Updated 8:07 p.m. | For years, many health care experts, medical professionals and politicians have been touting the benefits of electronic health records (EHRs . They say EHRs will not only improve quality and efficiency but also reduce costs by tens of billions of dollars annually to a system that too often orders unnecessary or duplicate tests and procedures.
But
a new study out Monday in Health Affairs challenges that premise and says that doctors may actually order more testing in some cases -- potentially adding to costs.
The findings come as the Obama administration has included new assistance to speed along the adoption of EHRs, which are a part of the Affordable Care Act reforms. And incentive payments were made available to hospitals and health professionals as part of the stimulus law.
The study, which was done by Cambridge Health Alliance's Danny McCormick and David Bor and CUNY School of Public Health's Stephanie Woolhandler and David Himmelstein, found that office-based doctors were more likely to order an imaging test if they had access to EHRs. The authors studied records of more than 28,700 patient visits to nearly 1,200 doctors. Physicians who could look at EHRs ordered imaging 18 percent of the time, compared to about 13 percent of the time with doctors who couldn't use EHRs.
We spoke with McCormick, the lead author of the study. An edited conversation is below.
Q: What were the most important findings of this study?
McCormick: I think the most important finding is that in contrast to what has sort of become common wisdom, which is that health IT is likely to decrease overall health care costs through the reduction in test ordering, we find in outpatient practice across the county in a nationally representative sample, there was no decrease in outpatient practices that have the capacity to view prior imaging studies or laboratory studies. And in fact, it appears that capacity actually drove up test ordering both for imaging and for laboratory studies.
Q: For years people in health policy have stated that EHRs would not only decrease testing but would save the country money on health care. Why do you think you found opposite results?
McCormick: I think that those conclusions or that idea was based on a few small studies that were done at cutting-edge hospitals years ago that in fact showed that when you have highly skilled health IT departments developing customized health IT systems for their own purposes -- understanding the needs of their institutions and carefully tailoring the health IT systems to their needs -- that you actually could decrease both redundant test ordering and unnecessary test ordering. Unfortunately, that really is the only data that exists on the question. No one has actually looked into actual practice -- whether those same findings were generalizable. This study finds that in fact it drives up costs.
We speculate that there are a couple of things: the two main mechanisms that people point to for decreasing lab testing and image testing ordering. One is that if computers could talk with each other in an effective way, you could decrease test ordering. If you could see a test that was done yesterday at another hospital, for example, you wouldn't necessarily have to order it again today. So sort of redundant test ordering.
The second is that computers could be devised so that they can help doctors make better decisions about who actually needs a radiology test, for example, in a particular situation. I think what we're seeing is that both of those conditions don't really exist in current-day outpatient medical practices in the U.S. That is, we don't have good interoperability -- the ability for computers to communicate -- and we may not have adequate decision aids that help doctors make those better decisions about who actually needs a test. Even though in idealized settings, that may work, in practice -- where health IT systems are often selected with billing features as the predominant criteria -- it may just be that the decisions aids are not adequate. They don't work well enough in general practice to decrease test ordering.
Q: What more do we understand about the reasons for this?
McCormick: We weren't able to study the motivation of physicians in this study. What may be happening is that if you make something easier to do, people will do it more often. What we think may be happening is that if physicians have the electronic ability to view test results and imagining results, it may lower the barrier to ordering a test because you know you can retrieve the test results the next day at your computer screen with certainty and without hassle. In contrast, physicians who don't have that ability often face the onerous task of chasing down the laboratory imaging tests that they order.
Frequently, it's not uncommon that if you don't have computerized way of doing the images, you may have to call a radiology facility the next day and try and track that result down. And they fax it over on paper that you can't really read because there are lines all over it -- that kind of thing. And you may have another call back to the facility or you may have to put somebody in your office on the case to retrieve those results. We think that it might make it slightly easier in borderline cases.
We don't think this phenomenon would influence decisions where clearly a patient needed an MRI or clearly they didn't. It's really in those gray-zone patients, where there's a moment of contemplating whether to get a test or an imaging study.
Q: What will the impact of this study have on those doctors who are wondering whether they should go to the effort to computerize patients medical records?
McCormick: I think it's important to point out that the conclusions of this study really aren't about the value of health IT overall. We really address one dimension of the purported benefits of health IT, and that's costs. It doesn't address quality or efficiency at all. There may be a lot of reasons from a quality point of view or an efficiency point of view that people would want to get health IT. And in fact, if you asked me as a doctor if I would give up my fairly sophisticated health information technology system, which I use every day and was just on a second ago, I would say no. I see the value of it.
However, what this study addresses is the cost piece. With regard to cost, it also doesn't say that in no system at no time with no amount of effort, a system couldn't be devised that would lower imaging (ordering . What it does say is that in current practice in the U.S. -- a sort of national snapshot based on more than 28,000 visits -- it does not seem to decrease test ordering or cost.
I think that the biggest implication is the national health policy implication. A lot of the discussion that led up to passage of the HITECH Act, the historic federal investment in health information technology that was passed in 2009, was predicated on the assumption that there would be substantial cost savings to the U.S. health care system. I think these results have most implications for people making those claims and should raise the question about whether that's actually correct and whether future investments in health IT are appropriately framed. That is to say, do they take into consideration the lack of evidence that costs savings will be realized? That may or may not influence whether the federal government makes investments in health IT. Again, it may be appropriate because of improvements in quality.
Q: What do you think this study says about the role IT may play in saving money on overall health care? Does it have the potential to throw cold water on this whole move to get the entire country on board with IT?
McCormick: I think it has implications on several levels, and I think the biggest one is the one I mentioned, which is the U.S. health care system costs. I think it's become common wisdom that health IT will substantially decrease those costs. I think that the study raises a substantial concern that may not come to pass. I think that if we figure that out, we can better align future federal investments in health IT or in other things with our national health priorities. And presumably they include coming up with a way of saving costs. If this may not be it, than it means that we need to consider alternatives that may be more affective.
I think there are some implications, to go backward, for health IT developers and for physicians. I think that those implications are that we need to make sure that health IT systems that are being developed actually perform well and are driving by clinical needs as opposed to billing needs or both.
And then physicians also will need help in selecting among the wide range of products that are out there, and (they will need help implementing (the systems . Most physicians now in practice are incredibly busy taking care of patients and have not been trained to implement health IT -- how to gear their practice, how to fit it into health IT systems in such a way that they're efficient, effective and decrease test orders. So there are lots of different steps I think that will need to be focused on, but I think what the study is saying is that, as currently implemented, it doesn't appear to be working to produce lower costs.
We also asked for a short response from Dr. David Blumenthal, who was the national coordinator for health information technology at the Department of Health and Human Services for the Obama administration from 2009-2011.
Blumenthal: This is one of many, many studies, and the studies are overwhelmingly supportive of cost-reductions by using electronic health records. Anytime you see anything that is complicated like this (the implementation of EHR throughout the system , some studies will be positive, some will be negative.
But if you look at the total review of literature that was done a year ago, it puts it into context: 92 percent of studies were positive. I expect that if you study something 100 times, there's going to be some variation.
Second, this is really not a study of costs. This is a study of test orders. It studies results, and it's a viewing of those results, not EHR overall. EHRs have many other aspects that are not included here. It doesn't look at EHR and total health costs. It only looks at particular tests. It's possible that the increased cost from imaging may reduce costs in other ways. Ordering a particular test that's being observed may or may not increase costs. You can't really infer any major conclusions about costs from this study. And the study doesn't look at the benefits for quality of care at all. It's possible the use of tests by some of the doctors could have avoided other costs. This study has no way of assessing the overall implications of the behavior that it's finding.
here.
Tribal communities nationwide are working to fight the trend toward obesity and its resulting health consequences.
Nutritionists such as DeWilde and Miller work with tribes to educate members about proper diet and healthier lifestyles.
In 2008, the Indian Health Service - a branch of the Department of Health and Human Services -
reported almost 500 nutritionists working at the country's 561 federally recognized tribes.
Using Nutrition Assistance to Promote Healthy Foods
Some tribe nutritionists work as representatives for federal supplemental nutrition programs.
Though AI/ANs make up
1.6 percent of the U.S. population, the "Federal Food Safety Net" covers a disproportionately high percentage of this demographic. In 2010, 13 percent of the U.S. population was enrolled in the Supplemental Nutrition Assistance Program (SNAP , formerly the food stamp program, whereas 24 percent of AI/AN households received SNAP benefits.
AI/AN children, along with those who are both white and AI/AN, make up 2.8 percent of children enrolled in the National School Lunch Program, which supplements kids' school lunches. In 2008, just under 900,000 of these children were enrolled in the program, which serves the greatest number of Native Americans out of all federal nutritional assistance initiatives.
AI/AN women and children participating in the Special Supplemental Assistance for Women, Infants and Children (WIC represent 2.4 percent of program recipients.
Of the Native American children ages 2-5 participating in WIC in 2008, more than 20 percent were obese.
DeWilde is the WIC coordinator for the Port Gamble tribe, where about one sixth of the tribal residents are enrolled in the program.
The trick, she says, is persuading people to spend their vouchers on slightly more expensive but nutritious foods.
"One of my goals has been to really encourage them to use those foods stamps in healthier ways," she says. For example, "cut the soda out and the money you'll save on that you can actually put towards your produce or your healthier food options for calorie needs."
To teach people how to navigate the grocery store, DeWilde has an extensive collection of food packaging, from cereals boxes to frozen dinners to chip bags in her office that she uses to illustrate how to read nutrition labels.
The federal government last year announced plans to increase access to nutritious foods for participants of nutritional assistance programs and to promote healthy eating and active lifestyles among children through its Healthy Hunger Free Kids Act.
"These changes have the potential for enhancing the ability of USDA nutrition programs to serve children and their families in Indian Country," said the government's
2012 report on child nutrition in Indian communities.
The full impact of these changes remains to be seen.
Recalling the Traditional Diet
Stressing the fact that healthy foods such as nuts, berries, vegetables and fish (in the case of Northwestern tribes are a part of the original Native American diet is key in motivating people to shift to these more nutritious options, says Miller.
"Our traditional plants program has been really popular," she says. The program teaches tribal members about plants traditional to both the Suquamish tribe itself and other tribes across the country, such as the "Three Sisters" vegetables: corn, beans and squash. It also emphasizes indigenous Northwest plants that can be gathered in the region. The effort to return to traditional foods is a national one.
"There's a whole native food sovereignty movement that is connecting a lot of native people today through newsletters and online forums. People are having meetings," says Harjo.
"They're saying 'Let's think how our ancestors did it before we got sick and what do we do to get back there?' "
Some tribes have buffalo herds now, and are reintroducing elk into their diets, she says.DeWilde says she uses the traditional diet as a motivator for why people should eat more healthfully.
"I just want to emphasize to Native Americans to know that in their past they used to eat off the land. When I bring that into the discussion there seems to be a better acceptance of 'Yes, it is true that we did eat a certain way back then and that our lifestyles have changed and as a result of it we're getting obese and we're getting diabetes.' "
Motivation Sparks Change Another lesson DeWilde tries to instill is confidence in the positive effect of losing weight and eating more healthfully. One of her teaching tools is a pyramid-shaped rubbery yellow object with red flecks on it, about the size of a pint of liquid. This lump represents a pound of fat.
"When people come to me and say 'I only lost a pound!' I say 'Well look how much a pound is!'" She explains.
Last year, the Port Gamble health services staff helped organize a community weight loss challenge.
"That was the big, 'Let's jump on this. Let's get this tribe healthy,' " says DeWilde, who helped mentor participants.
While many of the 100 who signed up for the 10-month challenge dropped out, DeWilde is proud of the 20 who stuck it out until the final weigh-in.
And she says the competition sparked an interest in weight loss among other tribal members. This year more than 15 people came together and started their own challenge, pooling some money together for a prize for the winner.
The Trickle-Up Effect: Starting from Early Childhood
Because trends toward obesity start at a young age among Native Americans, it's important to build a foundation for a healthy future early on.
Miller teaches weekly lessons at the local preschool. Children bring their enthusiasm about healthy eating home to their families, she says.
"We're sending home tasting kits with the students so that there's a family involvement component," she explains. "I have a lot of parents and grandparents telling me that their kids are so excited. There are instructions for how to prepare the food and the whole family tastes them together."
Tribal leaders take nutrition and health very seriously.
The mission statement of the Suquamish tribe is to provide for "the health, education and welfare of our families," and Miller says "they take that very seriously."
The tribe has invested in 4 community gardens, as well as fresh food cooked from scratch for its high school students.
At the nearby Port Gamble reservation, one mom says the early childhood program motivated her family to start serving more fruits and veggies after her son came home raving about his fresh vegetable snacks there.
"My son won't eat canned vegetables any more," she says. "Me and my husband actually switched over to fresh produce."
And, she says, she discovered that fresh produce is actually a bargain. "You can get 3 servings of fresh produce in comparison to canned vegetables."
Drawing on Community
Another asset that will work in American Indians' favor in the movement to improve nutrition is built into the very nature of the tribe: community.
"Traditionally, Native Americans put family and community above individual needs," explains Miller. "That cohesiveness is a real strength."
Indeed DeWilde says the Port Gamble tribe's newsletter reaches about 6,000 people around the state.
"News like that, when it gets published, obviously a lot of people are going to hear about it." In the next issue? The story of a man who works at the health center who has diabetes and recently lost weight, got in shape and is now off all his medication.
Sharing success stories is a great way to inspire people, says Miller. Suquamish's Facebook page taps into the tradition of oral history with online narratives from tribal members sharing stories about why nutrition and health have played an important role in their lives.
The final installment of this series, "Diabetes: Not a Death Sentence," will be featured on Food Safety News tomorrow, Wednesday March 7.
Middle and bottom photo taken by Gretchen Goetz. Kahti DeWilde pictured middle.
Primary Responsibilities:
1. Serve as the policy expert on behalf of community clinics and health centers in areas such as Medicaid/Medi-Cal, Reproductive Health, Oral Health, Public Health and Prevention, Managed Care, and Behavioral Health including mental health and substance abuse.
2. Under the guidance of supervisor, initiate advocacy strategies to improve and sustain community clinic and health center operations.
3. Track state and federal legislation and regulations in assigned policy areas.
4. Represent the Association with coalitions and other stakeholders in assigned policy areas. Build new and strengthen existing relationships in assigned policy areas.
5. Provide timely and thorough policy updates to members including but not limited to weekly updates, website and newsletters.
6. Partner with Association staff on the execution of the strategic plan.
7. Assist with grant writing and grants management.
8. Staff committees, taskforces or workgroups as assigned.
9. Serve as a resource for membership in assigned policy areas.
Skills and Talents Required:
1. Excellent written, oral and analytical skills.
2. Knowledge of state legislative and regulatory process.
3. Knowledge of and sensitivity toward diverse cultures.
4. Knowledge of primary care principles, practices and delivery systems.
5. Leadership skills.
6. Efficient time management.
7. Proficient in Windows-based computer applications and computer research skills.
Ability to:
1. Manage multiple tasks.
2. Establish rapport with staff members and others in business and community settings.
3. Analyze, organize and evaluate policy issues.
Education and Experience Required: Bachelor’s degree required with a Masters in Public Health, Public Administration, Public Policy or Juris Doctor desired. Three years experience in policy, advocacy and/or program management required. Experience in state policy development as well as policy support in areas of Farmworker Health, Immigration, Health Information Technology, Pharmacy and Homeless Health Issues desirable.
At Legacy Health, our legacy is doing what's best for our patients, our people, our community and our world. Our fundamental responsibility is to improve the health of everyone and everything we touch - to create a legacy that truly lives on. Ours is a legacy of health and community. Of respect and responsibility. Of quality and innovation. It's the legacy we create every day at Legacy Health.
And, if you join our team, it’s yours.
Legacy Health is a regional six-hospital health system, including a new state-of-the-art children’s hospital, offering a full range of primary and tertiary care services for both adults and children at sites throughout the Portland metropolitan and southwest Washington areas. We provide an integrated network of healthcare services, including acute and critical care, inpatient and outpatient treatment, a regional medical laboratory service, a research facility, community health education and other components of a complete health system. Legacy Health is known for its commitment to quality patient and family-centered care and team-oriented work environment.
We have an exciting opportunity for a system wide Director of Clinical Practice Support. Reporting to the System Chief Nursing Officer, this position provides strategic leadership in the development of clinical practice and education support services that support Legacy’s patient care enterprise. The Director is responsible for overseeing and directing the development of evidence based patient care standards and competency assessment system to optimize and ensure quality patient care and safety. This role is also responsible for the design of clinical education resources and staff education, and clinical academic relationships in alignment with the mission, values, and objectives of the department and learning needs of the organization.
Legacy Health places a high priority on building a culture that values diversity in how we work with each other, how we deliver care, how we partner with our community and how we do business. Diversity is a moral, social and business imperative for us. We believe that if we do the right thing for our employees, our patients and our communities, then we are doing the right thing for our business.
Competitive compensation and benefits package!
If you would like to join a progressive, quality-focused organization, then apply online at legacyhealth.org/jobs. For further information regarding this opportunity, please contact Barbara Becker at 503-415-5740 or email: bbecker@lhs.org. AA/EOE
In addition to exceptional leadership and communication skills, the ideal candidate will:
•Have a Bachelor’s or Master’s degree in nursing required. Master’s degree is required and/or to be completed within one year of hire and may be in nursing, education or other health related field (if Bachelor’s degree is nursing .
•Current Oregon and Washington RN licensure. Specialty certification if appropriate.
•A minimum of five years progressive professional and/or managerial experience within health care environment.
•Excellent negotiation and conflict management skills.
•Good organizational and project management skills. Knowledge and ability to apply adult learning principles. Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
At Legacy Health, our legacy is doing what's best for our patients, our people, our community and our world. Our fundamental responsibility is to improve the health of everyone and everything we touch - to create a legacy that truly lives on. Ours is a legacy of health and community. Of respect and responsibility. Of quality and innovation. It's the legacy we create every day at Legacy Health.
And, if you join our team, it’s yours.
Legacy Health is a regional six-hospital health system, including a new state-of-the-art children’s hospital, offering a full range of primary and tertiary care services for both adults and children at sites throughout the Portland metropolitan and southwest Washington areas. We provide an integrated network of healthcare services, including acute and critical care, inpatient and outpatient treatment, a regional medical laboratory service, a research facility, community health education and other components of a complete health system. Legacy Health is known for its commitment to quality patient and family-centered care and team-oriented work environment.
We have an exciting opportunity for a system wide Director of Clinical Resource Management. Reporting to the System Chief Nursing Officer, this position provides strategic leadership and direction to enterprise wide clinical resource management including staffing, scheduling, patient acuity and assignment, ensuring overall staffing effectiveness system wide. This includes oversight and direction of the staffing office and nursing resource teams, the development and implementation of staffing standards and policies, staffing effectiveness and monitors performance metrics/clinic resource trends across Legacy.
Legacy Health places a high priority on building a culture that values diversity in how we work with each other, how we deliver care, how we partner with our community and how we do business. Diversity is a moral, social and business imperative for us. We believe that if we do the right thing for our employees, our patients and our communities, then we are doing the right thing for our business.
Competitive compensation and benefits package!
If you would like to join a progressive, quality-focused organization, then apply online at legacyhealth.org/jobs. For further information regarding this opportunity, please contact Barbara Becker at 503-415-5740 or email: bbecker@lhs.org. AA/EOE
In addition to exceptional leadership and communication skills, the ideal candidate will:
•Have a Bachelor’s or Master’s degree in nursing required. Master’s degree is required and/or to be completed within one year of hire and may be in nursing, education or other health related field (if Bachelor’s degree is nursing . •Current Oregon and Washington RN licensure. •A minimum of five years progressive professional and/or managerial experience within health care environment. •Prior experience as a clinical department manager with 24 hour staffing responsibilities high desirable. •Excellent interpersonal and communication skills required. •Good organizational/ analytical and project management skills. •Familiarity with automated staffing and scheduling software is an asset.
Hair Therapy
by brienne walshyou see the derm once a year, the dentist twice a year, your therapist biweekly (no judgment . but when was the last time you really took a long, hard look at the health of your hair? sure, regular trips to the stylist can help, but to really get your strands on track, glo brings you five at-home hair tests, along with quick and easy fixes. damaged and prone to breakage? not anymore.
How It Works
tie a lock of hair into a loose knot and set it on your palm. if the knot stays closed, then it means your hair has likely been over-processed.
The Quick Fix
"if your hair is fragile, then don't brush it when it's wet, because that's when it's most likely to break,” says new york city hairstylist tyler laswell. instead, brush it before you shower and then, "once it dries naturally, style it with your fingers."
How It Works
pull a strand of hair from the back of your head and place it in a clear bowl of room-temperature water. if the lock sinks, then it means that your hair is dry and porous, possibly from too many color treatments.
The Quick Fix
"when hair is colored, the cuticle that protects the strand is lifted so that color can be deposited, making it very porous," explains laswell. the best solution (besides quitting the colorist altogether ? "use products like serums and waxes, which help smooth down the cuticle and bring shine back to the hair."
How It Works
gently tug a small cluster of hair. if more than a few strands come out of your head, then get to the root of the problem, literally. "the healthier and more hydrated your scalp is, the healthier your hair will be," says laswell.
The Quick Fix
"don't shampoo your hair every day," says laswell. "you need natural oils to keep your scalp protected." if you feel like your hair is getting greasy, then rinse it with water and apply conditioner only at the ends.
How It Works
take a loose strand of hair and with your nail, curl it like you would a ribbon. when you pull the curl straight, it should spring back into place. if it doesn't reclaim its shape, then it needs more strength and conditioning.
The Quick Fix
"try a strengthening shampoo followed by a leave-in treatment," says laswell. "but don't use a treatment every time you wash your hair. anti-breakage products have very intense direct proteins and if they're over-used, then they can make the problem worse."
Los Angeles Times. This discovery adds yet another twist to the ongoing story on hormone replacement therapy for treatment of hot flashes and poor sleep quality. The estrogen-only therapy appears to cut the risk of having breast cancer by about 20 percent and significantly reduces a woman’s risk of dying from the disease and the benefits appear to last for years after the therapy has concluded, reports Brenda Goodman, MA, for
WebMD. Executive director of the North American Menopause Society (NAMS , Margery Gass, MD, explained to Goodman: “certainly for some women hormone therapy dramatically improves their quality of life.” The report is a follow-up analysis of the landmark Women’s Health Initiative, a clinical trial of tens of thousands of women that began in 1993. That study compared two hormone replacement therapies, estrogen plus progestin, which most women must take, and estrogen alone, taken by women who have had hysterectomies. The double-hormone arm of the study was abruptly halted in 2002 after scientists found that it raised the risk of breast cancer without conferring hoped-for benefits on the heart. In 2004, the estrogen-alone arm of the study was also halted after researchers discovered an increased risk of stroke and blood clots. At the time, it was not clear how estrogen alone affected breast cancer risk, however research since then found that estrogen alone did not increase risk and maybe even lowered it. This latest study, published in the journal Lancet Oncology, provides the strongest evidence yet that estrogen alone not only lowers breast cancer risk for a sustained time for some women, it also decreases mortality for the disease. Study coauthor Dr. Rowan T. Chlebowski, an investigator at the Los Angeles Biomedical Research Institute in Torrance and chief of medical oncology and hematology at Harbor-UCLA Medical Center, told the LA Times reporter, “It’s a very interesting finding.” “It goes against a huge number of observational studies suggesting estrogen would increase the risk of breast cancer by itself. But this study points out that it’s much more complex than we originally thought. Estrogen alone for the period we studied seems to be pretty safe and maybe even beneficial.” Researchers studied more than 7,500 postmenopausal women who had undergone a hysterectomy and had taken estrogen-only HRT as a part of the Women’s Health Initiative, writes Liz Szabo for
USA Today. The women, aged 50 to 79, took estrogen for six years and then stopped when the trial was halted. Researchers continued to monitor the women for the next five years and found that the women who took estrogen were 23 percent less likely to develop breast cancer than those who took a placebo, reports Carrie Gann for
ABC News. Of the women taking estrogen-only HRT who did develop breast cancer, the study found that they were less likely to die from the disease. Six women taking estrogen died of the disease, compared with 16 in the group taking a placebo. “There’s no question that hormones remain the best treatment for hot flashes and night sweats,” says Dr. Janet Pregler, director of the Iris Cantor-UCLA Women’s Health Center. “The risk of doing that for a few years around menopause is really very low, depending on other health risks you have.” The study found several caveats to the effectiveness of estrogen-only HRT. The reduced risk of breast cancer applied only to women who were not already at risk for the disease. As a result, patients should not take estrogen with the goal of reducing breast cancer risk. Also, HRT is still associated with an increased risk of stroke, and doctors say that women who are at increased risk of stroke and blood clots should still avoid taking any HRT. --- On the Net:
A couple of weeks ago I shared some thoughts on
what I've been doing to avoid getting sick this winter season. After posting this article I was having a conversation with my friend and go-to health guy, Dr. DiBacco, about verifying the health-related decisions I make in my life. I asked Dr.
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GWEN IFILL: Now, the man who turned global health and population numbers into an Internet sensation.
Ray Suarez has that story.
RAY SUAREZ: Amid the glitter of a black-tie fund-raiser in New York City, a downright un-glittery guest made his way into the room.
Dr. Hans Rosling, a Swedish global health professor, was given a humanitarian award at the annual Action Against Hunger gala and was the night's star attraction.
WOMAN: Tonight, you are going to hear from one of the world's most inspired thinkers.
So, ladies and gentlemen, will you join me in giving Hans Rosling a very warm welcome.
(APPLAUSE
RAY SUAREZ: Over the last five years, this unassuming professor has collected millions of fans around the world with a usually un-glitzy topic: statistics.
DR. HANS ROSLING, Professor of International Health: $1,000, $10,000, $100,000, the difference in income per person in the world is two zeros.
RAY SUAREZ: Dr. Rosling's goal for the evening and the focus of his life's work was to wow his audience and teach it something.
He brings to life global health and development statistics, often dense and inaccessible, using a sophisticated visualization software he and his team created.
DR. HANS ROSLING: Because what do we have on the axis? Here, we have the number of children per woman, one, two, three, four, five, six, seven, eight, large families, small families. And here we have the child mortality, this most tragic marker of the quality of life in a society.
The size of the bubble is the population. This is China. This is India. Look here, low child mortality, small families. High child mortality, large families. What has happened? Here we come. China is very successful there, India coming there, Indonesia. Look here. This is Brazil. This is Mexico coming here. This is Indonesia. This is Bangladesh. Bangladesh is catching up with India. They're overtaking India.
Africa is falling down. And now we see some are delayed here, but almost the entire world is here. It's a completely new world.
RAY SUAREZ: The presentation is one he's been giving audiences at conferences and meetings around the world since he became an Internet phenom in 2006.
That's when a lecture he gave at the annual TED conference, a who's-who gathering of high-tech, design and entertainment leaders, was posted online and quickly went viral.
DR. HANS ROSLING: My students, what they said when they looked upon the world, and I asked them what do you really think about the world, and they said the world is still we and them. And we is Western world and them is Third World.
And, what do you mean with the Western world, I said. Well, that's long life and small family. And Third World is short life and large family. So, this is what I could display here. I put fertility rate here, number of children per woman, one, two, three, four, up to about eight children per woman. Here, I put life expectancy at birth, from 30 years in some countries up to about 70 years.
Are the students right? It's still two types of country? Here we go. Can you see there? It's China. They're moving against better health. They're improving there. Or the green, that's in American countries. They are moving towards smaller families. The yellow ones here are the Arabic countries. And they get larger families.
RAY SUAREZ: Over three million people have now watched this talk online.
DR. HANS ROSLING: And all the rest of the world moves up into the corner, where we have long lives and small family, and we have a completely new world.
(CHEERING AND APPLAUSE
RAY SUAREZ: Rosling's subsequent online TED talks have also been watched by millions.
I sat down with Hans Rosling during his recent visit to New York to talk about his method and maybe learn a little in the process myself.
Did it occur to you at some point that these lessons you're teaching had to be taught in a better way for people to understand them better?
DR. HANS ROSLING: Yeah, because obviously people do not understand some basic facts.
You see, I find holes, deep black holes of ignorance. And now I try to fill them. That means there are things which are facts, which we know, which still doesn't enter their head -- there are actually less children per woman in Brazil, Thailand and Iran than in Sweden. But it doesn't -- they still have a view of the world that is 25 years old.
RAY SUAREZ: Rosling got his start in global health practicing medicine in rural Mozambique in the 1970s.
While there, he discovered and treated patients with a new paralytic disease he called konzo. He's now chairman of the Gapminder Institute, which is dedicated to building a fact-based world view that everyone understands.
In addition to his popular animated software, which was acquired by Google, Rosling likes to use other visual aids to help him convey information about the world we live in -- Ikea boxes to explain population growth and a washing machine to illustrate how the lives and health of poor women and their families are drastically improved by the device.
DR. HANS ROSLING: So there must be one, two, three, four billion people more will live in between the poverty line and the air line. They have electricity. But the question is, how many have washing machines?
I've done the scrutiny of market data and I have found that indeed the washing machine has penetrated below the air line, and today there's an additional one billion people up there who live above the wash line.
(LAUGHTER
DR. HANS ROSLING: And they consume for more than $40 per day. So two billion have access to washing machine and the remaining five billion, how do they wash? They wash like this, by hand. It's a hard, time-consuming labor. And they want the washing machine.
RAY SUAREZ: During our conversation, he used LEGO characters to represent all humankind.
DR. HANS ROSLING: Look here. This is one billion people. There's one billion people in Africa. There's one billion people in Europe, one billion people in America.
And, as you know, we are seven. So, all the rest, one, two, three and four, are in Asia. This is the world population. And we know, beyond doubt, that there will be two billion more before we level off around nine to 10. And those two billion, we also know that one will be in Africa and one will be in Asia.
And any CEO of a big company looking, like, they say, wow, that's where the market is.
Believe me, there's nothing boring about statistics.
RAY SUAREZ: In 2010, the BBC aired a documentary about Rosling's work called "The Joy of Stats." Using some high-tech special effects, the production team was able to show his animations in real space.
DR. HANS ROSLING: So, down here is poor and sick. And up here is rich and healthy, Europe brown, Asia red, Middle East green, and the size of the country bubble show the size of the population.
RAY SUAREZ: Can you almost feel when the lights are going on, when people are saying, aha?
DR. HANS ROSLING: Yes, we have.
But it's also -- you have to check after a year if it's still there. And the old concept of the Western world and developing world is very strong. And it's also because it's sort of frightening. People think it's frightening with this Asia and Africa here.
No, these are customers. These are partners. And prosperity in the rest of the world means more peace. The U.S. armed forces doesn't have to make so many interventions in the world if we have less conflict. So it's sort of a new vision about the world we must have.
DR. HANS ROSLING: The bubbles are the countries. Here, you have the fertility rate.
RAY SUAREZ: Rosling says he is going to continue talking about important global health statistics whenever and wherever he can.
Like many successful entertainers and plenty of great teachers, Rosling knows that, once he's got your attention, he can pull out something unexpected.
DR. HANS ROSLING: Bring me my sword.
RAY SUAREZ: In this case, another passion: sword-swallowing.
DR. HANS ROSLING: And I will now prove to you that the seemingly impossible is possible by taking this piece of steel, solid steel, and push it down through my body of blood and flesh, and prove to you that the seemingly impossible is possible.
Can I request a moment of absolute silence?
(DRUMROLL
(CHEERING AND APPLAUSE
Like most people, I occasionally find myself in the trap of "Keeping Up with the Joneses". It's so easy to whine about the fact that we can't take that vacation this winter because the windows needed to be replaced, or bemoan the fact that my closet is a shadow of what it once was. In these trying times in our country, so many people are without work, health care, or even a home to live in. That in itself is enough to put things into perspective.
lovstromp on Flickr
The sad truth is that much of the 99% in this country would be considered the 1% in the poorer countries of the world. When I think about it that way, it makes me realize that my family and I have it good-
v
ery
good. A
piece I recently heard on NPR sparked my curiosity, so I did a little research into living conditions around the world. This, in turn, inspired me to compile a short list of things I am grateful for as a parent.
1. Access to clean drinking water - Did you know that
"884 million people lack access to safe water supplies; approximately one in eight people."? Every time I go to put water in a glass for my daughter, I can be relatively sure that what I am giving her won't make her sick-or worse. Not so for far too many people in this world. Here is a truly shocking statistic:
"3.575 million people die each year from water-related disease."
2. Access to education for my daughter - My daughter will have the same rights afforded to her, in regard to education, as a boy would. Though it seems much progress has been made in the world, there is still a disparity between the sexes in many countries (especially in Sub-Saharan Africa and South-Asia
"By 2009, the total number of OOS children declined to 67 million. Around 35 million girls were still out of school compared to 31 million boys.
3. Access to sufficient food - I have never known the heartbreak of hearing my daughter cry out from true hunger. Many children in this world-even in our own country-go to bed hungry each night "
925 million people do not have enough to eat and 98 percent of them live in developing countries".
4. Freedom of speech/assembly- I need only listen to the news and hear stories of protesters being harassed, beaten, shot at, tortured, or killed in places like Syria or Libya to make me realize how lucky I am in this regard. By and large, the "occupy" protesters in this country have been allowed to gather and protest peacefully. It's easy to take this for granted, but we can call the president or anyone else in government a jerk and not be persecuted for it.
5. Access to healthcare - I am grateful that my family has health insurance. I have been one of the "withouts" at different times in my adult life, but I am fortunate enough to have insurance now-through my husband's employer. The staggeringly high number of people in this country without insurance never fails to make my jaw drop.
"The number of people who lacked health insurance last year climbed to 49.9 million, up from 49 million in 2009" I can't imagine how stressful it must be to have a child and not have access to quality health care at a reasonable cost
It's a good exercise to sit down once and a while and take stock in everything I have, instead of focusing on what I want.
Sources:
water.org
web.worldbank.org
wfp.org
money.cnn.com
Piramal Healthcare is one of India’s largest healthcare companies, with a growth track record of above 27% CAGR since 1988. Piramal Healthcare had consolidated revenues of Rs. 2,990 crores in FY2011. With assets across North America, Europe and Asia, Piramal Healthcare is also one of the largest custom manufacturing companies across the world. It has significant presence in the critical care space with sales of anesthesia products to over 100 countries. In FY2011, Piramal Healthcare sold its domestic formulation business to Abbott USA for a consideration of Rs. 17,200 crores and Diagnostic Services business to Super Religare Limited for Rs. 600 crores
Post : Drosophila Scientist & Drosophila - Post Doctorate Fellow
No of Opening : Two
Experience : 1 to 3 yrs
Overall purpose :
a.The
molecular biology
department of pharmacology R&D is, located at the Piramal healthcare research centre is an internationally renowned institution delivering field-changing mechanistic insights into drug discovery focusing on the identification of new drugs/small molecule for cancer metabolic disorder, and inflammatory diseases.
b.The
molecular biology
department is concerned with development of in- vitro and cell based assay by cloning and expressions of various drugs targets for drugs screening in the context of cancer and diabetes. Department is also involved in the development of cancer and diabetic models of Drosophila
Main duties / key responsibilities :
1. Within the overall direction of the Drosophila programme of the group, the post-holder will make a significant input in the development of Drosophila Models including transgenic models
2. To develop and apply a broad range of techniques in order to pursue the research objectives of the group.
3. To participate in collaborative research, both within and external.
4. To be actively engaged in the dissemination of new research results in the form of scientific papers.
5. To present scientific work at seminars within the Unit and at external meetings where appropriate.
6. To communicate and collaborate with others to develop the most appropriate methodologies, and to receive training in the use of relevant experimental techniques.
Working relationships :
The post holder will report directly to the Sr. group leader but is expected to work closely with other members of the group. The post-holder will commit to develop and follow a personal development plan, attend relevant training courses and identify additional training which will support their career.
Salary : INR 4,00,000 - 7,00,000 P.A
Education :
M.Tech
- Bio-Chemistry/Bio-Technology,
M.Sc
- Biology, Bio-Chemistry,
Microbiology
,
Zoology
Desirable :
1. Experience with the following techniques: Drosophila development of transgenic Model
2.
molecular biology
: Cloning and expressions of genes of various pathways of Drosophila, protein Immunoprecipitation, confocal microscopy, cell transfections, SDS-PAGE, western blotting.
Location : Mumbai
Interested candidate can mail their resume : r
esearch.recruitment@piramal.com
Deadline : 02.04.12
As Canada’s population ages, can our current systems cope with the demographic shift?
Features
Mike Lakusiak — The Cord (Wilfrid Laurier University
WATERLOO (CUP — The baby boom generation of Canadians — those born between 1951 and 1966 — make up a large demographic in the nation’s workforce. The clock on their working lives seems to be ticking louder than ever before.
With lots of noise being made in media and government about the imminent retirement of so many people from the labour market and associated costs of government benefit programs and health care, the aging population is getting lots of attention.
The question for students looking to enter the working world is this: what does this shift mean for their future?
The more things change
It is encouraging, according to now-retired University of Waterloo professor of statistics and actuarial science Robert L. Brown, that the topic of what happens when boomers stop working is nothing new. “It’s going to be a challenge, but it’s not a crisis and it’s been known for years,” he said, reached between golf games in balmy British Columbia. “There’s probably been more research [in this] than any other Canadian topic, going back 25 years.”
A key component of this discussion is Old Age Security (OAS , the government program that provides a monthly contribution to those 65 years of age and older.
A recent study by Sun Life Financial lends to the idea that working life doesn’t just end at 65, however, with more than two-thirds of Canadians polled expecting to not be fully retired by 66. With the average life expectancy far greater than it was when the age threshold of 65 was brought in, an extension to 67 to be brought in by 2020 is being considered by the federal government.
“I’m not sure that it’s inevitable,” said Brian Lee Crowley, managing director of the Macdonald-Laurier Institute, a nonpartisan think-tank in Ottawa. “But I think it’s prudent to do it.”
The idea has drawn fire from some organizations including the Canadian Association of Retired Persons (CARP , who say that such a move would push some seniors below the poverty line.
“You can accommodate almost any kind of program as long as you’re willing to give up other things,” Crowley continued, noting that OAS and its sister service, the Guaranteed Income Supplement (GIS , will rise from 15 per cent to a full quarter of federal government spending in the coming decades. “Is that sustainable?” he asked. “Sure, you’ve just got to get people to agree to stop spending ten per cent on something else.”
The legacy of such a large cohort of people in the workforce is that perceptions of what working life and retirement should be like are maintained by younger generations as well.
“Part of the problem in people understanding this is that we’re all stuck with the image of the last 50 years,” Crowley said. “Everyone including older workers will have a very strong interest in keeping older workers in the workforce as long as we can.”
He noted that much of what has underpinned Canada’s economic growth and stability for the past few decades can be attributed to that generation making Canada’s labour force the largest relative to the number of dependents — children and the retired — among large industrialized nations. The costs associated with an aging population can be mitigated by creating conditions that don’t encourage people to retire early simply because they have reached a certain age, he said.
“I personally think that extending the working life of Canadians is very much going to be in the interests of young people as well as older people,” said Crowley, adding that If most of the population plans on working longer anyway, the benefits for both Canada’s production of wealth and the public costs of supporting those that are ready to retire would be substantial.
I can has jobs?
Whether the OAS age is raised to 67 or not, baby boomers will continue to retire, progressively more so as we near the next decade.
“The hope is, with the retirements among the baby boom age population, that will open up job opportunities,” said Morley Gunderson, the CIBC chair of youth employment at the University of Toronto’s Centre for Industrial Relations and Human Resources. “Not that someone at 65 retiring will have someone fill that exact slot, but other people will.”
It seems inevitable that because of retirements and the requisite cut cakes and gifted watches, recent graduates should be in higher demand as more slots open up. Crowley said that while there is some uncertainty as to how all this will play out, signs will start to emerge in the short term.
“The impact of the population aging on the workforce and number of people available to work has not really started to hit home yet because there is a five-year period where we make the transition from the baby boom generation in the workforce,” he said, adding that once this transition period is over, things will have changed considerably.
“Over the next 50 years, the workforce will barely grow — I think it’s supposed to grow 11 per cent over those 50 years, whereas it grew 200 per cent over the previous 50 years,” he explained.
“One of the consequences, in my view, is clearly going to be that the value of workers is going to go up, the wages are going to rise and employers are going to try and do everything they can to keep people in the workforce rather than see them retire.” Whether this means more job opportunities for young people is not assured, but it certainly cannot hurt.
Gunderson left some question as to whether labour shortages will be as endemic in the market as some have forecast, but there will be challenges. “It’s not clear that young people can expect the kinds of jobs their parents had,” he said. “Almost invariably now people will start out with a limited term contract or contract job if they get one at all — that’s in a sense the new probationary period. Some of those will turn into permanent jobs and some will be something to work while you look for a more permanent job.”
Recent graduates who either moved back in with their parents or struggled to find secure jobs can certainly attest to this reality — but will things change? Gunderson said that there has been a paradigm shift from working a secure job from graduation until retirement, the way previous generations often did.
“The jobs their parents had were often blue-collar manufacturing, well-paying blue collar jobs — now it is more extreme,” he said. “Some jobs are high-paying that people can move into, but the big issue is the middle where the job distribution has kind of fallen off and hollowed out.
"If you start off at the bottom end, working in a service job or flipping burgers, things like that, it’s possible you could be stuck there for a while. Those middle jobs aren’t there as much right now.”
Fortunately, and perhaps annoyingly so, the old adage that education is the best investment one can make seems to still apply, and is also encouraging some students to remain in school longer until the job market stabilizes.
“In general, getting more education still seems to keep paying off — perhaps somewhat surprisingly, given the large numbers entering higher education such as universities,” Gunderson continued. “Yet, those returns seem pretty high, though they vary considerably by field of study.”
Return on investment can vary, he said, from a five-per cent dividend made up in increased salary for each dollar spent on education to more than 15 per cent in some professional programs like engineering.
There is a legacy impact on when graduates enter the labour market to consider as well, he added, as shown in a study by his colleague Philip Oreopoulos at the University of Toronto. The study showed that when people enter a job market in a recession or find work that is lower-paying, the impact on their earnings over time lags behind those who began during a boom.
“We have moved to a knowledge economy and even people in fine arts and things like that get a reasonable return [on investment in education],” he said. “It’s much lower, but that’s a love of labour — it’s what they want to do.”
So, the short answer is not unexpected. Things will improve and there very well might be more jobs available for graduates once the baby boom cohort retires, but there is still a lot of uncertainty surrounding the situation.
What about when I want to retire?
With longer working lives seen even among the baby boomers, by the time current twentysomethings decide to stop the 9-to-5 and enjoy their golden years, the situation will have likely changed again. In 40 years, when a current student would be in their late 50s or early 60s, demographic studies lead Brown to believe that the situation will have normalized.
“If you’re retiring after 2050, you’d be coming back into a period of stability,” he said. “Students now will be retiring just on the cusp of the end of the bad times and the beginning of the next demographic dividend-paying period.”
“The baby boomers will just about be gone by 2050,” he explained. “The baby boom created its own cycle and was followed by the baby bust. There’s a tidal wave of shifts in dependency ratios and producers and retirees. It’s been fairly constant for the past 25 years so the period from 2050 to 2075 should be pretty predictable and it will be an easier time than from 2030 to 2050.”
Nevertheless, with possibilities for both private and public-sector pensions and benefits not as assured as they once were, adjustments will need to be made to prepare for when the next generation looks to retire.
The health question
Along with mechanisms like OAS, a common cause for concern when discussing an aging population is health care. Raisa Deber, a professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto explained that while there are some difficulties, Canada’s public health care system as a whole should weather the storm.
She said that any doomsday scenarios have largely been debunked by studies into the costs associated with aging and what such a large demographic of aging people might mean. “In every single age-sex group, people are pretty healthy and they don’t account for a whole lot of health care costs,” she said.
“Where it gets a little bit tricky is that a lot of costs are associated with the time right before death.” All things being equal, the cost of health care per person does not necessarily increase because they are older, it remains relatively stable in most cases until very close to the end of a person’s life, when there may be an increase.
Deber explained that extrapolating the health care costs to apply to the baby boomers makes little difference if people are working longer and living longer in general, simply extending the age they die.
“In fact, if you have someone who is aging and becomes very sick, the odds are the hospital isn’t going to throw everything at them in the same way they would if it was a younger person,” she said.
“There are a lot of reasons to be worried in terms of costs but the evidence is pretty solid that what’s driving the increased cost is more what you pay providers.”
She said that private-sector concerns like home care and nursing homes, many of which are not-for-profit private institutions, will be in greater demand as the population ages, but that largely falls to families or private insurance to cover costs. While health care as a provincial expenditure is increasing, she said that it does not draw the viability of the system into question.
“Maybe one or two per cent of the cost increase is coming from [having an aging population]. The question is whether that is the big cost driver that is going to make the system ‘unsustainable,’ and the answer to that is no, not from the data anyone is looking at.”
Between drugs, home care and nursing homes, Canada’s population will see increased money spent in the coming years, just as it is now; but on a broad level, things seem as though they should work out reasonably well. “It’s not that those aren’t real costs,” Deber said, “You’re looking at who is picking up those costs."
Prognosis
Brown chose to explain the situation on a very basic level. “It doesn’t matter how much money a person has, what the legislation says, it doesn’t matter how you label different generations: the point is that people need to produce goods and services in order to be consumed,” he said.
“Someone is out there so I can go golfing and go to a movie and have a steak for dinner and so you [students] can eat Kraft Dinner. Those things need to continue to be produced.”
He said that while the system may take some time to right itself, things should balance out when considering factors like women in the workforce — which wasn’t always the case to the degree it is now — as well as skilled immigration and people working longer.
“The point is that we have to produce goods and services before they can be consumed, that’s the bottom line. You can play games with everything else; pensions, money supply, it doesn’t matter.”
So there you have it, kids. There is no doubt that the baby boom generation’s gradual aging will impact Canada and younger Canadians.
Thankfully, the signs point to more possibilities for younger people in the labour market — even if it means they will be saddled with some of the burden of caring for baby boomers as they age.
-30-
Dartmouth-Hitchcock Medical Center, Lebanon, NH
At the general direction of the Administrative Director, the Information Technology Manager – Radiology Systems will assume leadership responsibility for the management and support of all information systems within the department, act as an active member of the Radiology Management Team, and act as a department liaison with Clinical Information Systems, Network Services, User Support and hardware/software vendors. Other responsibilities include working with ancillary departments to facilitate systems integration and performing software product evaluations, analysis, and design for interdepartmental systems projects as well as planning, coordinating and managing system implementations, upgrades and changes.
A Bachelor’s degree in Computer Science or health related field, with a minimum of 5 years of combined experience in systems maintenance, analysis, implementation is required. Prior experience in all aspects of imaging information technology management and maintenance is desired. Prior experience with electronic medical record system integration is helpful. Excellent communication skills are desired.
Dartmouth-Hitchcock Medical Center, located in Lebanon, NH on the Vermont/New Hampshire border is New Hampshire’s only integrated, academic, Level I trauma center. Home to the prestigious Ivy League Dartmouth College, the Lebanon/Hanover area is a vibrant, academic and professional community offering excellent schools, lively arts, and an unmatched quality of life in a beautiful, rural setting. Dartmouth-Hitchcock Medical Center includes a modern 400-bed tertiary care hospital, research and clinical facilities for Dartmouth Medical School, Norris Cotton Cancer Center and the Dartmouth-Hitchcock Clinic. In addition, we were the first hospital in New Hampshire to receive Magnet status and have been consistently rated one of America’s Best Hospitals by U.S. News & World Report.
At Dartmouth-Hitchcock Medical Center, Life Works Here.
Applicants are encouraged to apply online at: www.Dartmouth-Hitchcock.org
** If you would like to be kept up to date on all our Technical/Information Systems career openings via text messaging, please text “Cooltech” to 85775. We will send periodic updates to your mobile phone.
Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon, NH 03756
DHMC is an equal opportunity employer.
Works independently with general supervision by Executive Director Research.
Specific interest and expertise in health systems research, including health care delivery, organization, and management.
Characteristic Duties and Responsibilities
• Designs, develops, and directs well-defined research in the field of health systems and services research, ideally with an emphasis on comparative healthcare delivery systems.
• Prepares grant proposals, internal reports and peer-reviewed publications independently and collaboratively.
• Provides consultation on study design, analysis plans and interpretation of study results to PMG, KFH/P managers, clinicians, clinical staffs, and committees as directed.
• Provides service to the scientific community through membership on peer review groups and national boards.
• May consult with local, state and national voluntary and governmental agencies. • Provides consultation and direction to programmer analysts with regard to data management and analysis strategies for this position’s research projects and department programs generally.
• Presents papers at national scientific meetings; teaches and/or reviews papers for national journals.
• Seeks consultation from senior scientists for specific scientific and administrative issues.
• Work collaboratively to help develop the scientific program and goals of MAPMG and Kaiser Permanente.
• Works to advance research in health systems and services.
• Provide and receive consultation with MAPMG and KPMAS staff as required for research development.
MAPMG research scientist consistently supports compliance and the Principles of Responsibility (KP’s code of conduct by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures.
In addition to defined technical requirements, MAPMG research scientist is accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives.
Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions. Such changes are generally implemented only after notice is given to affected employees.
We value our diversity and E/O/E M/F/D/V
• Doctoral degree in Health Management or Services Research, Organizational Behavior, Clinical Research, Epidemiology, or related field, or equivalent training and mastery.
• Expertise in the statistical techniques, study designs and research methods used in epidemiological and health services research.
• Demonstrated ability to develop and conduct original and independent research and publishing peer-reviewed results.
• Experience developing successful federal grant applications.
• Experience working with and/or leading multidisciplinary teams.
http://www.annallergy.org/article/S1081-1206%2811%2900901-X/abstract
Eric Macy, MD, Southern California Permanente Medical Group, Department of Allergy, San Diego Medical Center, San Diego, California
Ngoc J. Ho, PhD, Kaiser Permanente Healthcare Program, Department of Research and Evaluation, Pasadena, California
Background
Population-based data on the demographics and clinical characteristics of patients with multiple unrelated drug class intolerances noted in their medical records are lacking.
Objectives
To provide population-based drug “allergy” incidence rates and prevalence, and to identify individuals with multiple drug intolerance syndrome (MDIS defined by 3 or more unrelated drug class “allergies,” and to provide demographic and clinical information on MDIS cases.
Methods
Electronic medical record data from 2,375,424 Kaiser Permanente Southern California health plan members who had a health care visit and at least 11 months of health care coverage during 2009 were reviewed. Population-based drug “allergy” incidence rates and prevalence were determined for 23 unrelated medication classes.
Results
On January 1, 2009, 478,283 (20.1% health plan members had at least one reported “allergy.” Individuals with a history of at least 1 “allergy” and females, in general, reported higher population-based new “allergy” incidence rates. Multiple drug intolerance syndrome was present in 49,582 (2.1% . The MDIS cases were significantly older, 62.4 ± 16.1 years; heavier, body mass index 29.3 ± 7.1; and likely to be female, 84.9%, compared with average health plan members. They had high rates of health care utilization, medication usage, and new drug “allergy” incidence. They sought medical attention for common nonmorbid conditions.
Conclusions
Multiple drug intolerance syndrome is in part iatrogenic. It is associated with overweight elderly women who have high rates of health care and medication usage. Urticarial syndromes only explain a small fraction of MDIS cases. Multiple drug intolerance syndrome is associated with anxiety, but not predominately with immunoglobulin E (IgE -mediated allergy or life-threatening illness. Multiple drug intolerance syndrome can be managed by medication avoidance and judicious rechallenge.
Doctorate degree in health services research or social science (sociology, psychology, demography, public health, or related discipline with an emphasis on social science research is preferred, or a Masters degree with extensive child health research experience is required.
Five years experience with social science or health services research required, plus a record of designing and managing complex research projects and publishing original research in peer-reviewed journals. Experience working with large public use data sets and federal surveys highly desirable, as well as advanced theoretical and applied knowledge of statistical techniques used in survey sampling, weighting, and statistical reliability estimation methods for complex surveys and/or longitudinal cohort studies. Experience working with physicians and medical professional societies preferred.
Demonstrated abilities in SPSS, SUDAAN/STATA, or SAS in conducting advanced analytical/statistical programming tasks including multivariate, logit, and time series analyses required, along with knowledge of and interest in a variety of child health research issues.
The AAP offers an excellent work environment, competitive salary, and a very comprehensive benefits package. Additionally, we are an Equal Opportunity Employer (M/F/D/V that values the strength diversity brings to our workplace. As a reaffirmation to our employee-focused culture, since 2005, the AAP has been named one of the 101 Best and Brightest Companies to Work for in the Chicagoland area.
Interested candidates should submit their resume, cover letter, and salary preference to:
American Academy of Pediatrics
ATTN: HR/AF/520
141 Northwest Point Blvd.
Elk Grove Village, IL 60007
Fax# 847-228-5099 or E-mail: resumes@aap.org
Barley
"That's not even a quarter of their profits," said Copeland, a law professor at
Pennsylvania State University. "I was up in arms."
Government officials say they are, too, and they've talked about incorporating some of Copeland's ideas.
"That's a question we've been struggling with for the last couple of years," said Gregory Demske, assistant inspector general for legal affairs at Health and Human Services. "We recognize there's a problem."
If a company is excluded from doing business with the government, then medications that only those companies produce will not be available to beneficiaries. But, Copeland said, the fees associated with corporate integrity agreements haven't been enough to keep companies from bilking the government again.
"It's still in the company's interest to promote off-label marketing because they're still going to make more in profits than they lose in fines," she said.
HHS officials are talking with those at the
Justice Department and Food and Drug Administration to fix the problem, Demske said.
Most of the cases come from off-label marketing of prescription medications. For example, Pfizer was accused of marketing Bextra, a painkiller, for uses other than what the
FDA had approved. Such uses constitute fraud because they take government money for purposes the FDA has not approved.
Instead of excluding an entire company from doing business with the government, Copeland said, the drug being marketed off-label could be excluded.
HHS officials considered that, Demske said, but they needed to ensure that beneficiaries could get their medications. The agency is considering taking away a company's patent rights as part of a settlement with the government.
That, he said, would allow other companies to make and sell the drugs to the government. Such a deal could be negotiated with companies as part of a fraud settlement and would not require congressional approval.
"We could require other things if the defendant will agree to it," he said. "If not, there might not be a settlement."
And if there's no settlement, there may be an exclusion.
Copeland suggested requiring companies to conduct clinical trials for the off-label uses they were accused of, requiring that they license a product to other manufacturers and holding high-level individuals criminally liable. Demske said that investigators began going after individuals in companies in 2010 and that they have focused resources on that idea.
Pfizer,
Bristol-Myers Squibb and
Abbott Laboratories did not respond to questions from USA TODAY.
"Imposing such a severe penatly on a person who had no knowledge of the wrongdoing at issue is manifestly unfair and unjust," said
Matthew Bennett, senior vice president of the Pharmaceutical Research and Manufacturers of America.
The Supreme Court ruled in the 1970s that the government may go after officials who should have knowledge that fraudulent behavior is happening under their management. However, the law applies only to individuals holding a position at a company.
"If they leave, we can't reach them," Demske said. "The law is written in present tense."
The government has to send a note notifying the person that it is considering excluding them, which leaves the person plenty of time to leave the company.
"They would be free to work elsewhere," Demske said.
A bill to address the problem passed the House last year but hit the Senate too late in the session to make it to a vote. A new bill, HR 675, has been introduced.
Officials with the Centers for Medicare and Medicaid Services are looking for answers, said Ted Doolittle, deputy director of CMS' Center for Program Integrity. Instead of excluding a company, the CMS can revoke payment, which the government plans to do more aggressively, he said.
Last month, 78 home health care agencies in Texas were suspended in connection with a fraud case, and Doolittle said the CMS will not pay them for services until they are cleared of wrongdoing. First, he said, the CMS had to make sure beneficiaries would be able to get the services they need if those centers were out of business.
Congress members have suggested mandatory exclusions for crimes, but Copeland said the cases often don't reach that point because the parties settle before a proclamation and because the government has to worry about patient access.
If the government targeted individuals more aggressively, that could send a powerful message to drug companies, said Stan Twardy, leader of law firm Day Pitney's health care compliance group.
"Something called a jail is going to send a lot stronger signal than a fine," he said. "The regulations can change, but individuals and companies will take advantage of any loopholes they may find. It's part of that game of maximizing profits."
Under a system of agreements and fines, he said, the corporate culture will remain the same.
Copeland said she doesn't think that's enough.
"If you go after the sales manager because the sales manager could have prevented the fraud, it doesn't change the corporate culture," she said. "The more prescriptions, the more money you make, so the incentive remains."
Patrick Burns, spokesman for the non-profit Taxpayers Against Fraud, said although there may be differences of opinion, there is a greater sense or urgency about fighting the problem.
"We're all thinking the same thing," Burns said of investigators and Congress members. "The good news is they're pushing to actually do it."
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GE Healthcare cuts more employees from its South Burlington, Vt., facility in order to "increase competitiveness."
Updated March 7, 2012, at 1:30 p.m. with comments from GE Healthcare.
MASSDEVICE ON CALL — GE Healthcare (NYSE:
GE announced another round of layoffs at its South Burlington, Vt., facility, a move it said is a result of declining demand for health care IT and performance solutions businesses.
The move is the "subsequent action" of layoffs numbering around 50 workers at the same facility last month, GE spokesman Corey Miller told MassDevice.
News Well,
Cardiac Rhythm Management,
Layoffs,
Medicare,
On Call,
Patient Monitoring,
Recalls
PATIENTS THINK THAT DOCTORS STAND IN THE WAY OF THEIR RECEIVING THE BEST TREATMENT AND CARE
A 400-page report, What do patients think of doctors?, published in early-March 2011 by UK research organisation PatientView, finds that over half (53% of the 2,500 respondent patient groups think patients believe doctors are standing in the way of their receipt of the correct diagnosis, treatment and and/or support—and are making patients ‘fight the system’ to obtain the care they need.
The situation is at its worst in five countries—Canada, Germany, Italy, New Zealand and the UK—where 60% or more of patient groups say that health professionals need to improve their relationships with patients by not making patients fight the system for their medical needs. 70% of patient groups representing the interests of patients with gastrointestinal problems, 60% representing the interests of patients with multiple sclerosis, and 60% rare diseases, feel that health professionals need to stop forcing patients to ‘fight the system’ to get the care they need.
Poor doctor-patient relationships have a negative effect on patient health
What do patients think of doctors?
focuses on the current state of doctor-patient relationships, and offers numerous insights into how they can be improved. The report finds that less than a third of groups representing patients believe GPs and consultants remain traditional and patriarchal in their attitudes to patients. On the other hand, only 15% believe that doctors treat patients as equals (and act on that belief —the rest believe that the situation varies from doctor to doctor, or that doctors may intend to take a partnering role, but fail to live up to it. Relationships between doctors and patients are undoubtedly in need of considerable improvement, especially in some of the less well-performing countries. The state of doctor-patient relations has an important bearing on how well patients respond to treatment. In the report, patient groups are quoted as saying that poor doctor-patient relationships prevent patients from coming forward for medical treatment and care—even when treatment and care is needed.
Doctors need to listen more to the patient
When asked what single intervention would most improve doctor-patient relationships, the groups cite “enhancing the communication-and-understanding skills of the healthcare professional” as their main choice, second only to “the provision of treatment and care that improves quality of life”. In Australia, Italy, New Zealand and the UK, improving doctors’ communication-and-understanding skills is ranked first, as the most important way of improving doctor-patient relations. Groups representing the interests of patients with cancer and HIV/AIDS also see such a development as the favoured way of improving doctor-patient relations among the patients in their disease specialties.
About the survey
What do patients think of doctors?
is based on the results of a November 2010 PatientView survey of 2,500 patient groups from around the world. The survey asked the respondent groups what they think of current doctor-patient relationships, and how they believe those relationships might be improved.
The report covers most subject areas in which patients would like doctor-patient relations to be improved, including:
l
Access to health professionals
l
Access and choice during diagnosis and treatment
l
Patient information provided by health professionals
l
Doctor-patient communication
l
Gaining patient trust
l
Respecting patients’ valuable time
l
Accountability of health professionals
l
Improving prevention practices
l
Which single action do patients want from government and payers to improve doctor-patient relationships?
l
Which pharmaceutical companies are having a positive effect on doctor-patient relationships?
l
Why pharma can have a negative impact on doctor-patient relationships.
The report analyses doctor-patient relations in 11 countries and one region of the world: Australia [
number of completed responses = 60
]; Canada [
138
]; Eastern Europe [
105
]; France [
80
]; Germany [
100
]; Italy [
110
]; the Netherlands [
30
]; New Zealand [
55
]; Spain [
80
]; Sweden [
56
]; the UK [
566
]; and the USA [
292
]. Doctor-patient relations are also analysed for the following 12 specialties: cancer
[160
]; diabetes [
55
]; gastro-intestinal [
40
]; heart and circulatory conditions [
70
]; HIV/AIDS [
72
]; mental health [
170
]; multiple sclerosis [
35
]; neurological [
195
]; Parkinson’s disease [
30
]; rare diseases [
70
]; respiratory [
35
]; and rheumatological conditions [
55
]
.
Back in December, the Department of Labor's Wage & Hour Division published a
proposed rule that would extend minimum-wage and overtime pay protections to the home care workers who assist elderly and disabled patients with their daily needs. The Fair Labor Standards Act requires that nonexempt workers be paid minimum wage (currently $7.25 per hour and 1.5 times their pay for hours worked above 40 hours in a week. (It also prohibits most forms of child labor, but allows children to work in agriculture,
as Celeste has discussed. Many of us are exempt from these requirements because we're salaried executive, administrative, or professional employees. There are other
FLSA exemptions based on industry or job type, and one of those exemptions is for "companions for the elderly." Under this exemption, home care workers who help clients with bathing, dressing, eating, wound care, and other essential activities are denied minimum-wage and overtime pay. The result is predictable: In 36 states, average hourly wages for Personal Care Aides are below 200% of the federal poverty level wage for full-time workers in one-person households.
As that statistic suggests, home health workers' earnings can vary depending on the state where they work. Sixteen states (California, Colorado, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Jersey, New York, Pennsylvania, Washington, and Wisconsin already extend minimum wage and overtime protection to home healthcare workers, and five states (Arizona, Nebraska, North Dakota, Ohio, and South Dakota and DC extend minimum-wage, but not overtime, protection. The Obama administration's proposed rule would extend FLSA protections to all home health workers, and this change would have the most impact in the 29 states that don't currently require minimum and overtime wages for home health workers.
The main rationale for this rule change is that Congress's intent in exempting "companions for the elderly" from FLSA protections was to make it easy for neighbors and friends to help out the elderly in their communities -- not to keep two million home care workers from earning fair wages. But the
Economic Analysis accompanying the proposed rule also describes some larger benefits that may not be immediately obvious.
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