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Meditation and Neuroplasticity

August 27th, 2023

           Back in the 1960s or as the Brits nicknamed it, The Swinging Sixties, lots went on that some of us would prefer to remember as interesting, youthful experiences that created lifetime memories.  Besides the British music invasion, drugs became popular and commonplace among the hippie generation, but I missed out on all of that because my education took place at a conservative school.

          Being a traditional student heading toward a teaching career also meant that my career would be significantly jeopardized had I not stayed within the parameters of expected behavior. Unfortunately, the movie, Animal House, was not a realistic depiction of my college experience.

          One phrase that did catch on during that liberal era of the late 60s and early 70s was “Don’t bother him, he’s contemplating his navel.” It’s thought that it became popular in Western culture during a time when the Beatles and other luminaries were practicing transcendental meditation.            This navel-gazing phrase related to introspective thinking and mindfulness through meditation. It  implied the person in question was engaged and completely focused on their own thoughts or mental silence. If done correctly, one’s emotions often feel disconnected from the outside world.

            Since that time, numerous well-known people have found meditation to be an important part of their lives. Meditation practicing entertainers include Hugh Jackman, Ellen DeGeneres, Jerry Seinfeld, Katy Perry, and the late basketball great Kobe Bryant who practiced meditation to enhance focus and mental resilience as part of a daily training routine. Of course, there are also thought leaders like the Dalai Lama, Drs. Deepak Chopra and Dean Ornish, publisher Arianna Huffington, the entrepreneur Russell Simmons, and former NFL player Ricky Williams who are famously recognized for using these mindful practices.

            Individuals who practice meditation regularly credit the practice with positive outcomes ranging from better sleep, stress reduction, relief from both anxiety and depression, much-improved focus and concentration, enhanced self-awareness, better relationships, lower blood pressure, pain management, enhanced creativity, spiritual growth, and one of my favorites, neuroplasticity.

            Several studies have shown that practicing and playing musical instruments can significantly contribute to neuroplasticity. Music can enhance fine motor skills, auditory processing, memory and pattern recognition, multi-sensory integration, cognitive flexibility, brain connectivity, and brain reserve.

            Neuroplasticity is the underlying property of the brain that includes learning, adaptation, and recovery from injuries. It truly represents the brain’s ability to rewire itself. With that in mind, neuroplasticity contributes significantly to education, therapy, and overall cognitive health.

            If I recommended that you meditate for 10 or 20 minutes in the morning and again at night, you might snicker and suggest that not only do you not have time, but more bluntly that you also think it’s a waste of time. If I told you that by doing so you could significantly impact the creation of new neural connections that would modify your brain’s function in ways that would permit you to improve and optimize your performance while adjusting to new circumstances, you also might suggest that I move on.

            Let’s, however, look at the list of positives related to further development of neuroplasticity beginning with the fact that it will allow you to acquire new skills, knowledge, and behaviors. It also enables you to adjust, and more importantly, to adapt to changes in your environment.  It contributes significantly to more efficient memory storage, the capacity to adapt and remain functional as we age, and the ability to shift perspectives and respond to new challenges. And the list goes on and on.

            If you’re a type A, hyper-active person, meditation may provide you with a welcome relief from yourself. Find a peaceful, quiet space, force yourself to focus on the present, breathe deeply and use that breath to anchor. Acknowledge external interferences but don’t dwell on them and remember that contemplating your navel by deep breathing alone will create a natural relaxation response that is good for your health. Try it. You might like it.

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Posted in Healthcare, Hospital Blog, Hospitals, Integrative Health, Leadership, Public Health, Wellness

A Possible Solution to Local Rural Physician Shortage

February 23rd, 2023

The Association of American Medical Colleges (AAMC) projects that a physician shortage could reach a high of 124,000 by 2024. The strain this will cause will not be borne equally.

“The COVID 19 pandemic has highlighted many of the deepest disparities in health and access to health care services,” said AAMC President and CEO David Skorton, “and exposed vulnerabilities in the health care system.”

Gerald E. Harmon, president of the American Medical Association, also raised alarms about the future of U.S. health care.

 “Because it can take up to a decade to properly educate and train a physician,” Harmon said, “we need to take action now to ensure we have enough physicians to meet the needs of tomorrow.”

He added, “The health of our nation depends on it.”

This bleak scenario recently was presented to Indiana Regional Medical Center, Indiana University of Pennsylvania (IUP), and Indiana County leadership.  As a local response, it was suggested that IUP, as one of the larger state universities in Pennsylvania, should take a lead role in creating a rural family practice medical school. Such an initiative would be a game-changer for not only the university but also for the entire Commonwealth.

Over the past ten years, universities throughout the United States have seen declines in student enrollment. These decreases have led to painful programming cuts as well as other downsizing initiatives. Still, most of the exceptionally strong programs still thriving at IUP are heavily directed toward STEM (Science Technology, Engineering, and Math). These programs have had continued robust enrollment numbers in healthcare and science-oriented degrees.

In December, IUP President Dr Michael Driscoll confirmed that the IUP Board of Trustees has approved exploration of this medical school initiative. The caveat? Funding will be a major factor in determining a “go or no go” decision.

The financial challenge may be exacerbated by Duquesne University’s decision to build a College of Oseopathic Medicine, which has garnered support from some Pittsburgh-based granting organizations. This might limit those organizations’ enthusiasm or capacity for an IUP medical school. That would be unfortunate because, although Duquesne University’s medical school is a positive addition to the area, the reality is that urban-trained physicians tend to remain in urban areas, and city training and resources are not always ideally suited for a rural setting.

Therefore, the most critical major potential source of support for this project is the Pennsylvania State System of Higher Education (PASSHE). Working with state legislators,  PASSHE could muster resources that would help create a Western Pennsylvania Medical School based at IUP.

Moreover, each year entry-level seats could be held for students from each of the 14 state universities that come under the PASSHE umbrella: West Chester, Slippery Rock, Shippensburg, Millersville, Mansfield, Lock Haven, Kutztown, Edinboro, East Stroudsburg, Clarion, Cheyney, California, Bloomsburg, and IUP

Numerous potential critical players in this scenario. Including private and community foundations, have not yet fully realized the extent to which a school like this would improve our region. The primary question they should ask is “How do we fill the dozens of physician openings we already have in this area?”

Without a plan to address this challenge, the number of openings will only grow.

Another regional asset that could provide significant depth and impact to this medical school is the Chan Soon-Shiong Institute for Molecular Medicine. CSSI currently houses not only 500,000 donated tissues samples for research, but also has on staff talented PhDs in genomics, informatics, and tissue banking who could contribute extensively to the educational research needed to support a medical school.

Finally, consider the cost we all bear when hiring physicians locally. Because the competition is intense, we must employ recruiters. Other expenses including advertising for the position; fees to locum tenens (substitute docs) during the hiring process; candidate interview costs; time spent on interviewing, onboarding and credentialing the doctor; candidate relocation costs; primary care physician salary and benefits, and incidentals. This list, according to the UNC Solutions blog, totals about $341,000.

Being able to locally source and train physicians from 30-plus graduates a year over a ten-year period would pay for itself three-fold.

We desperately need physicians in our region. We need this medical school. We need to support IUP in this initiative to help give students from Pennsylvania an opportunity to go to medical school in our region because that will ultimately benefit everyone in our region.

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Posted in Healthcare, Healthcare Marketing, Hospital, Hospital Administration, Hospital Blog, Hospitals, Integrative Health, Leadership, Medicaid, Medicare, Medicine, Public Health

COVID VACCINE CHALLENGE

September 23rd, 2020

COVID vaccine challenge
NICK JACOBS
Published Tue Sep 22, 2020 8:48 PM EDT

Besides wearing a mask, which we’ve known since 77AD protects us from the plague, the other best opportunity for stopping the progress of COVID-19 is through the discovery of an effective vaccine.

Rather than getting COVID via the natural infection pathway, a vaccine could produce herd immunity without harming or potentially killing people.

Thousands of Americans seem to have chosen the risk-it-all route as they go without masks, and attend large, unprotected social events and rallies.

Unfortunately, not unlike playing Russian Roulette with your loved ones and friends, this route is filled with potential suffering and an almost complete lack of predictability.

In an article in Time magazine, Alice Parks recounts how it was Edward Jenner who, in 1790, discovered that infecting people with small amounts of smallpox virus could produce immunity. Today, there are more than 100 vaccines being developed in an attempt to provide us with immunity from SARS COVID-19, and across the world, billions of dollars are being pumped into this effort.

There are numerous challenges to be faced in this effort including those of manufacturing and then distributing the vaccine in a humanitarian manner.

The good news is, regardless of political pressure, the major vaccine makers have already pledged to conduct complete safety studies before submitting their vaccines to international regulators. The not-so-good news is HIV/AIDS has been around for nearly 40 years and an effective vaccine is still not available.

Approximately 132,000,000 people in the United States are living with pre-existing health conditions. Thus, the challenge becomes who gets a vaccine and when. These decisions may literally produce a life and death lottery game.

The Time article cited researchers from CUNY’s School of Public Health’s computer simulation that calculated if 75 percent of the world’s population were immunized, to control the ongoing pandemic, vaccines would need to be about 70 percent effective. Any of us who are regular recipients of the annual flu vaccine know that some years it’s effective and some years it’s not.

Consequently, we will be faced with arguments over the world’s current state of nationalism combined with America’s anti-vaccination movement. Plus we still have the challenges of discovery, manufacturing and actual implementation.

Oh, and there’s one more speed bump in that the United States has chosen not to join the other 172 countries of the world in the COVAX initiative on international unity for epidemic preparedness innovations originated by the World Health Organization.

If we prioritize our high-risk populations which include health care employees, first-responders, people with pre-existing conditions, and the elderly living in group environments, and then add critical workers such as teachers, food growers and service providers, people in group homes and the incarcerated, we finally end up getting the vaccines to our most precious hope for the future, young adults and children.

In short, none of this is going to be easy. One batch of improperly manufactured polio vaccine in the 1950s resulted in thousands of children being accidentally infected with polio. and because there are so many variations of vaccines being developed, there is also the risk of triggering excessive immune responses that could end up being more harmful than helpful.

Finally, and this is one more example of the broken public health system in this country, any plans for massive immunizations will be dependent upon public-health initiatives that are appropriately supported and resourced.

Keep in mind many of our states have been seeking leadership, supplies, direction, and funding from the federal government since March. At about $35 per dose and in most cases the vaccines require two doses, herd immunity is not likely to be achieved either quickly or in a cost-effective manner.

One thing is clear, however. An effective plan needs to be implemented to stop this out of control COVID transmission and to produce a clear pathway to normalcy. We need to get back to normal through a national strategy.

 

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Posted in Current Affairs, Epidemics, Family, Future, Healthcare, Hospital, Hospital Administration, Hospitals, Immunization, Leadership, Medicare, Medicine, Public Health, Uncategorized, workplace

Integrative Medicine

July 20th, 2018
Having served in healthcare senior leadership for over two decades, my tolerance level for various “healthcare norms,” that revolved around the sometimes-insensitive treatment and care of patients and their families had reached the breaking point.  Consequently, at the end of my 40th decade when I became a hospital CEO, I arrived in the position with a quiver full of change arrows that were sure to shake up the status quo, and it did.Because I had entered the healthcare field some twenty years after most of my senior leadership peers, my life experiences were much more varied and non-traditional. For ten years, I had been a band and orchestra director in both City and Urban school districts.  After that, I ran what became a successful arts organization in a rural area, and finally, served as the CEO of a convention and visitors bureau.  It was during those years that I went back to school for another Masters degree in public management/health systems management.

When this CEO opportunity presented itself, I realized how each and every one of my life experiences could help me run a hospital, but not just any hospital. It was my vision to create a hospital that embraced all modalities used in integrative medicine with the ambiance of a fine hotel and the amenities of a health spa.  We carefully scrutinized and then credentialed practitioners specializing in massage therapy, integrative nutritional counseling, acupuncture, osteopathic manipulation, pet and music therapy, reiki, and spirituality to name a few. These practices intermixed with traditional Western medicine became our new norm.

As the traditionalists who are reading this article begin to shake and scream about a lack of medical evidence, I can only point to the 19,000 papers written supporting the efficacy of acupuncture and the thousands of other medical papers written about the healing powers of music, massage, and such. In that same spirit, there is also the fact that the head is connected to the body and provides a mind-body connection that doesn’t fit neatly into the scientific “heal to the pill” mentality of our current system.As a non-clinician, non-scientist, it was easy for me to believe in things like “the Placebo effect” as well.  It really didn’t matter to me why people got better. It was our goal to create a healing environment where people would not be immersed in fear and trepidation, where their loved ones could comfortably stay with them, and where unnecessary paging, and middle of the night prodding, and wake-ups were avoided as much as humanly possible.

It seemed to me that by training our employees at Disney University, allowing them to learn from the Ritz Carlton, and exposing them to sensitivity and emotional quotient training, we could create a healing environment. Because my philosophy was that you could not change the human condition, but you could change the condition under which humans worked, we also embraced an anti-bullying environment where employees were cherished and recognized for their contributions to the welfare of our patients.

How did implementing all of these ideas change healthcare in our little slice of Camelot?  Our infection rate dropped to below 1% and stayed there for eleven years. (The national average is nine percent.) And I know we weren’t washing our hands more than they were at other hospitals. Of our peer hospitals, we had the lowest readmission rates, restraint rates, and lengths of stay, and when the naysayers saw these numbers, they said it was because we were not a large hospital. My belief was that we successfully had created a healing environment where our patient’s white blood cells were actually able to function to fight off infection.  We were transparent, nurturing, and caring. We were not a “Healthcare FACTORY” where the patients became widgets in an Industrial Revolution model of care.

Music was always used in healing ceremonies by an indigenous man. Acupuncture has been deemed effective for over 5000 years. Massage makes you feel better, and sometimes your spine gets out of alignment and needs to be corrected. This is neither rocket science nor brain surgery. It’s about love, kindness, and caring, wrapped up in good Western medicine. Oh, and one more thing.  Even with a palliative care unit, a hospice, we had the lowest death rate of our peer hospitals. I had always wanted to put up a billboard that said, “Come to our hospital . . . you’ll die less often.”
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Posted in Healthcare, Hospital Administration, Hospital Blog, Integrative Health, Leadership, Public Health, Uncategorized

Pittsburgh Post Gazette. Op-Ed

December 11th, 2017

Nick Jacobs, among his other affiliations, is an officer of the Integrative Health Policy Consortium, which represents more than 600,000 IHM practitioners; president of the Clinical and Translational Genome Research Institute, which he founded; and a consultant to the Department of Defense in breast cancer research.

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Pennsylvanians received good news recently when the Pennsylvania Health Care Cost Containment Council reported that hospital readmissions and mortality rates continue falling locally and statewide.

The report shows these rates declining for a number of common types of treatments. It gives much of the credit to a “commitment of PA hospitals to provide quality care” and to the Affordable Care Act, which ties reimbursements to that quality care. This, in turn, encourages health care facilities to strive for improved mortality rates because doing so helps keep government funds flowing through their doors.

Regardless of the motivation, this is good news. But it’s not good enough.The mortality rate could be improved even more dramatically if more healthcare administrators and physicians would introduce integrative health and medicine practices into their services.

Integrative health and medicine (IHM), as defined by the American Board of Integrative Medicine and the Academic Consortium for Integrative Medicine & Health, recognizes the importance of the relationship between practitioner and patient. IHM focuses on the whole person, is evidenced-based and employs a wide range of appropriate therapies, healthcare professionals and disciplines to achieve optimal health and healing.

Integrative health practice includes treatments and therapies such as acupuncture; natural products; deep breathing; Tai chi and Qi Gong; meditation; massage; special anti-inflammatory diets; progressive relaxation; journaling; biofeedback; pet, music and dance therapies; hypnosis and guided imagery. When provided by a licensed or certified health care professional, IHM provides numerous benefits. It can decrease chronic pain, post-operative pain and the need for medications. It can improve patient satisfaction and shorten hospital stays. It can lower mortality rates. IHM methods also are relatively inexpensive.

Many places, including the Cleveland Clinic, have reported cost savings per patient, while also seeing reductions in patient anxiety, pain, and medications. During my tenure as CEO at Windber (Pa.) Medical Center, I worked with physicians, staff, and volunteers to create a healing environment by embracing all methods and therapies used in integrative medicine and combining them with the ambiance of a fine hotel and the amenities of a health spa. We carefully scrutinized and credentialed practitioners specializing in services such as aroma and massage therapy, integrative nutritional counseling, acupuncture, chiropractic manipulation, pet and music therapy, reiki and spirituality, to name a few.

In short, a healing environment permeated our facility.

Yes, we had our share of naysayers and opposition among physicians, allied health care professionals and others, but over time our infection rate dropped below 1 percent and stayed there for a decade. (The national average is 9 percent.) Of our peer hospitals, we had the lowest readmission rates, restraint rates and lengths of stay. Even with a palliative care unit to care for dying patients and their families, we had the lowest death rate among our peer hospitals.

For those who would say it was all coincidence because Windber is a small hospital, I would direct them to the 19,000 papers written supporting the efficacy of acupuncture alone, and then to the thousands of papers written about the healing power of music, massage and so many other treatments dismissed all too readily by traditional practitioners.

IHM practices are not at odds with traditional medical practices; rather, they enhance them. Yet in many hospitals and physicians’ offices, they are ignored, discouraged, even ridiculed. Such negative reactions result from ignorance, misinformation, prejudice and even greed — pharmaceutical companies, for instance, see no profit in promoting most IHM treatments, and some medical practices might earn less if, instead of scheduling patients for costly treatments or surgeries, they instead treated patients with acupuncture, spinal manipulation, massage therapy or even mindfulness.

Resistance to IHM is breaking down, but this shift in attitude needs to be accelerated. If you travel to Europe or Asia, you will see integrative medicine practices thriving because their value is acknowledged and embraced. In America, IHM beachheads are being established in health care systems and universities, thanks to such groups as the Family Medicine Education Consortium, Integrative Health Policy Consortium and the Academy of Integrative Health and Medicine, of which I am a co-founder. The academy includes among its member’s hundreds of licensed physicians who have successfully merged IHM with traditional medical practices.

Much remains to be done to more broadly spread the healing benefits of IHM, which will happen only when more patients take more responsibility for their health and demand IHM treatments, more physicians research and adopt them, and more insurance companies pay for them. When that day comes, there will be a lot more good news about mortality rates and other measures of medical care for Pennsylvanians and people all over the country to celebrate.

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Posted in Boomers, Children, Current Affairs, Diet, Family, Future, Healthcare, Hospital, Hospital Administration, Hospitals, Integrative Health, Leadership, Medicare, Military Medicine, Nutrition, Public Health

Four ways to improve access to Integrative Medicine Practices

November 13th, 2017

Licensure, regulation, medical evidence, and funding are four sure ways to speed up the process needed to allow integrative medicine practices to be embraced. If we begin with the assumption that money has a lot to do with everything medical in the United States, then we must look at the winners and losers and the WIFM’s?  (What’s in it for me?)  If you’re a practicing surgeon, and acupuncture or chiropractic care results in the patient not needing a surgery, that can be a financial threat to you. Let’s be fair, that probably doesn’t happen that often, but sometimes it does, and when it does, that’s money lost to your practice.

 

If you’ve spent four years in undergraduate school, four years in medical school, four or five years in a residency, and your educational debts amount to hundreds of thousands of dollars, the last thing you need is a clinical study demonstrating through medical evidence that thousands of patients won’t need your services, and your skills will become exponentially less in the demand.

 

On the other hand, if, like ophthalmologists who surround their practices with optometrists, orthopods did the same with chiropractors and acupuncturists, could that not create a steady stream of referrals for their practices?

 

Let’s face it, there is a role for all three of those professions, and there are skill levels in every profession and duties relegated to each that both overlap and potentially conflict. So, wouldn’t it be better to have the three practice as a team of professionals working together to help you?

 

“There’s not enough medical evidence”  has been the hue and cry of the uninformed for years. Ironically, once traditional medical evidence is thoroughly interrogated, it’s not unusual to find numerous flaws in even the most accepted medical practices. We’ve seen slanted reporting in even the furthermost prestigious journals where various drugs, procedures, and devices have been proven to be ineffective years later.

 

There are over 19,000 papers that have been written and submitted to medical journals in which acupuncture has been endorsed and proven to be effective, but there never seems to be enough medical evidence for the naysayers.

 

Credentialing is a very challenging area as well.  Not unlike the highly skilled surgeon with her medical degrees from the Sorbonne in Paris that is not permitted to practice medicine in the United States, there are sometimes economic and political reasons to limit the number of practitioners allowed in the United States. In my experience, by creating a hospital-based credentials committee that specializes in integrative medicine, the nay-sayers ability to discredit highly trained practitioners with different skills will become more limited.

 

Regulation may be the most difficult challenge in this discussion because, as we have come to know very well, political power can come from political contributions, and when it comes to regulations, those with the gold have more clout than those without. That is not to say that our politicians can be encouraged to be more flexible because they can.  All it takes is for hundreds of constituents to stand in front of a Congressional office to encourage change to occur.

 

So, what are we really dealing with here?  In 1910, the AMA put out a request for proposal to determine what should be taught in the medical schools of Canada and the United States and no physician would accept that assignment.  Consequently, a Ph.D., Abraham Flexner, did, and his approach was to eliminate everything that wasn’t already proven science.  From there we have evolved to a “heal to the pill” mentality where words like root cause and placebo have been dropped from the vernacular.

 

Finally, funding is the key. It has been proven time and again that integrative medicine practices can reduce health care costs exponentially. With that in mind, every bill that comes out of Washington ignores that fact, and funding for many of these well-documented practices is not present. There were over 5000 codes in the Affordable Care Act that were intended to fund such practices as acupuncture, but when the FAQ initially was released, it said, in essence, “Don’t worry about paying these codes.”

 

If you go almost anywhere in Europe and Asia and you will see integrative practitioners thriving because their value is acknowledged and embraced. Of course, we’re not professing that a massage therapist performs open heart surgery, but we do know that Integrative medicine can help to reduce costs across the board.

 

There are many good things that can come from Integrative medicine. You just need to be open-minded.

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Posted in Boomers, Communication, Current Affairs, Disability, Energy, Family, Future, Healthcare, Hospital, Hospital Administration, Hospital Blog, Hospitals, inspiration, Integrative Health, Leadership, Medicare, Partnerships, patient-centered care, Public Health, Public Policy, Science, Sports, Systems Medicine, Uncategorized

Random Thoughts About Things That Confuse ME

October 12th, 2015
 People have often asked me, “Where were you when Kennedy was shot?” In fact, I was in gym class. Six years after that, on April 4, 1968, I was in Pittsburgh when Martin Luther King was shot. I was back again in Pittsburgh on June 5, 1968 when Bobby Kennedy was killed. Finally, as a young teacher in Johnstown, on May 4, 1970, four students were killed and nine more were wounded by the Ohio National Guard at Kent State University. Between the riots and civil unrest that followed these events, I was pretty sure that our world was spinning out of control, and I had just graduated from college.

It was during that time of the Vietnam War, the escalation of the Cold War, the race riots and political rallies, that a chasm began to appear between those men who still had crew cuts and white socks, and conservative hippie kids like me with my wire-frame glasses, sideburns, and mustache.

In fact, at my very first job interview, the department head, a man who was still firmly planted in the 50’s, asked me if because I was my college class president, I’d ever been involved in a campus riot. Meanwhile, there had only ever been one small demonstration at my university, and I wasn’t even on campus when it happened. But his question offended me so much that I replied, “Only the one.” Needless to say that job went to someone with a crew cut and white socks.

Throughout my life I held profound optimism that because we were a country that embraced education, espoused Judeo-Christian love, and incorporated tolerance and diversity in our stated beliefs, our philosophies would prevail and the world would become a better place. Wrong.

Because I spend much of my time on the road, Facebook is often the way I keep in touch with my virtual and real families. It keeps me apprised of changes, challenges, and the daily activities of those I both care about and want to be connected to through this last quarter of my life.

Of course, Facebook is filled with puppies, kittens, babies, and opinions, and many of those opinions remind me of the Archie Bunker character who so famously dominated the airwaves in the All in the Family sitcom of the 1970’s. That series, along with MASH and The Jefferson’s attempted to challenge the way Americans dealt with race, war, and general closed-minded prejudices.

It makes me sad when my friends, people that I love and most often respect, write posts that are passionately in support of social beliefs that embrace continued gun violence, racial prejudice, twisted religious beliefs, intolerance, greed and hatred. It would be easy to unfriend them, to write them off, and forget about them, but the teacher in me wants to try to educate them and to help them find their way. That never works because most of them are Archie Bunker’s age and older. All I’m asking is for tolerance, the embracing of diversity, and a non-violent philosophy of loving others. It’s the Golden Rule. Unfortunately, it’s often the Rule of Gold that seems to prevail.

I can tell you where I was on April 20, 1999, April 6, 2007, December 14, 2012: Columbine, Virginia Tech, and Sandyhook. Unfortunately, I can’t even tell you the name of the school or how many kids were killed on January 4, September 14, September 30 of this year. October 1, 2015, however, became more tangible because the hospital that cared for the wounded in Oregon is run by a friend, and Troy Polamalu’s cousin Brandon, a teacher at Umpqua Community College, was on campus at the time of the shooting.

Minimally, as a country, can’t we invest in behavioral health initiatives and enforce background checks.

Meathead really was the voice of reason on so many levels

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Posted in Boomers, Children, Healthcare, inspiration, Leadership, Public Health, Public Policy, Uncategorized

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.

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Posted in Healthcare, Partnerships, Public Health

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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?

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Posted in Public Health, Travel

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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.”

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