Based on their experience during countless schleps to the market, moms know that kids pick cereals whose boxes have cartoon characters on them. Previous research by Yale scientists explained the phenomenon: kids say that the stuff poured from such boxes tastes better than the same stuff when poured from a cartoon-less box. The same thing happens when kids pick graham crackers, carrots and gummy fruit snacks.

Pictures of Shrek, Dora the Explorer, Scooby Doo and their kin make just about anything taste yummier, it seems.

Can this observation be leveraged to encourage kids to select healthier foods? Yes, it turns out. But the story isn’t as straightforward as you’d think.

To study the impact of licensed media spokescharacters and other nutrition cues on kids’ taste assessment of food products, scientists at the University of Pennsylvania fed cereal from a box that had been labeled either “Sugar Bits” or “Healthy Bits” to 80 kids. Half the boxes in each “brand category” were adorned with cute cartoon penguins, while the other half were not. The kids were between 4 and 6 years old.

The scientists then asked the kids to rate the taste of the cereals on a 1 to 5 smiley face scale. Surprisingly, kids loved the Healthy Bits, which scored 4.5 regardless of whether the penguin was present or not. However, the penguins had a marked impact on kids’ taste preferences for Sugar Bits. For this brand, the taste score sans penguins was below 3, whereas it was over 4 if the cereal was delivered from a box featuring the friendly penguins.

Lead author Matthew Lapierre didn’t know for sure why this happened. “One of the explanations we’ve been working with is that kids grow up with this negative association with sugar,” he reasoned in an interview.

To support his hypothesis, Lapierre noted that many cereal brands have replaced the word “sugar” with other words that imply a somewhat healthier message. Sugar Smacks are now called  Honey Smacks, for example. Sugar Crisps are now sold as Golden Crisps.

If Lapierre is right, then these healthier messages have been internalized by kids to the point that they have negative perceptions of the word ‘sugar’ in the faux brand created by his group. (more…)

Spring training 2011 is in full swing. With baseball’s regular season just 2 weeks away, pitchers are lengthening their starts and adding curveballs to the mix. Promising, but lamentably green prospects are being reassigned to Triple A. And word has it that Mariano Rivera is preparing to throw an inning or two, just to be sure his 4-seamer is game-ready before opening day.

People have said that Baseball is Life. That may be stretching it for folks not named Yogi, but surely the game holds lessons for us all…even health policy wonks! Before we highlight the top submissions to this week’s HWR, let’s review some of these lessons:

Lesson 1: People Will Believe Anything
Somewhere this spring, a local sports writer opined that the kid who touched 98 in the 6th inning of a Cactus League game is the next Tim Lincecum, even though he has never recorded a regular-season out above Double A. Another said this year’s Phillies’ rotation will match the prodigious ‘71 Orioles quartet of Cuellar, McNally, Palmer and Dobson. Others claimed that A.J. Burnett will win 20 this year, and that Vlad Guerrero (whose gait is reminiscent of the Tin Man in Wizard of Oz) will steal 20 bases.

And people believe it!

During the epic health reform debate of 2009-2010, Democrats tried to include provisions which authorized payments to physicians for time spent helping Medicare patients prepare living wills. But Sarah Palin claimed those provisions allowed the government to create “death panels,” and John Boehner warned that they would “start us down a treacherous path toward government-encouraged euthanasia.”

People believed that, too!

To this day, an astounding 30% of elderly Americans believe the new health law empowers government panels to make end-of-life decisions for Medicare beneficiaries.

Lesson 2: Sometimes You Get a Do-Over, Sometimes You Don’t
Umpire Jim Joyce robbed Tigers pitcher Armando Galarraga of a perfect game last year when he blew a call on what should have been the last out of the game. Although Joyce later admitted his mistake, there are no do-overs in baseball. The pitcher’s chance to make history was gone forever.

Meanwhile, GOP-appointed Federal District Judge Robert Vinson decided in January that since he found one provision of the Big O’s health law to be unconstitutional, he might as well trash the whole deal. The decision threatened to disrupt planning in 50 states and confused the bejesus out of the American public. But unlike baseball, the US judicial system does permit do-overs…sort of. Two weeks ago, Vinson issued a stay of his own ruling, effectively allowing the law to stand pending an appeal to the Supreme Court.

Galarraga would be immortal if Joyce could have done that!

Go figure. Anyway, the Yankees will rise again in 2011 (believe me!) and finally, thanks to the HWR All-Stars who contributed posts for this week’s edition. Here is the formidable line-up:

The Sluggers (Health Policy)
For his post on the Forbes website, Avik Roy produced a chart showing results from the Health Tracking Study Physician Survey. The chart confirms that physicians refuse to accept Medicaid patients at rates that far exceed those who are covered by Medicare and private insurance. Roy suggests this problem is responsible for poor clinical outcomes seen in Medicaid beneficiaries.

Between innings, Roy should have a beer with Austin Frakt, who pretty much blows-up the premise that Medicaid recipients receive poor quality health care. In a post for the Incidental Economist, Frakt shows that studies used to support the premise reveal an association between Medicaid and individuals with poor health… it’s their poor health, Frakt says, that is driving poor outcomes in this population, not lousy doctors or poorly designed care systems.

Now that President Obama has decided to support Wyden-Brown, disaffected governors and state legislators can craft PPACA alternatives that are more to their liking, writes Joe Paduda over at Managed Care Matters. According to Paduda, if Republicans actually have a better approach to the problems of health care access and cost, they are going to win big in 2012.

For his part, John Goodman predicts that the PPACA will encourage many patients and providers to opt-out of the third-party payer system. Posting on his own Health Policy Blog, Goodman visualizes a major shift toward concierge-type services and the creation of new markets in which providers compete for patients on price, quality and amenities.

Neil Versel is a huge fan of Don Berwick, but he deplores the way President Obama attempted to install the Quality Don as a recess appointment to head CMS in July, 2010. According to Versel, the underhanded nature of the appointment provided fodder for “uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts.” Versel’s blog is Meaningful HIT News.

Over at BNet Healthcare, Ken Terry observes an accelerating trend in which insurers and providers are partnering to create Accountable Care Organizations. Terry believes the 2 groups actually can cooperate to form such organizations, and cites several recent acquisitions and partnerships which appear to support his position.

Marsha Gold has followed the Medicare Advantage program and its predecessors for years. In her post on the Health Affairs Blog, she summarizes the program and describes how its beneficiaries will be affected by the PPACA.

In a post for his Health Business Blog, David Williams reminds us that many folks want to overturn new rules restricting Flexible Spending Accounts. Williams ups the ante a bit by suggesting that we eliminate FSAs altogether, and get rid of those pesky tax deductions for health insurance while we’re at it.

David Kindig reviews the implications of Wisconsin Governor Scott Walker’s plan to eliminate the state’s $3.6 billion dollar deficit. Kindig argues that some of Walker’s proposed cuts (including reducing Medicaid eligibility) will have serious health implications for people in his state. His post appears at Improving Population Health.

The Lucidicus Project’s Jared Rhoads reacts to presentations he heard at the TEDxDartmouth 2011 conference. After hearing Al Mulley’s familiar argument that our health system needs to adjust more effectively to consumer preferences, Rhoads doesn’t believe we can pull it off.

Reconciling state and federal laws can be difficult, and according to Louise Norris of the Colorado Health Insurance Insider, Health Reimbursement Arrangements (HRAs) are a particularly nettlesome case-in-point in her home state. Her post clarifies the situation, thankfully.

The Starters (Providers)
Roy Poses describes how physicians who are employed by corporations can be pressured to put the corporations’ economic interests ahead of their patients’ interests. Writing for Health Care Renewal, Poses argues that the primary means of corporate control includes restrictive covenants in contracts that have been signed by naive physicians, or signed by physicians under duress.

The PPACA will eventually generate a huge increase in the number of ER visits, according to Amer Kaissi. He argues that better coordination between ER and primary care doctors will be required to address the coming deluge, and offers a roadmap for this effort. Kaissi posts on Healthcare Hacks.

Julie Ferguson of Workers Comp Insider writes that nurses, nurses’ aides and paramedics are facing a rising tide of on-the-job violence. In fact according to Ferguson, only police and correctional officers experience higher rates of on-the-job assaults. Ferguson explores whether this is emblematic of a dysfunctional health system or just a sign of the times.

Liz Borkowski reminds us that while palliative care teams can reduce costs associated with the care of seriously ill hospitalized patients, most people who are eligible for these services don’t receive them. Borkowski, who posts at The Pump Handle, concludes that we have to do more to encourage utilization of these teams.

On The Health Care Blog, Matthew Holt posts an interview with JD Kleinke concerning the latter’s new novel, Catching Babies. Holt describes the book as a “tour de force of health policy and medical soap opera–Health Affairs meets Grey’s Anatomy–wrapped up in the complex world of childbirth.”

The Closers (Quality and Safety)
There is limited evidence to support claims that pay for performance programs improve quality and reduce the costs of health care, according to Jason Shafrin, who posts on The Healthcare Economist. Shafrin reviews Massachusetts’ pioneering P4P program and several other ones that failed to improve care.

Jaan Sidorov laments that a one-size-fits-all approach to health care—characterized by guidelines and decision support—is woefully behind sociotechnical trends that make “mass personalization” possible. Writing for Disease Management Care Blog, Sidorov argues that those who embrace the latter approach (by tailoring treatments based on the health status, preferences and values of individual patients, for example) will win in the marketplace.

At The John A. Hartford Foundation Blog, Chris Langston discusses the problem of overmedicating the elderly. He reviews a study in which 42% of the Indiana Medicaid population who live in nursing homes received at least one “potentially inappropriate medication.” Not surprisingly, these patients had worse health outcomes.

-Seventh Inning Stretch-
Famed HWR Contributor Argues Against a Key Policy Decision:

httpv://www.youtube.com/watch?v=xs0SinIno7A

The Base-Stealers (Health IT)
Many CEOs and CIOs believe that their healthcare IT systems are secure because they “use SSL encryption” or “have a firewall.” That’s not the case, according to The Healthcare IT Guy, Shahid N. Shah. Shah offers a list of questions that executives can use in order to assure their systems really are secure.

Walking through the palatial vendor displays at this year’s HIMSS conference, Anticlue blogger Elyse Nielsen heard surprisingly little buzz about “the cloud.” In her post, Nielsen explains why this was the case, and opines that it won’t be long before the buzz picks-up.

The Slick Fielders (Pharmaceuticals)
Over at Nuts for Healthcare, Jeffrey Seguritan wonders what things would be like if drugs and their makers were forced to endure the same mano-a-mano competition that makes the NCAA basketball tournament such a good watch. Although the FDA does not require comparative trials like this before green-lighting drugs, Seguritan reviews a few such trials that are actually underway.

The Five-Tool Guys (Media)
Lately, health media watchdog Gary Schwitzer has focused on instances in which press releases drive what we call “news” in health care. In a pair of posts on his HealthNewsReview Blog (here and here), Schwitzer warns that when this happens, independently vetted journalism may not have taken place. 

The Stud Prospects (Consumerism)
Employers and health plans continually seek ways to contain health care costs. According to Dave Kerrigan, limiting the size of provider networks is a powerful and potentially beneficial tool in this regard. Kerrigan’s post appears on A Musing Healthcare Blog.

The Rabid Fans
Nobody is immune from DrRich’s sharp-tongued post on The Covert Rationing Blog. DrRich skewers, in no particular order, lying doctors, the right-wing media, the left-wing media, and quite possibly my Aunt Millie as well. We’re not sure what DrRich is for, but we know what he’s against, and it’s just about everything.

“Unions get waivers,” the InsureBlog’s Bob Vineyard exclaims. “Campaign contributors get waivers. Business owners and states get waivers. Why should consumers be left out?” In his post, Vineyard points out that some Michigan Representative wants to give consumers the right to opt out of “Obamacrap.” Obamacrap? Really? Obamacrap?

Whatever. Two weeks from today, Jason Shafrin hosts the Health Wonk Review over at the Healthcare Economist. Good luck Jason, and thanks to the all-stars who contributed to today’s edition!

Teenagers with otherwise healthy lifestyles consume large amounts of sports drinks and high-calorie fruit drinks, probably because they believe the products are “healthy,” according to scientists from the University of Texas.

To reach these conclusions, Nalini Ranjit and colleagues surveyed 15,000 students attending grades 8-11 during academic year 2004-2005. The survey asked about dietary and exercise habits, as well as time spent watching TV, playing video games and using computers.

The scientists found that teens who preferred flavored and sports beverages (FSBs) over soda tended to exercise harder and more frequently, and to consume truly healthy foods more often.

“The most likely explanation for these findings is that FSBs have been successfully marketed as beverages consistent with a healthy lifestyle, to set them apart from sodas,” Ranjit’s team concluded in their write-up, which appears in Pediatrics.

FSBs contain miniscule amounts of fruit juice and about the same amount of sugar as carbonated soda.

The link between FSB intake and a healthy diet turned out to be stronger in girls. Girls who consumed 3 or more FSBs per day were more likely to consume more milk, fruit and vegetables.

The link between FDB intake and exercise was more apparent in boys. Boys who consumed 3 or more FSBs per day engaged in more vigorous exercise and participated more regularly in gym class and organized sports.

Commenting on the team’s findings for MedPage Today, Vanderbilt University sports medicine expert Alex Diamond said that, “marketing has a great deal to do with the perception that sports drinks are generally healthy. They have a role when it comes to prolonged activity or exercise, but on a regular basis, it’s not something kids should be drinking just to get hydration.”

In the latest permutation of social networking, you are what you buy.

Sachin spent $4.98 at Starbucks. Jenna bought earrings for$3.19 from Target (“They dangle/match my new dress”). AllieJ purchased Kind of Blue from iTunes for $8.89 (“’So What’ is such a classic!”)

Twitter-like feeds like this are appearing on these new social networking sites, which include Blippy and Swipeley. The feeds permit—indeed, encourage—users to automatically broadcast purchases they make to the world. And that lets people reveal their personalities through their purchases. Some people think is a good thing.

Are you a Levis guy or a Polo jeans guy? McDonald’s or Taco Bell? Dunkin’ Donuts or Starbucks? Here’s your chance to let everyone, and I mean everyone know!

According to Philip Kaplan, the co-founder of Blippy, users share $1.5 million worth of their purchases each week on his site, and that number is growing rapidly. Users give the company access to their credit and debit card accounts, along with other online accounts like Netflix and iTunes. Blippy compiles and posts their purchases.

Users can block certain purchases from their profiles, but Blippy’s default settings are set to “share all.”

Blippy has focused on user acquisition rather than monetization so far, but it hopes that the data it’s collecting can be eventually sold to marketers looking to understand purchasing behaviors in various demographics.

Privacy experts wonder whether users fully understand what’s happening when they sign-up for the service (even though it’s explained completely in the Terms of Service). “It’s not just about a private exchange between friends. The business is basically about providing access to you to advertisers and marketers,” Jeff Chester told the Washington Post. “There are little strangers listening in,” added Chester, who works for the Center for Digital Democracy.

Amanda Lenhart, a senior research specialist at the Pew Internet & American Life Project added that “people often fail to remember who is in their network, even though you’ve created it yourself.”

Tens of thousands of people use computer-based brain-training exercises to boost memory and mental fitness. These people will be disappointed to learn that a recently published study suggests the tools may not work.

In the 6-week study, Jessica Grahn and colleagues at the Medical and Research Council’s Cognition and Brain Sciences Unit in Cambridge, England randomized 11,430 healthy participants to one of 3 groups. The first engaged in online games designed to improve general intelligence skills like problem-solving and reasoning. The second group performed exercises aimed at increasing attention, short-term memory and mathematical skills—the focus of commercial brain-training programs. The control group browsed the Internet in search of answers to general knowledge questions.

Participants performed these activities for at least 10 minutes, 3-times each day.

Grahn’s team found that participants in the brain-training (second) group improved in the tasks that they practiced, but their improvement was about the same as that made by the control group. No groups showed improved cognitive skills that weren’t specifically targeted in their tasks.

The brain training industry is focused for the moment on software offerings and online programs. It generated $265 million in North American revenues last year, up from $225 in 2008. About 40% of these revenues came from consumers. The remaining came from schools and retirement communities.

Industry spokespeople said the study was flawed. “It’s not brain training,” Alvaro Fernandez, CEO of SharpBrains told the Wall Street Journal. Cognitive improvements can only be expected, he said, “after more than 15 hours of training and where each session lasts at least 30 minutes.”

Steven Aldrich, CEO of Posit Science, a brain-training vendor, added that the “study overreaches in generalizing that since their methods did not work, all methods would not work.”

Last week, Google released a list of governments that had requested various forms of private information from the search giant’s own data bases, and demands made by these governments to censor its applications or remove certain content.

Google said it disclosed the information in order to reveal an increasing trend by governments to block information on the Web. More than 40 governments censored Google-associated information in 2009, compared with just 4 in 2002.

“We at Google believe that greater transparency will lead to less censorship online,” David Drummond, Google’s chief legal officer told the Washington Post.

According to Google, Brazil and the US made the most requests. During the second half of 2009, these countries made more than 3,000 requests, particularly concerning YouTube and Orkut (a social networking site that is popular in Brazil). 

Germany was also near the top of the list. Most of that government’s requests concerned removing pro-Nazi material, according to the company.

Google’s figures are a bit difficult to interpret since Google counts a request to take down one Web address the same way as a request to remove hundreds of sites.

Google stated that many requests by governments seemed legitimate. Law enforcement agencies, for example, often request the removal of child porn sites or videos promoting violence or racial hatred.

Of note, Google’s disclosure included no information about China because, it said, China looks at “censorship demands as state secrets, so we cannot disclose that information at this time.” China is known to have erected firewalls that  prevent its citizens from accessing certain information, and other technological barricades that prevent certain users from communicating with others.

Google’s report was not obviously related to its decision last month to pull its search business out of China.

Last week, Twitter announced plans to derive revenue through advertising. The plan calls for ads on the popular micro-blogging site to look just like actual tweets. Thus, rather than seeing a banner ad for a Big Mac, users will see a sponsored McDonald’s tweet promoting a greasy delight.

According to the Washington Post’s Chadwick Matlin, this strategy is well-crafted because it is highly consistent with the formula that has made Twitter popular in the first place.  Twitter’s ads (the ones companies pay for) will appear right in your feed  of unsponsored tweets.

What makes this strategy so well aligned with the essence of Twitter? According to Matlin, self-promotion is what Twitter is, and has always been all about. Businesses and casual users alike load-up their tweets and their feeds with links to their own work. Regardless of the number of followers you have, every tweet amounts to a shill.

The new, sponsored ads will appear at the top of your feed, along with a “Sponsored by . . .” alert at the bottom, to avoid the perception that McDonalds has hacked your feed. They can be retweeted, replied to, and linked to, just like normal tweets.

Twitter is convinced the way it can make sure its ads work is by making sure they’re “resonant.” That word was all over Twitter’s ad announcement, and it’s sure to become a new buzzword for the Web.

Twitter’s general principle is that it’s going to display only ads that users like — the ones that resonate. It’s great in theory, impossible to do in practice. If Starbucks is spending hundreds of thousands of dollars on Twitter ads but its Twitter ads are lousy, is Twitter really going to tell Starbucks to take back its money?

This post originally appeared on EHRbloggers.com.

These days it’s a given that anyone you meet, from prospective employers to next Friday night’s date is probably Googling you. But how would you feel if you knew that practice extended to your psychiatrist?

If anecdotal observations by Brian Clinton, Benjamin Silverman and David Brendel are generalizable, the behavior is common.

Writing the Harvard Review of Psychiatry, the psychiatrists say they have not carried out research on the practice, but they admit having carried out such searches themselves. They claim to have witnessed other physicians conducting patient searches and to have spoken with many colleagues who had done likewise.

“Most patients would probably be shocked that their doctor had the time or the interest to conduct a search,” Brendel told the Wall Street Journal Health Blog. “A good number of people would feel like their privacy had been breached, although a number might be happy the doctor was thinking about them outside of the 15-30 minutes they were spending together.”

In some instances, the practice can save a life, such as when a patient blogs about suicide, but in other cases, doctors appear to be motivated by “curiosity, voyeurism and habit.”

In the absence of ethical guidelines on the matter, the psychiatrists recommend that physicians think through why they are conducting a search beforehand, and consider whether the result will interfere with their relationship with that patient. They should consider asking the patient for consent.

“Some people say absolutely it should never be done; it’s a breach of privacy,” Brendel said. “But many say it should be done as a matter of routine. It’s information that is in the public domain, and it may be information that is clinically relevant.”

The Obama administration has taken a baby step forward in its effort to simplify communication with the US government by clarifying how the Paperwork Reduction Act applies when new media like tweets, blogs and wikis are used in communication between federal agencies and the public.

The PRA was enacted in 1995, just before American life made a wholesale migration to the Internet. It requires that federal officials file an 83-I form with the Office of Management and Budget whenever they collect information from the public, to justify the effort.

That process routinely took months, but a new document appearing on the White House Web site lists a number of instances in which information collected using social media need not trigger the PRA process.

Among them:
– Federal wiki pages can support communication between federal agencies and the public without violating any law. 
– Webinars, blogs, discussion boards, forums, message boards, chat sessions, social networks and online communities can all go forward without triggering a PRA review.

On the other hand, “If an agency takes the opportunity of a public meeting to distribute a survey, or to ask identical questions of 10 or more attendees, the questions count as information collection,” that should trigger the PRA process, according to the document.

At the same time this document was released, several federal agencies released plans to expose more data and other federal information to the public.

For example, the Department of Housing and Urban Development announced it will post new information about homelessness. In addition, the Energy Department said it created a wiki to share information about clean energy, and HHS plans to post additional data about community health services.

Cancer is always in the news. Yet although nearly half of all US cancer patients die of their disease or related complications, no one seemed to know whether news reports reflected this reality.

Jessica Fishman and colleagues at the University of Pennsylvania decided to look into the matter by reviewing the content of cancer news stories in 8 high-circulation newspapers and 5 popular magazines.

The scientists identified 2,228 cancer-related articles appearing between 2005 and 2007, and focused on a randomly selected sample of 436 of them. They found that in general, the stories were overly optimistic about survival, more likely to focus on aggressive treatments and rarely covered negative things like death, treatment failure and adverse events. Almost none of the stories covered end-of-life issues.
 
In particular, 140 stories focused on people who survived or were cured of the disease, while 33 focused on people who were dying or had died of cancer. Just 57 articles mentioned that aggressive cancer treatments can fail. A majority of articles (249) discussed aggressive treatment exclusively, but only 57 reported that such treatments can fail to extend life or cure the disease, or that some cancers are incurable. Just 131 mentioned adverse events associated with treatment, and a grand total of 2 articles focused on palliative or hospice care exclusively.

“These portrayals of cancer care in the news media may give patients an inappropriately optimistic view of cancer treatment, outcomes, and prognosis,” the authors write in the Archives of Internal Medicine.

“For many patients with cancer, it is important to know about palliative and hospice care because this information can help them make decisions that realistically reflect their prognosis and the risks and potential benefits of treatment.”