National Health Spending – Lots of Confusion

August 4, 2008 / Michael D. Miller MD / Economics & Financing, Politics, Public Health / 3 Comments

I was at a party over the weekend with a number of clinical Fellows from a major academic medical center. They were all very nice, but I had a very strange conversation with a couple of the Fellows.

The conversation became strange when one of them asked me about what I thought was the biggest healthcare spending problem. Rather than let me fully explain what I thought, they somehow quickly pronounced that pharmaceuticals were the largest cost in the US healthcare system, implying that this was the biggest spending problem. The strange part of this conversation was that one of them had just taken a health policy class at the public health school affiliated with their Fellowship program.…

Literacy, Communications and Star Trek – Cores for Reforming Healthcare

July 30, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Health System Reform, Information & Communications, Quality of Care & Safety / 1 Comment

In talking to people about the problems with the US healthcare system, two fundamental truths have become apparent.

First, people really want the type of healthcare that is envisioned in science fiction such as Star Trek, where almost any ailment is treated with a single injection or pill, or a few waves of a healing wand. Unfortunately, medical science hasn’t accomplished that, except in a few instances – antibiotics for a bacterial infection, or perhaps relocating a dislocated finger or shoulder (and those still require weeks to heal and therapy to regain strength and mobility).

And second, the ongoing problem of healthcare literacy and communications may be getting worse as the complexity of medical treatments increases.…

Financial Returns from E-Prescribing – Saving Medicare $2.1 billion

July 23, 2008 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Information & Communications, Innovation, Medicare, Quality of Care & Safety / 5 Comments

The leadership of HHS had a tele-conference on Monday to highlight the new Medicare incentives for physicians to adopt e-prescribing systems. What the Washington Post and Kaiser Family Foundation reported about this press briefing that wasn’t in the HHS press release was that the Acting Administrator of CMS said that the per physician cost of e-prescribing systems is about $3,000 up front, and then $80-400/month for operation and maintenance.

These numbers caught my eye, because with the incentives in the Medicare bill, the break-even point for physicians is as follows:

First, let’s assume that the per month cost is $240 (the mid-point between $80 and $400), or $2,800 per year.…

New Health Posting in Iraq

July 22, 2008 / Michael D. Miller MD / Delivery of Healthcare, Miscellaneous, Politics, Public Health / No Comments

I couldn’t resist witting something about this when I saw today’s press release from HHS which announced that Terry Cline, Ph.D., the administrator of HHS’ Substance Abuse and Mental Health Services Administration is leaving that post, and starting August 31st he will be the HHS Health Attaché and representative at the U.S. Embassy in Baghdad, Iraq.

On the serious side, I’m sure he will do good things to help improve the healthcare system in Iraq. But on the less serious side, someone (maybe Jon Stewart?), needs to ask how did this happen? How bad did he step on someone’s toes to get moved from Rockville, MD to Bagdad?…

Vacations – Poker – Diagnostic and Research Skills

July 21, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Innovation, Miscellaneous / No Comments

What’s the point of vacations? As a consultant that’s something I often ask myself since with the internet, cell phones, etc., it seems almost impossible to really “get away” and not be connected to work.

So what’s the value of vacations? I think I’ve found the answer at the poker table. As Ricky Ricardo used to tell Lucy, “Lemme splain!”

The point of vacations is to recharge by being in a different environment that presents a new context for viewing our normal “reality.” A great practitioner of this principle was Teddy Roosevelt. He would travel to the wildest and most dangerous parts of the world, and hunt the largest of animals.…

Scientific Study of Resveratrol: Challenges for Reporters to Unravel the Spin

July 15, 2008 / Michael D. Miller MD / Information & Communications, Innovation, Politics, Public Health / No Comments

One of my interests in health communications is how the findings from scientific research are presented to various stakeholder audiences. Because of this, I was interested to see how the titles of several reports about one study of an investigational compound highlighted different perspectives.

The compound being investigated in this research was resveratrol, which has been shown to replicate the life-span extending effects of dietary restriction in lower animals. (Resveratrol is also the component of red wine that is believed to provide various health benefits.) The new study looked at the effects of resveratrol in mice. The titles of the journal article of the study’s findings, the NIH’s press release and the company’s press release were:

“Resveratrol Delays Age-Related Deterioration and Mimics Transcriptional Aspects of Dietary Restriction without Extending Life Span” (From Cell Metabolism’s web-site)
“Resveratrol Found to Improve Health, But Not Longevity in Aging Mice on Standard Diet” (From National Institute of Aging’s web-site)
“Long-Term Study of Middle-Aged Mice Shows Resveratrol Improves Health and Mimics Some Benefits of Dietary Restriction” (From Sitris’ web-site)

Looking at these titles it is interesting to note that the scientific journal only includes a general statement about life-span. …

E-Prescribing – Good? E-Dispensing Bad!!

July 10, 2008 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Delivery of Healthcare, FDA, Information & Communications, Miscellaneous, Public Health, Quality of Care & Safety / 1 Comment

With two notable government actions in the last couple of weeks there has been significant movement towards increasing the use of e-prescribing.

DEA Proposed Rule
The Drug Enforcement Agency (DEA), proposed regulations on June 27th that would make it possible for controlled substances to be prescribed electronically. Interestingly, this was released right after a National Journal article on this topic.

The DEA’s proposed rule is very important, because while it is appropriate to place stronger safeguards on medicines that are likely to be abused (which is the criteria for being a DEA scheduled medicine), having controlled medicines prescribed by pen and paper while all other medicines are e-prescribed would be a logistical problem and obviate many of the potential benefits of e-prescribing. …

Pharma Industry’s US R&D Spending Breaks Milestone

July 7, 2008 / Michael D. Miller MD / Innovation, Miscellaneous, Politics / No Comments

According to my calculations, sometime this month research and development spending in the United States by pharmaceutical companies will pass the $100 million per day mark.

The $100 million/day figure assumes R&D spending seven days a week, and it doesn’t include R&D spending outside the US, or spending by smaller biotech, medical device, diagnostic, or health IT firms. By comparison, the National Institutes of Health spends about $79 million a day.

With all the reports about the slowdown in the industry’s output, higher barriers for FDA approval of new medicines, and the criticism of the industry and the FDA, I hope that the industry’s ongoing R&D investments do produce new medicines that are valuable to individual patients and society overall.…

Public Health Advice for the Next President – Exercise

July 1, 2008 / Michael D. Miller MD / Politics, Public Health / 1 Comment

I was recently asked what I would advise the next President to make his number one public health priority. I said exercise, and here’s why:

Increasing the physical activity of Americans will have tremendous public health benefits, since it will fundamentally help address many conditions that significantly reduce overall public health, including obesity, diabetes, cardiovascular disease, cancer, arthritis, and mental illnesses. In addition, exercise initiatives can be constructed as public-private partnerships, built collaboratively with a number of advocacy groups, and would require minimal Federal spending.

…

The Face of Free Government Health Care

June 30, 2008 / Michael D. Miller MD / Economics & Financing, Medicaid, Miscellaneous, Politics, State-Level Healthcare Reform / No Comments

A couple of months ago I wrote about how one percent of adults in the US get free government health care. While the statistics in the February Pew study were very interesting (and somewhat shocking), I saw a report in a local Connecticut newspaper (The Day, June 26th) that put a face on these statistics.

The Day’s story was about Jihad Abdulshaheed, a 36-year-old man who had been incarcerated since November 2007. The judge was prepared to sentence to a one year sentence, and since he had already served at least 50% of his time, under the Department of Corrections guidelines for nonviolent prisoners he could have been released the next day.…

Updates on Vitamin D

June 27, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Innovation, Nutrition, Public Health / No Comments

Since I wrote about the importance of Vitaim D a few weeks ago, some new information has come out.

A report was released this week from researchers in Australia about Vitamin D reducing the risk of all causes of death. The study was in the Archives of Internal Medicine, about their evaluation of 3,258 men and women scheduled to have a angiogram of their heart arteries. They found that the people who had below average Vitamin D levels had about twice the risks of dying than those with levels in the highest 25% of the group.

While looking for the report of the Austrlian study, I found another study from a group of reserachers in Boston, that looked at 18,225 men who had no diagnosed heart disease. …

Increasing Diabetes Rate and Awareness in US

June 25, 2008 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Nutrition, Public Health / 4 Comments

The Centers for Disease Control and Prevention released some interesting data yesterday. They reported that in 2007 an estimated 23.6 million people (7.8% of the total US population) have diabetes. Of these people, only 17.9 million know they have diabetes, while 5.7 million have not been diagnosed. The good news is that the percentage of people with diabetes who don’t know it has decreased from 30 to 25% The bad news is that the number of Americans with diabetes is increasing.

Number of People in the US (in Millions) with Diagnosed Diabetes: 1980- 2005

(from http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm)

How Bad Is a Little Sugar?…

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