Thursday, June 30, 2016

Replacing Obamacare  from Intrepid Now with Sally Pipes as interviewed by Joe Lavelle.

Transformational Changes

Sally joined us to discuss why and how we should be replacing Obamacare and much more in this episode:
  1. (3:39) What is Obamacare?
  2. (5:07) Several insurers have noted that they are losing money on the health insurance exchanges. What does this mean for the future of the exchanges and its customers?
  3. (11:29) What must the federal government do to make health insurance affordable and increase accessibility?
  4. (16:07) Will you describe the Trump Healthcare Plan for our audience?
  5. (20:54) Will you also describe the Hillary Clinton Healthcare Plan?
  6. (22:18) If you were President, what healthcare program would you implement?

Sunday, June 26, 2016

The Five Percent in Health

The Wealth and Health Divide
The Growing Gap in the United States
Between the healthy and the sick

We have all heard about the one percent that have 95% of the assets in America.  The middle class is 'dead'.  

The same is true of the understanding of health financing in America. Only about one percent of patients (and providers) have the time or in following the endless changes in this area.

 Now that I am retired I find it a rewarding activity during my day. Health IT and reform have stimulated a new interest for me.

The remainder of my professional life is now dedicated to health information technology and health reform. These are my missions in my blogs.  Health Train Express is available for general knowledge about breaking news in health research and public health.

Digital Health Space encapsulates knowledge about health information technology for patients and providers. It is essential that both sides of our equation are equal in order to maximize the tremendous potential of information technology and the use of the internet to disseminate and acquire knowledge as well as accessing personal health records.

My efforts are self-funded...a truly non-profit activity in which I invest time and some money. I am beholden to no-one, no foundations, pundits, experts, nor authority. At times I quote others or just curate content without modification. Some source articulate issues much better than I do. My linguistic style is not as erudite or polished as some. More important should be my ideas...serious with much sarcasm and some humor.

How long will this continue ?

The Event Horizon

Friday, June 24, 2016

The Affordable Care Act, Accountable Care Organization and the Election

Better Together Health 2016 Event - Better Together     Are we really

The Affordable Care Act has stimulated many changes in health care. What is  considered good or bad depends upon the viewpoint of the provider and/or patient.

We have not yet seen the details of the Republican plan so Health Train Express will not offer our evaluation. Decisions based upon political rhetoric are at the least foolish, and at the worst dangerous.

It is doubtful if the ACA will be repealed entirely. Significant amendments ill be made. Other than some displeasure in the provider and health insurance industry patients who are able to access care are at less risk of not getting urgent care.  Even that presents problems in terms of provider accesss and the high deductible and premium expence for most receiving a partial subsidy. For those who are indigent, they have not expenses.

The progress of the organization being promoted by Medicare and some private insurers is the Accountable Care Organization (ACO).  The progress of developing this organization is fraught with many barriers. The ACO is an HMO on steroids.

Perhaps the closest organization to an ACO is the Kaiser Permanente model. The Counsel of Associated Physicians Group recently held a symposium, Better Together Health 2016 Event - Better Together.

The speakers represent a broad spectrum of the view on Accountable Care Organizations.

Robert Pearl, MD, is Executive Director and CEO of The Permanente Medical Group and President and CEO of the Mid-Atlantic Permanente Medical Group. Dr. Pearl serves on the faculties of the Stanford University School of Medicine and Graduate School of Business. Dr. Pearl is a frequent lecturer on the opportunities to use 21st century tools and technology to improve both the quality and cost of health care, while simultaneously making care more convenient and personalized.


Senator John Hardy Isakson (R-GA) is serving his second term in the U.S. Senate, and was recently tapped to lead the Senate Finance Committee’s Chronic Care Solutions working group with Senator Mark Warner (D-VA). The work of the bipartisan committee is to begin exploring solutions that will improve outcomes for Medicare patients requiring chronic care. Isakson is the first Georgian since the 1800s to have served in the state House, state Senate, U.S. House of Representatives and U.S. Senate. He also serves on the Senate HELP Committee, Senate Finance Committee, the Senate Foreign Relations Committee, the Senate Ethics Committee, and the Senate Veterans’ Affairs Committee.

Tim Gronniger is the deputy chief of staff and director of delivery system reform at CMS. He was formerly a senior adviser for healthcare policy at the White House Domestic Policy Council (DPC), where he was responsible for coordinating administration activities in healthcare delivery system reform. Before joining DPC he was a senior professional staff member for Ranking Member Henry Waxman at the House Committee on Energy and Commerce, responsible for drafting and collaborating to develop elements of the Affordable Care Act. Before joining the Committee staff, Tim spent over four years at the Congressional Budget Office.


Ceci Connolly became president and CEO of the Alliance of Community Health Plans in January 2016. In her role, she works with some of the most innovative executives in the health sector to provide high-quality, evidence-based, affordable care. Connolly has spent more than a decade in health care, first as a national correspondent for The Washington Post and then in thought leadership roles at two international consulting firms. She is a leading thinker in the disruptive forces shaping the health industry and has been a trusted adviser to C-suite executives who share her commitment to equitable, patient-centered care.


Dr. Karen Cabell is the chief of quality and patient safety and a practicing internal medicine physician at Billings Clinic, an integrated medical foundation healthcare organization, located in Billings, Montana. Dr. Cabell has implemented diabetes, heart failure and HTN disease management registries along with point-of-care tools for patients and clinicians to better manage chronic disease. She was involved with Billings’ rollout and adoption of an electronic health record implementation since 2004 including all clinic sites and regional partners to include 15 other hospitals with clinics across a 500-mile radius. Dr. Cabell has been instrumental in gaining alignment between the EHR, quality and patient safety as well as strategic planning to support Billings Clinic’s organizational goals of clinical excellence, operational efficiency, market growth and development, and financial strength.


Artist Regina Holliday is a patient advocate known for her series of murals depicting the need for clarity and transparency in medical records, and for founding the Walking Gallery movement. The Walking Gallery consists of more than 350 volunteer members who make statements about the lapses in health care at public meetings by wearing business suits or blazers painted with patient stories. Holliday’s experiences during her husband’s illness and subsequent death inspired her to use painting as a catalyst for change. Backed by her own patient and caregiving experiences, she travels the globe heralding her message of patient empowerment and inclusion in healthcare decision making. Holliday’s mission is to demand a thoughtful dialog with officials and practitioners on the role patients play in their own healthcare.


Dr. Marc Klau has been with the Southern California Permanente Medical Group for 31 years. He is currently the regional chief of Head and Neck Surgery, providing leadership for 100 surgeons.  He is also the Assistant Regional Medical Director for Education, Learning and Leadership. He now oversees the new KP School of Medicine and all of the Southern California Kaiser Permanente residencies, as well as continuing medical education and leadership.


Artist Regina Holliday is a patient advocate known for her series of murals depicting the need for clarity and transparency in medical records, and for founding the Walking Gallery movement. The Walking Gallery consists of more than 350 volunteer members who make statements about the lapses in health care at public meetings by wearing business suits or blazers painted with patient stories. Holliday’s experiences during her husband’s illness and subsequent death inspired her to use painting as a catalyst for change. Backed by her own patient and caregiving experiences, she travels the globe heralding her message of patient empowerment and inclusion in healthcare decision making. Holliday’s mission is to demand a thoughtful dialog with officials and practitioners on the role patients play in their own healthcare.

Janet Marchibroda is the director of the Bipartisan Policy Center’s Health Innovation Initiative in Washington, DC. She has been recognized as one of the Top 25 Women in Healthcare by Modern Healthcare and is a nationally recognized expert on the use of health IT to improve healthcare quality.


Since taking the reins of America’s oldest health department in Baltimore, Dr. Leana Wen has been reimagining the role of public health including in violence prevention, addiction treatment, and urban revitalization. Under Dr. Wen’s leadership, the Baltimore City Health Department has launched an ambitious overdose prevention program that is training every resident to save lives, as well as a citywide youth health and wellness plan. She is the author of the book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, and is regularly featured on National Public Radio, CNN, New York Times, and Washington Post. Her talk on on transparency in medicine has been viewed nearly 1.5 million times.

Better Together Health 2016 Event - Better Together

Saturday, June 11, 2016

76th Scientific Sessions | American Diabetes Association

June 10th-14th is the 76th Scientific Sessions | American Diabetes Association meeting in New Orleans, LA.

Our Mission:  To prevent and cure diabetes and to improve the lives of all people affected by diabetes.

The program will begin on Friday, June 10 at 11:45 a.m. with our new Mini-Symposia sessions and conclude on Tuesday, June 14 at 12:15 p.m. following the ADA Presidents Oral Session.

The ADA maintains an archive of previous events, posters, abstracts and webinars:

Remember, good blood sugar controls lessens the risks for retinopathy, renal disease, heart disease, and neuropathy.  Diabetes effects the entire body, not just blood sugar levels.

Thursday, June 9, 2016


It’s far more important to know what person the disease has than what disease the person has.  – Hippocrates (460-370) B.C.

"Precision medicine" is not a new concept. It was a term coined by Eric Topol and then parroted by President Barak Obama  As early as 435 B.C.  Hippocrates gave us the quote noted above.

Hippocrates established this idea long before the science of biochemistry, genomics, proteomics and DNA sequencing. Since 400 B.C. we have managed to prove his hypothesis, expanding our understanding and developing nomenclature to connect the dots.

Physicians have studied diseases and pathology to understand their process better. Each person however reacts differently to the disease, and so too does the disease react differently to the patient.  It clearly defines to what the term 'patient-centered medicine' applies.

To say that the disease choses the person is to 'humanize' illness. Illness is what occurs when disease conquers human defense mechanisms. in truth, a constant battle is taking place in our bodies each day as bacteria, viruses, autoimmunity and uncontrolled cell multiplication takes place. Inherent in our bodies is a wide array of defense mechanisms. Cellular immunity, circulating antibodies, free radical scavenging biochemisty, enzymatic defense, inflammatory mechanisms, apoptosis and others.

Tuesday, June 7, 2016

Sleep is not an option. A behavior that is common to all of us

What do Arianna Huffington and Oncologist Dr Steven Eisenberg have in common ? Like us, they require sleep to allow our brains to recover, store energy, and allow our neural network to organize our thoughts and emotions.

Consequences of Insufficient Sleep
In the short term, a lack of adequate sleep can affect judgment, mood, ability to learn and retain information, and may increase the risk of serious accidents and injury. In the long term, chronic sleep deprivation may lead to a host of health problems including obesity, diabetes, cardiovascular disease, and even early mortality.

Sleep and Disease Risk

The price of insufficient sleep may be poor health. Study after study has revealed that people who sleep poorly are at greater risk for a number of diseases and health problems. And now the search is on to discover why this might be. more

Sleep, Performance, and Public Safety

Lack of sleep exacts a toll on perception and judgment. In the workplace, its effects can be seen in reduced efficiency and productivity, errors, and accidents. Sometimes the effects can even be deadly, as in the case of drowsy driving fatalities. more

At a Glance

  • The cost of poor sleep is much greater than many people think: it may have profound consequences for our long-term health.
  • Research has revealed that people who consistently fail to get enough sleep are at an increased risk of chronic disease, and scientists are now beginning to understand why.
Treating sleep as a priority, rather than a luxury, may be an important step in preventing a number of chronic medical conditions.

Sleep deprivation research 

Researching the Link Between Sleep Duration and Chronic Disease

There are three main types of study that help us understand the links between sleep habits and the risk of developing certain diseases. The first type (called sleep deprivation studies) involves depriving healthy research volunteers of sleep and examining any short-term physiological changes that could trigger disease. Such studies have revealed a variety of potentially harmful effects of sleep deprivation usually associated with increased stress, such as increased blood pressure, impaired control of blood glucose, and increased inflammation.

The second type of research (called cross-sectional epidemiological studies) involves examining questionnaires that provide information about habitual sleep duration and the existence of a particular disease or group of diseases in large populations at one point in time. For example, both reduced and increased sleep duration, as reported on questionnaires, are linked with hypertension, diabetes, and obesity. However, cross-sectional studies cannot explain how too little or too much sleep leads to disease because people may have a disease that affects sleep, rather than a sleep habit that causes a disease to occur or worsen.

The third and most convincing type of evidence that long-term sleep habits are associated with the development of numerous diseases comes from tracking the sleep habits and disease patterns over long periods of time in individuals who are initially healthy (i.e.,longitudinal epidemiological studies). We do not yet know whether adjusting one’s sleep can reduce the risk of eventually developing a disease or lessen the severity of an ongoing disease. However, the results from longitudinal epidemiological studies are now beginning to suggest that this is likely.

Getting the Sleep You Need

The Dr. Steven Show | Arianna Huffington - YouTube

Monday, June 6, 2016

Revised Food and Nutrition Facts Label--A Step Forward...more to go

As the obesity epidemic continues unabated in the United States, costing more than $190 billion per year in health care expenditures,1 a public health crisis is unfolding that warrants careful reevaluation of existing policies to combat obesity and related chronic diseases. Recently, the US Food and Drug Administration (FDA) announced the first major amendment of the Nutrition Facts Label in more than 2 decades, to be implemented in the next 2 to 3 years, to reflect the evolving evidence related to dietary factors and risk of chronic diseases. The collective changes update the list of nutrients that are required or permitted to be declared, provide reference Daily Values based on current dietary recommendations or consensus reports, adjust serving sizes and labeling requirements for certain package sizes, and revise the overall format and appearance of the label for enhanced interpretability.2

The label provides point-of-purchase nutrition information in a standardized format to help guide consumers’ food and beverage choices. All packaged food items regulated by the FDA—everything from breads and cereals to canned and frozen foods, snacks, desserts, and beverages—are required to display information on the label pertaining to serving size, number of servings, total energy, and a selection of nutrients based on their role in chronic disease etiology or nutrient deficiency: energy from fat, total fat, saturated fat, cholesterol, sodium, carbohydrates, dietary fiber, sugar, protein, vitamin A, vitamin C, calcium, iron, and, most recently, transfat. With more than 61% of US adults reporting that they use the Nutrition Facts panel when deciding to purchase food, these labels have great visibility and potential to be important tools for public education and policy.3

Many people are already familiar with this label, and it is taught in some schools. It is fairly straight forward, however many people who need to know this the most seem to be unaware of what it contains, and how it simplifies what you should buy and eat.  It is not complicated.

Perhaps the most important part of the label is the Calories in each serving. Taking all other things in to consideration generally less is good. However what is in those calories is of major importance. Think of calories as energy, or gasoline in your car's fuel tanks. Calories can also be  equated with 'heat'. Your body produces heat by burning calories,  for breathing, basal metabolism, physical activity, and brain  power.  Your brain consumers about 25% of your caloric supply. 

Think of your fuel tank as containing 'good fuel and bad fuel'  Good fuel is burned efficiently and does not create toxic emissions when burned.  Bad fuel is not used efficiently and produces toxic byproducts which may be harmful to your brain and other cells.  

Look at the total number of fat calories in each serving. The total number of calories of fat should be less than 30% in  your daily diet. Be careful not to confused this with the % age of daily calories of fat in each serving.

Be that as it may some people just don't read or pay attention to the guidelines.  Would you put leaded gas in your tank? At one time many cars could burn leaded gas which raised the octane (power rating) of gas.  Today all cars have catalytic converters, and there is no leaded gas in the United States. (leaded gas destroys catalytic converters which contain platinum. 

And like the fuel industry, government is now regulating some foodstuffs, especially those containing large amounts of added sugar (soda).  The new labeling requirement for added sugar is timely and accompanies other policy initiatives aiming to reduce intake of sugar-sweetened beverages and added sugars. For example, in 2015 Berkeley, California, implemented an excise tax of 1¢ per ounce on sugar-sweetened beverages, and San Francisco, California, recently passed a ruling to issue health warning labels on sugar-sweetened beverages. Boston, Massachusetts, has prohibited the sale of sugar-sweetened beverages on city property, and many school districts have banned sales and vending of these beverages as strategies to help curb childhood obesity. Similar to the case of trans fat, these collective legislative actions to reduce added sugar intake can create an environment that fosters and supports behavioral change toward more healthful choices and are more 

Another factor is the amount of trans-fats (bad), the amendment to the original label was the addition of a required line for trans fat content, implemented in 2006 in response to substantial evidence linking intake of trans fat to adverse cardiometabolic health. This provided a strong incentive for manufacturers to eliminate trans fat; together with city- and state-level regulatory action limiting trans fat use in restaurants it has been largely eliminated from the US food supply. The FDA recently announced removing trans fat from the “generally regarded as safe” category, setting a 2018 deadline for the US food industry to eliminate it from all products. The substantial reduction in trans fat intake, from 4.6 to 1.3 g/d,4 accounted for about half of the improvement in US diet quality since 2000 and is likely a major factor contributing to improvements in blood lipid levels5 and a decline in type 2 diabetes in the United States.6


The new changes will further align the label with current dietary guidelines.7 One important change is the addition of a line disclosing “added sugar” content. The Daily Value (% DV) for added sugar is 10% of calories, representing a limit of 50 g (roughly 12 teaspoons) of added sugar for a 2000-calorie diet, a typical daily intake for adults (Figure). Although intake of added sugar has decreased in recent years in the United States, consumption still exceeds recommendations, with the average adult consuming 22 teaspoons of added sugar per day. Sugar-sweetened beverages alone account for 39% of all added sugar intake.7 Intake of sugar-sweetened beverages and added sugar is associated with weight gain and increased risk of type 2 diabetes and cardiovascular disease.8 Based on these data, the 2015-2020 Dietary Guidelines for Americans recommend limiting added sugar intake to less than 10% of daily calories.7 Once the changes are implemented, the label on a 20-oz (591 mL) bottle of soda, for example, would indicate that individuals are consuming 130% of their added sugar limit for the day (for a 2000-calorie diet).

Sunday, June 5, 2016

New Hope for Stroke Patients

Background and Purpose—Preclinical data suggest that cell-based therapies have the potential to improve stroke outcomes.

Methods—Eighteen patients with stable, chronic stroke were enrolled in a 2-year, open-label, single-arm study to evaluate the safety and clinical outcomes of surgical transplantation of modified bone marrow–derived mesenchymal stem cells (SB623).

Results—All patients in the safety population (N=18) experienced at least 1 treatment-emergent adverse event. Six patients experienced 6 serious treatment-emergent adverse events; 2 were probably or definitely related to surgical procedure; none were related to cell treatment. All serious treatment-emergent adverse events resolved without sequelae. There were no dose-limiting toxicities or deaths. Sixteen patients completed 12 months of follow-up at the time of this analysis. Significant improvement from baseline (mean) was reported for: (1) European Stroke Scale: mean increase 6.88 (95% confidence interval, 3.5–10.3;P<0.001), (2) National Institutes of Health Stroke Scale: mean decrease 2.00 (95% confidence interval, −2.7 to −1.3; P<0.001), (3) Fugl-Meyer total score: mean increase 19.20 (95% confidence interval, 11.4–27.0; P<0.001), and (4) Fugl-Meyer motor function total score: mean increase 11.40 (95% confidence interval, 4.6–18.2; P<0.001). No changes were observed in modified Rankin Scale. The area of magnetic resonance T2 fluid-attenuated inversion recovery signal change in the ipsilateral cortex 1 week after implantation significantly correlated with clinical improvement at 12 months (P<0.001 for European Stroke Scale).
Conclusions—In this interim report, SB623 cells were safe and associated with improvement in clinical outcome end points at 12 months.

Clinical Outcomes of Transplanted Modified Bone Marrow–Derived Mesenchymal Stem Cells in Stroke: A Phase 1/2a Study

Saturday, June 4, 2016

The Senior Learning Network

Health Train Express and the Senior Learning Network have agreed to provide content for seniors about health information technology, how to navigate the health insurance ecosystem, telemedicine, televideo and smartphone technology for health.

Senior Learning Network is a non-profit organization, providing content online for isolated seniors, for seniors living in assisted living, or in their own homes independently.

Senior Learning Network is partnered with another non-profit organization, Virtual Photo Walks

The content on the broadcasts is interactive, with multiple attendees who interact in real\-time during the two way video conference.

Telehealth and Televideo are becoming routine parts of the health system. In a previous Healthtrain Express post  we discussed


Event Schedules can be found at the  Generations Learning Web site

These organizations offer much to seniors, and non-seniors alike. They offer entertainment events for community group meetings and a stimulus for socialization for those who would ordinarily not experience it.

Comments & Reviews:


This exciting series highlights older adults experiences, interests, talents, and hobbies. There is so much to share! This free series can be requested under our program section on the top of the menu bar.
A center could also put together panels on topics of interest- clean water, climate change, health care, spirituality, education,the arts etc. Whatever topic they have the expertise to present.

John Butterill and his staff of videographers takes  you on a Virtual Photowalk


Please join us on the journey.

Wednesday, June 1, 2016

D.C. Hospital Makes Frightening Discovery About Zika in Pregnancy | Healthcare of Tomorrow | US News

Detecting Zeka Viral microcephaly in utero is difficult because ultrasound changes of the fetal brain do not appear until near 20 weeks gestation.  The legal cut off for abortion is 21 weeks in most jurisdictions.  The brain's rapid growth begins at about 19-20 weeks at the threshold of detection..

Most doctors are using information that may be giving a false sense of security to pregnant women infected with Zika.

 Zika Emergence Evokes Memories of Rubella]

Retinal fundus photographs bear some resemblance to that of Rubella Retinopathy, a sign of Rubella, also a viral infection (not spread by mosquitos rather airborne person to person)

A study conducted in Brazil suggests that babies born with microcephaly caused by the Zika virus may develop eye problems that could lead to blindness.
The research, which comes from Stanford University and from Brazil, was published Wednesday in the journal Ophthalmology. It found that children can be at risk for bleeding of the retina and abnormal blood vessel development, resulting in blind spots or decreased peripheral vision or hemorrhaging that can result in vision loss.
The latest study was limited in scope, involving only three Brazilian babies, but the findings were enough to have the American Academy of Ophthalmology update its clinical statement on Zika, adding the new symptoms observed.
Authors of the study note that they do not yet know whether Zika causes the eye abnormalities or whether they result from microcephaly, a condition in which babies are born with abnormally small heads. Babies who live in countries that don't have treatment available to them – like laser surgery or medicines – will be more likely to have vision problems or even to go blind.
(as reported in USA News)

The retina is a part of the central nervous system (brain) and reflects what pathology is also present in the brain. This photograph of a retina from a newborn reveals optic atrophy, hemorrhages. amd retinal inflammation.

The findings are consistent 

The Centers for Disease Control and Prevention reported on Friday that nearly 280 pregnant women in the U.S. and its territories have the virus. Health officials fear that more pregnant women could become infected this summer as the weather gets warmer and mosquitoes become more rampant. Health officials may have difficulty tracking all adults infected in the U.S. because for the most part symptoms aren't noticeable or are otherwise mild. The most severe cases have resulted in Guillain-Barre syndrome, which causes paralysis, and in other cases adults have developed symptoms that are similar to multiple sclerosis. A patient in Puerto Rico died after being infected.

D.C. Hospital Makes Frightening Discovery About Zika in Pregnancy | Healthcare of Tomorrow | US News