Beating the Prior Authorization Blues -- FPM

The Federal budget is impacted by rising health care costs. There are several factors in play.

1.  Due to increased length of life and successes in treating acute and chronic illness our population is aging. The percentage of patients over the age of 65 increases annually due to bursts of immigration, and birth rates as well as innovations of care resulting in lower mortality rates.

2. There are and will be fewer workers paying into Social Security and Medicare, as well as the effects of automation requiring fewer workers.

Medicare (CMS) attempt to control expenses by limiting procedures.  Private insurance does the same via a complex time-consuming process known as prior authorization.

The enclosed video illustrates the process, time-consuming, as well as non-productive work required by clinicians.

Like many family physicians, W. Ryan Neuhofel, DO, has spent his share of time on the phone asking insurers for prior authorization of medications or medical procedures for his patients.

Unlike many physicians, Neuhofel decided to videotape it. The Lawrence, Kan.-based physician recorded a 21-minute call of himself seeking approval for computerized tomography (CT) scan for a patient with a palpable mass on his skull and then posted the video on several social media platforms, where it attracted thousands of views.

Of course, the tactic has real costs for physicians and their practices. One study estimated that primary care physicians spend an average of 3.5 hours a week dealing with insurers, and the entire medical community spends the equivalent of between $23 billion and $31 billion annually in time on insurance matters, including prior authorization.1

Prior authorization can also negatively affect the quality of care. According to an American Medical Association survey, two-thirds of physicians said they waited at least a few days for preauthorization on tests, procedures, or medications, and between 10 percent and 13 percent said they waited for more than a week.  Insurers and other payers have long used prior authorization as a valuable tool. Lydia Bartholomew, MD, of Edmonds, Wash., is a medical director for a national insurer and a member of the American Academy of Family Physician's (AAFP's) Commission on Quality and Practice. She said insurers require prior authorization to confirm that the treatment prescribed by the physician is covered by the patient's health plan and is the most appropriate care in the best setting. This helps insurers control health care costs by reducing duplication, waste, and unnecessary treatments, as well as identifying patients who might benefit from case management services, she said.

Whether insurers are increasingly requiring prior authorization is difficult to assess. Anthony Akosa, MD, MBA, chief medical officer of HealthEC, which advises accountable care organizations and other large provider groups, believes insurers are reining in their prior authorization requirements to some degree. They are responding to customer frustration over delays or denials of medical treatment, he said. However, growth in high-deductible health plans, which tend to have more coverage limitations, might be contributing to a perception that prior authorization requirements are increasing when in fact more services are being denied for lack of coverage, he said.










Beating the Prior Authorization Blues -- FPM: Getting insurer approval for treatment can take hours out of your week. Here are some ways to reduce the pain.

The New West: Smoke In The Sky, A Purifier At Home | California Healthline

If you live in the West an air purifier should be on your 'must-have' list.  During a wildfire, you may see smoke, but even if you don't see it, you are still at risk.  Amid forecasts for increasingly unhealthy air due to wildfire smoke, residents in Western states are snatching up home air purifiers. With good reason.

Downtown San Francisco was obscured by smoke from the Camp Fire burning about 90 miles north of Sacramento on Nov. 16, 2018

An announcement in California HealthLine 

By Mark Kreidler
August 6, 2019


When the Camp Fire began to rage in Paradise, Calif., last November, the owners of the family-run Collier Hardware store in nearby Chico faced a situation unlike any they’d seen.

A business that might welcome 200 customers on an average day, Collier was suddenly dealing with five times that number — “and they all wanted the same thing,” co-owner Steve Lucena said.

Alarmed by dense smoke, shoppers were snapping up portable air purifiers and breathing masks in staggering numbers. Collier Hardware sold nearly 60,000 adult-sized masks in a couple of weeks, and gave away thousands more that were specially designed for children.

“With the purifiers, we had multiple people unloading them from the truck, and they were sold before we could get them all the way into the store,” Lucena said. “People didn’t care what model it was or how much it cost. We’d normally sell four to six in a year, and we sold 100 in a day.”

Sales of portable air purifiers in California alone are expected to rise dramatically over the next few years, from roughly 469,000 units in 2017 to a predicted 720,000 in 2023, according to a study by TechSci Research presented at a recent meeting of the California Air Resources Board.

Across the country, annual sales of home air filters are expected to cross $1 billion by 2023, according to a report by Research and Markets.

“Interest in effective air purification has significantly risen in recent years due to wildfires,” said Jaya Rao, chief operating officer and co-founder of Molekule, a maker of a $799 purifier. Sales of the unit have doubled each year since it debuted in 2017, Rao said.

Researchers from Harvard and Yale in 2016 produced a list of more than 300 counties throughout the West that will be at the greatest risk of dangerous pollution in the coming decades due to “smoke waves” emanating from increasingly intense wildfires. Among the most vulnerable are heavily populated areas such as San Francisco, Alameda and Contra Costa counties in Northern California, and King County in Washington.

Wildfire smoke is dangerous because of its concentration of noxious fine particles, which measure 2.5 micrometers or less (a human hair, by comparison, measures 70 micrometers) and which, unlike common dust, can be inhaled into the deepest recesses of the lung.

In addition to eye and respiratory tract irritation, this particulate matter — PM2.5 in scientific shorthand — can exacerbate heart and lung issues, including asthma and chronic obstructive pulmonary disease (COPD), and may lead to premature death. Children, older people and those with respiratory illnesses are, particularly at risk.

While much is still unknown about the long-term effects of exposure to wildfire smoke, the microscopic particles are regulated as an air pollutant. A study published last year in the journal GeoHealth found that the number of deaths linked to the inhalation of wildfire smoke in the U.S. could double by the end of the century, to nearly 40,000 per year.

Air purifiers essentially function as scrubbers, removing bacteria, viruses, and PM2.5 as the air passes through them. The air resources board recommends its use to limit the effects of wildfire smoke in the home. It maintains a list of devices approved for use in California.

AIR PURIFIER RATINGS, PERFORMANCE, AND VALUE

Portable air-cleaning units were once considered specialty purchases, but sales-driven competition has flooded the market, forcing prices down. Where a high-end portable purifier might cost $800 or more, several models now cost less than $100. Shoppers can find models with well-known consumer appliance names like Dyson, Hunter, Honeywell, and Whirlpool as well as scores of more obscure manufacturers. Several websites have attempted to evaluate air purifiers, including the size of the room they can effectively clean.

















The New West: Smoke In The Sky, A Purifier At Home | California Healthline:

First Black Female AMA President Talks Policy, Health Equity | Chicago News | WTTW

The Chicago-based American Medical Association is the country’s largest association of doctors and medical students. Now, for the first time ever, the organization has an African American woman as its president.

Dr. Patrice Harris, a psychiatrist from Atlanta, was inaugurated in June to the yearlong position. And while the AMA doesn’t represent all U.S. doctors, the organization is an influential advocacy group for a wide range of issues across the health and medical industries.

Looking ahead to her priorities over the next year, Harris says she hopes “to elevate the importance of mental health into overall health care, to elevate the importance of health equity, and making sure we have a diverse physician workforce … we need to work toward the faces of physicians matching the faces of our patients.”

As a lobbying group, the AMA has had an active presence in the health care debate, staunchly supporting the Affordable Care Act since it was passed under President Barack Obama in 2010.

The group has also held a longstanding opposition to single payer health care. But at its June meeting, the AMA House of Delegates only narrowly voted down a motion to overturn that policy.

“Certainly in our huge House of Delegates, you have a wide range of opinions, all towards getting to coverage for everyone,” Harris said. “But at the end of the day, after the debate, there’s a vote, and the vote this year has been to maintain our current policy.”

The AMA also recently waded into the abortion debate, filing a lawsuit earlier this month to block two laws in North Dakota the association says threaten the underlying trust between doctors and their patients.

The laws, Harris said, “compel physicians to provide information that is false, and misleading, and not science-based. And so that would be a violation of our duty to our patients … it is our obligation to give patients accurate information, and that is why we filed that lawsuit.”

Another issue Harris is prioritizing is health equity. That comes as a recent study in Chicago found a 30-year life expectancy gap between residents of the affluent Streeterville neighborhood and the low-income Englewood neighborhood on the South Side.

Harris says discrepancies like this aren’t just about access to doctors and hospitals.

“It is about your physical environment, whether you have access to healthy, nutritious foods. Even looking at some of the more structural policies in place, such as past discrimination and racism, all of those impact a person’s health, and that’s why you see those differences in zip code,” she said.

This comes at a time when diversity is a major challenge as well as a goal in all businesses.











First Black Female AMA President Talks Policy, Health Equity | Chicago News | WTTW: Meet Dr. Patrice Harris, the new leader of the Chicago-based American Medical Association, the country’s largest association of doctors and medical students.

This spray-on nanofiber 'skin' may revolutionize wound care

Imagine if bandaging looked a little more like, well, a water gun?

Shaped like a gun, Nanomedic’s SpinCare device emits a web of electrospun polymer nanofabric that stays put for weeks—no dressing changes required.

Israeli startup Nicast, has invented a new mechanical contraption to treat burns, wounds, and surgical injuries by mimicking human tissue. Shaped like a children’s toy, the lightweight SpinCare emits a proprietary nanofiber “second skin” that completely covers the area that needs to heal.

All one needs to do is aim, squeeze the two triggers, and fire off an electrospun polymer material that attaches to the skin.

The Nanomedic spray method avoids any need to come into direct contact with the wound. In that sense, it completely sidesteps painful routine bandage dressings. The transient skin then fully develops into a secure physical barrier with tough adherence. Once new skin is regenerated, usually between two to three weeks (depending on the individual’s heal time), the layer naturally peels off.

“You don’t replace it,” explains Nanomedic CEO Dr. Chen Barak. “You put it only once—on the day of application—and it remains there until it feels the new layer of skin healed.”

The SpinCare holds single-use ampoules containing Nanomedic’s polymer formulation. Once the capsule is firmly in place, one activates the device roughly eight inches towards the wound. Pressing the trigger activates the electron-spinning process, which sprays a web-like a layer of nanofibers directly on the wound.

The solution adjusts to the morphology of the wound, thereby creating a transient skin layer that imitates the skin structure’s human tissue. It’s a transparent, protective film that then allows the patient and doctor to monitor progress. Once the wound has healed and developed a new layer of skin, the SpinCare “bandage” falls off on its own.

The Nanomedic spray method avoids any need to come into direct contact with the wound. In that sense, it completely sidesteps painful routine bandage dressings. The transient skin then fully develops into a secure physical barrier with tough adherence. Once new skin is regenerated, usually between two to three weeks (depending on the individual’s heal time), the layer naturally peels off.

“You don’t replace it,” explains Nanomedic CEO Dr. Chen Barak. “You put it only once—on the day of application—and it remains there until it feels the new layer of skin healed.”

The product is already being tested in hospitals. In the coming year, following FDA clearance, Nanomedic plans to expand to emergency rooms, ambulances, military use, and disaster relief response like fire truck companies. 




This spray-on nanofiber 'skin' may revolutionize wound care

Evaluation of a Remote Diagnosis Imaging Model vs Dilated Eye Examination in Detecting Macular Degeneration | Diabetic Retinopathy | JAMA Ophthalmology | JAMA Network

ADVANCES IN MEDICINE

JUST WHAT THE DOCTOR ORDERED:
IMPROVING PATIENT CARE WITH AI

Artificial Intelligence is transforming the world of medicine. AI can help doctors make faster, more accurate diagnoses. It can predict the risk of a disease in time to prevent it. It can help researchers understand how genetic variations lead to disease.

Although AI has been around for decades, new advances have ignited a boom in deep learning. The AI technique powers self-driving cars, super-human image recognition, and life-changing—even life-saving—advances in medicine.

Deep learning helps researchers analyze medical data to treat diseases. It enhances doctors’ ability to analyze medical images. It’s advancing the future of personalized medicine. It even helps the blind “see.”

“Deep learning is revolutionizing a wide range of scientific fields,” said Jensen Huang, NVIDIA CEO and co-founder. “There could be no more important application of this new capability than improving patient care.”

Three trends drive the deep learning revolution: more powerful GPUs, sophisticated neural network algorithms modeled on the human brain, and access to the explosion of data from the internet (see “Accelerating AI with GPUs: A New Computing Model”)

Community Medicine is a term used to describe medical conditions in a large population setting. It often involves the screening of large groups to select those with disease and provide appropriate treatment to avoid further complications.  This involves an examination of large groups of patients. Often more than 100 persons will be examined with a positive finding of less than five in one hundred examinations.  This is a massive undertaking when screening perhaps as much as 1000 or more persons. It is often not cost effective. 

However, the development of image analysis, high-speed computing power, and deep learning machines can be trained to accomplish this task. Algorithms can be developed to digitize images (x-rays, CT scans, and photographs.

Artificial intelligence or machine learning is bringing a new powerful tool for rapid interpretation of medical images, such as chest x-rays, retinal fundus photography, and scans.  Images of the skin can be analyzed for suspicious moles to rule out malignant melanoma rapidly.   As the science matures there are sure to be significant cost savings as well as time. 

Machine learning is dependent upon large data stores, and accuracy improves as images are added and curated by human beings (physicians).  It is doubtful if AI will ever stand alone without human oversight.  

A study of retinal fundus evaluation (as reported JAMA) using machine learning showed
Remote diagnosis imaging and a standard examination by a retinal specialist appeared equivalent in identifying referable macular degeneration in patients with high disease prevalence; these results may assist in delivering timely treatment and seem to warrant future research into additional metrics.

The study has shown equivalency in diagnosing age-related macular degeneration using ocular coherence tomography. 

The use of deep learning has also been applied in dermatology to screen for malignant melanoma or other skin malignancy.

As radiology is inherently a data-driven specialty, it is especially conducive to utilizing data processing techniques. One such technique, deep learning (DL), has become a remarkably powerful tool for image processing in recent years. In this work, the Association of University Radiologists Radiology Research Alliance Task Force on Deep Learning provides an overview of DL for the radiologist. This article aims to present an overview of DL in a manner that is understandable to radiologists; to examine past, present, and future applications; as well as to evaluate how radiologists may benefit from this remarkable new tool. We describe several areas within radiology in which DL techniques are having the most significant impact: lesion or disease detection, classification, quantification, and segmentation. 

Some are concerned that AI, or deep learning may replace human radiologists, however, this is unlikely to occur.  But deep learning won’t be replacing radiologists anytime soon, Bratt explained, and one key reason for this is that deep neural networks (DNNs) are naturally limited by “the size and shape of the inputs they can accept.” But deep learning won’t be replacing radiologists anytime soon, Bratt explained, and one key reason for this is that deep neural networks (DNNs) are naturally limited by “the size and shape of the inputs they can accept.” A DNN can help with straightforward tasks reliant on a few images—bone age assessments, for instance, but they become less useful as the goal grows more and more complex. This limitation, Bratt explained, is related to the concept of long-term dependencies.  Another issue related to DNNs is how easily they can fall apart when introduced to small changes. A DNN can be working perfectly after being trained on one institution’s dataset, for instance, but its performance suffers when it is introduced to new data from a new institution.

“This again reflects the fact that ostensibly trivial, even imperceptible, changes in input can cause catastrophic failure of DNNs, which limits the viability of these models in real-world mission-critical settings such as clinical medicine,” Bratt wrote.

In addition to evaluating images, DNN can be applied to other tasks.

MINING MEDICAL DATA FOR BETTER, QUICKER TREATMENT

Medical records such as doctors' reports, test results and medical images are a gold mine of health information. Using GPU-accelerated deep learning to process and study a patient's condition over time and to compare one patient against a larger population could help doctors provide better treatments.

BETTER, FASTER DIAGNOSES


Medical images such as MRIs, CT scans, and X-rays are among the most important tools doctors use in diagnosing conditions ranging from spine injuries to heart disease to cancer. However, analyzing medical images can often be a difficult and time-consuming process.

Researchers and startups are using GPU-accelerated deep learning to automate analysis and increase the accuracy of diagnosticians:

Imperial College London researchers hope to provide automated, image-based assessments of traumatic brain injuries at speeds other systems can't match.
Behold.ai is a New York startup working to reduce the number of incorrect diagnoses by making it easier for healthcare practitioners to identify diseases from ordinary radiology image data.
Arterys, a San Francisco-based startup, provides technology to visualize and quantify heart flow in the body using an MRI machine. The goal is to help speed diagnosis.
San Francisco startup Enlitic analyzes medical images to identify tumors, nearly invisible fractures, and other medical conditions.

GENOMICS FOR PERSONALIZED MEDICINE

Genomics data is accumulating in unprecedented quantities, giving scientists the ability to study how genetic factors such as mutations lead to disease. Deep learning could one day lead to what’s known as personalized or “precision” medicine, with treatments tailored to a patient’s genomic makeup.

Although much of the research is still in its early stages, two promising projects are:

A University of Toronto team is advancing computational cancer research by developing a GPU-powered “genetic interpretation engine” that would more quickly identify cancer-causing mutations for individual patients.
Deep Genomics, a Toronto startup, is applying GPU-based deep learning to understand how genetic variations lead to disease, transforming personalized medicine and therapies.

DEEP LEARNING TO AID BLIND PEOPLE

Nearly 300 million people worldwide struggle to manage such tasks as crossing the road, reading a product label, or identifying a face because they’re blind or visually impaired. Deep learning is beginning to change that.

Horus Technology, the winner of NVIDIA’s first social innovation award at the 2016 Emerging Companies Summit, is developing a wearable device that uses deep learning, computer vision, and GPUs to understand the world and describe it to users.

One of the early testers wept after trying the headset-like device, recalled Saverio Murgia, Horus CEO, and co-founder. “When you see people get emotional about your product, you realize it’s going to change people’s lives.”

Further DNN utilizes optical diffractive circuits in lieu of electrons

The setup uses 3D-printed translucent sheets, each with thousands of raised pixels, which deflect light through each panel in order to perform set tasks. By the way, these tasks are performed without the use of any power, except for the input light beam.

The UCLA team's all-optical deep neural network – which looks like the guts of a solid gold car battery – literally operates at the speed of light and will find applications in image analysis, feature detection, and object classification. Researchers on the team also envisage possibilities for D2NN architectures performing specialized tasks in cameras. Perhaps your next DSLR might identify your subjects on the fly and post the tagged image to your Facebook timeline.  For now, though, this is a proof of concept, but it shines a light on some unique opportunities for the machine learning industry.










Dewinner of NVIDIA’s first social innovation award at the 2016 Emerging Companies Summit, is developing a wearable device that uses deep learning, computer vision, and GPUs to understand the world and describe it to users.

One of the early testers wept after trying the headset-like device, recalled Saverio Murgia, Horus CEO and co-founder. “When you see people get emotional about your product, you realize it’s going to change people’s lives.”


Evaluation of a Remote Diagnosis Imaging Model vs Dilated Eye Examination in Referable Macular Degeneration | Diabetic Retinopathy | JAMA Ophthalmology | JAMA Network: This study evaluates a retinal diagnostic device and compares its utility and outcomes with those of traditional eye examinations by retinal specialists for patients with potential retinal damage from diabetic retinopathy and age-related macular degeneration.

Opioid Prescriptions Drop Sharply Among State Workers

The recent efforts by the CDC and public media have initiated important advances in the crusade against opioid addiction.

The agency that manages health care for California’s massive state workforce is reporting a major reduction in opioid prescriptions, reflecting a national trend of physicians cutting back on the addictive drugs.

Insurance claims for opioids, which are prescribed to help people manage pain, decreased almost 19% in a single year among the 1.5 million Californians served by the California Public Employees’ Retirement System. CalPERS manages health benefits for employees and retirees of state and local agencies and public schools and their families. CalPERS is the second-largest public purchaser of health benefits in the nation after the federal government, and medical trends among its members are often reflected nationally.
Most notably, doctors reduced the daily dose and duration of opioid treatment: The number of new users who were prescribed large doses dropped 85% in the first half of 2018 compared with the same period in 2017, while new users prescribed more than a week’s supply dropped 73%, according to new CalPERS data.

The CalPERS data represents a cross-section of patients throughout California who are enrolled in Blue Shield, Kaiser Permanente, Anthem Blue Cross and other health plans.

This rapid change in prescribing habits indicates how quickly physicians reacted to the data as furnished by DEA and other regulatory bodies.

“These reductions are substantial,” said Beth McGinty, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “They signal a reduction in the overprescribing practices that have driven the opioid epidemic in the U.S.”

Indeed, the data showing a decline in opioid prescriptions among CalPERS members mirrors a nationwide drop that has been reported in all 50 states.

About 22% fewer opioid prescriptions were written in the United States from 2013 to 2017, dropping from 251.8 million to 196 million, according to the American Medical Association, the nation’s largest physician group.

A March study by researchers at the federal government’s Centers for Disease Control and Prevention revealed a 13% decline in average opioids prescribed per person from 2016 to 2017. Maine, Massachusetts and North Dakota have experienced the biggest drops over the past decade.

One major factor is that many health insurers have imposed limits on prescriptions, as recommended by the CDC in 2016. The CDC advises doctors to prescribe new users no more than a seven-day supply and to keep daily doses under the equivalent of 50 morphine milligrams in an effort to prevent overdoses and new addictions.

In addition, the AMA created a task force in 2014 that has encouraged doctors to “start low and go slow” and use the drugs only if the benefits exceed the risks for a patient. The association also is offering doctors education programs on pain management.

Pain management courses are being emphasized in medical school curricula, as well as continuing medical education courses.

“These are very positive numbers,” said Kathy Donneson, chief of CalPERS’ Health Plan Administration Division. “But we’re all going to keep working on it. Opioids are still a national crisis.”

Declines in prescriptions have not yet led to reductions in deaths, said Dr. Patrice Harris, president-elect of the AMA and chair of its Opioid Task Force. “Reducing opioid prescriptions is important but will not by itself reverse the epidemic,” she said. “We will 

Medical experts also warned of unintended consequences of fewer opioid prescriptions: More people may suffer unmanaged chronic pain, and some may resort to illegal opioids, such as heroin or street versions of fentanyl. About 50 million Americans experience chronic pain.

“The focus on reducing opioid prescribing has likely left a large void in access to pain care,” Harris said.

Even as insurers set limits on opioids, they have not increased access to other pain care options, she said. “If policymakers solely focus on limiting access to prescription opioids for pain relief without increasing non-opioid options, the result will be increased patient suffering.”
















http://tinyurl.com/yxbh4xkl

Say Bye-bye to Aspirin: The Remarkable Story of a Wonder Drug

The Remarkable Story of a Wonder Drug, Which Now Comes to an End in the Primary Prevention Setting: Say Bye-bye to Aspirin!

Aspirin is to date the most used drug worldwide and, in 2018, with some dispute about its real birth date, celebrated its 121st birthday; 2018 will most probably be remembered as the year when aspirin came of age, whereby multiple studies re-examined, and at least partially questioned, its risk/benefit ratio in various clinical settings.[1–4] While aspirin remains the cornerstone treatment for secondary prevention in patients with established cardiovascular disorders, three large, independent, and high quality randomized controlled trials have shed new light on aspirin in primary prevention.[2–4] These recent results now have to be incorporated within the context of previously existing evidence, which altogether questions the somewhat liberal use of aspirin that has so far been recommended by some,[5] but not by other, guidelines committees.[6]

The advent of the digital age, data analytics, and meta-analytic have exposed many accepted theories and treatments invalid.

Say Bye-bye to Aspirin: The Remarkable Story of a Wonder Drug:

Nurses are striking. Where are the physicians?

Strikes are not in the DNA of physicians.

In March, members of the New York State Nurses Association (NYSNA) at New York’s “big four” hospitals (Montefiore, Mount Sinai, New York Presbyterian-Columbia and Mount Sinai West/St. Luke’s) voted by an overwhelming 97% margin to authorize a strike. The nurses’ fight centers around conditions for patient care, including safer staffing ratios inside hospitals so that nurses can adequately care for each patient. Throughout NYC, nurses are forced to work long shifts and are chronically understaffed. The nurses who recently threatened to strike recognize that these working conditions are part of hospital executives’ push to squeeze greater and greater profits out of workers at the expense of patient health — and they have had enough. New York nurses are fighting just as teachers across the country did earlier this year — including the tens of thousands of Los Angeles teachers who struck last January for better conditions for in schools. They are also taking up the example of health care workers around the world, including the 40,000 Irish nurses who recently struck. Nurses are recognizing they have the power to fight and win better patient care. But while nurses across New York are standing up for themselves and their patients, a big question remains: Where are the doctors and why are they not threatening to strike together with nurses?

Why are the physicians on the sidelines?

Strikes are not in the DNA of physicians.

Physicians see first hand every day how our dysfunctional health care system is simply not built to adequately address patient and community health. For many doctors, these frustrations manifest in burnout and dissatisfaction within a field they once loved. Today there is an epidemic of burnout among physicians, with some studies suggesting burnout affects up to half of all physicians. After training for years with the desire to help others, doctors come to experience medical system that values profit over all else and rarely gives them the tools to make a difference in the communities where they work. This can leave doctors feeling hopeless, and combined with other factors, can lead to depression or even suicide. Today physicians are committing suicide at two times the rate of the population as a whole. Yet, even at this moment of frustration and anger, they continue to keep their heads down, providing validity to this broken system. We see nowhere, among doctors, a resistance like that now being organized by nurses.

Strikes are not in the DNA of physicians.

In order to analyze why doctors are not throwing down their stethoscopes and finally saying enough is enough, a review of the U.S. medical education process is in order. As longtime public educator John Taylor Gatto highlights in his book, “The Underground History of American Education,” the education system is built to create “tools for industry.” Gatto points out that this system conditions those who pass through it to take direction well and to not question authority. At the same time, education aims to instill the importance of profit and continually reinforces the legitimacy of the capitalist system. Health care education is not excluded from this, and both patient and community health remains secondary to profit maximization nonetheless.

Strikes are not in the DNA of physicians.

Physicians have seen themselves as managers in the past...the head of the team, executives, leaders.  Leaders do not strike.  Only until recently have physicians seen their management roles go away, and not by choice, rather by economic penalties and/or perverse incentives. Within the hospital, doctors typically adopt an individualist mentality in which they consider only how they can personally make an impact on their patients’ health while ignoring the need for systemic change. Until physicians begin to put individual endeavors aside and begin to organize collectively, they will continue to see their patients harmed by the "health care" system. though it is important to note, physician control is ever decreasing as health care becomes more corporatized.

If a physician ever thinks of organizing collectively to withhold his/her labor in order to demand better conditions for her patients, employers declare that doctors are “abandoning” those in need of care. The Hippocratic oath taken by physicians to “do no harm” is cited. This argument obviously disregards the fact that it is the employer and ownership class which is directly harming patients every day in pursuit of profit— denying care, pushing individuals into bankruptcy, pursuing unnecessary treatments, neglecting systemic causes of illness, etc. It also ignores the fact that by continuing to focus the treatment on narrow individualistic explanations for disease and illness, the physician helps to redirect the patient’s attention away from the larger issues that are truly causing his or her suffering. Physicians may consider abandonment as an issue, so too will attorneys who would have the legal means to defend innocent patients, which has been accomplished many times.  It is considered prima facie evidence for medical malpractice

Strikes are not in the DNA of physicians.

Physicians around the world have organized and withheld their labor for better conditions around patient care in the past. 

Strikes by physicians: a historical perspective toward an ethical evaluation.

It is an issue for moral and ethical reasons, for physicians and is a conundrum for most physicians.

Recent strikes in other countries indicate the real dangers to patients and the public in general.

List of health and medical strikes in the past

In the past doctors and/or nurses have threatened strikes over inferior patient care due to understaffing and other hospital issues.  Rarely has it revolved around pay.

Michael Pappas is a family medicine resident. This article originally appeared in Left Voice.

Nurses are striking. Where are the physicians?: Until physicians begin to put individual endeavors aside and begin to organize collectively, they will continue to see their patients harmed by the "health care" system.

Broccoli sprout compound may restore brain chemistry imbalance linked to schizophrenia -- ScienceDaily

Eat your broccoli, it's good for your brain.

In a series of recently published studies using animals and people, researchers say they have further characterized a set of chemical imbalances in the brains of people with schizophrenia-related to the chemical glutamate. And they figured out how to tweak the level using a compound derived from broccoli sprouts.

They say the results advance the hope that supplementing with broccoli sprout extract, which contains high levels of the chemical sulforaphane, may someday provide a way to lower the doses of traditional antipsychotic medicines needed to manage schizophrenia symptoms, thus reducing unwanted side effects of the medicines.

"It's possible that future studies could show sulforaphane to be a safe supplement to give people at risk of developing schizophrenia as a way to prevent, delay or blunt the onset of symptoms," adds Akira Sawa, M.D., Ph.D., professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Schizophrenia Center.

Schizophrenia is marked by hallucinations, delusions, and disordered thinking, feeling, behavior, perception, and speaking. Drugs used to treat schizophrenia don't work completely for everyone, and they can cause a variety of undesirable side effects, including metabolic problems increasing cardiovascular risk, involuntary movements, restlessness, stiffness and "the shakes."

In a study described in the Jan. 9 edition of the journal JAMA Psychiatry, the researchers looked for differences in brain metabolism between people with schizophrenia and healthy controls. They recruited 81 people from the Johns Hopkins Schizophrenia Center within 24 months of their first psychosis episode, which can be a characteristic symptom of schizophrenia, as well as 91 healthy controls from the community. The participants were an average of 22 years old, and 58% were men.

According to the World Health Organization, schizophrenia affects about 21 million people worldwide.

Sulforaphane is found in a variety of cruciferous vegetables and was first identified as a "chemoprotective" substance decades ago by Paul Talalay and Jed Fahey at Johns Hopkins.

The scientists say further research is needed to learn whether sulforaphane can safely reduce symptoms of psychosis or hallucinations in people with schizophrenia. They would need to determine an optimal dose and see how long people must take it to observe an effect. The researchers caution that their studies don't justify or demonstrate the value of using commercially available sulforaphane supplements to treat or prevent schizophrenia, and patients should consult their physicians before trying any kind of over-the-counter supplement. Versions of sulforaphane supplements are sold in health food stores and at vitamin counters, and aren't regulated by the U.S. Food and Drug Administration.

IBM's AI can predict schizophrenia by looking at the brain's blood flow.  And it does so with 74 percent accuracy

Function biomedical informatics research network recommendations for prospective multicenter functional MRI studies












Broccoli sprout compound may restore brain chemistry imbalance linked to schizophrenia -- ScienceDaily:

Why Bolstering Trust in Journalism Could Help Strengthen Trust in Medicine | Vaccination | JAMA | JAMA Network

Declines in public trust in US institutions has been widespread and well documented.¹ Neither journalism nor medicine is immune from this trend, although the combination has the potential to adversely affect both population and individual health. Individuals are inundated with health information from news media, with news stories ranging from the latest trends in health and wellness to breaking news about new treatments or technologies that have the potential to revolutionize health care.
The relationship that medicine and journalism have with the people they serve relies fundamentally on trust. Yet, that trust can be jeopardized by the way in which news about medical research and health care interventions is often disseminated to the public. While science is incremental, journalists are faced with trying to break through a cacophony of information using attention-getting headlines. As a result, media messages often convey scientific certainty when that certainty does not exist. In a review of more than 2600 news stories over 12 years that included claims about interventions, approximately two-thirds received unsatisfactory grades on quantifying benefits, harms, and costs.3 When an earlier version of these data was published, an editorial commenting on this study noted this “alarming report card of the trouble with medical news stories is thus a wake-up call for all of us involved in disseminating health research—researchers, academic institutions, journal editors, reporters, and media organizations…”4 Reviews of public relations news releases—from government agencies, medical journals, academic institutions, and industry—demonstrate an even greater likelihood of an unsatisfactory grade.3

The Problem

The problem is not limited to authors of news releases and news stories. Authors of the research studies and the peer-reviewed journal enterprise are partially responsible through the use of “spin” in the abstracts of peer-reviewed research papers, ie, emphasizing or exaggerating beneficial findings while minimizing or ignoring limitations in the research or potential harms.5 This becomes compounded by spin in promotional public relations news releases and then in the eventual media news coverage. Some patients who see these exaggerated claims may come to their physicians with false hope, while physicians may be frustrated with having to debunk claims that have raised false hope in the minds of their patients.

Moreover, undue weight is often placed on celebrity health news that often has no relevance in readers’ lives. For example, a celebrity parent can amplify a harmful message that vaccines cause autism through her lack of knowledge.  While celebrity health endorsements have always existed, the rise of social media as a way to disseminate traditional news media has changed the pace with which such news is spread.

Efforts to repair trust in the news media that also promote fair, accurate and unbiased coverage of health care stories could contribute to restoring trust in medicine. The medical community could have an important role in these efforts by engaging in the following activities.

Possible Solutions

Support High-Quality Health Care Journalism

High-quality health care journalism often appropriately raises questions about the trustworthiness and integrity of research and clinical care. Investigative data-driven news stories can focus on conflicts of interest, scientific fraud and retractions, overdiagnosis, overtreatment, and nonevidence-based recommendations. When science does not self-correct, a vibrant health care journalism sector can play a vital role in pointing to needed improvement and perhaps even in helping to restore public trust.  However, the health care journalism sector in 2018 is far from vibrant, particularly at the local level where news organizations are smaller and less well staffed than ever before if they continue to exist at all.  Local health news has always been more trusted by communities, featuring individuals and institutions readers know, written by journalists and produced by publishers who are their neighbors.  

At the national level, alternative models are aiming to fill this void. Such examples include STAT News or the nonprofit Kaiser Health News, which cover a range of health and health policy topics. Likewise, nonprofit investigative newsrooms, such as ProPublica and the Center for Public Integrity, have published excellent investigations in the health and medical spheres that many legacy newsrooms now lack the staff and resources to produce. The reporting of these organizations benefits from engagement with those in the medical community who work with journalists to inform the public and investigate problems in the health care system. Clinicians and health care executives should work with local media to highlight stories of interest to their communities. For example, the University of Chicago has partnered with a local radio station to feature a community health focus hour to highlight the most pressing health issues the community reported in a needs assessment.⁷

Hopefully, this article can serve as a point of embarkation to find credible information. All of the aforementioned sources are non-profit and hold no allegiance to any hospital, health plan or other principals.

Engage Media to Amplify and Share Truthful Stories

As traditional news media struggle to reach people in an era of information overload and changing revenue models, it is even more important for clinicians to be involved to amplify, share, and help create truthful news stories. While social media is often dismissed as a way “fake news” is spread, it serves as an important conduit for the medical establishment to engage with news media and amplify truthful stories. Examples of recent ways in which clinicians have amplified stories to advance public health include pediatricians joining Twitter (dubbed “Tweetiatricians”) and working in consort to advocate on vaccine effectiveness (ie, #VaccinesWork). Another example is the weekly #BCSM Tweetchats moderated by an academic breast surgeon and a leading advocate of patients with breast cancer that offers evidence-based discussions that debunk hype each week and hopefully lead to an increasingly well-informed group of women with breast cancer who are active on social media. Likewise, clinicians can offer to serve as key informants for news media about health and wellness stories so that truthful messages are communicated. For instance, Seattle Mama Doc is a pediatrician-authored blog for a major children’s hospital and frequently serves as a reputable source for news media on stories regarding children.

Actively Correct Stories That Are Not Accurate

To rebuild trust in both medicine and health care news, the response of clinicians to health care news stories that are not accurate is as important as their response to those that are truthful. It is easy for physicians to dismiss a news story with a patient in the privacy of their offices. It is more difficult to do so on a public-facing comment forum. However, journalism benefits from these corrections and feedback. In the race to put out a headline first, the headline may not always be correct. Physicians have an important role in correcting the record both through comments and through social media. Likewise, it is equally important for clinicians to challenge celebrities who may be given a platform to spread misinformation in traditional news media or on social media. For example, an obstetrician has spoken out on her blog to explain why the jade eggs promoted for vaginal health not only lacked evidence but could cause harm⁸ and an oncologist actively uses Twitter to address hyped cancer treatments based on insufficient medical evidence.⁹

Article Information

Corresponding Author: Vineet M. Arora, MD, MAPP, Department of Medicine, University of Chicago Medicine, 5841 S Maryland Ave, MC 2007 AMB W216, Chicago, IL 60637 (varora@uchicago.edu).

Published Online: May 13, 2019. doi:10.1001/jama.2019.0636

Why Bolstering Trust in Journalism Could Help Strengthen Trust in Medicine | Vaccination | JAMA | JAMA Network: This Viewpoint discusses how proliferation of health misinformation to the public undermines trust in science and medicine, and proposes ways the medical community and media might work together to make medical professionals better producers and consumers of accurate health information and to make...

Chronic Fatigue Syndrome: It's Real, and We Can Do Better

Sunday, May 12, 2019, is ME/CFS awareness day

ME/CFS is a complex, chronic, debilitating illness with systemic effects. It's characterized by reduced ability to perform activities that were well-tolerated pre-illness, accompanied by profound fatigue not improved by rest, and lasting for more than 6 months.

Most School's of Medicine teach little about this real syndrome. Some may even call it psychosomatic. The CDC Institute for Viral illnesses classified this a real illness despite there being no specific markers for it.

It is estimated 836,000 to 2.5 million Americans suffer from ME/CFS, a serious, long-term illness that can severely impair the ability of those affected to live normal lives. But the majority of those affected are not diagnosed, and many struggle with symptoms for years before receiving a diagnosis.

The absence of a definitive diagnostic test contributes to this problem. In addition, most medical schools in the United States do not include ME/CFS in their physician training. Less than one-third of medical school curricula and less than half of medical textbooks in the United States address ME/CFS, so many healthcare providers need more information about this condition.

A major concern is the difficulty in finding good healthcare from informed and compassionate providers. To address this need, we released an updated CDC website about ME/CFS for healthcare providers in July 2018. The new site was designed specifically with clinicians in mind. It offers information about how clinicians can better assess and help their patients manage this illness.

The new content includes:

Presentation and clinical course of ME/CFS;

Prognosis, epidemiology, and possible causes of ME/CFS;

Diagnostic criteria for ME/CFS, released in 2015; and

2015 Institute of Medicine Report on ME/CFS

A major stumbling block until now is a definitive evidence-based conclusion about ME/CFS. and that ME/CFS was a rule out diagnosis after all other differential diagnoses were considered.











Chronic Fatigue Syndrome: It's Real, and We Can Do Better: Chronic Fatigue Syndrome: It's Real, and We Can Do Better