Democrats Ask GAO to Study the Individual Health Insurance Market--They Are Really Trying to Set Up McCain and Cast Doubt on His Health Reform Plan

There is an old salesman's axiom, "Don't ever ask a question you don't already know the answer to."Key House Democrats have asked the Government Accountability Office (GAO) to take a look at the current state of the individual health insurance market. They also want the GAO to review the operation of the state high risk pools designed to provide a safety net for those who can't get coverage in

ActiveHealth Disease Management & Microsoft HealthVault

For your musing pleasure on my prior post (or just scroll down) on one aspect of the evolution of health information:

Want an example of an alignment of the personal health record and disease management? While its ActiveHealth's alerts/predictive modeling capabilities that are being used by Microsoft's Healthvault, this opens the door to myriad other possibilities....

Lifemasters

Let's see. Real estate? Munis? Treasuries? Rubles?

No... disease management!

Scientific Info and Policy Making: Print vs. the Web

The Disease Management Care Blog also recommends the Health Affairs Blog, where you’ll find top caliber thinking from the wisest of the healthcare Brahmins. Speaking of which, that’s where you’ll find an announcement that James Robinson is stepping down from the editor-in-chief post. In the interim, the highly regarded John Iglehart will return to his old post and look hard for a replacement.

Here’s an unsolicited opinion for Dr. Inglehart and his colleagues: the prognosis for scientific and policy web publishing using blog and wiki formats is much ultimately brighter than staid print journals like Health Affairs. Their exclusive web-based articles in addition to the paper-medium journal are a step in the right direction, but it’s not enough.

As someone who has had both peer-reviewed manuscripts make it to print and has also gotten a case of blog-fever, my impression is that blogging is a better deal for the writer and the reader.

Why is that you ask?

I'm still writing and submitting manuscripts to journals, but I've begun to notice that more and more of the useful references I quote are web-based.

In a blog, everything is really mine. In print, I have to assign copyright to the journal. It's theirs.

In a blog, I write, I post and *click!*, it’s up. In print, it typically takes months to make it through the peer reviewers and, if I’m lucky enough to get accepted, additional months before it’s published and mailed bulk rate. It’s not very satisfying to the writer and the topic can quickly turn obsolete.

In a blog, I’m completely responsible for the content. In print, I am at the mercy of space constraints and the peer reviewers. They are very smart, very dedicated and have helped me polish all my manuscripts, but I think they can also be biased with viewpoints that may not necessarily be perfectly aligned with the intended audience. Who knows, they know their readers but those biases can shape the final product that appears in print.

In a blog, the reader can comment immediately. In print, it’s a letter to the editor.

You may think the delay, process and peer review is worth it since that gives traditional journals the safeguards necessary to protect the reader from wrong information. While true, that assurance has become dented. Check out this review from the American Journal of Psychiatry that demonstrates how vulnerable the peer-review process is to intentionally and unintentionally contrived studies. Even the luster of New England Fortress of Medicine has been victimized by under-reporting of side effects, having its reviewers be vulnerable to allegations of misconduct and authors neglecting to report conflicts of interest.

This is why I predict some academic institutions and/or researchers will eventually start posting/blogging/wiki-ing their reports directly on the internet. Readers need to judge for themselves anyway and have the smarts to do it. No need for scientists and policy makers to worry about criteria for tenure, because their academic success will be measured not in the stature of the journal or the number of reprint requests, but by the number of “hits” or “comments” from members of the medical community. In the meantime, print will remain important but could fast become a medium that is used by fewer and fewer to write about less and less.

Remind you of the disintermediation going on in the music industry? It should.

Should the disease management industry take note? It should.

I’m sorry Health Affairs, but your business model is destined to change and soon. I’m sure you guys have already been thinking about this and may be already planning to have your blog eventually become the chief source of revenue. I hope Dr. Iglehart’s replacement finds a way to manage it, because I think it’s likely to happen soon.

Today's HMO Carnage on Wall Street

Maybe times have been just too good for so long that people have forgotten just what a challenging business this can be.After easy profits for the industry during a multi-year period when trend rates fell, today Wellpoint let us know nothing can be taken for granted.When the trend rate is steadily falling a monkey can make money. If an employer sees their claims go up by 9% the year before, it's

lost

When the dust had settled from yesterday’s traumatic train adventure (actually S. had put it all behind him by the time he hit the bathtub at his Grandma’s house. I, on the other hand, am still recovering) and once clothes were washed and boots were scrubbed, I realized that we had not made it off the train without leaving some things behind.

While still on the train, I had put all of the still clean contents of my son’s back-pack into a garbage bag, while putting the things that would need to be washed into another. Somehow my son’s thumb drive and mp3 player did not make the transfer (or perhaps we lost them when the bag fell apart, clattering his belongings all over the floor of the train station. I can’t be sure).

The loss was not noticed until much later. As I write this, we are still hoping to hear from Via Rail that at least the mp3 player has been found. I, am, however, not holding my breath.

At least these lost things are replaceable.

When my son was very young, he had a small stuffed dog. Little Dog (at that stage in his life, he named his toys very prosaically) went everywhere with him. Small enough to fit in the palm of my hand, we lived in fear of losing this toy to which my son was very deeply attached.

Little Dog was lost and then recovered several times. We found him once in a tree outside my son’s day care, another time in the middle of an intersection in front of the airport. Then, one day he was lost for good, having perhaps fallen out of a car on a day full of errands.

Six years later, my son still cannot bear to talk about it.

I understand this. More than once, I have put dolls and stuffed animals on buses so that they could make their way home to children who have left them behind. And once, on vacation, my own parents sent a taxi back to a hotel to recover my beloved stuffed kangaroo (more than thirty years later, ratty old Skippy still resides in my bedroom closet).

But an mp3 player, I console myself, can be replaced.

And some day, I am sure I’ll be ready to take the train with my son again.

The Higher the Price the Better It Works--Placebo Drugs That Cost More Found to "Work Better"

That was the somewhat humorous--but nonetheless valuable--conclusion from a study sponsored by MIT and led by a Duke behavioral economist.It seems that researchers told one group that a medication cost $2.50 per pill and told another group that it cost ten cents per pill. Both were identical placebos.85% of those who took the "$2.50 pill" reported pain relief.61% of those who took the "10 cent