USB & Your Health

 

This afternoon I was at my local Drugstore in line waiting for my prescription medication.  I regularly scan the shelves to see how technology is impacting the retail pharmacy business. There are the usual blood pressure monitors, glucometers, pregnancy tests,  STD tests, HIV tests, etc.

Even with all the hype about PHR, there has been a paucity and near absence of products which are supposed to make home health monitoring accessible to the patient’s physician.

Today I saw a glimmer of hope. My eye caught “USB” on a package, and no I was not in the electronics department.  Closer investigation revealed the Bayer’s CONTOUR USB meter. It looks quite like a standard USB flash device. Closer inspection reveals a few important differences.

The  device has two ends, the first has the usual insertion slot for test strips, the other end has a standard USB connection with a protective cap.

Overall the CONTOUR is the same size as a standard stick. On one side is a highly visible digital display for the measure blood glucose, and the time at which is was recorded. Software is available for Mac, Windows, to interface with a laptop, or desktop.  There was no mention for handheld portable devices, or interfaces for smartphones.

Health Train thinks that this may be a beginning, however the utility of the CONTOUR is severely hampered by the lack of it’s ability to transmit data directly to an online PHR. Perhaps this is the next step. Perhaps this will be a function of the PC software. At any rate Baxter fails to give it the final “kill”.

The software (which must be downloaded from an online source at Baxter does allow storage with graphs and trends for blood glucose levels as well as the ability to print results and graphs in  a pdf format.

Health Train can see a project for Health 2.0 Challenge to develop the glucometer which would plug directly into an iPhone, Android, or RIM smartphone and beam a report directly to the PHR or doctors EMR.

The price-point is amazingly low. My pharmacy was selling it for $ 75.00, about the same price as some of the high end standard glucometers.

A standard User Manual is available from their web site:

del.icio.us Tags: glucometer,usb glucometer,baxter contour,diabetes,monitoring,phr

The Reform Is Not the Change

According to Joseph Flower who writes in The Health Care Blog this weekend, Health Reform is not the Change, but rather The Catalyst, and according to him, “The enabler, and an accelerator of the change we are going through. It is not the change itself, and is not even the cause of it, because the change is driven by much larger economic and demographic factors, especially by the crushing cost of healthcare. If the reform law were to go away, the change would not go away.”

I agree with Joe. Many readers ask me if I am for or against health reform. My short answer is ‘yes’, to both.  Anyone who is vested in the present system, i.e., physicians, hospitals, health plans, pharma, payers, etc. exist with a certain level of ‘tension’ with their partners and ungarners. The tension with present system for most systems is near a breaking point. The question all are asking ‘Will this get better with a change, stay the same, or get much worse.

No doubt there will be ‘pain’ with reforms. Change seems to be difficult for most, however the human condition and potential for change is enormous with adaptability and acclimatization to seemingly impossible challenges, physically, intellectually and emotionally.  Let’s face it, Health Reform involves all of it. Fortunately our DNA was designed for changes to occur.

del.icio.us Tags: health reform,catalyst,joe flower,the health care blog,health train express NPR

A Story of Drug Addiction, Sadness and Love

Although the original version of this song by Mylene Farmer earned better critical acclaim, this version by “Moby” fits the Health Train Express for  physicians and families dealing with fatal illnesses and drug addiction will find these videos  breathtaking. I hope you will all enjoy this musical interlude:: “Blue Noir”

Moby Version

I also cannot help but include Mylene Farmer’s version of, ‘Blue Noir”

Mylene Farmer

The music and video above are copyright by the artist and the label. They should not be copied for commercial purposes. 

GML

A Thank you to SERMO

SERMO is a physician only  professional social network. It has been existence for about five years. Started by visionary Dan Palestrant MD, SERMO had a  brief romance with the AMA, however SERMO and the AMA parted ways, disagreeing agreeably that their missions were mutually incompatible. SERMO continues steady growth and has a loyal following. The business model is simple and quite stable. It is explained transparently on the web site.

Here were my comments upon receiving the SERMO Badge which is on the right hand banner.  Long Live SERMO !

On behalf of Health Train Express and all my fellow bloggers, thanks you to SERMO for the recognition of  Health Train Express.  Just as other bloggers I put some effort into the "enterprise".  It began as a simple newsletter regarding the development of a regional health information exchange in 2005. It eventually expanded into a free floating stream of 'nonsense", varying from topic to topic in health care.  This was in the days when few knew what a blog was, and there was no social media.

I find that writing the blogs offers me the opportunity to share serious, humorous and outrageous thoughts and events in my life.  It substitutes for lack of time to discuss all the important events in medicine on a daily basis and not wait for the next meeting.

It also has opened up a huge audience, and I receive many comments from around the globe. 

I highly recommend the medium.  Caution...You are entering the "NO SPIN ZONE (Bill O'Reilly) and it is highly ADDICTIVE !  (Ask my spouse)

 

del.icio.us Tags: sermo,dan palestrant,healthtrain express,blogging

Health Merger Mania

 

Medical Practice Mergers Key in Employer Healthcare Cost Hikes

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: May 20, 2011

WASHINGTON -- Employers can expect to spend an additional 8.5% on employee healthcare costs in 2012, as patients who had been putting off medical treatment during the recession flock to the doctor's office, according to a new survey from the consulting firm PwC.

 

Last year, employers' costs for providing healthcare to employees rose 8%, and the year before, they grew by 7.5%. Both rates were much lower than predicted.

Most larger employers -- including two-thirds of those who responded to the PwC survey -- are "self-insured," meaning that they pay employee healthcare costs themselves rather than paying premiums to an insurance company.

Economists and actuaries realized that during the flagging economy, people were putting their healthcare needs on the back burner in order to save money. But as Americans move further out of the recession, they are expected to seek out the healthcare they've been putting off for the past two years. And that should contribute to an uptick in medical treatments in 2012.

The survey includes four main components in its definition of healthcare costs: physician services, inpatient hospital care, outpatient services, and prescription drugs.

The largest single component of these costs is physician services, which makes up one-third of the cost of healthcare benefits. Inpatient hospital care is a very close second (31%), followed by outpatient hospital services (17%) and prescription drugs (15%).

Three factors are contributing to the projected increase, according to PwC analysts:

Increased mergers: More and more hospitals and physicians are consolidating, which is seen as a way to increase efficiency and reduce costs. This can mean more treatment is delivered at a hospital-based outpatient clinic rather than a freestanding physician office.

Medicare rates paid to a hospital-based practice can be more than 50% higher than those paid to a freestanding practice, and private insurers often use Medicare as a guide for their own rates.

Cost-shifting: Both Medicare and Medicaid plans have been paying less and less; the report noted that the increase in Medicare inpatient hospital rates is expected to be 3.3 percentage points below the expected growth in their costs.

"Hospitals and health plan executives agree that when Medicare and Medicaid pay less than costs, private payers must make up the difference," the report said.

Increased stress: Post-recession stress will lead to poorer health once people start going to the doctor again. Several health plans interviewed by PwC said they are already seeing more claims for stress-induced illnesses.

As stress increases, people are less likely to maintain a healthy lifestyle, and more prone to stress-related ailments, including heart disease and cancer.

The PwC analysts said that if employers decrease the benefits they offer, and pass more costs on to workers, the increase companies face could be more along the lines of 7%.

"The big question is how much of the medical cost increase will be passed on to employees, as employers recognize the economic burden on their workers given that wages have been stagnant over the past few years," PwC said.

There are also a few factors that will drive down costs in 2012:

• The trend toward increased use of high-deductible plans will continue. In 2011, 17% of employers said plans in which their employees paid a high deductible were the most common plan, up seven percentage points from 2010.
• A historic number of blockbuster brand-name drugs will go off patent, including Lipitor, Seroquel, Actos, Zyprexa, and Levaquin, paving the way for the sale of cheaper generics.

• Employers are increasing deductibles for seeing out-of-network providers and are becoming more selective about who's in-network.

The Affordable Care Act won't have much effect on employer costs next year because many of its main provisions don't go into effect until 2014 or later.

The survey was conducted by PwC's Health Research Institute and involved 1,700 employers across 30 industries; it also included interviews with hospital executives and insurance actuaries.

 

del.icio.us Tags: hospitals,mergers,cost hikes,self insured,cost shifting,employers,deductibles,affordable care act

Cloud Computing: A Reply from Practice Fusion

Some of you may have read my comments about the  “death of cloud computing”.  My comments may be premature according to Ryan Howard, CEO and founder of Practice Fusion:

Mr. Howard sends me this quote;

“On April 21-22, there was a major Amazon EC2 outage that brought down many business and websites. Some of the data was unrecoverable and transactions were lost. The outage event, however, actually might have some unexpected beneficial effects, by raising the awareness and understanding of cloud computing – and the differences implicit in their implementation. 

In this particular case, the major distinction between two types of cloud computing is infrastructure management/control: a) cloud applications dependent upon and written on top of a utility-style service, like Amazon, where the application is susceptible to outages by its host and b) much more dependable and robust cloud applications hosted in a truly private, scalable, protected infrastructure, like Practice Fusion’s, that allow more efficient management of computing traffic and a guaranteed level of uptime for users of time-critical enterprise applications.

Ryan Howard, Founder and CEO

Practice Fusion EMR

Ryan, Thanks for the response.  Let’s hope you are correct. 

GML

del.icio.us Tags: cloud computing,practice fusion,amazon web services

A Word About SERMO

 

I had a bit of a surprise email from SERMO this week. HealthTrain received a prize, no it was not monetary, something even nicer…some recognition for all the early morning wakeups to post prior to the clinical load for the day.

It’s in the form of a ‘badge’ (of honor?).  It will be displayed on the right hand side of the ‘widgets’.

It gave me an urge to look back in HealthTrain’s Archives to read  observations HealthTrain expressed in mid 2010. :

What hath Sermo Wrought?

Average Rating  (3 ratings) 

Posted by gmlevinmd123 on June 29, 2010 - 01:06PM EDT
Author Specialties: Ophthalmology, Geriatrics

Sermo represents the best of what Matt Holt of The Health Care Blog calls 'Health  2.0'.   While some aspects of Health 2.0 are 'consumer oriented' (ie, patient oriented) Sermo has offered a network for physicians. Originally conceived as a medium for feedback from physicians regarding treatments and diagnoses, it has evolved into something much more than that.

Especially noteworthy is the cross-specialty open access to information which might not be immediately available to readers.

Some have  used the SERMO platform to seek out consultations in regard to difficult cases, or recommend treatments in response to requests from other physicians.

Others have chosen to use the SERMO platform to serve social issues, political discord, and at times allows physicians to vent and share other serious concerns.

Many comments are made in the forum that are controversial, and open to inquisitive minds and scholarly thought.

A certain banter has developed on SERMO, ( a virtual forum) humor, sarcasm, and all that human interaction one would expect at a real social occasion.  I as well as others look at SERMO daily as a routine, much like stopping by the Doctors Lounge to chat, gripe, find out who did what and to whom, and then continue the daily routine.

At times the level of discussion becomes quite academic along with references to  peer reviewed articles, and at time quite anecdotal....Frequently SERMO regulars await responses from others who have become close and respected colleagues.

As a relative old timer it keeps me current with our future generation of physician leaders, and also allows me to mentor in whatever way I can.

For physicians in relatively isolated practices it serves a commendable purpose.

The evidence is in regarding SERMO. It has played a unique role in Health Care Reform. While we still have much to accomplish, SERMO has earned national recognition in the media, and has also stimulated the AMA to become more relevant. SERMO has chastised the AMA for it's false impression that they represent physicians. At one time this may have been true, and hopefully physicians will come together in one forum to represent us all.

However just as in national and local politics, we all do not agree, and the difference in opinion are what makes us all the same.

My best wishes for continuing success to SERMO and all of us.

KEYNOTE BLOGGERS IN THE HEALTH UNIVERSE

 

About five years ago there were few physicians and/or health industry gurus who even knew what a blog was. Pedal forward a few years to today in mid-2011 and the scene has changed enormously.  Although I have been a blogger since mid 2004, using blogging to bring a newsletter to our community of IT aficionados information about our health information exchange, I am a ‘newbie’ compared to elementary, middle school and high school bloggers, FBers, and tweeps.  My own children and grandchildren have blocked me from their personal sites.  FBing, tweeting, and blogging are categorized now into personal, business, and professional. Blogging or FBing, tweeting in the wrong space is considered taboo, and marks you as ‘inappropriate’ much like being a nerd in high school or an “uncouth visitor at the local fraternity or sorority house. 

There are bloggers and then there are bloggers who use SM for purposes such as marketers, artists, musicians, politicos, writers, celebs, and even terrorists. Blogging and social media can be and is used for the writer’s own purposes.  I have seen some bloggers burn out, otherwise very capable and excellent communicators announce they are done with blogging.(like some physicians burnout on medical practice)  SM is an addiction, some who no longer have time will often recruit others to write their blog for them, or have invitees publish for them at regular intervals.

Health Train Express has long had a blogroll of the blogs that I read, however there are many other sites that are outstanding, and other venues worth following on twitter and/or Facebook. And while Twitter and Facebook are the best known SM sites, there are many others.

Blogging nor Social media is not for the lazy or faint of heart. There are readers out there that have RSS feeds and other links watching for the posts that are their favorites.  There are now awards, not unlike the Academy Awards, or perhaps a better term “The Pulitzer Prize” for blogging excellence.

                              

End Part I   Part II to follow.

Health Care & Newt Gingrich

 

Health Care Policy and reform will now take an abrupt shift into the political lane. The stage is the same and the players are about to change as they audition and pose for their own ‘stake’ in the game. Some are already withdrawing from their auditions, Trump, Huckabee, and others.  Others such as Gingrich are attempting to revive their political careers, and return to the ‘Broadway’, inside the beltway. The issues now are not ‘should we have health reform”, but should we deconstruct it before it is built. The specifics of the Obama Bill are coming at us along a planned timeline. It is complex with mandates dependent upon financial plans, exchanges, individual mandates, threatened penalties/incentives, insurability and ‘willingness’ of the electorate to accept what seems inevitable. Also key features of the legislation have been struck down by courts. However, in the United States nothing is truly inevitable (in a country that can print money whenever it wishes.

Michael Millenson paints a elaborate picture of Newt Gingrich as a manipulative persona, continuing his relentless and articulate march from politics into health care, and then back into politics, enriching himself with a ‘bogus’ Center for Health Transformation. He writes in The Health Care Blog today.

  If what Mr. Millenson writes is true, it demonstrates how politicians, and the public are misled by big names with big ideas, and how reality is turned by unscrupulous people. Five years ago Gingrich did form the Center for Health Transformation with all the ideas as explained by Millenson. Mr. Gingrich is a chameleon and seems to favor introducing chaos into the already chaotic world of politics. The current ‘transformation’ a word not used by Obama has created chaos and is forcing the health industry to change with threats of financial intimidation and a small carrot of incentives, which are truly miniscule when compared with subsidies to big agriculture, oil, the automobile industry,, the mortgage industry, and the financial markets.

Medicare is a disaster, formed over 40 years ago after a long lost battle with medicine opposed to it’s  being financed and the benefit structure which health advocates predicted would lead to possible demise of the financial integrity of the federal government.  Medicaid, a poorly operated system is not proposed to be a vehicle for expanding health care coverage. Never mind the fact that many physicians will not accept patients with Medicaid since it introduces impossibilities for reimbursement and/or adjudication of disputed claims. The eligibility process is critically flawed with unrealistic criteria and ridiculous share of cost based on a monthly share of income. The main criteria such as the poverty level is obsolete. Anyone capable of addition can see how flawed the eligibility process is. The adjustments to income are incomprehensible and imaginary (to say the least)  It is designed to disqualify eligibility. Recipients are penalized severely with threats of being overpaid.  Rather than having an annual deductible it expects recipients to be on a month to month dole which has no reality for those with fluctuating income. Based on observation it is hard to believe 47 million Americans are eligible for the SNAP program (formerly the food stamp program).It does not fly in the fact that 47 million Americans live in poverty and yet the average income for people in the U.S is near $40,000 dollars. The threshold for the SNAP is $1100/month (roughly $ 25,000/annum) for a husband and spouse living together.  The food stamp program really is no longer a ‘voucher’ or funny money chit but a modern system of EBT cards, identical to a ‘debit card’ and used in an identical manner.

Health Train’s Aggregation Today

May 17,2011

From iHealthBeat

Standards Panel Seeks Feedback on EHR Certification Program
Read more…………here   The Health IT Standards Committee's implementation work group is seeking public comment.

What Percentage of Surveyed Physicians in the U.S. Have Adopted Smart Phones?
Read more:…….here.

Hospitals launch ED online reservation systems. Plan your emergencies, sounds like an oxymoron as our health system attempts to use new technology to address basic systemic flaws in healthcare delivery. here .

Can Federal Health Care Websites Tap Best Practices from the Private Sector?  here

The new websites -- which include HHS' vaccines.gov and healthcare.gov -- are much more dynamic and consumer-friendly than previous government websites.  The complete transcript of this Special Report is available as a PDF.

WEBMD:

Causes of Fatigue and Sleepiness and How to Fight Them. This very common problem affects nearly all of us.  Read on.

Do You Color Your Hair?   Women and Men in their attempts to retain young appearance should know some of the details:

Does Your Voice Betray Your Age ? Of course, we all unconsciously respond to a mature voice differently than an adolescent’s voice or child on the telephone. What goes into this almost automatic calculation?

Med page Today

This series is brought to you by Med Page Today, Putting breaking medical news into practice.

1. Med Students Cram for Exams With Wikipedia. About half of medical students see Wikipedia as a trustworthy source of information for helping them prepare for exams.

2. Atypical Antipsychotic Use High in Kids. Almost half of children treated as inpatients for psychotic and mood disorders are given atypical antipsychotics.

3. Suicides, Stagnant Economy May Be Linked. When the red-hot Japanese economy of the 1970s and 1980s cooled off and a period of stagnation set in, suicide rates spiked, and researchers here suggested the same thing could happen in the U.S.

Weight adds to  Colon Surgery Infection Rate

:Rehab After Stenting Saves Lives.  Risk of death decreased by 47%

Tai Chi Helps Prevent Falls and aids mental health..

VA HealthCare News:
The Department of Veterans Affairs (VA) recently published the interim final rule for implementing the Family Caregiver Program of the Caregivers and Veterans Omnibus Health Services Act 2010. This new rule will provide additional support to eligible post-9/11 veterans who elect to receive their care in a home setting from a primary family caregiver..

Coalition Seeks to Raise Awareness and Help Returning Veterans 

In the coming weeks, Sen. Kirsten Gillibrand, D-N.Y., will introduce new legislation that calls on the Veterans Affairs Department to be more proactive in informing and providing veterans with the services they're entitled to receive.
The legislation is called the Pro-Vets Act and would require the VA to offer each service member a thorough assessment of benefits and the materials they need to apply. Service members leaving the military would be automatically enrolled in VA health care. Gillibrand's office says that even though they are eligible for up to five years of free care, many never claim the benefit

del.icio.us Tags: aggregation,webmd,medpage today,VA,Pro-Vets Act,health it standards,ed online appointments

Why Cloud Computing may be Dead for Healthcare and Medicine

 

Much has been said about the advantages of cloud computing, or what used to be termed ‘asp’ solutions for EMR in lieu of in house client server applications, less costly, reduced maintenance and upgrade challenges,

Despite these advantages this methodology has not caught fire in medicine. The main reason is now apparent by the outcome of a demonstrated failure of AWS (Amazon Web Servicesl)

Many EMR vendors do not own their own servers. They are rented from companies like Amazon, Microsoft, Apple, ,and other less well known data bank companies. Chances are good that your EMR flows on the same server, and hard drives as Twitter or Facebook.

The uproar over the down time in those spaces was huge….and that for what has become an income generator or marketing vehicle for what was previously a meaningless trivial pursuit during idle time.

And so while there are some advantages and convenience in cloud computing, or application server providers.  We all share the advantages and we also will suffer from the disadvantages.

On the other hand, if EMR is not affordable without the cloud, physicians if so mandated by unrealistic mandates and inadequate incentives (which do not support long term usage of EMR), since it is a one time payment) Physicians will have to make an uncomfortable decision.

How responsible can physicians or hospitals be for breaches by a vendor, or cloud system. Who will be fined…the hospital, clinic or the vendor? The cloud vendor, the EMR vendor or the individual physician?

 

IMHO it has reached the point that physicians can no longer attest, nor be the ultimate responsible party for HIPAA security nor the arbiter of it’s success.

 HIPAA becomes rather meaningless, except for the occasional well publicized incidents of large fines to large entities for their “breaches'” What about hackers? Often hackers just ‘hack’ for entertainment, just like playing an online game. Can they beat the system?

del.icio.us Tags: hipaa,aws,amazon web services,security,cloud computing,emr adoption,emr incentives

Singularity University

 

How Will Technology Impact the Future of Healthcare and Medicine? By exploring and driving the future of medicine through  exponential, game changing technologies.

A 5-day program at Singularity University in Silicon Valley in the NASA-Ames Research Park brought together participants who gave an over-the-horizon perspective in what is emerging in the lab and clinic and where opportunities in medicine are rapidly moving through disruptive, convergent technologies.

 

 

Here is a summary of day one of the FutureMed at Singularity University.

FutureMed’s Executive Director Daniel Kraft, MD presents “What’s next in healthcare?” at TEDxMaastricht’s Future of Health

 

Dan Kraft MD delivers a fast paced view into the current state of biotechnology and future of advancements.

 

The computing industry makes profits and stands to make even more profits by anticipating and meeting the technological demands from medicine and healthcare. The relationship is synergistic, each driving medicine and healthcare forward. The participants included 

-Physicians
-Bio-MedTech & Pharma Executives
-Health focused Innovators & Inventors
-Investors & Entrepreneurs

The Faculty included distinguished personalities from a wide diversity of disciplines and accomplishments.

The FutureMed Singularity University Executive Program is geared around six exponentially growing areas, each taught by world class experts from the worlds of medicine, biotech and innovation.

The Program Tracks include: Information-Data Driven Health, Personalized Health & ‘omics’, Regenerative Medicine, Intervention, Medtech/Biotech & Enterpeneurship,

Three specific Application Areas, the future of…..Medical Practice, Wellness/Prevention, and Global Health.

Planned site visits included:

• Intuitive Surgical (robotic surgery)
• NASA Life Sciences & Human Factors
• Stanford Institute for Stem Cell Biology & Stanford Medical Simulation Center
• Kaiser-Garfield HealthCare Innovation Center
• Autodesk — 3D Printing
• Google Health & Google Headquarters

 

del.icio.us Tags: singularity,futuremed,nasa,ames,data.gov,health,regenerative medicine,intervention,neuromedicine,medtech,biotech,medical practice,wellness,prevention,global health

Social Media for Physicians IV

I am continuing my literary masterpiece from Parts I-III on Social Media for Physicians.

Let’s say you have invested some time and money into a social media presence. Now you have your Facebook, Twitter and/or email sites operating.  It has been several months and you have followed 1000 other tweeters but the number of followers is 5.  Humbled by this statistic you realize this is not going to be an easy expedition to become the next Paris Hilton or Charlie Sheen of the social media medical circle.  After all medical things just don’t have the same Shock and Awe value as Charlie Sheen’s tour of “Winning”, nor Paris Hilton’s vapid face and torso in a million dollar chic dress. 

   

Marketing experts will tell us that we have about five seconds to grab attention with our web site, Facebook landing page, or Tweet before clicking on to the next site. So you need sophisticated analytics of your ‘metrics”.

Who are your users?  Five? that shouldn’t take more than a #2 pencil and a yellow legal pad, or perhaps in this instance a progress note sheet of which you have many stored somewhere since you haven’t used one since your last ‘crash’ of your EMR.

Perhaps a more sophisticated way exists for you to waste a little more of your most precious resource (dwindling reimbursements)..

Along comes another entrepreneur, selling analytics for social media users.

I write about some of these in my other blog, NEXT.IND.in . This is unabashedly an attempt to ‘market’ my other blog (3 followers), and yes it is outsourced, unlike the cataract surgery I do (or at least used to do).I may have few admitted users, but they are glued to my posts, or they have become  catatonic reading my meanderings. I have been advised to draw in my audience by interaction and meaningful discourse just  as we do in face-to-face interactions with colleagues (if they still admit to knowing me.) and/or patients (customers?). So if you can, find those 5 users and RT(rewet) or  reply to them and ‘Like” their Facebook page. (If it’s Becky or Hot lips and they really want to meet someone like you because your FB page or tweet fascinate them, don’t bother to answer them. Even I get a lot of those, and you can block them. However even their tweets and likes will boost your ratings on “Klout” a free online analytics web site 

Buddy Media-Spinback offers a possible high priced solution to analyze your social media investment to maximize your ROI. After all your EMR may pay for itself in five years, so why take the chance that social media will be another ‘failed whale’ in your portfolio of foolish investments

“For only one dollar !

..