to make decisions about the peoples’ health care. Arbitrary cuts to providers, short-sighted decisions that stifle innovation and rationing of care are sure to follow, they claim.

ipab21 IPAB: Fix It, Dont Repeal ItWhile it’s true that the rules governing IPAB are flawed and should be fixed, eliminating IPAB altogether would be a mistake.

Created by the Affordable Care Act, IPAB is a fundamental part of the law’s plan to control health care cost escalations. The law contemplates that each of the Board’s 15 members would be appointed to a 6-year term by the president. Members are to include providers, health policy and public health experts, and consumer representatives. Each would have to be confirmed by Congress, much like Supreme Court justices. And unlike a frightening, wizard-like bureaucrat operating behind a curtain-as critics would have you believe-the IPAB chairperson would be required to appear before any committee of Congress that desires a hearing, just as the President’s cabinet members are required to do.

IPAB’s mandate would be to recommend ways to prevent excessive escalations in Medicare expenditures. Specifically, whenever these costs grow faster than targets established by the Affordable Care Act, IPAB would propose ways to reduce Medicare spending by up to 1.5%. When that happens, Congress can either approve those recommendations, develop alternatives with the same impact, or simply allow Medicare costs to accelerate. In the last instance, a 60% majority of the Senate would be required to overrule the IPAB recommendation.

ipab11 IPAB: Fix It, Dont Repeal ItSome sort of cost-governing approach is mandatory, because we want to offer comprehensive coverage to Medicare beneficiaries within some reasonable cost structure, and because Congress has shown no inclination to do so, for example by enacting quality- and efficiency-based payment models. As Jonathan Cohn points out, Congress is unlikely to do this going forward, because its members are heavily influenced by lobbyists whose job it is to maintain the lucrative status quo. IPAB members, shielded as they would be from such influences but still wholly accountable to Congress, may well succeed where lawmakers have not. (more…)

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Elective Coronary Stenting: A Case in Context

August 3rd, 2011 | No Comments | Source: Commentary

The Case
In 2009, administrators at St. Joseph Medical Center in Maryland wrote letters to the patients of Mark Midei, MD, informing them that its staff cardiologist may have subjected them to a coronary artery stenting procedure inappropriately. That communication prompted an article in a local newspaper, which triggered an investigation by the Senate Finance Committee.

lightening 300x199 Elective Coronary Stenting: A Case in ContextThe Committee subsequently released a report which asserted that Midei performed nearly 600 stenting procedures unnecessarily, and charged Medicare nearly $4m for these procedures. According to the report, all the procedures involved stents made by Abbott Labs. Abbott, in turn, had paid Midei $31,000, added him to its roster of top stent volume cardiologists, and feted him with a pig roast at his home to celebrate a prodigious day in which he implanted 30 stents (apparently a company record). Then, after St. Joseph’s dropped Midei from its roster, Abbott hired him to provide services in Japan and China. In the subsequent year, the number of patients who received stents at the hospital fell to 116 from 350 in the previous year.

Most recently, the Maryland Board of Physicians revoked Midei’s license to practice medicine after concluding that he inappropriately implanted stents into the coronary arteries of 4 patients. The Board also determined that he exaggerated the severity of coronary blockages and claimed incorrectly that they had unstable angina. Midei has denied the allegations and sued St. Joseph for damaging his career.

The Context
The Midei case is particularly egregious, but a recent study in the Journal of the American Medical Association suggests that many thousands of percutaneous coronary interventions (PCIs)—perhaps as many as 4% of all those performed each year in the US—are inappropriate.

The study was organized by Paul Chan of Saint Luke’s Mid America Heart and Vascular Institute. Chan’s team found that when PCIs were done for acute indications like an evolving myocardial infarction (heart attack), the overwhelming majority of cases (98.6%) were performed for appropriate indications. A remarkably low 1.1% were done inappropriately (in the other cases, the benefit was uncertain).

For elective procedures like the ones performed by Midei however, fully 11.6% of all PCIs were inappropriate, and an additional 38% were carried out for indications associated with unclear benefit. Most of the procedures deemed to be inappropriate were carried out on patients with no angina (54%), low-risk ischemia as determined by exercise testing (72%), or patients that were not receiving ‘maximal’ medical therapy (96%). Ninety-four percent of these patients also did not have ‘high risk’ coronary anatomical findings. (more…)

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