Shopping for health insurance

Over the long weekend, I had a chance to catch up on some reading. I pulled out the August 3rd edition of Forbes and started reading the "Fact and Comment" section by Steve Forbes, Editor-in-Chief of Forbes magazine. The heading for this column was "Washington: Still Abusing the Economy... and Undermining Health Care." These days, it seems like you can publish just about anything when it comes to politics and health insurance reform.

Forbes suggests some "helpful and constructive measures" that may move our country to a more genuinely "free-enterprise" health care system. One of the points he mentions is this:

• Allow consumers to shop for health insurance across state lines.

I don't know how often people think about health insurance plans in other states. If you move around quite a bit, then perhaps you're aware of the differences that may be present. However, unless you're a student and you have your health insurance through your parents who live in a different state, you won't find many people who have coverage through a different state. You simply can't purchase health insurance from a different state.

When looking to buy insurance, you can save time and money by getting auto insurance quotes or health insurance quotes from reliable insurers. I recently did some insurance shopping for my family and I got quotes from everyone. It helps to use a broker if you're too busy to fill out forms, but you may be surprised to know that much of this can be done online these days. I also used comparison sites like J.D. Powers and Associates to compare different insurance plans.

When we see a public health insurance plan emerge, will this new plan actually cause enough competition that private insurers lower their prices? If it's properly designed, then I'm sure we will. Otherwise, it will flop. I'd like to be optimistic and hope that the government sponsored health insurance plan will be a success. If so, I'd like to see some public insurance options for auto, homeowners, and malpractice insurance.

Now this is a "giant" nevus!

Wow, now this is a giant nevus! I don't think you can get much bigger than that! This image is from the New England Journal of Medicine (NEJM) and it's appropriately titled, "Giant Congenital Nevus." Supposedly, a 17-year-old teen presented with painful swelling of the front of his chest after a roadside brawl. He had been born with a birthmark on his chest that had grown steadily to its present size. Can you imagine waking up with this on your chest? To read the full story on the NEJM, click here.

I'm now on the Be the Match Marrow Registry by the NMDP

The Be the Match Registry is operated by the National Marrow Donor Program (NMDP). After swabbing my cheeks and submitting my DNA, I now have my own bone marrow donor identification card. I realize that there is a great need for bone marrow donors out there. I was inspired to join the registry because of the "Save Jodie Gee" group on Facebook. Perhaps you've heard of her. Jodie is a young woman who was very healthy until she discovered that she had aplastic anemia last November. She recently had a bone marrow transplant and it sounds like she's doing well. You can follow her story here on the Save Jodie Gee blog.

I know several other people who are currently in need of a bone marrow transplant. You probably too as well. If you're Asian, you can order a free kit from the www.AADP.org to be part of the national bone marrow registry. There is a significant need for donors from all ethnic groups. If you haven't joined the Be the Match Registry, perhaps you'll want to stop by a bone marrow drive or simply order a kit so that you can save a life.

A crazy medical lawsuit story in Florida

We hear of many crazy lawsuit stories, don't we? Warning, this story is rated PG-13, so don't continue reading if you're easily offended by medical stories involving surgery of male body parts.

This story involves a 62-yr old man with diabetes who had a penile implant. The surgery didn't go well and he developed a serious infection. As a result, his implant and his male body part had to be removed. The man (and his wife) are suing the urologist. Here's the lesson for the day: don't practice medicine in Florida. I wonder if the endocrinologist and infectious disease specialist are also going to get named in this lawsuit. To read the story on CBS4.com, click here.

Man's finger bitten off at a healthcare reform meeting

Don't attend any healthcare reform town hall meetings. A man's finger was bitten off in California. Don't believe me? Watch this CNN video clip.

Will Gardasil get approved for boys and men?

Gardasil is a vaccine made by Merck and it's currently indicated for girls and women to prevent cervical cancer that's often caused by human papillomavirus (HPV) infection. Will Gardasil get an indication for boys and men? After all, those same viruses (HPV) cause warts in guys. Guys are just as guilty for spreading HPV, so why not vaccinate them as well? Would it be possible to eradicate HPV? That would be quite a public health accomplishment. What if HPV suffers a similar fate as smallpox? (well, terrorists are trying to bring smallpox back, but I doubt that any terrorist will have much interest in HPV).

Water bottles and BPA

I spent the day at the beach today and our family took our ice chest out there so that we could have snacks and drinks on such a hot day. As I was filling up our water bottles, I started thinking about the whole issue regarding BPA (Bisphenol A) again. You see, I have some water bottles that I've had for many years. Naturally, they are made up of Type 7 plastic (the "catch all") and hence, they contain BPA.

Plastic types 1, 2, 4, 5 and 6 do not contain BPA. Many of the newer water bottles are not made of Type 7 plastic (although if you buy a generic water bottle made in China, then it's probably still Type 7). You'll even see new water bottles advertised as "BPA free." What I often wonder is, "OK, so let's say it's free of BPA. How do we know that it simply doesn't contain a different chemical that may also be toxic (or potentially more toxic) to the human body?"

The FDA is currently exploring the public health implications associated with BPA exposure. I doubt we'll hear anything conclusive anytime soon. Perhaps someday in the future, we'll realize that all types of plastic were hazardous to our health. Perhaps we'll go back to traditional glass and metal containers.

Impaired physicians and alcohol rehab

We all know that there are impaired physicians in the community. We may not want to admit this reality, but it's true. Physicians fall into addictions and they often need rehab, including alcohol rehab. Whether it's inpatient rehab or outpatient rehab, these programs offer important services that can eventually protect the public from dangerous healthcare professionals who may have drinking problems.

You don't need to be a classic "alcoholic" to have a drinking problem. You don't need to fail the CAGE questionnaire to have a drinking problem. Some people have the misconception that they don't have an alcohol problem because they never need an "eye opener" and they only drink at night. Others may think they're drinking is fine because they never feel guilty about it. These people may be in desperate need of alcohol treatment, but they may simply be living in denial.

Let's hope that the statistics improve as more impaired healthcare professionals recognize their need for help. Let's also hope that co-workers are not shy to approach their impaired colleagues who may require assistance. Since physicians often hold the lives of other people in their own hands, they can't afford to be impaired. The effects of alcohol misuse or dependence may impact the lives of many patients if physicians don't get the help they need. The best way to get results may be to send our loved ones to private alcohol rehab.

Robot doctor Dr. Kevin Chung

The U.S. Army has a robot doctor. This is a pretty cool video of Dr. Kevin Chung using a sophisticated robot to deliver remote medical care. Check out this CNN video clip:

Gigantic nursing union has formed: National Nurses United

Wow, this is gigantic. The California Nurses Association/National Nurses Organizing Committee, the United American Nurses, and the Massachusetts Nurses Association have joined forces to create the largest union of registered nurses. This union is called: National Nurses United. Sounds very patriotic. Seems very fitting, considering that our entire healthcare system is about to go through a major overhaul.

Their founding convention will take place this December in Arizona. Can you imagine what kind of power this 150,000 member union will have? Physicians have talked about creating a union for many years, but nothing has ever happened. Perhaps that will change if healthcare reform changes become unbearable for physicians. What if Sermo transformed itself into a physician union?

Teen cries tears of blood (haemolacria)

This is a very unusual case. Calvino Inman is a 15-yr-old teen who lives in Tennessee. When he cries, he cries tears of blood. According to this story on CNN: Dr. Barrett G. Haik, director of the University of Tennessee's Hamilton Eye Institute, says... "crying blood," a condition called haemolacria, is common in people who have experienced extreme trauma or who have recently had a serious head injury." The strange part is that Inman has no history of head trauma. So why would he be crying blood?

The CNN story also notes that Inman will under a psychiatric evaluation to rule out the possibility that he might be faking those bloody tears.

IsoFlow infusion catheter receives FDA marketing clearance

If you haven't seen this video about the IsoFlow infusion catheter, I think you'll be impressed. This is targeted drug delivery (not to be confused with targeted biologic drugs).

San Jose, Calif. – September 2, 2009 – Vascular Designs, a medical device company, today announced that its IsoFlow™ infusion catheter has secured 510(k) marketing clearance by the U.S. Food and Drug Administration (FDA) for the direct delivery of medications into highly targeted areas. An important application of IsoFlow may be in the treatment of cancer.

The IsoFlow Infusion catheter enables sideways perfusion, which allows physicians to precisely target and isolate areas within the body where the infused drugs are delivered. With IsoFlow’s unique design, medications can be delivered into areas that could not previously be treated directly, for instance, a cancerous tumor. According to numerous studies, this approach lets physicians increase drug concentrations at targeted sites while reducing systemic exposure, thereby improving efficacy and patient outcomes when treating illnesses such as cancer with chemotherapy.

To read the entire press release, visit: Vascular Designs

Are TV ads causing cancer patients to distrust their providers?

You've probably seen direct-to-consumer or DTC ads on TV about cancer therapies. I don't watch too much television, so I don't consider myself an expert when it comes to these types of ads.

Do these television ads hurt or help patient-provider interactions in the world of oncology? To answer this question, a group of researchers did a study and published it in the Journal of Clinical Oncology, Vol 27, No 25 (September 1), 2009: pp. 4182-4187. The study was titled, "Cancer-Related Direct-to-Consumer Advertising: Awareness, Perceptions, and Reported Impact Among Patients Undergoing Active Cancer Treatment"

The authors on the paper were: Gregory A. Abel, MD, MPH, Harold J. Burstein, MD, PhD, Nathanael D. Hevelone, MPH, and Jane C. Weeks, MD. From the Center for Outcomes and Policy Research and the Division of Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.

So what did the investigators find?

• A majority of those aware reported that cancer-related direct-to-consumer advertising (CR-DTCA) made them "aware of treatments they did not know about" (62.2%), provided information in "a balanced manner" (65.2%), and helped them to have "better discussions" with their provider (56.8%).
  
• These perceptions were significantly more favorable among those who had not graduated from college (P < .05 for each).
• Overall, 11.2% reported that CR-DTCA made them "less confident" in their providers' judgment.
  
• Of those aware, 17.3% reported talking to their provider about an advertised medication, although less than one fifth of those reported receiving a prescription for the advertised medication.
• The authors conclude that CR-DTCA was found to be accessible and useful; however, it decreased some patients' confidence in their providers' judgment.
  

Are patients too demanding? Or are they becoming more educated through these ads and are they simply trying to make informed decisions? Are these ads misleading patients? You're only going to find ads on TV from the newest drugs, so don't expect ads about old drugs, generics, etc.

The JCO abstract can be found here:
http://jco.ascopubs.org/cgi/content/abstract/27/25/4182

Speaking of Dana-Farber, I did some cancer research when I was a student at MIT. Those were the days. I used to ride my bike across the Harvard bridge or take the T to get to the hospital. I miss those Boston days. Life was so simple back then. If only I could go back in time...

Physicians, patients, and social media (Facebook)

What happens if your patient finds your profile on Facebook and requests to be your friend? What if your patient follows you on Twitter? Have you thought about how social media may impact physician-patient relationships? There's an interesting story on CNN about this topic. In that story, the president of the AMA, Dr. J. James Rohack, is quoted as saying: "Communicating with existing patients online can add value to the patient-physician relationship, however there are certain aspects of medical care that cannot be handled virtually."

There have been many recent stories where patients have looked for their physicians on Facebook. Before you know it, your patient may have access to a lot of your personal information. Phone #, e-mail address, contact list, address, etc. Do you really want your patients to know all of this? Doctors need their privacy too. If you're a single physician, do you want your patients to know that you're single and "Looking for Dating/Relationship" on Facebook?

In the New England Journal of Medicine (NEJM), Sachin H. Jain, M.D., M.B.A. (an intern at the time of writing this article) writes a perspective about "Practicing Medicine in the Age of Facebook." Click here to read the NEJM article. He shares some of his personal experiences about this social media tool and perhaps you may have some stories to share as well.

Epocrates on the BlackBerry Storm

Last month, I had the opportunity to use a BlackBerry Storm as my own smartphone. I installed several medical applications (apps) on it, but I was quickly disappointed by the fact that it only has 120 MB (not GB, but MB) of memory for apps. It has plenty of storage space (thanks to an 8 GB storage card), but I need space for applications, not for things like MP3 files and videos. I quickly filled up that 120 MB of space and that was one of the reasons why I ended up returning it to Verizon.

Of course, I installed Epocrates to see how it would run on the BlackBerry Storm. I was very impressed by the way it operated and I noticed that Epocrates was always running in the background, even after a reboot (which took over 5 minutes!). Epocrates was fast and responsive and I think it ran really well on the BlackBerry Storm. Unfortunately, you're currently limited to Epocrates Rx or Rx Pro. You can't get Epocrates Essentials for BlackBerry right now.

You can read about my initial impressions of the BlackBerry Storm here at MedicalSmartphones.com.

I returned the BlackBerry Storm to Verizon Wireless and I have no regrets. I'm back to Windows Mobile (now running 6.5) and I'm sure that the BlackBerry hardware and operating system will continue to improve over the next year. The Storm 2 is coming out this fall and the price on the current Storm is very low ($50). I really hope that the Storm 2 has much more space devoted to apps.

If you're a healthcare professional and you're using a BlackBerry Storm, you've probably loaded Epocrates. What else are you running on your BlackBerry?

To keep up with all my smartphone discussions, visit: http://www.medicalsmartphones.com

Senator Tom Coburn, M.D. on Sermo discusing tort reform

Tom Coburn, M.D. is a US Senator, Oklahoma (R) and a physician. He posted something on Sermo recently to get some feedback about tort reform and I found it to be very interesting. The post has only been up for a few days, but there are already over 200 comments!

Physicians recognize the need for some serious tort reform, especially in the midst of major healthcare reform. However, do we know what that's going to look like? Two current ideas include:

• Expert panels to review medical disputes. In this scenario, the panel would consist of 3 attorneys and 3 medical professionals. That panel would review cases and determine whether a healthcare provider is responsible for wrongdoing and what, if any, relief is warranted.
  
• Formation of independent health courts. In this scenario, a judge who has expertise in health issues would preside over an independent health court. He/she would render a binding decision using the same legal standards as a traditional trial judge.

Sounds quite interesting, doesn't it? Which would you vote for? Sounds like the data will get published once it's all collected on Sermo, so stay tuned! I wonder how all the medical malpractice attorneys feel about all these talks regarding healthcare reform.

How did a frog get into a Pepsi can?

I'm glad I don't drink soda (I should say, I rarely drink soda). Someone in Florida found a frog (it could have been a toad) inside his can of Diet Pepsi. Sounds pretty crazy, doesn't it?

Since so many people carry cell phones (or smartphones) and have cameras on their devices, I suppose it would be really easy to capture such a memorable moment. Read this crazy story on CNN here.

OK FDA, how did this happen?

Pfizer and a $2.3 billion settlement

Wow, you don't hear about a $2.3 billion settlement every day. It's hard for me to even imagine that much money. According to several circulating reports, Pfizer will pay $2.3 billion for improper marketing of Bextra (Valdecoxib), which was removed from the market in 2005. Bextra was a COX-2 inhibitor. I remember when COX-2 inhibitors came out. Many people were so excited to see an NSAID that wouldn't harm the stomach. We saw tremendous success with Celebrex (Celecoxib) and Vioxx (rofecoxib). We thought they were going to be wonder drugs for older adults with arthritis, back pain, etc.

You probably know who made Vioxx (Merck). Do you know who makes Celebrex? It's Pfizer. Now, we're left with Celebrex as the only COX-2 inhibitor. I wonder if we'll see new COX-2 inhibitors emerge on the market.

H1N1 (swine flu) advice for parents now that students are returning to school

Now that many students are back to school, parents are very concerned about swine flu (H1N1). Dr. Sanjay Gupta on CNN offers some practical advice for parents who have concerns about this pandemic. The four points outlined by Dr. Gupta include: keep your sick kids at home, call your pediatrician before taking your child to the doctor, and make sure you know when you must call your doctor.

We know that many students (and parents) are going to get sick this fall/winter with H1N1. Let's hope that parents and teachers don't over-react to this situation but that they use common sense as they deal with swine flu and that they consult their healthcare providers appropriately. Emergency rooms and primary care offices will be extremely busy this fall/winter. What's going to happen as healthcare providers get sick? We're probably going to see some significant shortages of healthcare providers this fall/winter.

Here's my tip for parents:
Have a backup plan so that you can go somewhere else in case your healthcare provider is unavailable. If your pediatrician is a solo practitioner and he/she gets sick, then you'll have to find a different office.

2009 ASCO EHR Symposium

The 2009 ASCO (American Society of Clinical Oncology) Electronic Health Record (EHR) symposium is this October in San Francisco, CA. Because of the HITECH provisions found in the ARRA, we know that EHRs will become very prevalent across all medical specialties, including oncology.

In the field of oncology, so many medications cause significant adverse reactions. Plus, combination therapy is often used to treat cancer. EHRs can help clinicians keep track of all the treatment infusions and they may also alert providers about the possible risks associated with combining certain chemotherapy agents with targeted biologics.

Interested in knowing who will be speaking? Here are just a few examples:

• Peter Yu, M.D. - Chair ASCO EHR Workgroup, Oncologist, Palo Alto Medical Foundation (PAMF)
• Barbara McAneny, M.D. - CEO, New Mexico Oncology Hematology Consultants
• Charles McKay, M.D. - CEO, Tennessee Oncology
• John Cox, D.O., M.B.A. - Editor-in-Chief, Journal of Oncology Practice
• Robert Miller, M.D. - Oncologist, Johns Hopkins Kimmel Cancer Center
• Kenneth Buetow, Ph.D. - Director, NCI's Center for Biomedical Informatics and Information Technology (CBIIT)
• Lawrence Shulman, M.D. - Chief Medical Officer, Dana- Farber Cancer Center
• William Hersh, M.D. - Chair, Department of Medical Information and Clinical Epidemiology, Oregon Health and Sciences University

If you're an oncologist (and you're not retiring anytime soon), you won't want to miss this! To get more information about the ASCO EHR symposium, visit: http://www.asco.org/ehrsymposium

How much is a kidney worth? $20,000 on the black market.

Wow, this is quite an interesting story. In this story, CNN is reporting that one kidney donor responded to a black market ad and received $20,000 for donating a kidney for organ transplantation. According to the editor's note: Since the FBI arrested a Brooklyn businessman in late July on federal charges of organ trafficking, CNN has been conducting a worldwide investigation into the sale of kidneys using willing donors and willing recipients from China to Israel to the United States.

Nick Rosen has made his story public by creating a documentary film called "Kidney Beans." Sounds like a very fascinating tale. When I stop to think about all the corruption that's in the world, I'm surprised that we're not hearing more stories of involuntary donation of organs - where people are literally forced to donate their organs. I've heard of rumors that prisoners in China are often forced to donate their organs (I have no idea of this is true, so I'm not trying to spread rumors). I wonder how many unreported organ transplants occur in other countries. If Israel is really leading the world in organ trafficking, I wonder which countries are second and third. My guess would be countries where human rights laws are not heavily enforced.

I know several people who have donated kidneys. It's very noble and I respect them highly for their sacrifice. It's such a shame to think that some are doing it for cash (and that others may be forced into it).

Grand Rounds Sept 1 Vol 5 No 50

Welcome to Grand Rounds Vol. 5 No. 50 @ Medicine & Technology. This week, I've asked medical bloggers to reflect on the theme of "medical safety and technology." We all want to see safer hospitals and avoid medical errors. Advances in technology may allow us to practice safer medicine if we leverage it appropriately. Technology may also improve public health and safety.

Bongi from other things amanzi writes about a "terrifying" experience during his psychiatry rotation at a maximum security ward. Let's hope that innovations in technology are keeping healthcare professionals safe while they work in dangerous settings like psychiatric wards and prisons.

Nancy from Teen Health 411 takes us on a journey as she outlines articles from Teen Health 411. You'll find several that deal with personal health and safety. As more teens embrace technology, let's hope they'll use it to learn about the ways they can improve their health.

At Henry's Webiocosm Blog, we see a cartoon about euthanasia and 'death panels' (we'll never see the end of cartoons on healthcare reform). Who's heard of a waiting list for dying? Perhaps someday in the future, some of these unpleasant aspects of medicine will be automated by robots.

Flavio writes on Pharmamotion about the pharmacokinetics, MOA, indications and adverse effects of serotonin 5-HT3-receptor antagonists. These drugs are used for the prevention of chemotherapy induced nausea and vomiting (CINV). It's great to see how advances in drug development technology are leading to new and innovative compounds.

Jolie from The Fitness Fixer talks about some common medications that may cause musculoskeletal pain (and you just thought you were getting old). Don't ever stop taking any pills before you get a chance to speak with your healthcare provider. Use technology to send your clinician an e-mail, text message, or voice mail if you have any questions about your medications.

At How to Cope with Pain, we read about Using f-MRI To Measure Pain. Have you ever had a functional MRI? Maybe we won't need those pain rating scales anymore as technology evolves to simplify pain management.

Adam at Receiving writes about a recent interview with Detroit Receiving Hospital's Dr. Larry Schwartz, one of the countries preeminent medical student educators. As the healthcare system changes, how will budding medical students adapt? I'm sure all new grads will be much more tech-savvy compared to current physicians when it comes to electronic health records and computer use.

Dr. Shock blogs about the use of computers in the hospital. On ward rounds, the majority of tasks (57.3%) were completed using a generic Computer On Wheels, while 35.9% were completed using a tablet PC. I'm a huge fan of the tablet PC and it's great to see how computing technology is leading to safer hospitals.

InsureBlog's Mike Feehan takes to task Physicians for a National Health Program, explaining why their stance is so off-track. He makes a compelling argument of why we need real physician leadership. We especially need strong leadership as it relates to healthcare and the use of health information technology and I think we have a lot of that in this country.

Ryan at the ACP Internist writes about some of the uncertainties that surround the H1N1 vaccine. Some people may even refuse the H1N1 vaccine, but will that result in major public health safety problems? What's the use of an effective vaccine if it never reaches the masses?

Alison at Shoot Up or Put Up writes about how technology is great, but what happens when it lets you down and you're a diabetic away from home without a working insulin pump? Then you're in trouble and it becomes "one of those days..." Insulin pumps continue to evolve and perhaps we will soon see the day of a true artificial pancreas.

Paul at Medicine for the Outdoors writes about a national ambulance service in Nepal. Sounds like a fascination program that should appeal to many individuals interested in global humanitarian relief and international medicine. What kind of technology is available in the remote regions of Nepal? They'll need to depend on strong wireless communications to get up that high.

Toni blogs at EverythingHealth about the famous California kidnapping story of Jaycee Dugard. Wasn't that a fascinating story? I wish her the best as she re-enters the normal world. Let's hope that safety surveillance and other forms of technology will prevent this type of thing from ever happening again. Would you implant a GPS tracking chip in your child?

At the Cockroach Catcher, we read about her recent visit to the farmers’ market in Panama City. Despite all the advances in medical technology we've seen, nothing seems to compare with some of the fruits and vegetables we can get to keep us healthy.

Daryl at Listed As Probable blogs about how sports injuries are a combination of physical and mental components. Modern imaging technology makes it so quick and easy to diagnose injuries these days. Soon, we'll probably see portable X-ray machines and MRIs on the playing field. Can you imagine watching a football game and then seeing a radiographic image of the actual injury?

David at SharpBrains writes a review of a new study comparing medication vs. working memory training for kids with ADHD. Some kids are using computers to help them manage their ADHD. It's great to see how technology is helping these patients.

Lauren at the Novel Patient blogs about the way she got "a new look" at herself as goes through rounds of immunosuppressant medications. Despite advances in drug development, we still haven't found effective ways to cure certain diseases. How will that change as medical technology evolves?

Kerri at Six Until Me is on the brink of a new insulin pump and is talking to her readers about the pros and cons of their diabetes technology. So many new pumps, glucose monitors, and gadgets are popping up these days. As I wrote earlier, the days of an implantable artificial pancreas may be nearing.

Well, that wraps up Grand Rounds this week. Thanks for visiting. Next week, you'll find Grand Rounds Vol. 5 No. 51 @ Medic 999 (http://medicblog999.wordpress.com)