A Year Later: Never Again! Enough is Enough! We Call BS! ‘Survivors of a Cruel and Silent Nation’

Republished below from February 2018 on this anniversary of the horrific shooting. Our hearts  go out to families, friends, and a nation still trying to heal. The cries for hope to the end of violence still resonate.

Parkland, Fla.

Parkland has well-manicured lawns, new developments, and huge parks, with trails and tennis courts and basketball courts and ballfields. At the intersection of Coral Springs and Parkland is a horse riding academy, Malachi Acres, with a boarding stable, amidst the palms.  Town hall is beautiful, and residents talk about the sense of community. A resident recalls how there was a mini-scandal when there were some car break-ins in a neighborhood.  The reason, he said with a near smile: “The owners left their doors unlocked.” It’s that kind of place. A month ago, my wife and I left Parkland, heading to the airport after visiting relatives there. The Lyft driver told us why he moved to Parkland, this proud man from Brazil. For the schools, he said. For the schools.

Yesterday, it was about all of this, a sense of place,  the schools, and something much more profound:  passion, determination, unyielding force. Angry teen-agers with a grudge, clutching a sadness no one should have, fighting to curb gun violence, restrict the access to guns — assault weapons – and vowing, vowing, vowing to make politicians know they will be ousted from office if they don’t comply. So there is no more  terrible nonsense of gun violence that is taking lives, the “17 angels” — the 17 people –  students,  a football coach and athletic director, who were killed at Marjory Stoneman Douglas High School on Valentine’s Day. There were 14 wounded. The gunman was mentioned only in passing yesterday during the March For Our Lives rally, only in a word like horrible, but also as a pathetic reason why, why, why laws must be changed, gun laws, mental health laws, funding, you name it. All our hearts are broken, and we’ve had enough was the refrain, constant and true.

Parkland was center stage as a place, but its students were also taking the center stage  in  a rally in Washington D.C. Parkland is one piece of the gun-control puzzle. So is Chicago. So is New York. So is Miami. So is Los Angeles and everywhere where marches were held.  One bullet that fells any kid in a school, on a street. That’s what they fought against yesterday, mostly these kids, but there was plenty of support, no doubt about it, from parents, teachers, friends, the elderly.  Stop the gun violence. Stop people from having assault weapons.  Down with NRA. Thump the Trump. (ok, my term). Placard after placard. Sign after sign. The message was clear: Lawmakers and the President, if you don’t do enough you will be voted out by their supporters, damn it, when they are old enough to vote.  One student from Parkland told how she thought the privilege of the town helped draw it attention, but the fight  represents all races, all genders, all lifestyles. Those  voices at rallies across the country related personal experiences of friends, relatives, loved-ones cut down in senseless violence, in emotional, drive you to tears speeches. Eyes welling up all over.  Let’s hold those thoughts.

“We are survivors of a cruel and silent nation,” said D’Angelo McDade, 18, of Chicago at the Washington D.C. rally.  “I too, am a victim, a survivor and a victor of gun violence,” McDade said. “We are survivors not only of gun violence but of silence. I come from a place where minorities are controlled by both violence and poverty, leading us to be deterred by success. But today we say, ‘No More.’

No more, he said: violence, no more poverty, no more unjust policies and lack of resources. “You must be the change,” he told the crowd.

In 1970, after National Guard troops shot students at Kent State, we were young and demonstrated with passion and fury. We were convinced the wrongs of America would turn to rights.

We didn’t have social media. We had bull horns.

There’s something magical going  on now amidst the sadness.

These kids are articulate and their speeches are raw and practical. Blunt.  No more BS!

There are still huge bureaucratic mountains to climb, but as the protestors insisted yesterday, this is just the beginning. We’ll be hearing more of the words Ballet Box. — Joe Cantlupe

Too many hospital mergers are ‘flying under the radar’ of FTC, says Harvard prof in NEJM Catalyst report

While the Federal Trade Commission has challenged some mergers and acquisitions of health care systems, it has more work to do — such as stepping up investigations of largely ignored “cross-market mergers,” which may constitute antitrust violations, says Harvard Business School Professor Leemore Dafny and colleagues in a study.

These mergers,  involving hospitals more than 30 minutes apart, have been relatively free of FTC scrutiny,  a study about “cross-market mergers,”  says in an article  I wrote for  the New England Journal of Medicine Catalyst

pexels-photo-hospital-239853“There is a whole set of potentially problematic mergers that flies under the radar,” Dafny says.  “Cross-market is a different frontier, and it is time to turn attention to it.”

Since its publication in March, the Dafny study “has made waves within antitrust circles,”the NEJM Catalyst report says.

A Young Entrepreneur Cracks the Code of Healthcare Inefficiency

Everybody is talking about value-based care, says Chris Bradley, CEO of Mana Health, referring to the term for new paths to treat patients with more efficiency across healthcare systems.

The move to value-based care, payment for procedures a patient wants and needs, has been a focus for hospital systems as they move from a traditional fee-for-service models, a kind of payment that is extremely variable, and not based on quality. Procedures, such as imaging and screening, can have great variations of cost regardless of the kind of care, according to Dartmouth-Hitchcock.

But value-based care has little value if the technology isn’t working, the electronic health records are slowed, and the cost of integrating a system is nearly half million dollars, never mind that doctors and administrators aren’t happy about it, Bradley says.

Yet that’s where a lot of hospital systems and health centers find themselves.  “Let’s be honest, it’s not where it could be,” Bradley says. “The EMRs (electronic medical records) themselves, they are not as useful as people had hoped, and for interoperability, many haven’t seen them take off as they thought.”

Interoperability is the extent into which systems and devices exchange and interpret data.

The immense possibilities – and sometimes improbabilities – of healthcare is what got Bradley into this business. He is the founder and co-owner of New York City -based Mana Health, a technology provider that focuses on healthcare data access solutions, with the idea of making them faster, and more cost-effective.

The idea of Mana Health – which means ‘flowing energy’ – is to streamline data access, interoperability, and innovation. The analogy makes sense for Bradley, who has a neuroscience background, who grew up in a family of doctors and initially thought he’d go into medicine. Instead, he found he could help more people on the technology end of things.

“We want to crack the code of having a sustainable and scalable network.”

The company touts its innovative key data access programs, including those named ManaCloud, ManaCreate and ManaPortal.  ManaCreate works, in part, to reduce the usually  time-consuming function of bringing IT systems to market, and the company has a specific focus on application program interface (API), the protocols and tools to building software applications.

 

Bradley says there is a growing movement to standardize the way applications can access data, through API, which has been “notoriously absent in health IT until very recently” in an article he wrote for  MedCity News.

Integrating and launching an application on top of medical data can be a nightmare, and getting the data into the application and hosting that data in a HIPAA (The Health Insurance Portability and Accountability Act of 1996) compliant service is where things slow down and cost begins to spin out of control, Bradley says.

Although Mana Health is only a few years old, Bradley says it is growing its clientele, and has recently completed a program for an as yet undisclosed upstate New York hospital system that may save them upwards of $1 million. In one plan, Mana Health is working on proposals to develop a chat room for patients and families, where they can create data “and everyone knows what’s going on,” Bradley says.

Bradley puts it this way in a statement: “A cardiologist envisions treating patients faster with the right data points and providing targeted content. She is certain that with this experience she can improve outcomes.” So, where does she go from there? Bradley says.

“With ManaCreate and an efficient development team, she can expedite the design process, integrate all the right data and move into deployment mode faster for the betterment of healthcare,” Bradley adds.

“Data and interoperability and API, that is now a hot area,” he tells me.

Bradley says he recently attended a CEO roundtable, and the discussion was supposed to be about “value-based care, and that’s what they wanted to talk about. It delved into a conversation about interoperability. You cannot have value-based care without it.”

But when the CEOs talk about what they want, or the problems they face, often the topics revolve around data: it can be applications they want to deployed faster, saving millions from an EPIC investment, or improve tracking of patients with EMRs. “The one thing they have in common is the data” question, he says.

“That’s the highest value problem to solve,” he says of the data.

“Sometimes (healthcare leaders) don’t know they need to solve it until they go down that rabbit hole and realize, ‘Wait a second, I’m being asked to implement a variety of population health measures to integrate an (Accountable Care Organization), and I can’t because these systems don’t work with each other.’ Then you say you have an API, and you can launch an application in weeks instead of six months, they say ‘that’s interesting.”

“That,” he adds, “is how we get into it.”

Will the anti-depressant you take work? Researchers looking for clues: smiles included

As more Americans take antidepressants, the feeling is that the already large numbers may grow considerably in the stress-filled world we are in. Look how turbulent the past 12 days have been in light of the elections.

What if we can predict what antidepressants would work for some patients, or not, based on their childhood stresses, and brain activity, and studying their facial expressions, such as smiles?

That could mean a big difference, not only for patients, but for healthcare, and its spending on medications.

A team from Stanford University led a study to do that very thing; they “created a model, based on brain activity and exposure to stress in childhood, that predicts the likelihood that antidepressants will benefit a patient,” according to a recent National Institutes of Health Research Matters story Predicting the Usefulness of Antidepressants. The model has a80 percent accuracy for prediction of antidepressants helping patients.

“Addressing this question could provide a new mechanistic understanding of why some individuals respond to antidepressant treatments and others do not, as well as offer new targets for intervention,” the researchers said in the study.

The study findings indicate that many patients who faced stressful situations should be considered for other therapy techniques before medication.

Certainly, however, many people are now taking the meds.

In 2013, Roni Caryn Rabin of The New York Times wrote that the use of antidepressants skyrocketed, with one of 10 Americans taking antidepressant medications. Last November, Justin Karter reported in Mad in America that from 1999 to 2012, the percentage of Americans on antidepressants increased from 6.8% to 13%, citing the Journal of American Medical Association.

Not only are the numbers increasing, but a report in the Medical Daily show that most people take some type of anti-depressants, even though they don’t need it.

Finding the keys to antidepressants

As Tianna Hicklin, a writer at the NIH who wrote about the federal agency sponsored study, notes, antidepressant medications usually are linked to the treatment of depression, but done so as a result of a “trial and error” process.

So researchers looked into the mechanism of depression, examining patients’ stressors at childhood, and the brain’s handling of emotions. They reviewed  data from 70 patients who had  major depressive disorders, and asked them how many life stressors they had experienced before age 18, Hincklin wrote. Those stressors could include abuse, neglect, family conflict, illness, or death and natural disasters, she said.

In the meantime, the  researchers evaluated the amygdala activity of the brain linked to depression. Amygdala is a mass of gray matter inside each cerebral hemisphere. The researchers found that amygdala circuitry and early life stress (ELS) are both “strongly and independently implicated in the neurology of depression,” the team, led by Leanne Williams and Andrea-Golstein-Piekarski said. Williams did not respond to questions from Health Data Buzz.

Impact of Smiles

Using an MRI, the researchers measured brain activity in patients  and  viewed pictures of “emotional faces,” including smiling,  Hicklin wrote. Brain scans were taken before and after patients started taking antidepressants.

Ironically, antidepressants were less likely to work for those patients considered in the high -stress category, but “these patients had a greater chance of benefiting from the medications if their brains were highly responsive to happy facial expressions,” Hicklin added.

Also, patients with low childhood stress were most likely to benefit from antidepressant treatment. Their chances increased if their brains were less sensitive to both happy and fearful stimuli,” according to Hicklin.

“These results suggest that, for some patients, it might help to first try therapy techniques that address the impact of trauma in a person’s life before considering medication,” she wrote.

 

 

 

Cancer Moonshot: Shared Hope, Yet Still Not Enough Cooperation

President Nixon announced the war on cancer in 1971, in which we as a society are still slogging through, this immense battlefield. Vice President Biden, who ends his term in January, says one of his regrets is that he wouldn’t have been the commander-in-chief to preside over the “end of cancer, as we know it.”

He knows the heartbreak that cancer could cause, with the loss of his eldest son, Beau, who died at age 46 in 2015.

Of the VP’s vision to end cancer, he noted, “I said it, because I believe it’s possible.”

Is it?

There’s much to be happy about the progress we’ve made, as Biden said delivering the Cancer Moonshot task force report, a strategic plan to transform cancer research and care, to President Obama, since its work began in January.

Some of the areas of innovation and hope are wrapped around coordination and cooperation, the possibility  for penultimate team approaches.

There is still much to be concerned about, however: because there is still not enough coordination and cooperation, holes significant enough to stymie progress. Moreover, there may be questions ahead about research funding, because without the money, no matter how big the dreams, research will only go so far.

There is a $1 billion plan, but there are questions now with the GOP- led Congress and an incoming Donald J. Trump administration, and  how much money will actually be pumped into research, in which the new president-elect has not tipped his hand, or has shown conflicted interest.

Sharing Information

Let’s start with the question of sharing information to get us moving along the best path of the Cancer Moonshot. In science and elsewhere, it’s not easy. Biden notes there has been much progress, but there are still outstanding issues to be resolved.

The existing obstacles cited by Biden, in the words of the report:

  • Rapidly and effectively poor retention and recruitment in cancer clinical research trials
  • An antiquated culture of research and funding
  • Failure of sharing of medical records
  • Insufficient collaboration, (and) slow dissemination of cancer center knowledge.

What Biden Sees Ahead

Biden said he was convinced that the obstacles are not insurmountable.

The vice president didn’t want to dwell on the pitfalls. He noted the tremendous progress that has been made in bringing together some teams in research. Inevitably, the idea is to have more people understand the impact of the data and help them control their own healthcare.

Five years ago, oncologists weren’t routinely working closely with immunologists, virologists, genetics, chemical engineers and others – now they are, Biden said.

It’s different today. There are at least 70 commitments of partnerships, public and private, under Cancer Moonshot. Among them: the National Cancer Institute, Amazon Web Services and Microsoft are announcing a collaboration to build a sustainable model for maintaining cancer genomic data in the cloud. In addition, the Department of Defense  is establishing a groundbreaking new study to transform an  understanding of the biological basis of cancer. The administration says researchers will have at their fingertips potentially 250,000 samples to uncover new connections between the earliest signs of cancer.

The Money Issue

What’s ahead next year is uncertain as the GOP swept the House and Senate as well as the White House. Some analysts believe that Trump isn’t inclined to be a large booster of research programs in science, but the verdict as of yet is pretty unclear.r

Some analysts believe that President-elect Trump is not inclined to be a large booster of research programs in science, while others do not. It’s a mixed forecast, according to the Verge.  The media outlet noted that Trump had told a conservative radio host the NIH was “terrible” but told  Scientific American “we must make the commitment to invest in science, engineering, healthcare and other areas that will make the lives of Americans better, safer and more prosperous.”

When the Obama administration launched the National Cancer Moonshot program, officials described it as a $1 billion initiative to provide funding for researchers to speed up development of new cancer detection and treatments the White House said. The initiative would begin immediately with $195 million slated for new cancer initiatives at the National Institutes of Health (NIH) in fiscal year 2016.

Recently, the American Association for Cancer Research has asked Congress in its “lame duck” session to support a $2 billion increase for the National Institutes of Health in a fiscal year 2017 appropriations bill. That includes $216 million for the National Cancer Institute.

The AACR  calls for “alternative funding stream for targeted multi-year initiatives” such as the National Cancer Moonshot Initiatives, and other programs.

Nearly everyone involved, as one official told me, “has their fingers crossed.”

“The mission of this Cancer Moonshot is not to start another war on cancer, but to win the one President Nixon declared in 1971,” Biden said.

To do so, the battles must be consistently – and cooperatively – fought.

 

 

100 Percent Hand-Washers at Hospitals? Not so Fast. Technology Gives The Real Score

When I worked for a healthcare business-to-business magazine a few years ago, it was the rage that hospital workers should wash their hands. Of course, they should. Hospitals were touting they even hired workers undercover to catch all the would-be non-hand washers. Lots of handwringing, I’m sure, was going on.

Despite the hoopla awhile back, healthcare hand hygiene compliance remains below 40 percent, according to the World Health Organization. Unwashed hands may have millions of bacteria on them, and can cause infections, disease, and even death. Think of this: 80 percent of hospital staff that dressed wounds infected with MRSA carried the organism on their hands for three hours.

Ugh.

At hospitals, they’ve often used the “hidden spies” approach to doing a better job of getting rid of the hidden germs. Undercover colleagues would be named as part of a team to check in whenever co-workers used the restrooms or other areas after leaving surgical or other units, and make note whether they washed their hands or not. Studies are now showing that’s not really a too effective approach, and doesn’t do a good job of finding out what’s really going on.

Riverside Medical Center in Kankakee, Ill, is among a growing list of hospitals using technology, specifically an electronic hand hygiene compliance system, in this case operated by a company named  DebMed that evaluates the true amount of hand-washing going on. And you know what? It’s a plan that’s working, the hospital says.

The process starts this way. No spies needed. Well, human anyway. A computerized chip is put into soap or sanitary dispensers that sends signals through a wireless network to a DebMed database and calculates hand-washing usage, versus opportunities in specific areas of a hospital through the day. Real-time data is then sent through dashboards at the hospital that officials can monitor. DebMed touts its system as providing accurate and unbiased hand-hygiene compliance.

While Riverside was extremely confident in its method of undercover hand-washing checks, its officials discovered after implementing the DebMed system they weren’t doing as well as they thought.

Before DebMed, hospital officials believed they were having a hand-washing compliance rate of some 90 percent or more. The DebMed system found it was more like 57 percent, which was, “frankly, a little shocking,” says  Michael D. Mutterer senior VP, CNO. Mutterer couldn’t get over it. “It was puzzling. Our organization has been very quality driven. We had a false sense that we were doing an amazing job, guys.”

As a leader, he’s thinking: what’s wrong with the data? “Truly, we’re not a 57 percent organization for anything,” he thought to himself. As a result, Mutterer says, “We all knew we had a false sense of what we were doing. We knew we had to get these numbers up, it wasn’t an option.”

Using the DebMed system, Mutterer says, vast improvements have resulted. So far, the hospital is up to 80 percent – not where they want to be, but getting there.

“We always knew what we could do; what we do here is a focus on quality and safety, and one of the first things is about hand hygiene.” The hospital launched a team-focused effort, a “positive way to implement the system, and not nurse specific or punitive in nature,” he says.

The dashboards give Mutterer reminders, including some “dings” at 3 a.m. on his computer – the compliance report, telling him how things were going.

“One of the really nice things about (the DebMed) it doesn’t go to the person level, and it’s not punitive. It’s not the same as watching your peers and have to say ‘after you left that isolation room, you didn’t wash your hands.’ ”

“It’s ingrained in our system now,” Mutterer says. The goal? 100 percent, of course.

 

Soap vs. Hand Dispensers 

Wherever you are, washing hands with plain soap and running water is one of the most important steps that consumers can take to avoid getting sick and to prevent spreading infections to others, so says the CDC. If soap and water are not available, the CDC recommends using an alcohol-based sanitizer that contains at least 60 percent alcohol.

But what kind of soap should you use? That may be the rub.

Recently, the FDA issued a proposed rule requesting “additional scientific data” to support the “safety and effectiveness of certain active ingredients used in topical consumer antiseptic rubs, including hand sanitizers.”

Based on new scientific information and reviews by medical and scientific experts from an advisory committee, the FDA wants to be sure that these antiseptic rubs really reduce bacteria on the skin.

As a result, the agency is requesting manufacturers provide data for three active ingredients — alcohol (ethanol or ethyl alcohol), isopropyl alcohol and benzalkonium chloride. Since 2009, 90 percent of all consumer antiseptic rubs use ethanol or ethyl alcohol as their active ingredient, the FDA said.

“Today, consumers are using antiseptic rubs more frequently at home, work, school and in other public settings where the risk of infection is relatively low,” said Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.

“These products provide a convenient alternative when hand washing with plain soap and water is unavailable, but it’s our responsibility to determine whether these products are safe and effective so that consumers can be confident when using them for themselves and their families multiple times a day.”

“To do that, we must fill the gaps in scientific data on certain active ingredients,” Woodcock said.

The proposed rule does not require any consumer hand sanitizer products to be removed from the market at this time. Instead, it requires manufacturers who want to continue marketing these products under the OTC Drug Review to provide the FDA with additional data on the active ingredients’ safety and effectiveness, including data to evaluate absorption, according to the agency.