Dr. Weinstein. A surgeon's struggle with mental health.

Doctors are the healers and the helpers. But what happens when it’s the doctors 
who need the healing and the help?

An estimated 300 to 400 doctors die by suicide each year, a rate of 28 to 40 
per 100,000; more than double that of general population (according to a review 
of 10 years of literature on the subject presented at the American Psychiatry 
Association annual meeting in May 2018).

Doctors who die by suicide often have untreated or undertreated depression or 
other mental illnesses, a fact that underscores the need for early diagnosis 
and treatment.

However, the stigma of a mental illness may be too overwhelming for some 
in the medical community to deal with, and they often mask their pain, rather 
than seek help.  That’s why Dr. Michael Weinstein, a surgeon at Thomas 
Jefferson University Hospital, is so very brave.

When his piece was published, Dr. Weinstein couldn’t anticipate the 

response, but said he received an overwhelming number of affirming

 messages from people from all different walks of life. However, 

perhaps most importantly inthis case, he heard from many colleagues in the 

medical field from across the countryand across the world who saw themselves 

in Dr. Weinstein’s story, and no longer felt alone in their own journeys.

“I realize that, from the outside looking in at me, I’m in potentially a position 

of power, of 

influence.  I’m in a world that could be stereotyped as a world that should be strong 

and courageous and infallible,” he said. “Telling a story from that perspective might

both be able to help folks in similar situations.”

Today, Dr. Weinstein is on a new path of healing. He has embraced Buddhist

 philosophy, and has found the practice of mindfulness meditation to be an 

important part of his recovery. 

Listen to him read excerpts from his inspiring essay “Out of the Straight Jacket” 

and listen to his reflections on his journey to date in this very moving 

OC87 Recovery Diaries video. 

EDITOR IN CHIEF: Gabriel Nathan | EDITOR: Glenn Holsten | 

DESIGN: Leah Alexandra Goldstein | PUBLISHER: Bud Clayman

 

AHRQ launches app to help patients preplan questions for doctors | MobiHealthNews

AHRQ launches app to help patients preplan questions for doctors | MobiHealthNews: The new app, called Question Builder, lets consumers input their health information and then brings up potential questions for them to ask their doctors.

7 Enabling Capabilities To Improve Poor Results From Massive AI

 A survey of over 1,200 executives has just revealed that despite massive and increasing investments in digital transformation and technologies such as artificial intelligence and big data, companies are struggling to turn those investments into real business results.

A survey unveiled today by Deloitte has found that the number of companies investing heavily in digital transformation has almost doubled in the past year.

The accounting and services giant questioned 1,200 executives at organizations of at least 500 people with above $250 million in revenue, finding that 19% planned to invest $20 million or more during 2019. When asked the same question at the start of 2018, 10% gave that answer.

Despite Massive Investments In AI And Digital Transformation, Survey Finds Poor Results And 7 Enabling Capabilities

The term “digital transformation” has come to mean steps that move an organization towards adopting data-driven business models, typically involving artificial intelligence (AI), big data and predictive analytics technology.

The survey also found that budgets dedicated to this transformation at medium to large-sized companies increased from an average of $11 million to $13.5 million this year.

However, it also highlighted the finding that most organizations still report a gap between their investment in this technology and the impact it is having on key performance indicators such as profits, revenues and customer satisfaction.

In an effort to understand this, it identifies 7 “pivots” - capabilities that, when developed, contribute towards a business successfully bringing about positive growth through a technology initiative.

It found that "higher maturity" organizations – those who had progressed their digital transformation to the point where they are driving positive growth - deploy an average of 40 initiatives targeting these pivots capabilities, suggesting they are indeed a contributing factor.

Data mastery is about aggregating, activating and monetizing data that is still often siloed and underutilized in order to generate better products, services and business operations that will drive business success.

“Those are the enabling pivots that allow us to begin thinking about transformation.”

Data mastery involves generating value from data to increase the efficiency and effectiveness of business processes.

“I would say that 90% of the corporate world is not going to capture value through naked monetization of their data assets the way Google or Amazon does. For the most part, they will capture data to increase the efficiency and effectiveness of their company.”

That could mean finding better ways of targeting customers and understanding their behavior and optimizing marketing and retail channels based on the data they collect. In other words, the majority of companies approaching levels of digital maturity where their data becomes a valuable asset is doing so by creating growth for existing, core products and services, rather than creating new ones from their "data exhaust."

The next key pivot – talent – revolves around the way data is used to understand and nurture a business’s most vital asset – it’s employees.

“This is actually the hardest thing to do,” explains Gurumurthy. “One can figure out cloud migration strategies, one can figure out how to collect and store data, and how to run analytics on it, but its harder to manage change around talent.

“If you ask people what their biggest challenges are in digital transformation they will say it is the talent deficit – there's often resistance to cultural change and a deficiency in the kind of talent that's needed.”

This is challenging because of the different mindset which becomes necessary when transitioning to data-driven business models, particularly when human staff are being asked to put their faith in technology like artificial intelligence and advanced analytics which may result in insights and observations which seem counter-intuitive to many of us.

"It's often about retraining the talent – another phrase we use is the ‘digital mindset,'" explains Gurumurthy.

So, what is holding businesses back from unlocking the full potential of digital transformation? Well, aside from the talent deficiency already mentioned (cited by 36% as a barrier), challenges posed by existing, legacy operating models, and a lack of a strategy for clearly prioritizing adoption of transformative technology were cited by 49% and 45% of respondents, respectively.

This makes it clear that whatever industry you’re in, the rewards of driving growth through digital transformation are there for the taking.

Suggested Reading,  

Artificial Intelligence in Practice: How 50 Successful Companies Used Artificial Intelligence to Solve Problems 1st Edition

by Bernard Marr  (Author)

7 Enabling Capabilities To Improve Poor Results From Massive AI:

VA Secretary Robert Wilkie announces precision medicine testing initiative with Sanford Health | FierceHealthcare

PRECISION MEDICINE FOR THE VA

Veterans will access the test at their local VA facility, and Sanford Health will process the tests at its South Dakota-based Imagenetics facility—which is overseen by former VA Secretary David Shulkin. (

Up to 250,000 veterans could receive access to no-cost pharmacogenomic testing by 2022 under a new partnership with Sanford Health. The announcement comes just months after the former secretary of the U.S. Department of Veterans Affairs took on the role of chief innovation officer at the Sioux Falls, South Dakota-based health system.



The program will launch at a pilot site in Durham, North Carolina, and will initially enroll cancer survivors, officials said. It will expand to up to 250,000 U.S. veterans at 125 sites by 2022.

PHASeR, or the Pharmacogenomics Action for Cancer Survivorship, is funded by a $25 million gift from philanthropist Denny Sanford and matching fundraising from Sanford Health.

Veterans will access the test at their local VA facility, and Sanford Health will process the tests at its South Dakota-based Imagenetics facility, officials said.

The test results will help physicians with clinical decision-making for a variety of drugs, including those for mental health, cardiovascular disease and pain management. The National Institutes of Health estimates that inappropriate treatments and adverse drug reactions cost up to $30 billion a year.

What is Precision Medicine ?

VA Secretary Robert Wilkie announces precision medicine testing initiative with Sanford Health | FierceHealthcare:

What Indoor Plants Clean the Air Best? None of Them. - The Atlantic

The science is clear: Indoor vegetation doesn’t significantly remove pollutants from the air.

For several years, research really did suggest that houseplants might cleanse the air of certain pollutants. But now most scientists say that’s not right.

“It’s such an alluring and enticing idea,” Elliot Gall, a Portland State University professor, told me. “But the scientific literature shows that indoor houseplants—as would be typically implemented in a person’s home—do very little to clean the air.”

“My view is even harsher than that,” Michael Waring, an engineering professor at Drexel University, told me. “I do not think that houseplants clean the air.”

“A resounding ‘no,’” agreed Richard Corsi, a longtime air-pollution researcher, in an email. Houseplants do not clean the air “any more than an old pair of socks or baseball cap that I would hang on the wall.”

In the late 1980s, the NASA scientist Bill Wolverton investigated whether common houseplants could remove a certain type of air pollutant, called “volatile organic compounds,” or VOCs, from the air. VOCs are regularly released by common household products such as drywall, house paints, nail polish, shampoo, and almost anything with a scent. Their harmful effects can range from an itchy throat to nasopharyngeal cancer.

Read: Why pop culture links women and killer plants

Unlike other types of air pollution, such as soot or particulate matter, VOCs can’t be filtered out of the air with a fine-grade filter. This means that they can build up in hermetically sealed environments … such as laboratories or spacecraft. The problem for NASA was obvious. So Wolverton, a former military scientist who began his career studying whether plants could break down Agent Orange, now examined whether houseplants could absorb VOCs.

His 1989 report announced a cheerful answer. Plants were “a promising, economical solution to indoor air pollution,” it declared. “If man is to move into closed environments, on Earth or in space, he must take along nature’s life support system.” The report—jointly funded by NASA and the Associated Landscape Contractors of America, a trade group—was picked up by the media. The idea gained even more currency in 1996, when Wolverton published How to Grow Fresh Air: 50 Houseplants That Purify Your Home or Office. (Wolverton did not respond to a request for comment.)

That study provides the scientific basis for almost all the plant-and-air-pollution content you see online. “I’ve seen it on so many pop internet sites—‘researchers from NASA’ is the common phrase you see,” Waring, the Drexel professor, said. He told me that there’s nothing especially wrong with Wolverton’s 1989 study. Its results “fall right in line with other stuff that’s been measured in the literature.”

Recently, Waring and his colleagues reanalyzed all 195 studies that have examined whether houseplants can filter the air. They found that some types of plants can remove higher amounts of VOCs than others. But once you factor in the effects of working in a large room, none of the plants are able to do much.

Waring told me to imagine a small office, 10 feet by 10 feet by eight feet. “You would have to put 1,000 plants in that office to have the same air-cleaning capacity of just changing over the air once per hour, which is the typical air-exchange rate in an office ventilation system,” he said. That’s 10 plants per square foot of floor space. Even if you chose the most effective type of VOC-filtering plant, you would still need one plant per square foot, Waring said.

Or as Waring (who owns 10 to 20 houseplants) recently put it in a presentation for the National Academies of Sciences, Engineering, and Medicine:

“Bringing plants in, bringing greenery in—it’s about having something near you that’s alive, that you’re caring for, that brings you joy and happiness,” she said. “And that affects your mood, whether or not it’s giving you more oxygen to breathe or something.”

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.  

What Indoor Plants Clean the Air Best? None of Them. - The Atlantic: The science is clear: Indoor vegetation doesn’t significantly remove pollutants from the air.

Medicare Annual Wellness Visit Association With Healthcare Quality and Costs

Analytics are essential when making decisions in health care.  When I was a young physician I was told the annual wellness visit for patients was a waste of time.   Today, not so !



In the context of 2 primary care physician–led accountable care organizations, Medicare Annual Wellness Visits were associated with lower healthcare costs and improved clinical care quality for beneficiaries. Although use of the Medicare Annual Wellness Visit (AWV) is increasing nationally, it remains unclear whether it can help contain healthcare costs and improve quality. In the context of 2 primary care physician–led accountable care organizations (ACOs), we tested the hypothesis that AWVs can improve healthcare costs and clinical quality.


Between 2014 and 2016, we examined the association of an AWV with healthcare costs, ED visits, hospitalizations, and clinical quality measures. The sample included Medicare beneficiaries attributed to providers across 44 primary care clinics participating in 2 ACOs.

Results: Among 8917 Medicare beneficiaries, an AWV was associated with significantly reduced spending on hospital acute care and outpatient services. Patients who received an AWV in the index month experienced a 5.7% reduction in adjusted total healthcare costs over the ensuing 11 months, with the greatest effect seen for patients in the highest hierarchical condition category risk quartile. AWVs were not associated with ED visits or hospitalizations. Beneficiaries who had an AWV were also more likely to receive recommended preventive clinical services.

Conclusions: In a setting that prioritizes care coordination and utilization management, AWVs have the potential to improve healthcare quality and reduce cost.



Sources:

Periodic health visits by primary care practice model, a population-based study using health administrative data.

Evaluation of Pharmacist Involvement in Medicare Wellness Visits.

The Medicare Annual Wellness Visit.
Improvement in preventive care of young adults after the affordable care act: 
Practices Caring For The Underserved Are Less Likely To Adopt Medicare's Annual Wellness Visit.




Medicare Annual Wellness Visit Association With Healthcare Quality and Costs:

Music: The part of your brain that will never get lost to Alzheimers - Big Think

Study: Memories of music cannot be lost to Alzheimer's and dementia

Have you ever noticed how nursing home patients will respond to music when they do not recognize or remember relatives ?  This story elaborates on the neuroscience of music.

Some music inspires you to move your feet, some inspires you to get out there and change the world. In any case, and to move hurriedly on to the point of this article, it's fair to say that music moves people in special ways. 

If you're especially into a piece of music, your brain does something called Autonomous Sensory Meridian Response (ASMR), which feels to you like a tingling in your brain or scalp. It's nature's own little "buzz", a natural reward, that is described by some as a "head orgasm". Some even think that it explains why people go to church, for example, "feeling the Lord move through you", but that's another article for another time. 

Turns out that ASMR is pretty special. According to a recently published study in The Journal of Prevention of Alzheimer's Disease (catchy name!), the part of your brain responsible for ASMR doesn't get lost to Alzheimer's. Alzheimer's tends to put people into layers of confusion, and the study confirms that music can sometimes actually lift people out of the Alzheimer's haze and bring them back to (at least a semblance of) normality... if only for a short while. ASMR is powerful stuff! 

This phenomenon has been observed several times but rarely studied properly. One of the most famous examples of this is the story of Henry, who comes out of dementia while listening to songs from his youth:

Jeff Anderson, M.D., Ph.D., associate professor in Radiology at the Univerity of Utah Health and contributing author on the study, says  "In our society, the diagnoses of dementia are snowballing and are taxing resources to the max. No one says playing music will be a cure for Alzheimer's disease, but it might make the symptoms more manageable, decrease the cost of care and improve a patient's quality of life."

Man In Nursing Home Reacts To Hearing Music From His Era comments by Oliver

Sacks,M.D.

YOUNG ONSET ALZHEIMER DEMENTIA

VIDEO

Music: The part of your brain that will never get lost to Alzheimers - Big Think: The part of your brain responsible for ASMR catalogs music, and appears to be a stronghold against Alzheimer's and dementia.

Smart Apps and A.I. may be the best way to track . your Nutritonal Intake

Forget government-issued food pyramids. Let an algorithm tell you how to eat.

The Food Pyramid

Nutritional Algorithms

Algorithms To Personalize The 'Best Diet' Are Not Yet Ready For Prime Time

There is no diet which is perfect for everyone. Any algorithm will have to take into account age, weight, height, initial weight, amount of weight to be lost, as well as individual personalized information such as food allergy, diabetes, lactic acid intolerance, gluten sensitivity.  The combinations may be unlimited. An algorithm may be able to approach an optimum diet.

Some months ago, I participated in a two-week experiment that involved using a smartphone app to track every morsel of food I ate, every beverage I drank and every medication I took, as well as how much I slept and exercised. I wore a sensor that monitored my blood-glucose levels, and I sent in a sample of my stool for an assessment of my gut microbiome. All of my data, amassed with similar input from more than a thousand other people, was analyzed by artificial intelligence to create a personalized diet algorithm. The point was to find out what kind of food I should be eating to live a longer and healthier life.

The results? In the sweets category: Cheesecake was given an A grade, but whole-wheat fig bars were a C -. In fruits: Strawberries were an A+ for me, but grapefruit a C. In legumes: Mixed nuts were an A+, but veggie burgers a C. Needless to say, it didn’t match what I thought I knew about healthy eating.

It turns out, despite decades of diet fads and government-issued food pyramids, we know surprisingly little about the science of nutrition. It is very hard to do high-quality randomized trials: They require people to adhere to a diet for years before there can be any assessment of significant health outcomes. The largest ever — which found that the “Mediterranean diet” lowered the risk for heart attacks and strokes — had to be retracted and republished with softened conclusions. Most studies are observational, relying on food diaries or the shaky memories of participants. There are many such studies, with over a hundred thousand people assessed for carbohydrate consumption, or fiber, salt or artificial sweeteners, and the best we can say is that there might be an association, not anything about cause and effect. Perhaps not surprisingly, these studies have serially contradicted one another. Meanwhile, the field has been undermined by the food industry, which tries to exert influence over the research it funds.

Now the central flaw in the whole premise is becoming clear: the idea that there is one optimal diet for all people.

Only recently, with the ability to analyze large data sets using artificial intelligence, have we learned how simplistic and naïve the assumption of a universal diet is. It is both biologically and physiologically implausible: It contradicts the remarkable heterogeneity of human metabolism, microbiome and environment, to name just a few of the dimensions that make each of us unique. A good diet, it turns out, has to be individualized.

We’re still a long way from knowing what this means in practice, however. A number of companies have been marketing “nutrigenomics,” or the idea that a DNA test can provide guidance for what foods you should eat. For a fee, they’ll sample your saliva and provide a rudimentary panel of some of the letters of your genome, but they don’t have the data to back their theory up.

Opinion | The A.I. Diet - The New York Times: Forget government-issued food pyramids. Let an algorithm tell you how to eat.

Your Thoughts and Feelings Have Power

Healium is a biometrically-controlled, drugless solution for stress, a $300B profit and people killer. This digiceutical is powered by the user's feelings of love and calm via their wearables and our proprietary technology. These therapeutic stories packaged in a portable, digital kit allow users to see their feelings heal virtual world.

Frontiers in Psychology and the Journal of Neuroregulation both published studies on Healium’s ability to quickly reduce anxiety and increase feelings of positivity in as little as four minutes using real-time EEG feedback and heart rate. Healium is used worldwide in areas of acute, workplace, 

According to the World Health Organization, stress is the 21st-century EPIDEMIC. Healium is a reminder that your thoughts and feelings have power. Our immersive media channel helps users become more self-aware of their feelings, their ability to control their stress level, and the brain patterns associated with neuromeditation. With our loving-kindness and quiet mind content, Healium is a powerful tool for people who might struggle with traditional meditation .

Think of Healium like power steering for mindfulness. You can SEE your brainwaves and heart rate empowered as easy to remember stories. A headband worn on your forehead senses electrical activity in your brain, your smart watch detects your heart rate and allows you to see those patterns represented inside virtual reality, mixed or augmented reality. (The headband is only *listening* to your brain. It's not transmitting anything to it.)  Don't want to use goggles? Healium's augmented reality experiences work without goggles and just your smart phone or smart watch. 

Change is what is occurring in most aspects of our lives, including how medical care is accessed and delivered.  It has required an intensive effort of both time and money for providers to engage the new improvements.

The Future of Medicine . (2012)

Most people are no strangers to these changes during the past ten years. Some of the following have become extinct or nearly so.

1.  Telephone books
2.  Print Newspapers
3. Taxi cabs (replaced by Uber, Lyft)
4.  Checks, and even cash in some circumstances
5.  Sears, Kmart and other brick and mortar retail outlets.
6. Physical mail

The largest search engines

Google
Amazon

Other resources:

HealthGrades
Yelp
WebMD
Google Maps

Future of Medicine, an ongoing encyclopedic source for future changes in healthcare.

Artificial intelligence is being used in some limited capacity for interaction on chatbots, and promises to revolutionize engagement on the internet.  It may assist physicians with diagnosis and treatment of diseases.

Health portals for insurance, clinics, messaging apps and smartphones all expedite our healthcare. Anyone not using these new tools faces serious issues in obtaining appointments, getting lab results, or ordering prescription renewals.   All of these tools eliminate waiting on hold on the telephone or standing in line.

Health Train Express will be offering an interactive chat to teach patients how to obtain these apps and how to use them.  Look for the new tab on future posts.  CONVERSATION

Only digital health can bring healthcare into the 21st century and make patients the point-of-care. We prepare everyone in healthcare for the adoption of innovative, disruptive and smart technologies while keeping the human touch. – Dr. Bertalan Meskó

Human Errors

Drug Companies and Doctors Battle Over the Future of Fecal Transplants

Your doctor tells you "You need a Poop Transplant" . Really ???

Donated fecal material in the middle of the processing procedure at OpenBiome, a nonprofit stool bank.

There’s a new war raging in health care, with hundreds of millions of dollars at stake and thousands of lives in the balance. The battle, pitting drug companies against doctors and patient advocates, is being fought over the unlikeliest of substances: human excrement.

An oral fecal microbiota transplantation product made by OpenBiome, a public stool bank 

The clash is over the future of fecal microbiota transplants, or F.M.T., a revolutionary treatment that has proved remarkably effective in treating Clostridium difficile, a debilitating bacterial infection that strikes 500,000 Americans a year and kills 30,000.

The therapy transfers fecal matter from healthy donors into the bowels of ailing patients, restoring the beneficial works of the community of gut microbes that have been decimated by antibiotics. Scientists see potential for using these organisms to treat diseases from diabetes to cancer.

Frozen processed samples at OpenBiome.

At the heart of the controversy is a question of classification: Are the fecal microbiota that cure C. diff a drug, or are they more akin to organs, tissues and blood products that are transferred from the healthy to treat the sick? The answer will determine how the Food and Drug Administration regulates the procedure, how much it costs and who gets to profit. If the FDA gains regulatory authority over FTM the cost would escalate significantly.  The question remains is this a drug, alternative therapy and does the manufacturing process need to be regulated. There are strong reasons on both sides for the decision making process.

What Is a Fecal Transplant, and Why Would I Want One?

Would you like to become a poop donor?

WARNING Experts offer this final piece of sage advice: “It is not recommended to perform stool transplantation at home without guidance from a physician.”

SOURCES:

Pubmed

New York Times, Washington Post

Drug Companies and Doctors Battle Over the Future of Fecal Transplants - The New York Times: As pharmaceutical companies seek to profit from the curative wonders of human feces, doctors worry about new regulations, higher prices and patients attempting DIY cures.