Archive for the ‘Public Health’ category

On Cancer Research, Incentives and Cures

September 18th, 2011

From a blog entitled TTAG, The Truth About Genetics, comes a scathing indictment of the American Cancer Society. Truthfully, some of the contents are infuriating, but especially so, because as a co-founder of a research institute, I’ve lived them. First hand. When I saw that  the American Cancer Society’s two CEOs make a combined $1.6 million dollars in salary, I wasn’t shocked. Heck, the president of a 120 bed hospital who retired recently made almost that much. ACS is a big organization with lots of moving parts. It takes talented people to run big organizations, and they typically don’t work just for food.

From the TTAG  blog:

Today, ACS’s revenue is $1 billion, and the amount that goes to research is a measly 16%. Research is not the primary goal of ACS, and one of the great things they do is help patients undergoing chemotherapy by buying them plane tickets and paying for their costs. But, even when you consider other program costs like cancer treatment for patients, ACS has the lowest score for charities in terms of efficiency: 1-2 stars out of 4. (24.78%, according to CharityNavigator.org)

See also:

Once again, no surprise. The main issue that I had with the ACS was that their research funding, as meager as it is, goes to the “Good Ole Boys,” the group that is already part of the NIH/NCI club. Okay, you say, they have to have some standards. The Komen people don’t follow that same “Good Ole Boy” path, and thank goodness. They look for good science wherever they can find it.

So, what’s the real reason that I get upset? I sometimes think I’ve written too many posts about this already, but let me say it one more time: Unless and until we realign the system that currently is used to fund basic science in this country, we will never find true cures for cancer. There is very little to no incentive to cooperate, to work together, to encourage scientists to share and to reward them with grants for cooperating.  In fact, the entire system actively discourages it. It is a “Diva”-based system, that encourages silos of power around individuals.

Bottom line? We have a healthcare system that does not support wellness and prevention, but  instead financially rewards sickness and continuous testing and care for what may have been preventable ailments, and we have a research system that discourages cooperation and collaboration. We have a pharmaceutical industry that is interested in financial blockbusters…just like the movie industry.  We have a political system that caused our country’s credit rating to be downgraded and the price of money to escalate, and finally, we have an infastructure that is crumbling.

The good news, however, is that we still are the United States of America, and if we work together T-O-G-E-T-H-E-R  this can all be fixed.  It’s time for those of us who understand this to be heard.

Health 2.0 Leadership (1 of 2) from Nick Jacobs, FACHE on Vimeo.

Sandpaper sheets, green jello and patients who leave with infections they didn’t have when they were admitted. Hospitals DON’T have to be this way. Nick Jacobs FACHE reveals how, as CEO, he transformed a rural, critical care hospital from near bankruptcy to a consistently profitable, internationally-recognized model of patient-centered care and innovation. By creating a hospital environment that embodies healing in every aspect of its operations, Nick’s hospital also achieved one of the lowest acquired (nosocomial) infection rates in the U.S. for five years running.

Barcelona, VAT and Ambiance

August 18th, 2011

Last weekend, I traveled to Barcelona. How does one afford to spend a weekend in Barcelona in this economy with the dollar at $1.40 to one Euro, one might ask?  Points, my friends, points. When you travel enough, it’s possible to build up quite a few of these delightfully-useful but quickly-diminishing-in-value “perks,” and that’s how I got there.

Because it’s “Vacation time in Europe,” numerous hotels, restaurants, and tourist attractions offer nice packages for a reasonable number of points, and because I’d never been to Barcelona or anywhere in Spain for that matter, it seemed like a good plan. Albeit brief, my 4 day journey into yet another culture was almost worth the pain of traveling. Of course, if you remember my Serbia, Nigeria, Bosnia, Netherlands and Italy blog posts, you know that I’m all about “experiences.”

Barcelona - juice seller - Flickr Photo

Barcelona: juice seller at the Mercat de la Bouqueria - Flickr photo credit: Halvorson Photo

The longer I live, the more interested I am in how other people live. Many years ago, probably 20 or so, we had an exchange student, Monica, from Barcelona who used to stand in my family room, look out the window into the rolling fields and proclaim, “Nick, Nick, I am sooo bored.”  Truthfully, I was, too.

So, why Barcelona, VAT and the “A” word? I fell in love with the city. I loved the ambiance, the food, the wines, the architecture, and the people. Maybe it was the fact that there are two million souls living there, and I never felt uneasy even once. Unlike my last trip to Chicago, where I couldn’t sleep all night because of the continuing chorus of sirens from emergency vehicles, Barcelona’s street in front of our hotel erupted in the wail of those distinctive, European sirens only
about four times, from Friday until the following Monday.

Interior of La Sagrada Familia basilicaSome of the little things that captured my attention included the walk/don’t walk sign on the streets that actually allowed you enough time to cross at your leisure without being hit by an oncoming car. The people and cab drivers were polite and, most importantly, there was a feeling of helpfulness and respect in the shops, restaurants and architectural wonders.

Of course, by Sunday evening, we had visited nearly every architectural work of Antoni Gaudí, and toured and listened to a great concert at the inspiring Palau Música Catalana. Barcelona is today one of the world’s leading tourist, economic and cultural and sports centres, and this all contributes to its status as one of the world’s leading cities.

But what about the rest of the title of this blog post? Every time we purchased something material there, the VAT tax was applied, and when I asked someone to explain it, the answer was simple, “It’s how we pay for healthcare.” Consequently, when we walked the streets over that entire weekend, we saw a total of five beggars, and three of them had a Starbucks Cup to catch the falling Euros.

The other things that we saw everywhere were dumpster-style recycling binsBarcelona: color-coded recyclying bins. And not just any bins, either. Very fancy, clean, able-to-be-picked-up-mechanically bins, that were specifically color coded for every imaginable kind of recyclables. Not rocket science, but a comment on community pride, sustainability or climate change, perhaps.

So, we’ve taken care of the creation of a pleasant ambiance on numerous levels with extraordinary architecture, beautiful tree-lined streets, recycling, healthcare, low crime and compassion for fellow human beings. We didn’t see many Mercedes, but we also didn’t see much evidence of poverty, either. The beaches in town were public, and not controlled by exclusive beachfront hotels. Barcelona’s public transportation was a pleasure — clean, comfortable and efficient, with a train to Paris that delivers you there in about three hours…and the Tapas, wine and customer service were all simply amazing.

Nationally, Spain’s unemployment rate hit 21.3%, and they are listed as one of the PIIGS:  Portugal, Ireland, Italy, Greece and Spain…i.e., economically-unsound EU countries. In spite of these huge challenges,  Barcelona was a great city, a great experience, and a great setting with world class arts. So, should we charter an Airbus 380, load up our U.S. Congress, and fly them to Barcelona?

Nah, it wouldn’t help.

Hmm. Maybe we should fly them to Somalia?

Geographic Variances in Medicaid Spending – And the Winner Is?

July 7th, 2011

Health Affairs cover - Nick Jacobs, FACHE - Medicare - MedicaidWhen Health Affairs released a first-ever study of geographic variances in Medicaid spending on July 7th, it was a new twist on transparency that is just the beginning of what will become a detail-by-detail exposé of care and treatment of patients in the United States.  Just imagine a few years from now, when every record is electronic and every detail will be instantly available to the government.  Like this variance report, we will begin to see the good, the bad and the ugly of how medicine is practiced in this country.  So… how do you spell transparency?

A few weeks ago, the New York Times ran an article in which the “overuse of Medicare-funded CT scans” was explored. Featured in the digital version of this article was an interactive map showing virtually every hospital in the United States, and as the mouse was passed over each hospital, the percentage of inappropriate CT scans appeared above the facility’s name. If yours was one of the hospitals that was 80+ percent over using this device in multiple single-day scans, you were, as they say, “busted.”

Well, this release exposed at least one entire section of the country that is overusing Medicaid on numerous levels.  Although the study revealed a wide variance in per-beneficiary spending, one geographic region outshined them all.  The findings showed that after adjusting for the case-mix of patients, variations are driven mostly by volume of services provided and, to a lesser degree, by price.  Per-beneficiary spending in the ten highest states was $1,650 above the national average, mostly caused by the greater number of services provided.

Image credit: New York Times

One of the most significant findings revealed by this study was that the supply of primary care physicians in specific areas was associated with reduced rates of admissions for diabetes, lung disease, and adult asthma.  The authors suggest that this finding might point to the fact that increased access to primary care providers may result in improved management of common chronic diseases for people on Medicaid.

So, by now you’re asking, “Who won?  Who used more money per capita to treat Medicaid patients?”  It was The Mid-Atlantic States : New Jersey, New York and Pennsylvania used more Medicaid funds per capita than any of the regions in the United States. For example, the per beneficiary cost in New York was twice that of California; $21,195 for New York vs. $11,200 for California.

As a region, New England used the least amount of Medicaid resources and as a state, Washington provided the best example of “how things should be.”  How did they do it?  They increased access to primary care and reduced hospital care.

Todd P. Gilmer, Ph.D.

Todd P. Gilmer, Ph.D. - UCSD

Finally, places that had higher numbers of hospital beds and specialists were associated with higher numbers of hospital admissions while higher numbers of primary care physicians were associated with reduced rates of hospital admissions… Todd P. Gilmer, PhD, professor of health economics in the Department of Family and Preventive Medicine at the University of California – San Diego said, “By looking at service mix, access and price, states can find ways to make their programs work better.”

Coffee and Cancer

May 19th, 2011

Several years ago, at the Clinical Breast Care Project’s (CBCP) offsite retreat with the physicians from Walter Reed Army Medical Center, our biomedical informatics group had prepared a demonstration for the CBCP’s Scientific Advisory Board, a group of distinguished scientists, breast cancer consultants and physicians.

Colonel Craig D. Shriver, MC Director, Clinical Breast Care Project Program Director and Chief, General Surgery Walter Reed Army Medical Center

COL Craig D. Shriver, MC Director, Clinical Breast Care Project (CBCP), Program Director & Chief of General Surgery, Walter Reed Army Medical Center

As the 7:00 PM meeting time approached, it was obvious that there was not going to be a quorum present to start the formal meeting.  The two additional members had called in and we sat waiting patiently for the remainder of this august body to join us; fifteen minutes passed, then twenty and finally at about 7:25 PM, the group burst apologetically into the conference room to begin the call.

In case you’re wondering what would have caused such a delayed response from an otherwise very prompt group of individuals, it was the introduction provided by the biomedical informatics group of how this data repository’s capabilities could be explored.  The advisory group was so captivated by the power of this tool that they literally became lost in the excitement of the demonstration.

This form of science was fascinating to me, because having trillions of pieces of data available from thousands of women allowed the queries to be guided by the data itself.  When this power was coupled with the normal questioning generated by the intellectual curiosity of the individual scientists, the outcomes were beyond fascinating.

For example, you could ask the question, “How many of you drink coffee?” The thousands of participants whose biopsies – both malignant and benign – were being stored in the tissue repository at our research institute had agreed to answer over 500 demographic questions relating to their very personal and now anonymous lives. A graph appeared showing the proportion of women who were coffee drinkers. When I then asked, “How many cups a day do you drink?”a new graph appeared with that information as well. My final question was, “How many of you were diagnosed with breast cancer?” This resulted in an interesting fusion of information. The women who consumed the most coffee had the least amount of breast cancer. Of course, that general assumption needed to be researched, confirmed and proven in numerous ways, but there it was, way back in about 2005.

A report that touched on this topic was released during the second week of May, and it was fascinating. It was a Harvard study that followed almost 50,000 male health professionals for more than two decades.  Over 5,000 of the participants got prostate cancer – 642 of them the most lethal form. “For the men who drank the most coffee, their risk of getting this bad form of prostate cancer was about 60 percent lower compared to the men who drank almost no coffee at all,” says Lorelei Mucci, an epidemiologist at the Harvard School of Public Health and an author of the study. The same group reported about a 50 percent reduced risk of dying from prostate cancer among men who took two or three brisk walks a week. As a part of our funding, similar studies performed by the Preventative Medicine Research Institute under the direction of Dr. Dean Ornish also confirmed this exercise theory of risk reduction for prostate cancer.

The new study shows that a 60 percent reduction in risk of aggressive prostate cancer requires at least six cups a day. However, men who drank only three cups a day still had a 30 percent lower chance of getting a lethal prostate cancer, and that’s not bad. Earlier research also suggests coffee reduces the risk of diabetes, liver disease and Parkinson’s.

But here is best part of this story. Just last week, Swedish researchers reported that women who drink at least five cups of coffee a day have nearly a 60 percent lower risk of a particularly aggressive breast cancer that doesn’t respond to estrogen.

Epidemiologist Mucci says more research is needed before officially urging people to drink coffee for its health benefits. Meanwhile, she says, “there’s no reason not to start drinking coffee.

So, all of these years later, the National Cancer Institute is using about 200 of these CBCP biopsies from that same tissue repository to map the Human Breast Cancer Genome, and everyday new reports are emerging that confirm the value of this research. All of this from a little coal mining town in Western Pennsylvania – the location of the research institute and hospital where I served as President and CEO – just three seconds in air miles from where Flight 93 went down.

Now that’s a story.

Things People Are Thinking About

October 14th, 2010

Every few weeks or so, I take the time to read articles produced by The Pew Research Center, a non-partisan fact tank. Pew does not take sides in policy disputes, but they do provide a valuable information resource for political leaders, journalists, scholars and citizens. I believe that I come under that last category, citizen. The only requirement that Pew has relative to their findings is that their sources are cited accurately and in context.

Recently, they provided some fun statistics:

For example, among the public, one-in-four (25%) believe in astrology (including 23% of Christians); 24% believe in reincarnation, nearly three-in-ten (29%) say they have been in touch with the dead; almost one-in-five (18%) say they have seen or been in the presence of ghosts. If none of those statistics surprise you, then you clearly are not me.

Here was another great poll finding: 87% of scientists say that humans and other living things have evolved over time and that evolution is the result of natural processes such as natural selection, but only 32% of the public accepts this as true. (From the work of Jodie T. Allen and Richard Auxier, Pew Research Center)

Conference on Climate Change, Poznan, Poland

Well, this next poll was even more interesting to me. As both a business person and a humanist, it has been difficult for me to hear large numbers of my friends and acquaintances literally “going off” about how ridiculous global warming is. They say things like, “Global warming and global cooling happen all the time; it’s just a natural course of events.” Others say, “Al Gore filled us with lies about global warming for his own financial gain.” Finally, I have heard over and over, “Well, we can’t do anything about it anyway, so why worry.”

Then there’s the opposite side where experts say things like, “If we stopped using all fossil fuels right now, the earth will continue to heat for another 60 years, and all of the devastating floods and fires that we’ve seen this year were the result of only a 1 degree increase in the world’s temperatures, and in 60 years we will heat up by 5 degrees.”

What did Pew find about the current global attitudes about climate change?

Pew - global attitudes about global climate change - Nick Jacobs, FACHETheir international polling shows that publics around the world are concerned about climate change. In the recent spring 2010 Pew Global Attitudes survey, majorities in all 22 nations polled rate global climate change a serious problem, and majorities in ten countries say it is a very serious problem. There are some interesting differences among the countries included in the survey. Brazilians are the most concerned about this issue: 85% consider it a very serious problem. Worries are less intense, however, in the two countries that emit the most carbon dioxide — only 41% of Chinese and 37% of American respondents characterize climate change as a very serious challenge.

Even though majorities around the globe express at least some concern about this issue, publics are divided on the question of whether individuals should pay more to address climate change. In 11 nations, a majority or plurality agree that people should pay higher prices to cope with this problem, while in 11 other nations a majority or plurality say people should not be asked to pay more.

These findings remind me of numerous other examples of confusion created by the short term winners and losers in what are serious economic discussions. There are 1.5 B Chinese, and over the next several years, many of them are going to want a car. Regardless of your own personal stand on this issue, that’s some serious potential pollution.

Congressman John P. Murtha

February 9th, 2010

Yesterday’s phone call from the Somerset Daily American caught me off guard.  “Hi, Nick, have you heard?  Congressman Murtha passed away this afternoon.  Could you give us a quote?”  the reporter said.   Truthfully, I was not ready for this call.  Having talked to friends who had been with him only a week earlier, everything seemed like it was going to be okay, but obviously, okay was not what it was.  He had one of the 500,000 or so laparoscopic cholesystectomies performed each year to remove a gallbladder.  This surgery has a .05% complication rate, but the call proved that, regardless of the percentages, there is always risk from human involvement.

The Late Rep. John Murtha I’ve decided to dedicate this as a very personal look back at my journey with Jack Murtha.  Ironically, we had grown up practically as Pennsylvania neighbors in Westmoreland/Fayette Counties.  My first real meeting with Mr. Murtha was during the 1977 Johnstown Flood.  I was a young teacher and volunteer who was mopping the floors of the relief centers,  getting things ready for survivors who had lost their homes when I heard a helicopter come flying in and saw a tall, impressive, 44 year old Congressman deplane.  He had only been in Congress for a few years, but had clearly learned enough about the  System to keep then-President Carter on his toes and get legislation passed to help his home district.

My very next encounter with Mr. Murtha wasn’t until about three years later, when his Washington office called me to see if they could help my employer at that time, Laurel Arts of Somerset, with a bill that was going through the House before Ronald Reagan took office.  Nothing came out of that call except for the fact that I realized that his employees were parents of former students and people who liked and respected my work from those days.

Then the big encounter hit.  Mr. Murtha was looking into bringing the National Park Service into Cambria County to start what became the America’s Industrial Heritage (Tourism Development) Project.  He and several other Congressmen came to the University of Pittsburgh in Johnstown to hold a Congressional hearing on the project, and, as the newly-elected President of the Laurel Highlands Convention and Visitors Bureau, I testified against the plan and explained that if they didn’t include Westmoreland, Somerset, and Fayette Counties, we would not display any literature promoting it at all of the tourist sites that we controlled.  They agreed, and not many months later, he ended up representing Fayette County as part of his district.   It worked out for both of us.

A few years later, I had transitioned into healthcare senior leadership and  invited Mr. Murtha to introduce Bob Hope at a fund raising event for the Mercy Hospital of Johnstown.  Approximately 6,000 people were in attendance and Mr. Murtha got as much applause as Mr. Hope.  The following year he helped us bring in Henry Mancini and his orchestra for a similar event and our respect for each other began to grow.

Rep. Murtha speaking at Biotechnology expo (2004)

Rep. John P. Murtha speaking at Biotechnology Expo (2004)

In 1997, when I became the President of Windber Medical Center, Mr. Murtha and I were seated near each other at a dinner party.  It was there that we  began to discuss healthcare, and his vision for the future.  Anything that would help the soldiers stay well, prevent illness, or stop it before it became an issue was his goal.  I heard him speak at the opening of one of his many health center initiatives at Walter Reed Army Medical Center, and he said, “I have 13 honorary degrees, hundreds of awards, and am well known as for my work in defense, but I want my legacy to be healthcare, prevention, and wellness.

His contributions to healthcare, however  small they may seem compared to what he has done for the world and for mankind, through his tireless and dedicated work were where his heart was.  His strength and vision made him the most impressive human being that I have ever known, and my love and respect for both him and his wife, Joyce, cannot be calculated in mere human measurements.  I am proud of him, his work, and his commitment, and I know that the seeds that he has planted in Breast Cancer Research will go on to save thousands of lives someday.

Ironically, it was healthcare that took his life.  No one can ever replace Jack Mutha; his knowledge of the system, his guts and determination, his singular efforts to help a district that had been devastated by natural disaster, his kindness and great personality.  No one.  So, today, I write with great sadness that our great friend is gone, but at the same time, I vow that his name, his contributions to humanity, and his memory will never be gone.

Look at wriwindber.org or windbercare.com, and see what Jack Murtha built.  We loved you, Jack.

Healthcare Reform or Health Insurance Reform?

September 12th, 2009

President Obama’s eloquent address to Congress on his proposed changes to the U.S. healthcare system was fraught with ambiguous issues that will certainly provide a feeding frenzy for opponents. When the President stated that “This country’s failure to meet this challenge year after year, decade after decade has lead us to a breaking point,” he was exactly correct. We are the only industrialized nation in the world that has not addressed this challenge.

There are too many people without coverage of any kind who use emergency rooms as their primary care physician. Unfortunately, the difference in cost between a visit to your emergency room vs. a visit to a physician’s office is exponentially different.

Q-tipsIf we, as a country, do not believe that we are paying for these patients in some real way, then we are not cognizant of how the system is being contorted in order to allow hospitals to remain solvent. When you hear individuals complain about the high cost of Q-tips in a hospital, it’s because they are being priced to help cover the losses being incurred from the millions of uninsured.

So, what is it that we must address? When the President said, “Under the present system, due to job loss or illness, many could lose their coverage,” he was totally accurate. Unfortunately, millions of Americans have come to experience this phenomena first hand, and could lose their homes, investments, and their possessions because they have no insurance. So, as President Obama appropriately questioned, “What is the best solution that is both moral and practical and best reflects the ideals and freedoms upon which our country is based?” He was clear to explain that implementation of either a Canadian-style system or an individual based system would both be a radical shift, and each represents extreme positions that would completely change the way healthcare is delivered in this country.

barack-obama-health

So, if we eliminate the extremes and concentrate on compromise, we begin to see signs of conciliation that might be embraced. For example, there appear to be very few people who would argue against providing “more security and stability to those who have health insurance.” The majority of Americans also seem to embrace the concept of providing some type of coverage for those who currently have none.

What the President and most of our elected representatives are avoiding in the conversation is talk about quality, safety, end of life care, wellness, prevention and outcome data.

Nash_inlay
David B. Nash, MD

I had the fortuitous opportunity to hear David B. Nash, MD, MBA and Dean of the Jefferson School of Population Health’s presentation on Population Health. At the risk of misquoting Dr. Nash, I will carefully attempt to touch on only a few of the facts, figures, and points that he made in his analysis of what it would take to fix the system.

One of the most profound points that Dr. Nash made was in seeking the answer to the following question:

What percent of adult Americans do all the following?

  1. Exercise 20 minutes 3x a week
  2. Don’t smoke
  3. Eat fruits and vegetables regularly
  4. Wear seatbelts regularly
  5. Are at appropriate BMI (Body Mass Index)

The answer surprised even this writer. Only 3% of American adults are following all five of these wellness and prevention guidelines, and 40% of deaths are the result of smoking, unhealthy diet, physical inactivity and alcohol use. In an interesting analysis of the President’s healthcare speech, finance author  J. André Weisbrod writes: “I see it as a Darwin Awards kind of issue. You are free to be stupid and I am free to not have to pay for your stupidity…”

Bundled payments, end-of-life counseling, evidence-based medicine, an emphasis on quality and systemic approaches to ensuring safety are only a few of the myriad suggestions recommended in Dr. Nash’s presentation.  Bottom line? The third rail of politics is limiting honest, open dialogue regarding reform, and time is running out.

In My Opinion, It’s Tinker Bell Dust!

June 4th, 2009

Everyone has seen the media reports on the $1.7 trillion of cost cuts being projected by health care leaders over the next decade, but does anyone really believe it? According to this group, the premises embraced that will lead to these cuts are based upon improving care for chronic diseases, reducing unnecessary care, and streamlining administrative costs. Included in this wish/promise list are cutbacks, commitments to permit fewer Caesarean sections, better back pain management, less use of antibiotics and a reduction in diagnostic imaging tests.

U.S. President Obama meets with health care executives at the White House on May 11 (Pete Souza)
U.S. President Barack Obama meets with healthcare executives at the White House on May 11 (Photo credit: Pete Souza)

The groups involved have made commitments to try to reduce medical errors, begin the use of common insurance forms, to initiate a reduction in patient re-admissions, to improve the efficiency of drug development, and to promote the expansion of in-home care. (The majority of the preceding information comes from an article by Janet Adamy entitled “Health Groups Detail Plans to Reduce Costs,” in the June 2nd Wall Street Journal. )

If you are reading this, and you are a health care professional, it may be reminiscent of listening to your three hundred fifty pound, five foot tall neighbor describing how he is going to get back into his size 34 Levi’s. It also reminds me of a conversation that I had about 22 years ago when a hospital vice president said to me, “We are going to begin putting  computers into the hospital, and they will reduce costs, lower the need for staff, and contribute to much higher efficiencies.” What part of this equation didn’t happen? Even at the little hospital from which I just retired, we went from two, to three, to four… to about a dozen experts in every aspect of computer technology, and IT has been a dominant part of the capital budget for over a dozen years. So, what’s wrong with this scenario? As the equipment became more sophisticated, more well trained experts were needed. The higher the cost of the equipment, the greater the overhead required for maintenance, and the larger the demand became for everyone in the facility to be computerized.

It is not my intention to be a complete cynic, but isn’t it true that tens of thousands of people who have become used to a certain standard of living will be controlling these cuts? If we could have improved chronic disease care, why wouldn’t we have done that already? It’s all about the reimbursement system. We are still reimbursing for sickness rather than wellness. How do we line up the incentives so that statements like “we will permit fewer Caesarean sections or we will initiate better back pain management” will not ring hollow as words directed toward placating the new President? Nowhere in the equation is there any reference to initiating tort reform. As long as doctors, hospitals, and other clinicians have to practice defensive medicine, we will not be able to reduce tests. We will not be able to reduce unnecessary costs.

pixie-dustl1Yes, of course a reduction in medical errors would be great. So would common insurance forms, and fewer re-admissions. I’m sure we will see our peers work diligently toward those ends, but, unless or until incentives are aligned, the system will continue to roll along pretty much as is. I’m not sure why the President hasn’t called me yet. Maybe it’s because he knows how I feel about tort reform. Maybe it’s because he knows that I’ll say that the list articulated in the opening paragraph is filled with smoke, or maybe it’s because, like all government-touted initiatives, it’s not supposed to actually come completely into play until two and possibly six years after he leaves office. That philosophy certainly didn’t work for our former Presidents, and, unless someone gets really serious about changing the way healthcare is delivered in the United States, these pledges will be just what they appear to be, “Tinker Bell dust!”

A Different Kind of Saturday Night Fever for Some

April 25th, 2009

In August 2006, I was inspired to write a disconcerting blog post regarding the potential outbreak of the avian flu.  It was a disturbing post not only because it contained potentially negative statistical mortality outcomes on an international basis, but also because, as a relative insider, it was clear to me that we were not ready at all for this type of pandemic.

Churchgoers in Mexico City | Photo Credit: AP

Churchgoers in Mexico City Sunday | Photo Credit: AP

With new grandbaby Zoey safely here on earth less than a week ago as the youngest member of the family,  today’s opening story of a potential influenza pandemic made my blood run cold.  The rate and speed with which this type of pandemic could overtake our world is almost immeasurable, and, having flown from San Francisco, to San Diego, to Richmond to Pittsburgh in the last week, it was clear that,  if I had been a carrier, literally hundreds of people could have been infected simply by my presence.

Those who are realists or pragmatists will simply say, it is Mother Nature’s way of “thinning the herd,” but herd thinning in our case is something that is uncomfortable, especially in such a random way.  During the pandemic of 1917/1918, mass graves were dug not ten miles from my home, and undertakers were not even permitted to prepare the bodies for burial.

My previous blog focused on the avian virus, but this morphed virus that appeared in Mexico, not China, not the Far East as originally predicted, is a combination of human, swine, and avian viruses.  No one has ever seen or found cures for this type of radical new flu yet.


View H1N1 Swine Flu in a larger map

The World Health Organization came out today with only a level three warning, but when they described this level of warning, they indicated that it was simply because they did not yet have enough information to take it to level six.  There are confirmed cases in San Antonio, San Diego, and one report even indicated that New York had two cases, and over 68 are known dead in Mexico.  Fever, sore throat, coughing, nausea, body aches, headaches, chills and fever are some of the symptoms presenting with this flu that can result in pneumonia and respiratory failure.

Mexico City closed it schools on Friday, and more such initiatives are expected as this powerful force of nature begins to take on a life of its own.

How can you avoid getting this flu?  Wash your hands, stay away from infected people, cover your nose and mouth.

In children, emergency warning signs that need urgent medical attention include:

  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting

Let’s all hope that this never gets any worse than it did in the 1976/77 cycle when only a very few people died at that time…mortality rate was low with swine, but this is swine, avian and  human combination.

Tonight, say a little prayer.

Also by Nick Jacobs:

Are We Ready for the Avian Flu?
Hospital Impact
August 8th, 2006