HHS Again Turns Focus to Prevention. Once again, the federal government is rolling out a plan to make the nation healthier — this time it’s a National Prevention Strategy (Pizaazz comments on this plan next week).

Food Allergies Impact Millions of Kids. A new survey finds that one in twelve children is impacted by food allergies. The most common allergies were to peanuts, milk and shellfish. Two in 5 kids had experienced at least one severe or life threatening reaction.

Red Sox Expand Efforts to Accommodate Fans with Food Allergies. Boston’s venerable baseball team banned peanuts and crackerjacks from an entire 226-person section of Fenway Park last Sunday, for the second time this season.

Hospitals Courting Primary Care Doctors. With ACOs looming on the horizon, hospitals are trying harder than ever to lure primary care physicians from their private practices to work as salaried employees alongside specialists.

North Carolina Mulls Amends for Sterilizations. A consensus is emerging on how to compensate men and women sterilized as part of one of the nation’s largest eugenics programs. But the state’s fiscal problems mean it’s unlikely the aging victims will get paid anytime soon.

The Affordable Care Act is the most important piece of federal health care legislation since the Social Security Act created Medicare in 1965. It assures that 32 million Americans will gain access to health insurance for the first time. But who will care for these people?

The flood of newly insured people will create a surge in demand for physician services. By 2015—one year after the major provisions of the ACA take effect—the US will have 63,000 fewer physicians than it needs to meet this demand, according to the Association of American Medical Colleges.

The shortfall will hurt everyone, but its impact will be devastating for medically underserved populations where finding a doctor is already difficult. This includes nearly 20% of the US population.

Unfortunately, the ACA doesn’t include a manpower plan that sufficiently accommodates the surge. The most optimistic projections suggest it will add 500 or so physicians per year to the workforce during the next decade, and even that modest growth has recently come under attack by House Republicans.

Two weeks ago, the GOP-controlled House voted 234 to 185 to eliminate $230 million in mandatory ACA funding for the creation of a new teaching model for residents in primary care. The model is based around “teaching health centers,” which would be placed in medically underserved areas and mirror the practice environment residents will enter upon completion of their training.

The GOP isn’t against the new training model, but objects to the automatic, mandatory payouts associated with it. They propose that funding for the manpower initiative should be subjected to votes each year during Congress’ annual appropriations process. “It’s time to move these programs back to the discretion of this Congress,” Marsha Blackburn (R-Tenn.) explained, referring to it as one of many  “slush funds” provided by a debt-ridden federal government.

Democrats counter that subjecting the funds to an annual, politically-charged appropriations process will dissuade physicians from entering primary care. “Training physicians should be assured with funding they can rely on,” said Rep. Henry Waxman (D-Calif.).

The House bill will likely never see the light of day in the Democratically controlled Senate. But it is distressing that Congress is wrangling over a largely inadequate solution to the coming physician manpower crisis.

What Should Be Done?
The AAMC has asked Congress to require at least a 15% increase in residency training slots beginning immediately. This would add 4,000 physicians per year to the pipeline. To do this, the AAMC suggests that Congress overturn a 1997 law that froze Medicare-funded residency positions, and increase by at least 15% the number of GME positions funded by Medicare.

This isn’t a bad idea, but it seems like a pipe dream with public opinion entrenched against new spending programs and Congress posturing for the press around various budget deficit plans.

The only viable alternative was proposed by the Institute of Medicine last fall. The IOM concluded  that the best way to deal with the coming tidal wave is to expand the roles and responsibilities of nurses.

Reasoning that nurses are cheaper and quicker to produce than doctors, the IOM recommended incentive programs that increase the number of nurses with bachelor degrees to 80% by 2019. It further recommended that nurses assume central roles in redesigned, team-based care systems, and that regulatory and institutional obstacles, including limits on nurses’ scope of practice, be removed so that advanced practice registered nurses can practice more freely. This includes increasing their power to prescribe drugs.

The IOM report cited studies of care systems (including the VA) that have already implemented such models. The studies show the new systems to have experienced no fall-off in the quality of care while cutting the annual increase in health expenditures by more than 50%.

Although organized medicine has scoffed at the IOM report, I think these changes are inevitable.  The ACA is right-minded, socially responsible legislation that can improve access to care for tens of millions of Americans, but it can’t work (especially in an era of unprecedented deficit spending) unless health professionals figure out how to transform our health system so as to better leverage its professional workforce.

A redesigned system that focuses on patients is a lofty, socially responsible goal, the kind that drives people to become health professionals in the first place. Physicians will sit atop these newly redesigned teams and remain responsible for patient care; they needn’t worry about that. But they need to set-aside any unreasonable urges they may have to keep the status quo and let this transformation occur. Otherwise, they are going down with the ship.

Facebook Adds Facial Recognition. Without telling its users, Facebook has launched a facial recognition feature designed to make it easier for users to tag photos. As it has in the past, the social networking giant set ‘opt-in’ as the default privacy setting for the new feature.

Sleep Pattern Affects Major League Hitters. A major league baseball player who prefers rising with the larks may hit better in day games than night games and vice versa, a researcher suggested.

Pesticide Residues Taint Apples. The apple industry faces a potential public-relations headache in the wake of USDA testing that revealed pesticide residues in 98% of America’s second-most-popular fresh fruit.

NQF Adds New Serious Reportable Events. The National Quality Forum has expanded its list of serious reportable events to 29. The 4 new ones are patient death or serious injury resulting from failure to communicate test results, and death or serious injury of a newborn baby associated with labor or delivery in a low-risk pregnancy.

Physicians Leaving Practices for Health System Employment. By 2013, less than a third of physicians will be in private practice, electing instead for employment with larger health systems, according to a new report by Accenture.

Federal Panel Votes To Delay Stage 2 Meaningful Use by One Year. The Health IT Policy Committee, an advisory panel to the federal government, divided over the appropriate start date for implementing Stage 2 EHR meaningful use requirements, voted to delay Stage 2 from 2013 to 2014.

Startup Health Launched to Spur Innovation in Healthcare. Former Time Warner CEO Jerry Levin will be chairman of the new program that proposes to help health startups raise capital, offer long term mentorship, and bring other resources to bear.

Pfizer Clinical Drug Trial Implemented through Phone, Computer. Results of the trial of the overactive bladder drug Detrol will be compared with those from a previous, traditional trial of the same drug. A close correlation might eventually help reduce the cost of commercializing other drugs.

CMS Extends Deadlines for Medicare ACO Demonstration Program. The Centers for Medicare and Medicaid Services has extended its deadline for letters of intent and applications to participate in Medicare’s Pioneer Accountable Care Organization Model demonstration program for at least 5 years

Healthy Vision with Dr. Val Jones, Now Available on iTunes. The engaging, free program covers the importance of regular eye exams, contact lens care and UV protection for eyes. Jones is CEO of the popular health blog aggregator Better Health.

One in Three Employers May Drop Health Benefits by 2014. A McKinsey Quarterly report suggests that nearly a third of employers are likely to stop offering health insurance to employees by the time major federal healthcare reform provisions kick in.

Comparing Online Pill Identifiers. iMedicalApps has posted a review of the Pill Identifier Lite app, an offering from Drugs.com that has become the top-selling paid medical app on iTunes. The review also covers similar products by Epocrates and Lexi-Comp

Virtual Workout Partners Spur Better Results. New research from Michigan State reveals that working out with a virtual partner improves motivation during exercise.

Seniors’ Medical Pot Collective Stirs Up Some Smoke. More senior citizens turning to marijuana — legal or not — to ease the aches and pains of aging.

Legislative Changes Let Practices Get Paid for Helping Patients Quit Smoking. Practices can expect to receive $10 to $30 from most insurers for quit smoking sessions provided by trained office personnel.

Unicef Reveals Vaccine Prices. Unicef, one of the world’s largest vaccine buyers, is now publishing the prices it pays individual companies for immunizations. Public health officials hope the move will boost competition and drive down prices for all vaccine buyers.

Will Doctors Heed IBM’s Watson? History Indicates Otherwise. IBM’s supercomputer is being groomed to advise doctors about diagnoses and treatments. But there’s no guarantee physicians will heed its advice, even if it delivers more accurate answers faster than other decision support tools.

Facebook to Pharma: Comments Allowed. The social networking site has told pharmaceutical companies that as of August 15, they will no longer be able to disable the comment feature on their Facebook pages.

Scientists Find an ‘Ultra-Bad Cholesterol’. Ultra-bad cholesterol is more likely than LDL (bad) cholesterol to attach to arterial walls and form plaques. It is more prevalent in the elderly and those with type 2 diabetes.

App Helps Diagnose Concussions in Youth Sports. When a child suffers a potential concussion while playing a sport, parents and coaches can find out what to do from an app on their iOS and Android devices.

It was 1999 when the Federal government first acknowledged our nation had a problem with race and health care. That year, Congress tasked the Institute of Medicine to study the matter, and the resulting report was not good. Minorities were in poor health and receiving inferior care, the report said. They were less likely to receive bypass surgery, kidney transplants and dialysis. If they had diabetes, they were more likely to undergo amputations, meaning their disease had been poorly controlled. And there was a lot more where that came from.

The IOM report was a call to action. In subsequent years, lawmakers crafted policies and established goals for improvement. Federal and state governments and numerous foundations set aside billions to fund projects. Health services researchers expanded their efforts to study the problem.

Twelve years later, we have something to show for the effort. Steep declines in the prevalence of cigarette smoking among African Americans have narrowed the gap in lung cancer death rates between them and whites, for example. Inner city kids have better food choices at school. The 3-decade rise in obesity rates, steepest among minorities, has leveled off.

Nevertheless, racial disparities persist across the widest possible range of health services and disease states in our country. The overall death rate from cancer is 24% higher for African-Americans than white people. The racial gap in colorectal cancer mortality has widened since the 1980s. African Americans with diabetes experienced declines in recommended foot, eye, and blood glucose testing between 2002-2007.

Why is this problem so hard to solve?
The reason is that the problem is exceedingly complex. Hundreds of factors contribute to racial disparities in health care. Progress on just a few of them is therefore unlikely to move the needle much (which isn’t to say we shouldn’t try!). The key contributing factors are these:

Identifying Target Populations-Studies of racial disparities in health care rely fundamentally on tools that classify people by race. These tools are notoriously imprecise. Most of them classify all people whose family immigrated from a country that was once considered part of the Spanish empire as “Hispanic,” for example.  This means people of Panamanian, Mexican and Venezuelan descent are grouped together (to name but 3 countries).

The resulting “Hispanic population” in studies of health disparities is actually a polyglot of culturally-driven lifestyle choices, tendencies to seek care from physicians, and dozens more behaviors that impact health. This heterogeneity severely undermines the value of information obtained from the studies.

The Genetics Don’t Work: The genes responsible for phenotypic traits that forensic pathologists and anthropologists use to study race aren’t the same ones that govern how sodium-potassium ATP pumps work (and how they impact hypertension risk, for example). They have nothing to do with the genes that govern the body’s tendencies to store fat and establish a basal metabolic rate (and how they impact obesity risk). In fact race is largely a red herring in the search for genetic links to cardiovascular disease, cancer and other conditions that kill US minorities disproportionately .

Teasing-Out Environmental Factors-There are so many! A list of environmental causes of racial disparities in stroke mortality for example, might begin with culturally-driven preferences for certain foods or body types, cigarette smoking, exercise and so on. It might include personal income, educational levels, local availability of fast food restaurants, preventive services and safe places to exercise, and access to health insurance. And it probably also needs to include many causes we don’t yet appreciate. Just this week for example, scientists showed that African Americans suffering strokes tend to call friends first–not 911–a behavior that delays onset of lifesaving treatment. We don’t know what we don’t know about the universe of environmental factors that impact health. That is a serious problem.

Attribution for Poor Outcomes: Scientists have long struggled to determine whether observed disparities are caused by poor care or simply the result of caring for sicker people. The best available severity adjustment tools are no better than fairly good at helping scientists assess burden of illness in a population. To the extent these tools are imprecise, scientists can’t solve the ‘apples to apples’ problem in population-based health research.

Exploring hypotheses about poor care is equally problematic. Racial disparities could be traced to providers themselves, or to a lack of resources at their disposal. Any correlations involving providers could be caused by poor cultural sensitivity on their part (a bad thing), or their desire to develop care plans that reflect the preferences of their patients (presumably a good thing).

The Hundred Years’ War
Twelve years into our war on racial disparities in health care, we can celebrate several narrow, yet significant victories. In addition, we now better understand the factors that drive racial disparities, and this will create a foundation for additional success going forward.

Architects of the Affordable Care Act hope their law will turn out to be our nation’s greatest step forward in solving the problem of racial disparities in health care. But the law is under political siege and its very constitutionality has been questioned in the courts. As well, many deficit reduction plans threaten funding for the law.

In the best of cases, the ACA will be fully implemented in 2019, by which time our nation will be 20-years into our war on racial disparities in health care. The guess here is that we will be struggling with the problem for the better part of this century.

DOJ Decries Lack of Internet Protocol Data From Smartphones. Amid a national uproar over the belated, surprising news that mobile devices track your whereabouts, the Justice Department has expressed unhappiness with its inability to access such data.

Bandwidth Speed Limits Smartphone Use for Diagnostic Imaging. Researchers in Calgary are suggesting that the frame rate associated with 3G cellular networks is insufficient for practical use in viewing radiology images.

Primary Care Still Hard to Find in the Bay State. More than half the primary care practices in Massachusetts don’t accept new patients, and wait times for new patients continue to lengthen 5 years after the state passed its landmark healthcare reform law.

High-volume Hospitals Recommended for High-Risk Heart Transplants. Older, sicker heart-transplant patients are more likely to survive for one year after surgery if they were treated at hospitals that do a lot of transplants, a study showed.

Health Consumers Trust Traditional News over Social Media. A new poll shows that most people trust health and medical research information provided by traditional news sources more than that provided by social media and mobile devices.

Like everybody else, physicians are expanding their online personal identities. At the same time, they are trying to comply with codes of conduct that help consumers trust them and their profession.

There’s no problem so long as the personal online activities of physicians don’t jeopardize their obligations as professionals, which means that there is a problem, unfortunately.

In a recent study for example, 17% of all blogs authored by health professionals were found to include personally identifiable information about patients. Scores of physicians have been reprimanded for posting similar information on Twitter and Facebook, posting lewd pictures of themselves online, tweeting about late night escapades which ended hours before they performed surgery, and other unsavory behaviors.

As I mentioned Monday, medical students and younger physicians who grew up with the Internet have to be particularly careful, since they had established personal online identities before accepting the professional responsibilities that came with their medical degree.

Medical schools, residency programs and teaching hospitals can help young professionals manage their dual lives online. Some have implemented curricula and policies that foster appropriate use of social media, but surprisingly these programs are not widespread. In a recent study of medical schools that had experienced at least one incident in which a student used social media inappropriately, only 38% had adopted formal policies to handle future incidents. An additional 11% reported they were developing such policies. We can do better than this.

Non-teaching hospitals, CME providers and professional organizations like the American Medical Association can also help providers navigate the online world. The AMA’s recent guide to Professionalism in the Use of Social Media provides helpful guidance in this regard.

What You Can Do Now
Frankly, this is not something that can wait. If you haven’t already done so, you should immediately take steps to assure your personal online identity doesn’t threaten your professional identity, your patients’ rights to privacy, and other responsibilities you have as a physician. Here are some tips for getting started.

1-Look Before You Leap. If you are just starting to expand your online personal identity (say, by registering for a Twitter account), don’t feel compelled to lay yourself out there right away. There’s nothing about Twitter or Facebook that requires you to do anything after you register (nor for that matter, is anyone compelling you to generate searchable events like comments on newspaper articles, donating to political campaigns and so on). A quiet listening period up front allows you to get a feel for things before taking part. After a few days of following the tweets and posts of others, particularly other physicians, you’ll get a sense for etiquette and social boundaries.

Remember that if you see content posted by a colleague that you think is unprofessional, you should inform him or her. After that, it’s up to them to remove it or take other appropriate actions.

2-Review and Maintain your Online Profile. This advice appears in the AMA guidelines and is the centerpiece of a recent article on the subject by Arash Mostaghimi and Bradley Crotty.

The recommendation amounts to carrying-out an electronic self-audit of your online identity and taking action to create a “dual online citizenship” to the extent possible. Often, a simple search of your name on Google or Bing is sufficient for the audit. If the audit reveals a relatively sparse professional footprint online, you can beef it up by creating a web page for your office, posting your CV online, posting information about yourself on Google Profiles, starting a professional blog, and so on. You may also need to address personal issues that show up during the audit as well. Finding these issues is a key reason for doing the audit in the first place.

3-Go Ahead! Answer General Questions from Patients Online.  It’s safe and reasonable for you to answer general questions like ‘What is heart failure?’ and ‘When is the right age to get a mammogram?’, so long as you do not include individually-identifiable information about a patient. Just remember that existing and prospective patients read this stuff, so make it good!

4-Think Twice before Using Social Networking Sites to Communicate with Patients. Companies like Facebook and Twitter control the information posted on their sites. The same goes for search engine companies, who are having a field-day with your online search behavior as we speak. These companies’  privacy and security policies have been criticized as flimsy and capricious. Once you post something, it can be nearly impossible to delete it completely.

That said, social networking sites are great platforms for your general announcements like the addition of a staff member, flu shot availability and matters of public health.

iPhone Can Diagnose Stroke Quickly, Accurately. Doctors that evaluate iPhone displays of CT scans and CT angiogram tests can diagnose a stroke with the same accuracy as if they had viewed the images on a medical computer workstation, a study showed.

Birth Control Pills Mask Signals That Draw the Sexes Together. New studies suggest that hormonal contraceptives disrupt women’s production of and responses to pheromones. This affects their attractiveness to men and their preferences for romantic partners.

Scientists Use Twitter to Document H1N1 Disease Activity. Retrospective review of Twitter feeds during the Swine Flu pandemic allowed US researchers to track disease burden in local communities and its spread throughout the nation.

Boston Scientific Chief Resigns. J. Raymond Elliott announced he will step down at the end of 2011 after less than two years in charge of the device maker. The move shocked investors and sent the company’s shares sliding.

Hospitalist Management Companies Finalize Merger. The tie-up between Hospitalists Management Group and Cogent Healthcare forms the largest private hospitalist company in the US.