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America’s healthiest and least healthy states

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Article source: http://www.cnn.com/2017/12/12/health/2017-health-disparities-report/index.html

Why we removed an article on the My Health Record

The Conversation published a story earlier today that was incorrect.

The story, titled “We have less than three months to opt out before the My Health Record system has our details, and no-one told us”, asserted that a three-month period to opt out of being registered for a My Health Record had already begun.

This is incorrect. According to the Australian Digital Health Agency, which is responsible for the My Health Record, the date the period begins has not yet been set.

In a statement to The Conversation, the Agency said:

The opt out period will be set by a Notifiable Instrument which is anticipated to be around mid-2018 […] The Agency will implement a comprehensive communications strategy to advise Australians that a record will be created for them in 2018, unless they tell us they don’t want one.

We are committed to providing accurate and reliable information. Where errors do occur, it’s our policy to correct them promptly and be transparent about what happened.

We apologise for this mistake and greatly appreciate the Australian Digital Health Agency bringing the error to our attention.

Article source: http://theconversation.com/why-we-removed-an-article-on-the-my-health-record-89087

Can cooking with aluminium pans cause dementia? DR MARTIN SCURR answers readers’ health questions

Some years ago, I watched a documentary on Alzheimer’s, which said that microscopic flakes from aluminium cooking utensils were found in the brains of Alzheimer’s patients. Should we switch to non-aluminium pots and pans?

Jim Taylor, Plymouth.

The possibility of a link between aluminium and Alzheimer’s has been the subject of research and debate for years.

Suspicion began as long ago as 1921, when an association between aluminium poisoning and memory problems was first noted.

We all have some aluminium in our brains (it doesn’t occur naturally, but can get there via the foods we eat or be absorbed through the skin when we’re exposed to it), and it builds up with age.

The possibility of a link between aluminium and Alzheimer¿s has been the subject of research and debate for years. Suspicion began as long ago as 1921, when an association between aluminium poisoning and memory problems was first noted

The possibility of a link between aluminium and Alzheimer’s has been the subject of research and debate for years. Suspicion began as long ago as 1921, when an association between aluminium poisoning and memory problems was first noted

Brain scans from post-mortem examinations of Alzheimer’s patients have shown there is an accumulation of aluminium in the brain. And patients with a genetic susceptibility to early-onset Alzheimer’s have been found to have even more.

Also, in patients on dialysis for kidney disease, a condition called dialysis encephalopathy can develop, which leads to a type of dementia — one cause of this encephalopathy is damage caused by an accumulation of aluminium in the brain.

However, none of these cases prove a causal link, just that there is an association.

The main risk factor for Alzheimer’s disease is age — and aluminium aggregates in brain tissue with age, so these events may just be occurring in parallel.

The reason people have pointed to aluminium cookware as a potential problem is that certain acids in foods will dissolve some of the metal and form chemical salts which will then be absorbed into the body.

When these get into nerve tissue, such as in the brain, they can accumulate. Aluminium ions (charged particles) are known to be neurotoxic, meaning they can poison the brain and nervous system. However, once again, the risk posed by aluminium cookware has not been proven.

Furthermore, the view is that it would be difficult to significantly reduce the amount of aluminium we absorb by simply avoiding the use of aluminium cookware or foil for food wrapping, because it can still get into the body from other sources, such as processed foods, tea, wine, fizzy drinks, cosmetics and medicines such as aspirin (this may be because of the way they are produced or stored).

Our body removes most of the aluminium as waste, but a theory is that if we absorb large amounts, then it is deposited in tissues.

In particular, black tea — which is the leaf of a small, evergreen shrub, a variety of Camellia — as it grows, accumulates large amounts of aluminium.

Yet there is no evidence that people who drink a lot of tea have a higher incidence of dementia. And no one has suggested that we all stop drinking tea. I am not convinced there’s a risk. If you are particularly concerned, or know you are at risk of Alzheimer’s, you may be reassured if you switch to stainless steel cookware, which is cheap and widely available.

But bear in mind you can’t avoid aluminium completely.

I have a large hiatus hernia and it causes a lot of discomfort, making me feel sick and as if I’ve been punched in the stomach. Can you suggest anything to alleviate this? I am 83.

E. Macdonald, Watford.

A hiatus hernia occurs when part of the stomach squeezes into the chest through an opening in the diaphragm, the domed wall of muscle that sits across the chest and separates the gullet from the stomach (the gullet passes through the diaphragm in an opening called the hiatus, and connects to the stomach on the other side).

By the way… I’m worried about the lack of radiologists

Most people have little more than a hazy idea of what radiologists do — but there is hardly a nook or cranny in medical care that does not depend upon their skills.

Gone are the days when these doctors were just stuck in a darkened room reading X-rays: now, they are skilled in ultrasound and MRI techniques, perform procedures such as biopsies and treating blocked blood vessels and play a vital role in the diagnosis of many conditions.

Sadly — much as I have been saying about general practice — there is a pressing crisis in the service. A study last year by The Royal College of Radiologists confirmed one in ten consultant radiologist posts is vacant, and more than 60 per cent have remained unfilled for a year.

Worse still, 22 per cent of radiologists are predicted to retire in the next five years, yet we’re not training enough to replace them — even when we already have a shortage of radiologists and thousands of scans and X-rays are waiting more than a month to be analysed.

Once again, the root of the problem lies in poor planning and political short-termism.

The solution? The Government must fund training in radiology and make the specialty more attractive — fast. Applying tighter financial stringency and bureaucracy by rearranging the deckchairs as usual will not cut it.

But is there light at the end of the tunnel? The Government’s recent Cancer Workforce Plan sets out ambitions to enhance diagnosis and treatment by investing in technology and equipment, and it recognises that without sufficient trained staff — radiologists, radiographers and nurses — none of that can be used effectively.

The plans include a pledge to increase the number of radiologists by around 300. But there is no new money for this, only a shuffling of priorities originally set out in a spending review in 2016 — in other words, we will have to rob Peter to pay Paul. What was I saying about deckchairs?

This part of the diaphragm acts as a valve to prevent the stomach contents rising up. 

But when this muscle weakens, as a result of ageing, obesity or anything else, the valve action fails, a gap opens up and the stomach itself pushes through the widened space and into the chest area.

In most cases, hiatus hernias do not cause symptoms and won’t need treatment.

However, patients with large hiatus hernias — where the stomach plus gullet move up into the chest — may have symptoms of heartburn, such as a sense of regurgitation, an acid taste in the throat, trouble swallowing, a cough, or nausea, just as you describe in your longer letter.

Treatment for hiatus hernia involves medicines that help reduce acid reflux to ease the symptoms. 

This includes antacids to neutralise the acid or medicines such as ranitidine which suppress acid production — both are available on prescription, as well as over-the-counter.

More powerful is a prescription-only medication called a proton pump inhibitor, such as high-dose omeprazole. Ask your GP about a prescription for one of these medicines, if it has not been done already.

If these don’t work, you may need surgery to fix the hernia, although this involves a major operation and is a last resort.

Do bear in mind that some simple lifestyle changes can be helpful. 

These include not eating large meals in the evening, eating slowly and going for a short walk after each meal.

If your symptoms persist despite acid suppressant treatment and taking great care, as above, further investigations may be necessary.

Discuss again with your GP and consider a referral to a specialist gastroenterologist as your symptoms have persisted and are so troublesome.

Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — include your contact details. Dr Scurr cannot enter into personal correspondence.

Replies should be taken in a general context and always consult your own GP with any health worries.

 

Article source: http://www.dailymail.co.uk/health/article-5169171/DR-MARTIN-SCURR-answers-readers-health-questions.html

Martin Sorrell Handpicks an Ogilvy Veteran to Manage Finances at WPP Health & Wellness

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Article source: http://www.adweek.com/agencies/martin-sorrell-handpicks-an-ogilvy-veteran-to-manage-finances-at-wpp-health-wellness/

How your office job is destroying your health | Daily Mail Online

We’ve heard it all before: desk work is wrecking havoc on our health. 

But experts warn that, while 86 percent of Americans work at a desk, few of us know how to offset the damage. 

If you spend at least six hours a day at a desk, your heart attack risk is double what it should be. Computers also increase your risk of vision loss by 40 percent, increase insulin resistance, and affect our mental health. 

This culture of working has given rise to the ‘weekend warrior’ who packs a week’s worth of exercise into two days, and after-hours yoga or meditation. 

However, research shows that may only have a superficial impact on boosting your health.

We spoke to a cardiologist, a personal trainer, and an optometrist about the dangers of desk work, and some concrete tips that really could balance out the downsides.

Data show around 86 percent of Americans work at desks, but few of us know what it is doing to our bodies 

Data show around 86 percent of Americans work at desks, but few of us know what it is doing to our bodies 

HEART HEALTH: EVEN FOUR WORKOUTS A WEEK IS NOT ENOUGH IF YOU DON’T HAVE STANDING BREAKS

What’s the damage? 

‘The major things from a point of view of your heart is if you’re sitting your heart rate will lower, and this affects everything,’ Dr Allan Stewart, MD, Director of Aortic Surgery, Icahn School of Medicine at Mount Sinai, tells Daily Mail Online. 

He runs through the laundry list of issues: 

1) You tend to eat less healthy foods

‘If you don’t have the ability to get up, you will just make do with the food near you or that can be delivered to you, which tends to be less nutritious,’ Dr Stewart explains.

‘Also if you’re going to be sat all day, you’re going to look for things that will give you a sugar rush for energy.’ 

2) You build up fat on your heart

‘Muscles burn less fat because you’re less active. Because you have an increase in circulation of fatty acids and cholesterol to the heart, this increases your risk of a heart attack,’ Dr Stewart says. 

‘Even if you go to the gym four times a week you won’t completely offset the damage of sitting for at least six hours a day. You will still have a higher risk of heart attack.’

A toll on the heart: A Mount Sinai cardiologist breaks down how sitting impacts the heart

A toll on the heart: A Mount Sinai cardiologist breaks down how sitting impacts the heart

3) You build up dangerous insulin resistance

‘We have also seen that people who sit for six hours a day are less sensitive to insulin,’ says Dr Stewart. 

Insulin resistance is the hallmark of type 2 diabetes, which is triggered by sedentary behavior and obesity – but Dr Stewart warns even seemingly healthy desk workers have a high risk.

4) You gain a ‘spare tire’ around your middle

‘If you are not moving your muscles, you’re not processing glucose enough, meaning you’ll have more fat around your ‘spare tire’ (i.e. belly and love handles),’ Dr Stewart warns.

5) Increased close on the lungs 

What can you do?

Unfortunately for weekend warriors, Dr Stewart claims that most of the damage to your heart and muscles will already be done. 

Without some breaks during the day, you still carry the same risk, he says. 

Here are his tips to offset your risk: 

1) Stand whenever possible

Dr Stewart recommends getting up at every opportunity to keep your heart rate up – whether it’s to take a phone call, to have a conversation, or to grab a glass of water. 

2) Take a standing break every hour

If you maintain regular bouts of movement, Dr Stewart says, you will prevent your heart rate from grinding down to a sluggish rate. 

3) Walk and talk meetings

‘If you have a meeting that doesn’t require sitting at a computer to look at a screen, why don’t you go for a walk if the conditions are nice,’ he suggests. 

4) Turn your desk into a workout if you’re at home

‘Get an exercise ball and put it on an uneven surface so your core is engaged,’ Dr Stewart recommends. 

‘Or put your laptop on a treadmill so you can walk while you work.’ 

4) …And keep up with your normal workouts

‘You need to get 30 to 45 minutes of exercise at least four days a week,’ he says.

POSTURE AND TONING: WHY SITTING FOR HOURS CAN ATROPHY YOUR MUSCLES

What’s the damage? 

‘Believe it or not the less we sit, the better for our body’s natural state,’ Moe Widdi, a ‘master trainer’ at New York Health Racquet Club, told Daily Mail Online. 

‘We are a creation of labor. Sitting down for a majority of the day, can increase our body’s risk for injury.’

He explains that we will lose strength in key areas like our core and our glutes, forcing more pressure on our bones.  

‘All parts of the body work together, so if something is off it throws everything else off. Muscles begin to fire up differently and joints begin to change jobs to help compensate,’ Widdi explains. 

‘In addition, posture is extremely vital to a person’s life. It helps exude confidence, lessens the chance of injury, and can help you avoid asthma. 

‘When you develop poor posture, the shoulders close off towards the front of your body causing the back to round, restricting the lungs from getting efficient oxygen.’

Do you have 'desk butt': Trainers warn sitting all day atrophies your muscles, making your bottom flat

Do you have ‘desk butt’: Trainers warn sitting all day atrophies your muscles, making your bottom flat

What can you do? 

To avoid injuries and poor posture, it’s important to strengthen your posterior and anterior muscles, muscles that control the back and front of your body.

Widdi recommends these exercises four times a week to offset the damage: 

1) WALL SLIDES 

  • Lay against a flat wall or mirror
  • Flatten your back against it by contracting your core and tilting your pelvis to the back
  • Put your arms and hands against the wall making a foot ball field goal
  • Tuck in your chin by trying to put the back of your head against the wall, and press against the mirror as you are sliding your hands up and down. By doing so you’re forcing the muscles we need in the back and neck to isolate and activate by keeping the back flat as you wall slide
  • PRO TIP: if you can keep good form use a light bar or light pole

2) SUPINATED REVERSE FLYS 

  • Keeping the same form for your back as the Wall Slides, grab a Thera band with your hands supinated (palms facing up) to externally rotate your shoulders which allows you to contract your back muscles more when you do a reverse fly.
  • Keep hands straight out in front of you, elbows locked in
  • Then touch the wall with each rep if your range of motion permits 

PROTECT YOUR EYES: HOW SCREENS AFFECT YOUR VISION

What’s the damage?

Screens are not going to make you go blind, assures Dr Randy McLoughlin,an optometrist at The Ohio State University Wexner Medical Center.

However, he says the jury is still out on how damaging screens’ UV rays can be to our eyes, and sitting for hours on end staring at one thing close up can put an increasing amount of strain on our retinas. 

‘The whole world is up close when you have a much higher neural demand from screens all day long,’ he told Daily Mail Online. 

‘It means you’re going to notice and feel that strain more.’

He added that, while research is still ongoing in this field, ultra-violet rays are known to be unhelpful, if not directly damaging, for our eye health.

Straining your eyes: Ultra-violet rays and focusing on one thing for hours creates eye strain

Straining your eyes: Ultra-violet rays and focusing on one thing for hours creates eye strain

What can you do?

1) Take vision breaks

‘We recommend that people take visual breaks every 20 to 30 minutes,’ Dr McLoughlin explains. 

‘Look away and relax your eyes for at least 30 seconds. You don’t need to break your train of thought, just break your screen time for a moment.’ 

2) Use over-the-counter eye drops

‘Liquid eye drops from the pharmacy work well, and that can relieve dryness or eye strain,’ he says. 

3) Get your eyes checked every two years 

For people who do not have vision issues or concerns to check out, you should be aiming for an optometrist check-up every other year. 

‘A lot of people may assume that their eyes are fine, and when they get round to getting checked out in their 40s they’re embarrassed saying “I haven’t been since high school!” 

‘Don’t worry – we’re not going to shame you for not coming! But we do recommend getting checked out every two years, just to make sure everything is fine.’

 

Article source: http://www.dailymail.co.uk/health/article-5168649/How-office-job-destroying-health.html

Generation at risk: America’s youngest facing mental health crisis

Alex Crotty was just 11 when things started feeling wrong.

It wasn’t just a matter of being unhappy. She always felt empty and miserable — never content or connected to other children. For years, she suffered alone, filled with shame. She switched schools, but that didn’t help.



“I didn’t feel unloved. I just felt numb to the world. Like, I was surrounded by great things, but just I couldn’t be happy. And I didn’t know why that was,” Alex told NBC News.

Finally, at 14, she decided to break her silence. “I can’t feel anything,” Alex simply told her mother, Heather Olson of New York. “So she just gave me a hug, cradled me in her arms on the bed, and was like, ‘Well can you feel me? Can you feel my love?’”

“A hug and kisses was the only thing that came to mind at the spur of the moment, but that was precisely what she needed to start the journey forward,” Olson said.

Image: Alex Crotty


Image: Alex Crotty

Alex was diagnosed with major depression and anxiety. Now 16, she is in therapy and on medication. She’s far from alone.

There is an acute health crisis happening among members of the youngest generation of Americans, with critical implications for the country’s future.

Graphic: Kid at risk


Graphic: Kid at risk

The Centers for Disease Control and Prevention reports that 1 in 5 American children ages 3 through 17 — about 15 million — have a diagnosable mental, emotional or behavioral disorder in a given year.

Only 20 percent of these children are ever diagnosed and receive treatment; 80 percent — about 12 million — aren’t receiving treatment.

Recent research indicates that serious depression is worsening in teens, especially girls, and the suicide rate among girls reached a 40-year high in 2015, according to a CDC report released in August.

Related: Anxiety, irritability may be first warning signs of depression in kids

“Child and adolescent mental health disorders are the most common illnesses that children will experience under the age of 18. It’s pretty amazing, because the number’s so large that I think it’s hard to wrap our heads around it,” said Dr. Harold Koplewicz, founding president of The Child Mind Institute, a nonprofit children’s mental health advocacy group.

Over the next few months, NBC Nightly News will examine the state of American children’s mental health, including reports on what has led to this increase — especially in anxiety and depression — treatment obstacles, promising research and innovative programs to help children.

Related: Generation at risk: Children at center of America’s opioid crisis

Is your toddler depressed?

Mental health problems may actually start much earlier than previously thought.

A toddler who is crying for hours and angrily stomping his or her feet may not be having a temper tantrum, but showing signs of depression. Research suggests that 1 percent to 2 percent of children 2 to 5 years old have depression, said Dr. Joan Luby, director of the Early Emotional Development program at the Washington University School of Medicine in St. Louis and a pioneer in the study of the condition in preschoolers.

She believes untreated depression in toddlers can lead to more depression later in life.

“Young children are more cognitively sophisticated, more emotionally sophisticated, than we previously understood. They have complex emotions. They’re aware of emotions in their environment. They feel emotions like guilt,” Luby said. “They have all the prerequisites of what depressive symptoms are.”

That may show up as constant sadness and low self-esteem. A child may not want to play with a favorite toy or with friends over a sustained period of time.

IMAGE: Myla Haper and Vickey Harper


IMAGE: Myla Haper and Vickey Harper

Vickey Harper of St. Louis became worried when her 2-year-old daughter, Myla, began having “scary” tantrums that sometimes lasted almost an hour. The girl would scream, kick and hit her mother in the face.

“My gut was just telling me that something was not right,” Harper said. Mental illness runs in the family, but she was surprised when doctors suggested Myla had depression.

The girl is taking part in Luby’s research to see whether early intervention can make a difference. Parents are coached on how to play with and respond to their kids — exercises meant to help kids recognize their emotions, like being sad, angry or nervous. The hope is that will help them learn to control those feelings and “change a lifelong trajectory,” or prevent episodes of depression later in life, Luby said.

Now, Myla’s long tantrums are gone.

“She is not the same kid that walked into those therapy sessions,” Harper said. “She can tell me when she’s feeling something. She still yells sometimes, but it’s on a much smaller scale.”

Why adolescents are so vulnerable

Teens are known for their moodiness, and adolescence — a particularly turbulent time of life — is one of the most vulnerable periods to develop anxiety and depression. About 50 percent of cases of mental illness begin by age 14, according to the American Psychiatric Association. A tendency to develop depression and bipolar disorder nearly doubles from age 13 to age 18.

But for teens like Alex Crotty, depression is very different from adolescent angst, Koplewicz said.

“Teenagers have a different kind of depression. They don’t seem sad. They seem irritable,” he said. “This really has an effect on your concentration, which will affect school. It will affect your desire to continue playing sports. It’ll affect your desire of being with your friends.”

Related: Suicides in teen girls hit 40-year high

Warning signs also include the duration and the degree of symptoms, he said. Take notice if your teen is experiencing moodiness or irritability for more than two weeks and it’s occurring every day, for most of the day, and if you see a change in sleep patterns and a change in desire to work and socialize.

Teenagers also think about suicide more often — and 5,000 young people take their own lives every year in the United States, Koplewicz added.



For years, Alex was too scared to reach out for help because she thought that if she told her parents about her depression, they wouldn’t believe her or they would overreact and send her to a “psych ward,” she said.

It’s why The Child Mind Institute is collecting brain scans from 10,000 children and teens, hoping to identify biological markers of psychiatric illness. The project could improve the diagnosis and treatment of mental disorders.

After medication and therapy, Alex is doing great.

“I am so much stronger after coming out of this,” she said, urging other kids to speak up. “If you always feel like something’s wrong, talk to somebody. If you feel like you’re blaming things on yourself all the time, talk to somebody. Just if things don’t feel good, talk to somebody.”

Article source: https://www.nbcnews.com/health/kids-health/generation-risk-america-s-youngest-facing-mental-health-crisis-n827836

Funding at risk for children’s health insurance, clinics

  • FILE - In an April 25, 2017, file photo, Sen. Debbie Stabenow, D-Mich., speaks during a media availability on Capitol Hill in Washington. Stabenow and others are sounding the alarm over the expiration of federal funding that provides health insurance to 116,000 lower-income children in Michigan, saying cancellation notices may be sent to families as early as next month despite bipartisan support for continuing the program. Photo: Alex Brandon, AP / Copyright 2017 The Associated Press. All rights reserved.

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LANSING, Mich. (AP) — U.S. Sen. Debbie Stabenow and others are sounding the alarm over the expiration of federal funding that provides health insurance to 116,000 lower-income children in Michigan, saying cancellation notices may be sent to families as early as next month despite bipartisan support for continuing the program.

The Children’s Health Insurance Program was not reauthorized by the Republican-led Congress in September, and lawmakers are at odds over how to pay for a five-year extension. CHIP funds programs such as MIChild, which provides health and dental coverage for children from working families that make more than double the federal poverty level — $43,290 for a family of three.

And in the wake of Flint’s water crisis, Michigan also is allowed to spend some of the federal money to remove lead hazards from the homes of low-income residents in Flint and other communities.

Stabenow, a Democrat, said there will be “very serious” consequences if Congress does not extend funding for CHIP and community health centers that serve the poor and uninsured.

“This is unacceptable. This is something that is bipartisan, strongly bipartisan,” she told The Associated Press in a phone interview.

On Friday, President Donald Trump signed a two-week spending bill to prevent — for now — a government shutdown, which also makes money available to several states that are in danger of running out of CHIP funds this month. Michigan’s allotment has been expected to last until April or May, said state spokeswoman Angela Minicuci. But cancellation notices must be sent 90 days in advance in case the funds are not replenished.

More imminent are funding cuts to the community health centers, which are located at more than 260 underserved urban and rural sites across the state and served more than 680,000 people last year. They will lose 70 percent of their funding starting next month, with more exhausting their federal funds each month through June.

Centers whose grant cycles begin in January — and are at risk first — include Advantage Health Centers in Detroit, Bay Mills Health Center in the eastern Upper Peninsula, Community Health Social Services Center in Detroit, Covenant Community Care in Detroit, MidMichigan Community Health Services in the northern Lower Peninsula and Western Wayne Family Health Centers outside Detroit.

Among those in the Michigan delegation pushing to renew the funding is Republican Rep. Tim Walberg of Tipton. He said last month that CHIP is a “successful federal-state partnership” and called the health centers a “key component of the health care safety net.”

Legislation won approval in the House in November, and a Senate committee that Stabenow sits on OK’d a funding bill in October. But the popular programs have been caught up in talks over several end-of-year agenda items, including the budget, hurricane aid and protections for immigrants brought to the country illegally as children.

Families in MIChild pay a $10 monthly premium for coverage, and there are no co-pays.

“It literally is saving lives of children in Michigan,” Stabenow said.

The insurance, she said, lets parents who make too much to qualify for Medicaid take their kids to a doctor, avoiding expensive and potentially unnecessary trips to the emergency room.

The Flint Water Interagency Coordinating Committee, which Republican Gov. Rick Snyder created to help address the Flint crisis, is expected to soon send a letter to Congress warning that lead pipe replacement funding will be compromised if CHIP is not extended.

If the funding is not reauthorized, the state may try to keep MIChild and other programs going with additional state money.

“We need to discuss that with the Legislature to see if the funding would be available,” Minicuci said.

___

Follow David Eggert on Twitter at https://twitter.com/DavidEggert00 . His work can be found at https://apnews.com/search/David%20Eggert

Article source: https://www.sfgate.com/news/article/Funding-at-risk-for-children-s-health-insurance-12417941.php

Winning Health Tech Entrepreneurs Will Focus On Implementation, Not Fetishize Invention

One word: implementation.

Shutterstock

Increasingly, I’m convinced that the underappreciated challenges of implementation describe the ever-expanding gap between the promise of emerging technologies (sensors, AI) and their comparatively limited use in clinical care and pharmaceutical research. (Updated disclosure: I am now a VC, associated with a pharma company; views expressed, as always, are my own.)

Technology Promises Disruption Of Healthcare…

Let’s start with some context. Healthcare, it is universally agreed, is “broken,” and in particular, many of the advances and conveniences we now take for granted in virtually every other domain remain largely aspirational goals, or occasionally pilot initiatives, in medicine.

Healthcare is viewed by many as an ossified enterprise desperately in need of some disruption. As emerging technologies shook up other industries originally viewed as too hide-bound to ever change, there was in many quarters a profound hope that advances like the smart phone or AI, and approaches like agile development and design thinking, could reinvent the way care is delivered, and more generally, help to reconceptualize the way each of us think about health and disease.

In particular, these technologies offered the promise of helping improve care in at least five ways:

  • From reactive to anticipatory
  • From episodic to continuous
  • From a focus on the average patient to a focus on each individual patient
  • From care based on precedent (previous patients) to care based on continuous feedback and learning
  • From patient-as-recipient of care to patient-as-participant (and owner/driver of care) – a foundational theme of both the PASTEUR translational medicine training program Denny Ausiello and I organized in 2000 (summarized in the American Journal of Medicine, here), as well as of Eric Topol’s The Patient Will See You Now (my Wall Street Journal review here).

As Denny and I wrote in 2013, this time in the context of our CATCH digital health translational medicine initiative, emerging technology:

“…provides a way for medicine to break out of its traditional constraints of time and place, and understand patients in a way that’s continuous rather than episodic, and that strives to offer care in a fashion that’s anticipatory or timely rather than reactive or delayed.”

These technologies also afforded new hopes to pharma, in particular, the ability to:

  • better understand disease (assessment of phenotype and genotype that’s at once more granular and more comprehensive);
  • better understand illness/patient experience of disease (can capture more completely and perhaps more quantitatively and in more dimensions what it feels to experience a condition);
  • forge a close connection with patients, and add value beyond the pill. The idea of moving from assets to solutions is a perennial favorite of consultants (this, for example).

… And How’s That Going?

And yet, here we are. While some consultants suggest we are further along than even their extravagantly optimistic predictions of 2013 had imagined, my own conversations with a range of stakeholders suggests progress has been painfully slow, and the practice of both medicine and drug development generally have not felt the impact of these emerging technologies, to put it very politely (and most experts with whom I’ve spoken over the last several months have been far blunter than that).

As Warner Wolf used to say, let’s go to the videotape. Consider some of the published, peer-reviewed studies evaluating digital health approaches:

Given these data, it may not come as a great surprise that a soon-to-be-published review (previewed by its lead author, Brennan Spiegel, on twitter) representing a systematic evaluation of high-quality randomized control trials reportedly finds that “device enabled remote monitoring does not consistently improve clinical outcomes,” according to Spiegel.

The struggles of digital health to demonstrate value are not new – see this post from January of 2014 – nor are they exceptional in medicine. In fact, as I’ve previously noted, many technologies and approaches thought intuitively to offer obvious benefit turned out not to, from the use of bone marrow transplant in breast cancer to the use of a category of anti-arrhythmic medication following heart attack to the routine use of a pulmonary artery catheter in ICU patients. In each case, benefit was thought so obvious as to question the ethics of even doing a randomized study, and then studies were done refuting the hypothesis.

Technology Adoption In Pharma

Doubts about efficacy are also one of the reasons pharma has been extremely slow to adopt some new technology, concerns that have been validated by some early pilots. For example, I am aware of what seemed to be the perfect case of delivering a solution rather than a product: a company made a surgical product, and invested significant resources in developing a service that provided useful post-op advice and support (delivered by highly trained nurses) to patients who received the product, thus helping the patient, the surgeon (unburdening his or her office, while simultaneously helping drive better outcomes), and the company, by making it’s product more attractive. Result: I have been told that the service ultimately was shut down, because few patients availed themselves of it.

Article source: https://www.forbes.com/sites/davidshaywitz/2017/12/10/winning-health-tech-entrepreneurs-will-focus-on-implementation-not-fetishize-invention/

Mental health: Jeremy Hunt says the NHS needs to ‘be better’ at dealing with crisis patients

The health secretary says the NHS must be better at dealing with mental health crisis cases.

Jeremy Hunt, who’s in charge of the health service in England, was speaking to Newsbeat about our iPlayer documentary My Mind and Me.

He watched Radio 1 listener Bex talk about failures when she needed urgent help after a mental health crisis.

Mr Hunt admits there’s a “bottleneck in parts of the country” for mental health beds.

“Compared to the scale of what we want to do which is to be much better at being there for people going through the agony that Bex is, there’s a long way to go,” he tells Newsbeat.

girl in therapy

The government’s latest plans to improve support for people up to the age of 18 with mental health issues were unveiled earlier this month.

They include schemes to provide mental health care in schools in England.

The proposals, part of a £300m investment by the departments of health and education, include introducing a four-week waiting time for those needing specialist support and new mental health support teams in schools.

It’s planned that around one in four schools in England will have this provision in place by 2022.

Campaigners say it’s a welcome development, but overdue.

Speaking at the time of the announcement Sarah Brennan, chief executive of the charity Young Minds, said the move was “still only a start.”

bex and cat

Twenty-four-year-old Bex has been diagnosed with OCD, depression, borderline personality disorder and anxiety.

She opened up about one experience she had seeking help in hospital.

“I was quite suicidal and just impulsively dangerous so I kept saying I am not safe,” she explained.

She was told there was no doctor to give her medication.

“I got back home at three in the morning and then two days later I had another bad panic attack, they tried to admit me but there were no beds.”

Jeremy Hunt

Mr Hunt admitted that “there needs to be more help for sure” for people like Bex.

“There were some positives and some negatives,” he says.

“The positive is that she did have a crisis team at her local hospital and those have only started in the last three years.

“We also have more beds than we have before.”

woman bites hand

In 2015, the government promised more funding for child and adolescent mental health services.

Extra money has also been set out for adult services in England.

The pledges mean, by 2020-21, an extra £1.28bn more should be spent in on mental health care real terms than was in 2015-16.

However, despite £140bn being spent on health care across the UK last year – analysis by King’s Fund health think tank suggested 40% of mental health trusts in England had seen their budgets cut in 2015-16.

Figures like this have led to some suggesting that mental health care is still “the poor relation” to physical care.

Theresa May

Earlier this year the prime minister admitted mental health services are “patchy” and has told Newsbeat she’s going to review them.

Labour told Newsbeat that “since 2010 mental health funding has been cut and the number of mental health nurses has fallen.”

“Remaining mental health budgets have been raided to plug holes elsewhere in the NHS,” it argues.

If you’re struggling with your mental health or any of the difficulties mentioned in this article you can find help at BBC Advice.

Find us on Instagram at BBCNewsbeat and follow us on Snapchat, search for bbc_newsbeat

Article source: http://www.bbc.co.uk/newsbeat/article/42272042/mental-health-jeremy-hunt-says-the-nhs-needs-to-be-better-at-dealing-with-crisis-patients

Polluted air, health problems brought by Southern California fires are expected to linger

A week of major wind-whipped fires across Southern California has caused significant air pollution and health problems.

The air quality is worst in and around fires burning from Ventura County to San Diego County, but the smoke has traveled to places not threatened by the flames. And with the Santa Ana winds dying down, officials say the smoke could stick around for a while.

Phil Moyer, air quality specialist with the Ventura County Air Pollution Control District, said a winter storm or new Santa Ana winds could lift the smoke out of Ojai, which is heavily polluted. But there’s no rain in the forecast and winds would have to be very strong to reach the low-lying community, and would likely intensify the fires.

“They’re going to see stacks of smoke for a while,” he said.