Inefficiencies of Health Care

Is healthcare cost control possible? Aurametrix addressed some unhealthy aspects of healthcare in other articles, but there is always more to add.

"Despite the rampant inefficiencies and extremely high costs of health care in the United States, it is still possible to make the American health care system even more inefficient and more costly", say Drs. Fodeman and Book in the Wallstreet Opinion journal. What really drives health care spending is it's inefficient structure and business model along with increasing prevalence of chronic disease. Health Care spending is often wasteful failing to improve health outcomes and not bringing any value to the patients. Health care providers seem to be able to charge whatever they like. Existing system insulates both patients and providers from normal market incentives to reduce prices and spending. We recommend to read this article as it provides more insight.

Or watch the video to better see what's wrong with our health care system.

Healthcare: Is cost control possible?

Teenagers love to spend, Health care consumers love to test.

Recent mammogram debate shows why reform will fail - most women don't like to get mammograms later in life and less frequently. Of course, this furious reaction is fueled by those who would face payment cuts if the new guidelines are implemented - radiologists, for example.

How many medical tests do you need to sleep sound at night knowing that you are healthy enough? Billions, trillions, googols?
How many out of a few thousand existing medical tests are redundant or irrelevant to individual consumers?

Mamograms and colonoscopies are perfect examples of overused diagnostic procedures. (see also the consumerreports article on overused tests and treatments).

Colonoscopy accounts for up to 75% of costs of an IBS patient, while the probability of it yielding meaningful results is less than 3%.
Citing Dr. Rex: Low-risk patients might undergo too many colonoscopies; high-risk patients, too few. When given a range of hypothetical findings on initial colonoscopy, most physicians would recommend repeat colonoscopy earlier than is indicated by the U.S. Multi-Society Task Force guidelines.

If 2000 women are screened regularly for 10 years, one will benefit from the screening, as she will avoid dying from breast cancer.10 healthy women, however, will have either a part of their breast or the whole breast removed. Even statistics deny that early screening for breast cancer saves lives.

Early and frequent screenings often lead to false alarms and unneeded biopsies, without substantially improving women's odds of survival. About 90 percent of abnormal mammogram findings are benign. A 2009 study in the British Medical Journal estimated that roughly one in three breast cancers detected by mammograms would never have caused harm. Earlier studies were suggesting this too, raising (along with harmful consequences of false positive results)

Perhaps the biggest problem with performing too many screening tests in healthy people is a phenomenon called over-diagnosis: Screening can detect slow-growing, harmless cancers that would never have killed you. But even if a mammogram "involves a tiny dose of radiation", a bigger dose used in radiotherapy is harmful when given to healthy people. Breast cancer radiotherapy regimens can increase mortality from heart disease and lung cancer 10-20 years afterwards.

How often does this happen with breast cancer?

Dr. Kevin Pho, an internist in Nashua, N.H., thinks the rebellion indicates a larger problem with ObamaCare. "The fact that [the administration] is distancing itself from what I consider to be very robust guidelines portends a very poor future for comparative effectiveness," he says. "If they back down now, what's going to happen when a comparative effectiveness body says there's no difference between angioplasty and medical management of heart disease?"

The American College of Obstetrics and Gynecology (ACOG) has just revised their guidelines for Pap smears under some pressure. This resulted from an Annals of Internal Medicine article which documented that only 16.4% of gynecologists followed the College’s prior guidelines. Most did more screenings than indicated, the worst record of the specialties tested. But the ACOG still recommends that nearly all women obtain regular screening at intervals of 1-3 years.

Cervical cancer is a rare disease in the US: just over 11,000 cases are predicted in 2009. There will be nearly as many cases of testicular cancer, 8,400. In comparison both breast and prostate cancer are just under 200,000. Most women have been led to believe that cervical cancer is rampant and they need yearly screening to prevent it. Testicular cancer however, is rarely mentioned. Most physicians don’t even bother to recommend that young men self-examine.

Here is a different example. Man sues over “botched” testicular surgery. Doctors later discovered that the tumor was not malignant and did not need to be removed. Was it possible to offer a better testing, say biopsy? Urologists can tell you that testes should never be biopsied prior to removal if cancer is suspected as it significantly increases the risk of tumor dissemination. Studies show that those who had scrotal incisions for biopsy have a higher local recurrence rate as well as a higher relapse rate. If there is a solid growth in the testes, there is 95-97% probability of the growth being malignant. Sounds very reasonable, in this case doctors are sued for proper care, but was another cost - the cost of inconvenience, perhaps even mental trauma - ever taken into consideration?

Medicine is as much art as science – there are many cases where there are no “right” answers. Health care providers can prescribe as many procedures as they want and charge whatever they like. It's time for this to be changed.

Personal risk of cervical cancer, for example, can be easily estimated by every woman as it depends on whether she had multiple sexual partners, prior negative Paps, long term mutually monogamous relationship. HIV (that has a five times greater incidence than cervical cancer) tests are not administered to people without risks, right? Well, not quite right, but that's another story.

Dr. Joel Sherman (Medical Privacy, A Patient Oriented Discussion) has seen many women who are angry that the facts on cervical cancer have been hidden from them. They are pushed into getting Paps, but never told the pros and cons of screening. Never mentioned are the high incidence of abnormalities that resolve spontaneously, like negative biopsies and colposcopies.

And last, but not least - another reason of why healthcare is so costly - the insurer's overestimates, in a way their overdiagnosis of our health problems.

If the law says insurers have to treat every person the same, without taking into account whether they’re sick or healthy, young or old, a rational insurer will do some rational things. For example, it will assume disproportionate numbers of people who buy a policy from them will be sick and old. Of course, when they do this, the product becomes expensive, and young, healthy people start to wonder if they should even buy it in the first place. After all, they don’t really need insurance, right? Coupled with the overall rise in the cost of health care, insurers now push through new rounds of price increases, which, in turn, create more uninsured people. It is a very nasty cycle.

Aurametrix is developing decision support systems to help you evaluate personal health risks, decide on preventative measures, estimate cost/benefits of performing diagnostic tests. Better tools for a healthier world.

Related articles by Zemanta

• New cervical cancer screening guidelines released (cnn.com)
• Elastography reduces unnecessary breast biopsies (scienceblog.com)
• Rethinking the Benefits of Cancer Screening (wellness.blogs.time.com)
• Yearly Mammograms: More Harm Than Good? (abcnews.go.com)
• Cost Was Factor in Screening Advice (online.wsj.com)
• 20-somethings can go 2 years between Paps (msnbc.msn.com)
• U.S. guidelines call for fewer Pap tests for women (ctv.ca)
• Hand-held device may reduce time needed to diagnose cervical cancer (tissuepathology.typepad.com)
• Study provides new evidence that annual mammograms may be overkill (bendbulletin.com)

Changing Culture of Medicine

by Aurametrix

Healthcare is the largest service industry in the world. Its old ways don't work anymore.
One of the reasons is that medical profession is seen increasingly in financial terms. Can you separate the businessman from the doctor? Not in American Medicine, says Kevin Pho, MD, author of the web's leading physician blog.

We need to change the way health care is envisioned, organized and delivered. We need creative approaches to building novel business models, and "disruptive technologies" to shake up the current system.

The current model motivates doctors to think about diagnostic tests based on available technologies and profit, not the need. They will, indeed, order a heart-stress test when the nuclear camera is in the next room, diagnose and treat harmless cancers, and be under financial pressure to see as many patients as possible.

The reform should create a different culture among health care professionals. Solutions include retail clinics that let people pay cash for low-end services and care, new primary care models such as Qliance, MDVIP, QuickHealth, and 1Life, clinics staffed largely by non-physicians, divorcing of physician payments from volume of services, more electronic encounters between doctors and patients and more automation.

Aurametrix works on automatic solutions beyond electronic medical records, for a healthier world.

Molecular Nutrition and Dietetics

Image by Marco Veringa via Flickr

Diet and food components are prime factors that affect our genes, proteins and metabolism, defining our health or disease. We are starting to understand the molecular basis of the interaction of foods with our molecules and cells. Nutrition and dietetic science are going genomic, protein and metabolic connections are getting better understood, preparing the basis for next generation dietitians and nutrition practitioners.

How to become one?

E-How lists a few steps starting from takingbiology, chemistry, mathematics, home economics and health courses in high school.

American Dietetic Association, visually explains the pathways from High School to Registered Dietitian (RD) or Dietetic Technician Registered (DTR)

To become a registered dietitian you would need to:

* Enroll in a Coordinated Program. This may be a bachelor or master's degree program that combines classroom and supervised practical experience and is accredited by the Commission on Accreditation for Dietetics Education. Graduates are then eligible to take the Registration Examination for Dietitians to become credentialed as RDs, registered dietitians.
Or:
* Enroll in a Didactic Program in Dietetics academic program. This is a program, granting at
least a bachelor's degree, that is accredited or approved by CADE. After you receive your degree, you will then need to apply for and complete supervised practical experience in a CADE-accredited Dietetic Internship Program. You will then be eligible to take the Registration Examination for Dietitians to become credentialed as a RD, registered dietitian.

There are three steps to becoming a professionally qualified dietitian in Canada - education, supervised practical experience and registration with the dietetic regulatory body (College or Association) in the province where you intend to practice

The first step is a Bachelor's degree with major credits in Foods and Nutrition from a university offering a Dietitians of Canada accredited dietetic education program or an academically equivalent program. Step 2 is successful completion of a program of supervised practical experience and step 3 is registration with the regulatory body.

Knowledge, Skills and Competencies for entry level education programs in dietetics
and entry-level dietitians:
1. COMMUNICATIONS
2. PHYSICAL AND BIOLOGICAL SCIENCES
3. SOCIAL SCIENCES
4. RESEARCH
5. FOOD (food tech, biotech, ...)
6. NUTRITION
7. MANAGEMENT
8. HEALTH CARE SYSTEMS

Nutrigenomics, Nutriproteomics and Nutrimetabolomics links

• Novel omics technologies in nutrition research.
• Nutritional Genomics in Practice — Where Do We Begin? (PDF)
• Metabolomics in Practice — Emerging Knowledge to Guide Future Dietetic Advice toward Individualized Health (PDF)
• Nutrigenomics, Proteomics, Metabolomics and the Practice of Dietetics (PDF)
• Nutrigenomics — From Molecular Nutrition to Prevention of Disease (PDF)
• Nutrigenetics, Plasma Lipids and Cardiovascular Risk (PDF)
• Single-Gene Autosomal Recessive Disorders and Prader-Willi Syndrome — An Update for Food and Nutrition Professionals (PDF)
• Ethical and Legal Issues in Nutritional Genomics (PDF)
• Epigenetics — What It Is and How It Can Affect Dietetics Practice (PDF)
• Genetic and Epigenetic Contributions to Human Nutrition and Health — Managing Genome-Diet Interactions (PDF)
• Nutritional Genomics, Polyphenols, Diets and Their Impact on Dietetics (PDF)
• Nutriproteomics: Identifying the Molecular Targets of Nutritive and
  Non-nutritive Components of the Diet (PDF)
• Nutrimetabolomics from the points of systemic estimation of function of metabolic complexes
• Nutrimetabonomics: an approach to assess individuals health trajectory (PDF)

Stress 2009

The health of the nation has declined mostly because of stress caused by job losses, money worries or increased workload. According to recent US and UK studies, more people are losing sleep, take antidepressants and live unhealthy lifestyles.

Mental stress spirals with economy, and costs economy.

A study by Harvard Public School published in the May 8 issue of Demography analyzed U.S. data on a wide range of occupations: managerial and professional positions; sales, clerical and craft jobs; machine operator jobs; and service positions.The likelihood of reporting fair or poor health increased by 54 percent among those who lost a job through workplace closure (similar across all occupations and positions). The odds of developing a new health condition rose by 83 percent among those who had no preexisting health problems. Job loss due to lay-offs, being fired or voluntary resignation more than doubled the likelihood of reporting fair or poor health among blue collar workers, but it had no effect on the health status of white collar workers.
Losing a job can lead not just to financial hardships but to health problems as well, including high blood pressure, diabetes, heart disease, heart attack and stroke.

Americans worry and struggle as economy worsens

“Where and how we live, work, learn and play have a greater impact on how healthy we are than the health care we receive,” David R. Williams, staff director of the Robert Wood Johnson Foundation Commission to Build a Healthier America and a Harvard professor, said in a news release.

Economy keeping many up at night. According to the 2009 Sleep in America poll by the National Sleep Foundation, out today, more than a quarter (27%) of Americans are losing sleep over financial worries.Young adults use more sleep aids, women are using more antidepressants & less estrogen.

Job stress can affect a person’s health as bad as smoking or a sedentary lifestyle can.

According to UK Insurance Daily News, the percentage of respondents admitting to being under a significant amount of stress increased from 38% to 40%.

Half of those surveyed agreed that stress is affecting their personal lives and 41% revealed that money worries were at the root of the condition, while 22% blamed an increased workload.

The problems of increased stress are exacerbated by a lack of exercise. According to PruHealth, the number of people reporting that they never exercise has increased from 11% to 14%, with more than a quarter (28%) of adults blaming work commitments.

Unemployment Rate Rises as Pace of Layoffs Slows. But hopefully the worst days are behind. Job stress has severe consequences, for us all and for the economy. Scotland's mental health improvement plan was launched today indicating that an understanding of the importance of protecting a person's own mental health could be key to reducing health problems. How people deal with stress greatly affects their well-being.

Stress can affect nearly every part of your body. So plump up your pillows, get more sleep, exercise and stop worrying.