Wednesday, May 19, 2010
A pox on disease management you say? Stone them?
Think again. Two important publications in the mainstream peer-reviewed medical literature suggest that traditional telephonic disease management is quite effective.
Are doctors and parents trying to “perfect” children through various cocktails of medications? That’s what Judith Warner assumed, until she began researching her new book—and found that we are not, after all, a Ritalin nation.
Aren’t all kids on some kind of medication? Isn’t everyone diagnosed with something these days? Isn’t ADD as common as the sniffles?
Not really, says Judith Warner, author of the new book We’ve Got Issues: Children and Parents in the Age of Medication. Warner is best known for outing the culture of overparenting in her first book, Perfect Madness: Motherhood in the Age of Anxiety, and her Domestic Disturbances column on The New York Times Web site, and now she’s decided to quiet the cacophony of misconceptions about children, medication, overdiagnosing, and overmedicating in one confident hush.
How does Warner do it? She starts by challenging her own beliefs.
When she began writing her book, almost five years ago, she came to it thinking the narratives the media had spun about children and medication were true: Parents were trying to “perfect” their children through various cocktails of medications; doctors were going prescription-happy; and kids who occasionally got sad were being labeled “depressed.”
“Those assumptions, however, weren’t borne out by clinicians, parents, children, or statistics,” says Warner, who did lots of research to support her thesis.
Here’s what the numbers teach us:
About 5 percent of kids take psychiatric medication and, depending on how one reads the data, anywhere between 5 and 20 percent of kids today have mental-health issues. We are not a Ritalin nation. According to The National Institute of Mental Health, attention deficit disorder occurs in about 3 to 5 percent of school-age children.
Tuesday, May 18, 2010
Deciding on a career path is a journey. By choosing to become a radiologist or sonographer, you're launching yourself into a lucrative and rewarding career field. Or are you? These blogs by radiologists, sonographers and industry professionals reveal the ups, downs and nitty gritty details that you would want to read before making a huge decision such as a career path. Check out these top 50 blogs and see if diagnostic imaging is in your future.
Health care has become the most salient political issue over the last few years. It is particularly interesting for political junkies because there are so many different facets, from ethics to workman's comp, to legal reform to delve into. To help you educate yourself on the myriad health care policy issues we've selected what we consider to be the 100 best blogs at explaining news, viewpoints, facts and opinion relating to health care policy.
Monday, May 17, 2010
Also not among the new drugs approved was A5G27, or whatever more mellifluous name a drug company might give it. In 2004 Hynda Kleinman and her colleagues at the National Institutes of Health discovered that this molecule, called a peptide, blocks the metastasis of melanoma to the lungs and other organs, at least in lab animals. The peptide also blocks angiogenesis, the creation of blood vessels that sustain metastatic tumors, they reported six years ago in the journal Cancer Research. Unfortunately, A5G27 has not been developed beyond that discovery. Kleinman was working at NIH's dental-research institute, and, she says, "there was not a lot of support for work in cancer there at the time. They weren't interested." She did not have the expertise to develop the peptide herself. "I continued doing cancer research on it, but I couldn't take it to the next level because I'm not a cancer specialist," she says. "I was trained as a chemist."
No one is saying A5G27 would have cured metastatic cancers, which account for some 90 percent of all cancer deaths; the chance of FDA approval for a newly discovered molecule, targeting a newly discovered disease mechanism, is a dismal 0.6 percent. Diseases are complicated, and nature fights every human attempt to mess with what she has wrought. But frustration is growing with how few seemingly promising discoveries in basic biomedical science lead to something that helps patients, especially in what is supposed to be a golden age of genetics, neuroscience, and biomedical research in general.
From 1998 to 2003, the budget of the NIH—which supports such research at universities and medical centers as well as within its own labs in Bethesda, Md.—doubled, to $27 billion, and is now $31 billion. There is very little downside, for a president or Congress, in appeasing patient-advocacy groups as well as voters by supporting biomedical research. But judging by the only criterion that matters to patients and taxpayers—not how many interesting discoveries about cells or genes or synapses have been made, but how many treatments for diseases the money has bought—the return on investment to the American taxpayer has been approximately as satisfying as the AIG bailout. "Basic research is healthy in America," says John Adler, a Stanford University professor who invented the CyberKnife, a robotic device that treats cancer with precise, high doses of radiation. "But patients aren't benefiting. Our understanding of diseases is greater than ever. But academics think, 'We had three papers in Science or Nature, so that must have been [NIH] money well spent.'?"
More and more policymakers and patients are therefore asking, where are the cures? The answer is that potential cures, or at least treatments, are stuck in the chasm between a scientific discovery and the doctor's office: what's been called the valley of death.
The barriers to exploiting fundamental discoveries begin with science labs themselves. In academia and the NIH, the system of honors, grants, and tenure rewards basic discoveries (a gene for Parkinson's! a molecule that halts metastasis!), not the grunt work that turns such breakthroughs into drugs. "Colleagues tell me they're very successful getting NIH grants because their experiments are elegant and likely to yield fundamental discoveries, even if they have no prospect of producing something that helps human diseases," says cancer biologist Raymond Hohl of the University of Iowa. In 2000, for instance, scientists at four separate labs discovered a gene called ABCC6, which, when mutated, causes PXE (pseudoxanthoma elasticum), a rare genetic disease in which the skin, eyes, heart, and other soft tissue become calcified—rock hard. By 2005, scientists had genetically engineered lab mice to develop the disease. The next step would be what's called screening, in which scientists would laboriously test one molecule after another to see which had any effect on ABCC6. But "academic scientists aren't capable of creating assays [test systems] to do that," says Sharon Terry, CEO of the Genetic Alliance, which supports research on rare genetic diseases (her children have PXE). "It's time-consuming drudgery and takes an expertise that hasn't trickled down to the typical academic scientist." Ten years later, there is still no cure for PXE.
Should a lab be so fortunate as to discover a molecule that cures a disease in a lab rat, the next step is to test its toxicity and efficacy in more lab animals. Without that, no company—for companies, not academic scientists, actually develop drugs—will consider buying the rights to it. "A company wants to know, how specific and toxic is the molecule?" says Kenneth Chahine, an expert in patent law at the University of Utah. "It might work great in a mouse, but will it make a rat keel over? Doing this less fun research is not something an academic lab is interested in. The incentive driving academic labs is grants for creative, innovative research, and you're not going to get one to learn how much of a compound kills a rat."More ...
Dartmouth College has received a $35 million commitment to establish The Dartmouth Center for Health Care Delivery Science, PresidentJim Yong Kim announced today. The anonymous gift will advance a new field of study, harnessing the knowledge and expertise of faculty across multiple disciplines from the arts and sciences as well as from the medical, business and engineering schools.
Kim said the gift will speed Dartmouth's work on the next stage of needed health care reform: "The passage of health reform was a historic event that will result in millions of Americans having access to our health care system. Health Care Delivery Science is about ensuring that the care they receive is the best it can be."
"We know – and this has been documented by the Dartmouth Atlas of Health Care – that there are glaring variations in how medical resources are used in the U.S. More care and more expensive care do not guarantee high quality care," Kim said. "What we need is a new field that brings the best minds – from management, systems engineering, anthropology, sociology, the medical humanities, environmental science, economics, health services research, and medicine – to focus on how we deliver the best quality care, in the best way, to patients nationally and globally. Those people are here at Dartmouth."
Senators Judd Gregg, R-NH, and Jeanne Shaheen, D-NH, applauded the new Center:
Senator Gregg noted that studies from The Dartmouth Institute for Health Policy and Clinical Practice "are constantly turned to by policymakers in Washington, especially as they relate to getting better health care at a more affordable cost. The establishment of this new Center will put the findings ofDartmouth researchers into practice and will further the Institute's efforts to advance health care innovation, rein in health care costs, and provide quality care for people throughout the country."
Said Senator Shaheen: "The formation of the Center for Health Care Delivery Science is great news. This will help Dartmouth remain on the cutting-edge of studying our health system and developing new practices to make health care delivery more efficient and cost effective. I look forward to working with and supporting President Kim and the Center in their efforts, especially as we implement new laws that will provide affordable health coverage to millions more Americans."
In addition to integrating across the Arts and Sciences (undergraduate and graduate), the Tuck School of Business, the Thayer School of Engineering, Dartmouth Medical School, and The Dartmouth Institute for Health Policy and Clinical Practice, Health Care Delivery Science creates a unique partnership between the College and Dartmouth-Hitchcock, its affiliated academic health system. Dartmouth-Hitchcock will provide the base for innovation and implementation in clinical practice, said Co-Presidents James N. Weinstein and Nancy Formella.
"In the past decade, Dartmouth-Hitchcock has created a number of innovative models in clinical care, including the Spine Center, the first-in-the-nation Center for Shared Decision-Making, and the Comprehensive Breast Program," Weinstein said. "This is a fantastic opportunity to build new partnerships within the College, and take advantage of President Kim's experience in tackling the challenge of health care delivery in some of the most difficult settings in the world."
One of the first initiatives will be a new Master's program in Health Care Delivery Science, offered jointly by The Dartmouth Institute and the Tuck School of Business. Traditional health care management courses have been built around general "best business" practices from a wide range of professions. The Dartmouth curriculum will be unique in its singular focus on discovery and analysis of innovations and real-time implementation in health care. Executive education and distance learning will be incorporated into the new degree program, scheduled to enroll its first class in July 2011. Undergraduate offerings in this field will be developed as well, Kim said.
Dartmouth Provost Carol L. Folt said: "Health care is now one-sixth of the U.S. economy, and arguably as important as any issue we face today. Our undergraduate students, whatever their career path, will be affected by its impact on our economy, national discourse, and of course, will experience health care first-hand as patients or family members of patients. We know that teaching political science, economics, sociology, philosophy, etc. to our students is critical to their liberal arts education. The opportunity to study health care and its impact on society – in its broadest form – will only enhance our ability to produce enlightened graduates and leaders."
Jeff Immelt, Chairman and CEO of General Electric and a Dartmouth trustee said: "As an employer of 300,000 people around the world and with $3 billion of our resources going into health care for our people each year, there are few issues more important to me and to GE than the quality and cost of health care. I'm proud of Dartmouth for taking this on, for applying expertise from across the College to the challenges, and for partnering so effectively with the Dartmouth-Hitchcock health system."
The Dartmouth Center for Health Care Delivery Science will focus on five areas with a goal of improving the quality, effectiveness, and value of health care for patients, their families, providers, and populations.