Gov. Newsom signs landmark MICRA modernization bill into law

 Gov. Newsom today signed AB 35 into law, and in doing so put an end to a decades long political battle and ushered in a new era of stability around malpractice liability.

Since California’s landmark medical malpractice reforms – the Medical Injury Compensation Reform Act (MICRA) – were enacted almost 50 years ago, they have successfully struck a balance between compensatory justice for injured patients while maintaining an overall health care system that is accessible and affordable for Californians.

Since that time, California’s physician and provider communities have repeatedly defended MICRA through expensive battles at the ballot, in the courtroom and in the legislature.

This year, we were again facing another costly initiative battle. The so-called Fairness for Injured Patients Act, which had qualified for the November 2022 ballot, would have obliterated existing safeguards for out-of-control medical lawsuits and would have resulted in skyrocketing health care costs. This act demanded that patients who are injured have the right to seek compensation from alleged providers who 'injured' them. The original MICRA act of thee1970s limited compensation to $250,000.

But for the first time in a generation, we were met with an opportunity to achieve a meaningful consensus between competing interests through a revised framework that could protect both the rights of injured patients while keeping MICRA’s essential guardrails solidly in place for patients and providers alike.

“With today’s signing of AB 35, we have achieved what few thought was possible,” said California Medical Association President Robert E. Wailes, M.D 

AB 35 passed through the California Legislature with nearly unanimous support, demonstrating broad bipartisan support. As part of the landmark agreement reflected in AB 35, proponents of the Fairness for Injured Patients Act have withdrawn the initiative. The initiative cannot be returned to the November 2022 ballot.

California’s new modernized MICRA statutes will provide predictability and affordability of medical liability insurance rates for decades to come, while protecting existing safeguards against skyrocketing health care costs. It will also bring greater accountability, patient safety and trust by making it possible for physicians and patients to have a full and open conversation after an unforeseen outcome. 

Under the modernized MICRA law reflected in AB 35, which will go into effect on January 1, 2023, the underlying principles of MICRA were preserved – ensuring access to care and protecting our health care delivery system from runaway costs. Important guardrails of MICRA will continue unchanged, including advance notice of a claim, the one-year statute of limitations to file a case, the option of binding arbitration, early offer of proof for making punitive damage allegations and allowing other sources of compensation to be considered in award determinations. Furthermore, a new provision has been added to the law that protects expression of sympathy by a health care provider to an injured patient and their family, allowing physicians to express empathy, benevolence and even statements of fault after an unforeseen outcome without fear that such statements or gestures will be used against them.

The element that has garnered the most interest surrounds changes to the limit on non-economic damages in medical malpractice cases, which has been $250k since 1975. As opposed to the ballot measure, which would have effectively eliminated the cap on non-economic damages entirely, under the agreement:

Cases not involving a patient death will have a limit of $350k on the effective date of January 1, 2023, with an incremental increase over the next 10 years to $750k and a 2.0% annual inflationary adjustment thereafter.

Cases involving a patient death will have a limit of $500k on the effective date of January 1, 2023, with an incremental increase over the next 10 years to $1 million and a 2.0% annual inflationary adjustment thereafter.

Other critical MICRA guardrails that will remain in place with modest updates include the ability to pay awards of future damages over time and limits on plaintiff's attorney's contingency fees. CMA has prepared a publicly available fact sheet that provides additional details on this important legislation.

“CMA is proud to have been part of this landmark achievement for the benefit of all Californians,” said Dr. Wailes. “We look forward to a new era of long-term stability around MICRA that will allow California’s physician and provider communities to focus on other ways to improve access to care and public health for all Californians.

Gov. Newsom signs landmark MICRA modernization bill into law:

Digital Health News - Digital Salutem

Digital Health came upon the scene in 2005, with a nationwide effort to transform health care with  digital transformation. Anyone practicing medicine would not recognize how healthcare would transform between 20012 and today, 2022. 

Scientific peer reviewed journals in medicine have a plethora of articles documenting the efficacy and efficiency for better cost effective medicine and evidence based information to sustain it's utility and further development, and proof of ROI.

In 2020 as the COVID 19 pandemic exploded across the globe digital health allowed for our health system to not implode, even when stretched to overcapacity.

Computing power allowed for data analytics, tracking and reporting of the pandemic.

The World Health Organization and Johns Hopkins University produced daily maps and statistics individualized to state, and nationality of the pandemic as it progressed. These were available on the internet in real time.

Daily Moving Average (in real time)

Three trends in eHealth you need to know

3 new trends in eHealth

Here are 3 recent innovations or trends in eHealth:

Virtual clinics: Virtual clinics let you see an expert doctor remotely at home on your computer instead of having to travel outside your home (or waiting in line). The idea behind this type of solution is that doctors can make appointments from anywhere in the world instead of having doctors based around your area (which means you can get more high quality health care). This is great for consumers because it allows them to see specialists or other specialists outside their area (for example as part of an emergency room) but less so for patients because remote care requires trained staff who are highly specialized and often expensive to get hold of.

Remote Clinical Care: A lot of people simply do not want or need access to an actual doctor when they need help with their health issues, especially if they live far away from an actual hospital (which is why there are so many virtual clinics available). But if we combine remote clinical care with virtual clinics then you can get high quality accurate care anywhere any time, be it at home or online, without needing access to an actual doctor at all! This allows patients who might not feel comfortable calling out sick or going into hospitals on their own but still need help with something like diabetes or heart disease can go online and see someone who has experience treating those issues remotely rather than having them deal directly with doctors at hospitals near them.

Virtual medical centers: are used to provide services easier and more cost-effectively when you call. A virtual clinic is a planned contact by the Healthcare Professional Responsible for Care with a patient for the purposes of clinical consultation, advice and treatment planning. It has been found to increase patient access to healthcare services, enhance health outcomes, improve patient experience and make optimal use of scarce medical resources.

Digital Health has made possible Precision Medicine whereby treatments can be specifically tailored to individual patients. 

The University of California San Diego (as well as many others) has developed a Digital Health Lab,  founded by Professor Edward J. Wang as a joint research laboratory of UCSD Design Lab and the Electrical & Computer Engineering department of Jacobs School of Engineering.

Digital Health News - Digital Salutem

Perspectives from the Frontline of the Fight for Public Health: A Live Q...

Leana Wen likes to say: “Public health saved your life today. You just don’t know it.” Join the conversation as she describes her experience on the frontlines of this critical—and often invisible—field.

FAKE NEWS ? Psilocybin treatment for major depression effective for up to a year for most patients - ScienceBlog.com

DISCLAIMER: 

This information is neither a recommendation nor advice for treatment.  The reader is cautioned to consult with their personal physician prior to using psilocybin for the treatment of any medical or psychiatric condition.

For readers who wish to dive deeper into the subject, read this

Psilocybin is not an FDA approved drug

Previous studies by Johns Hopkins Medicine researchers showed that psychedelic treatment with psilocybin relieved major depressive disorder symptoms in adults for up to a month. Now, in a follow-up study of those participants, the researchers report that the substantial antidepressant effects of psilocybin-assisted therapy, given with supportive psychotherapy, may last at least a year for some patients.

A compound found in so-called magic mushrooms, psilocybin produces visual and auditory hallucinations and profound changes in consciousness over a few hours after ingestion. In 2016, Johns Hopkins Medicine researchers first reported that treatment with psilocybin under psychologically supported conditions significantly relieved existential anxiety and depression in people with a life-threatening cancer diagnosis.A report on the new study was published on Feb. 15, 2022 in the Journal of Psychopharmacology.

The study was done under carefully controlled scientific studies by professional monitors who sat side-by-side with the patient.

• 11-4-20 Psychedelic Treatment with Psilocybin Relieves Major Depression, Study Shows (1 of 2 videos)

• 11-4-20 Psychedelic Treatment with Psilocybin Relieves Major Depression, Study Shows (2 of 2 videos)
• 
  

• 11-4-20 Roland Griffiths on psilocybin research.mp4

Magic Mushrooms have been used for many decades by drug users. It is a powerful psychedelic drug produced by many different fungi, and ingested orally. Like LSD it has been proposed for treatment (Timothy Leary). Leary earned a PhD at U.C. Berkeley and was a psychologist at Harvard University and famous for a speech given "Turn up, turn in, and turn out ". 

John Lennon and Yoko Ono were patrons of Leary, Lennon composed the song "Come Together" after meeting Leary.

L-R John Lennon, Timothy Leary, Yoko Ono

 Johns Hopkins is one of the sites of a national multisite randomized, placebo-controlled trial of psilocybin for major depressive disorder. 

The study was supported by philanthropic donors The Steven and Alexandra Cohen Foundation, Tim Ferriss, Matt Mullenweg, Craig Nerenberg, Blake Mycoskie, and Dave Morin; as well as by grants from the Riverstyx Foundation and the National Institute on Drug Abuse (T32DA007209, R01DA003889, K23DA035915).

References

Psilocybin treatment for major depression effective for up to a year for most patients - ScienceBlog.com

It isn't easy being green

"It isn't easy being green."   Kermit, the frog

Why are some potato chips green? are some potato chips green?  

 This is how poisonous green crisps are - and why you still find them in your packet

Few people will happily eat the green crisp - but here's the amount you'd have to eat to get ill, and what causes them.

Why are some potato chips green? — Tasting Table

Sunlight: Optimize Health and Immunity (Light Therapy and Melatonin)

Melatonin acts in many ways to maintain your health.  Most of you use it to help fall asleep, however, it has many important other functions to maintain good health.  Melatonin is produced in the pineal gland. There are receptors (ipRGCs) in the eye, intrinsically photosensitive retinal ganglion cells that are sensitive to infrared radiation. These retinal photoreceptors (nonvisual) send signals to the pineal gland which suppresses melatonin release.

There is another source for melatonin production, mitochondrion. Melatonin is produced as part of the mitochondrial oxidative chemistry.  Melatonin serves to ' cool down' mitochondrial overheating. This pathway for NIR penetrates the skin and enters mitochondria stimulating melatonin release. Thus there are two separate paths for melatonin, 1.pineal gland 2. intracellular mitochondria.  

Sunlight: Optimize Health and Immunity (Light Therapy and Melatonin)

Melatonin and the circadian rhythm play a pivotal role in rest, good health, and eliminating oxidative stress.  The video by Medcram (Robert Seheult, M.D., UC Riverside School of Medicine

Melatonin and the Optics of the Human Body

https://doi.org/10.32794/mr11250016

Goldie Hawn Opens Up About Her Childhood Depression & The Importance of ...

The Covid pandemic may be somewhat better, however, our children are still in recovery mode. The best way to deal with childhood depression is to discuss it with them. Ask how they are feeling.  

Goldie Hawn developed "Mind Up", a course for children about mental health.. This course is inexpensive and gives guidance and a curriculum for assisting children develop mental health.

Hobby Tool | Find New Activities to Replace Gaming

In the world of addiction therapy, most psychiatrists treat addiction as an obsessive-compulsive personality disorder.  OCD can be difficult to treat, and there are some psychoactive drugs now available to treat OCD.  Many of these drugs are SSRI'S and carry significant side effects. The use of SSRI drugs in children also carry other significant side effects

Most parents and physicians prefer to not put children or teens on psychoactive drugs, except in the most severe types of depression, when other options fail.  While it is challenging to treat OCD it is possible to transfer their form of gaming addiction to other forms of entertainment, or activity.  Teens often have sports activities, tennis, running, baseball or football. The neurochemical response to any addiction is a release of endorphins, running in particular. ( Endorphins, dopamine and serotonin are all related to mood elevation.  What is the difference between endorphins and dopamine in your brain? While endorphins are neurotransmitters that help you to cope with pain and stress, dopamine is a mood-boosting neurotransmitter that is released after you reach a goal.)

In this way, dopamine is involved in the reward circuit in your brain and helps to motivate you toward tasks (in contrast, low dopamine would also be de-motivating). Higher endorphins can actually lead to higher dopamine production; in this way, endorphins and dopamine are not mutually exclusive but are actually connected in the system that promotes action toward rewards and the good feelings that result.

In other words, you might feel motivated to participate in a marathon because of your dopamine reward system, which is further reinforced by the endorphins that are released during the actual act of participating in the race. In this way, endorphins are the quicker-acting "feelings" while dopamine is the longer-acting afterglow.

Need new activities to replace gaming? Use our hobby tool. Contains 70+ different ideas with 12 filters from which to select new hobbies

Our most recent edition of Health Train Express discussed Behavioral addiction to online social networking and its association with emotion regulation deficits.

Most parents and others recognize that their children are missing from the dinner table or refuse to participate in normal family activities.  They linger far into the night with their bedroom doors closed.  In some cases, they may be gaming alone or have a virtual social network to play games with friends they know already or have never met from other countries.

In previous generations, many parents wanted to know who their children hang out with.  Today, such is not the case.  Parents rarely know with whom their children socialize.  Back in the day mothers would insist on meeting the 'friends' and also their parental units to either give approval or suggest they find other friends.

Many parents from prior generation(s) are internet incompetent, however, today's young parents grew up in the internet age and are knowledgeable about its pitfalls.

Parent Guides from ConnectSafely

Is a handy guide for parents with information about many internet gaming sites, such as Snapchat, Instagram,  Roblox, Tiktok, Amazon Parent Dashboard, Amazon Fire TV. Discord, Cyberbullying Messenger, Messenger for Kids, developed by Facebook allows parents the ability to control their kid's messenger contracts.

One important tool is Google Family Link which allows monitoring and permissions remotely from a parent's smartphone or computer.  It requires an app on the child's device and the parent's device. Other software such as parental blocking on a home Wi-Fi router can help as well, but many social networks and games can be accessed via cell phone without internet.

Top Questions from Parents

1. What is Family Link? 

Family Link is an app from Google that allows you to set-up, manage and monitor a Google account and Android device for your child so even young children can take advantage of the benefits of having a smartphone or tablet. 

2. What does Family Link do? 

The app gives you the ability to manage what apps your kids can use and when they can use them, what websites they can visit, and when they can use the device. Parents can set a device’s “bedtime” so that it can’t be used for anything except phone calls during specific hours of the day or night. 

3. What do I need to set up a Family Link account? 

You need a compatible Android smartphone or tablet for your child (find details on this webpage) and either an Android or Apple phone or tablet for yourself to manage your child’s account. You can manage some of your child’s account settings from a web browser, but need an Android device for some features and settings. You’ll also need to be in the U.S., and have your own Google account. 

4. What are the minimum and maximum ages of kids who can use Family Link? 

The app doesn’t have a minimum age. It’s up to parents to decide when their child is ready to have a managed smartphone. For Family Link users, Google will notify both the parent and the child before the child’s 13th birthday, “to encourage a family conversation around when the child will be ready to take control over their own account and device.” The child has the option to transition to a regular account or remain under parent management up until their 18th birthday. 

5. Why should my family use Family Link? 

There are a great many benefits to smartphones and tablets, even for very young children. We can’t list them all, but they include the ability to make calls and send and receive texts and emails with family members, the ability to use educational apps or games, the ability to take and share pictures, track health and fitness data, and much more. Also, it’s possible to configure your child’s phone so that it securely reports its location to you, which means you know where the phone is and, if the phone is with your child, where the child is as well. Of course, you could give your child a device without Family Link but then you wouldn’t have the ability to manage the apps they use, the sites they visit, and the times they’re using it, and be able to monitor how your child is using the phone. Family Link helps your child learn how to responsibly use their device while giving parents extra peace of mind. 

6. Who can manage my child’s account? 

By default, it’s just the person who sets up the account but the family manager can add another family member to serve as a second parent who can manage and monitor the child’s device. 

7. What should I say to my child before installing Family Link? 

It is always a good idea to have a discussion with your child before allowing them to use a device and before using any monitoring or device management tool. Remind your child about their responsibility to use the device appropriately and to take good care of the device. Explain any family ground rules and policies, and talk with them about the features in Family Link so they understand what information you can monitor and how you will be able to manage what they can do with their device. If you elect to limit the apps and sites they use, explain how they can ask permission if they come across an app or site that they would like you to add.

Authors notes:

The situation is not hopeless, and there are credible solutions to protect children from exploitation. As the reader can see Facebook has "Facebook for Kids", Tiktok has Privacy settings, 

Hobby Tool | Find New Activities to Replace Gaming

META and SNAPCHAT are sued by parent of 11 year old who committed suicide.

Are Meta Platforms Inc. and Snap Inc. to blame for the suicide of an 11-year-old who suffered from depression and sleep deprivation after becoming addicted to Instagram and Snapchat, the girl’s mother alleged in a lawsuit.

If the parent prevails in this case it would be a huge precedent-setting case, not dissimilar to the Perdue opioid settlement for opioids.

The case will require evidence from experts in addictive behavior. Some neuroscientists have published evidence (Andrew Doan, MD, Ph.D.). Dr. Doan is an ophthalmologist, whose Ph.D. thesis included addictive behavior in video gamers. He also authored "Hooked on Games"

The complaint appears to be the first of its kind against Meta, formerly known as Facebook Inc., said attorney Matthew Bergman, who founded Social Media Victims Law Center in Seattle and represents Rodriguez’s mother.

“There is a mental health epidemic among American teens,” Bergman said. He added that he anticipates a significant number of similar cases will be filed after a former Facebook employee turned whistle-blower testified in Congress in October that the company knew about, but didn’t disclose, the harmful impacts of services like Instagram.

This is unacceptable behavior behind the curtain of 'freedom of speech' and unaccountability.  Despite Meta and Snapchat's disavowal of responsibility, there is a growing concern about their effect on morals.   Young children's perception of reality becomes confused with virtual reality during their formative years.

Unguided children self treat their anxiety and fear on the internet.

Craving Facebook? Behavioral addiction to online social networking and its association with emotion regulation deficits

What You’ll Learn

The study finds that social media, sex, and nicotine might be equally addictive

Social media addiction and substance abuse

Facebook addiction linked to brain reward and gratification

Contributing Factors to Social Media or Social Networking Addiction

Dangers of teen social media addiction

Signs of social media addiction in teens

Limiting teens’ social media use to prevent addiction

Problematic Social Media Use

Internet Gaming Disorder—was included in Section 3 of the diagnostic and Statistical Manual of Mental Disorders (DSM–5)

If you are concerned about social media addiction and/or video gaming addiction Social Media Victims Law Center in Seattle, Washington is an excellent starting point.

Other References:

WEBMD

MAYO CLINIC

WIKIPEDIA

GAME QUITTERS 

Video Game Addiction Test for Parents

Video Game Addiction Test for Gamers

PSYCHIATRIC TIMES

Potpourri of Healthy Eating Habits

Slowing the Aging Process: Two Blood Proteins Could Be Key to a Long and Healthy Life

Two blood proteins have been shown by scientists to influence how long and healthy a life we live, research suggests. 

Developing drugs that target these proteins could be one way of slowing the aging process, according to the largest genetic study of aging.

As we age, our bodies begin to decline after we reach adulthood, which results in age-related diseases and death. This latest research investigates which proteins could influence the aging process.

Many complex and related factors determine the rate at which we age and die, and these include genetics, lifestyle, environment, and chance. The study sheds light on the part proteins play in this process.

Some people naturally have higher or lower levels of certain proteins because of the DNA they inherit from their parents. These protein levels can, in turn, affect a person’s health.

University of Edinburgh researchers combined the results of six large genetic studies into human aging – each containing genetic information on hundreds of thousands of people,

Among 857 proteins studied, researchers identified two that had significant negative effects across various aging measures.

People who inherited DNA that causes raised levels of these proteins were frailer, had poorer self-rated health, and were less likely to live an exceptionally long life than those who did not.

The first protein, called apolipoprotein(a) (LPA), is made in the liver and thought to play a role in clotting. High levels of LPA can increase the risk of atherosclerosis – a condition in which arteries become clogged with fatty substances. Heart disease and stroke are possible outcomes.

The second protein, vascular cell adhesion molecule 1 (VCAM1), is primarily found on the surfaces of endothelial cells – a single-cell layer that lines blood vessels. The protein controls vessels’ expansion and retraction – and function in blood clotting and the immune response.

Levels of VCAM 1 increase when the body sends signals to indicate it has detected an infection, VCAM1 then allows immune cells to cross the endothelial layer, as seen for people who have naturally low levels of these proteins.

The researchers say that drugs used to treat diseases by reducing levels of LPA and VCAM1 could have the added benefit of improving quality and length of life.  

One such example is a clinical trial that is testing a drug to lower LPA as a way of reducing the risk of heart disease.

There are currently no clinical trials involving VCAM1, but studies in mice have shown how antibodies lowering this protein’s level improved cognition during old age.

The findings have been published in the journal Nature Aging.

Dr. Paul Timmers, lead researcher at the MRC Human Genetics Unit at the University of Edinburgh, said: “The identification of these two key proteins could help extend the healthy years of life. Drugs that lower these protein levels in our blood could allow the average person to live as healthy and as long as individuals who have won the genetic lottery and are born with genetically low LPA and VCAM1 levels.” 

Professor Jim Wilson, Chair of Human Genetics at the University of Edinburgh’s Usher Institute, said: “This study showcases the power of modern genetics to identify two potential targets for future drugs to extend lifespan.”

Reference: “Mendelian randomization of genetically independent aging phenotypes identifies LPA and VCAM1 as biological targets for human aging” by Paul R. H. J. Timmers, Evgeny S. Tiys, Saori Sakaue, Masato Akiyama, Tuomo T. J. Kiiskinen, Wei Zhou, Shih-Jen Hwang, Chen Yao, Biobank Japan Project, FinnGen, Joris Deelen, Daniel Levy, Andrea Ganna, Yoichiro Kamatani, Yukinori Okada, Peter K. Joshi, James F. Wilson and Yakov A. Tsepilov, 20 January 2022, Nature Aging.
DOI: 10.1038/s43587-021-00159-8

Drinking This Before Bed May Help You Sleep (And It's Not Warm Milk)

Foods that Help you Sleep

One of the most important ways to ensure you have a great day is to get a good night's rest. Yet one-third of Americans report they get less than the recommended amount of sleep, says the Centers for Disease Control and Prevention (CDC). This can not only leave you feeling groggy—which leads to a higher incidence of accidents and motor vehicle crashes— but can also cause serious health issues down the line, including an increased likelihood of heart disease, obesity, depression, and diabetes. "Getting enough sleep is not a luxury—it is something people need for good health," the CDC warns.

Things to NOT DO before you sleep

NyQuil Cold & Flu Medicine

Excedrin Migraine

Excedrin contains caffeine, which is obviously a stimulant that makes your brain more alert,

Sudafed

 One key ingredient in Sudafed for relieving nasal congestion is pseudoephedrine. "Pseudoephedrine will often make it difficult for people to both go to sleep and stay asleep," says Kerr.

Benadryl

This medicine forces the brain to spend more time in the lighter stages of sleep. This means reduced sleep quality. And when you wake up after eight hours of slumber, you will be likely to feel like you've had only five."

Beta-Blockers

A few examples include Lopressor, Toprol, Tenormin, and Betapace. But they've got a long history of disturbing sleep. "Beta-blockers may cause nightmares and nighttime waking. By slowing the secretion of melatonin, the body's hormone devoted to regulating your internal clock, beta-blockers have been known to promote chronic insomnia.

If you need to take beta-blockers, consider taking melatonin supplements.

And finally here are. 

50 Tips for Sleeping Better Tonight, According to Experts

Expert Newsletters - Cardio Prevention, Covid 19

Joel Kahn M.D.  Interventional Cardiologist

A weekly collection focused on cardio prevention

Joel Kahn, MD, FACC of Detroit, Michigan, is a practicing cardiologist, and a Clinical Professor of Medicine at Wayne State University School of Medicine. He graduated Summa Cum Laude from the University of Michigan Medical School. Known as "America’s Healthy Heart Doc", Dr. Kahn has triple board certification in Internal Medicine, Cardiovascular Medicine, and Interventional Cardiology. He was the first physician in the world to certify in Metabolic Cardiology with A4M/MMI and the University of South Florida. He founded the Kahn Center for Cardiac Longevity in Bingham Farms, MI. Dr. Kahn has authored scores of publications in his field including articles, book chapters and monographs. He writes health articles and has 6 books in publication including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses and The Plant-Based Solution, and Lipoprotein(a): The Heart’s Silent Killer. He has regular appearances on Dr. Phil, The Doctors Show, Dr. Oz, Larry King Now, Joe Rogan Experience, and with Bassem Yousef. He has been awarded a Health Hero award from Detroit Crain’s Business. He serves as medical director of the largest plant support group in the USA, www.pbnsg.org. Dr. Kahn can be found at www.drjoelkahn.com.

The Red Wine Study Many Are Raising Their Glasses Too

An analysis of the relationship of red and white wine drinking and C19 infection shows an association with benefits to raising a glass? Caution all but at least hypothesis-generating. Do you know your Lp(a) level, your patient's levels? The prognostic power of Lp(a) suggests you should as I check in 100% of my clinic visits. CIMT is a powerful tool I use routinely to track plaque and it is valid in children too. Broccoli, aging, cherry juice, and dietary epigenetics finish the list with a bowed head and a walking meditation in memory of Thich Nhat Nahn.

The study found that those who drank one to two glasses of red wine per day had between a 10 and 17 percent lower risk of getting Covid-19 when compared with teetotalers. White wine drinkers in the study who drank between one and four glasses a week reduced their risk of contracting Covid-19 by 7 to 8 percent.

Meanwhile, beer and cider drinkers increased their risk of contracting the virus by 28 percent over non-drinkers, regardless of the amount they consumed. Those who drink five or more hard alcohol drinks a week also increased their risk of infection. Heavy drinkers of all types of alcohol also had an increased risk.

The Effect of Long-Term Atorvastatin Therapy on Carotid Intima-Media Thickness of Children With Dyslipidemia

Expert Newsletters - MashupMD

TELEHEALTH IMPACT ON CLINICIANS

 

Author. Beth Kutscher,  Path to Recovery

Welcome back to Path to Recovery, a newsletter that will bring you weekly conversations on how the health care profession will recover from one of the most significant crises of our time. Click "subscribe" above or follow along using #PathtoRecovery.

Here’s what we’re talking about this week.

One of the most fundamental ways that the pandemic has reshaped health care has been the rapid adoption of telemedicine. Technology is now ubiquitous and a staple of care. While the volume of telemedicine visits has come down from its April 2020 peak, virtual care leveled off at the beginning of last year at a number 38x higher than prior to the pandemic.

Not only are there practical reasons to offer telemedicine — like decreasing the no-show rate, allowing clinicians to see more patients and, of course, controlling the spread of covid — surveys show that a sizable percentage of people prefer the convenience, particularly younger patients.

The shift has given an opening to a number of direct-to-consumer companies that connect patients to clinicians. The convenience sell is three-fold: not only can patients see a doctor or nurse practitioner directly from their living room, but they can often get an appointment much faster than an in-person visit and have their medications delivered directly to their homes. In that way, DTC companies aim to take some of the pressure off stretched doctors’ offices and pharmacies. 

I sat down earlier this month with Varsha Rao, CEO of San Francisco-based Nurx, to talk about how the industry is changing. Nurx is a direct-to-consumer telehealth company focused on medications for birth control, skincare concerns and migraines. Like many of these platforms, it offers a self-pay rate for people without insurance.

Rao joined the company in 2019 after serving as chief operating officer of Clover Health. But her background spans travel, fashion and beauty. Here, she discusses why doctors and pharmacists are joining these companies and how Nurx fits into the larger health care ecosystem.

Let me know: How do you think direct-to-consumer telehealth platforms are changing the industry? What role do you think they play alongside traditional practices?

Below is an edited transcript of our conversation.

LinkedIn News: Tell me about some of your growth plans, both within women's health and outside of it.

Rao: We’ve been focused on building out areas of care that have been really important to our patients. We started off with contraception as a key area where a lot of people have had challenges accessing care. There are a lot of stigmas. It’s also the first place as a younger person where you’re really interacting with the health care system typically. Then we expanded to broader sexual health, so STI testing, HPV testing, and herpes. And then we continued to ask our patients about other areas where they needed care and so that's what led us to migraine.

About 35% of our patients experience migraines and we felt like that was really important for us to address. Over 55% of our patients have acne or rosacea challenges and so that was what led us to acne and rosacea. Coming up next we have new areas of service that we are launching this quarter. We’ll [also] look to continue to expand in dermatology like anti-aging. [Dermatology is] an area that we're going deeper in in general; our focus is really trying to be world-class in the areas that we're in. 

LinkedIn News: When you say world class, what do you mean?

Rao: In a way that is a lot more accessible from multiple dimensions. It can take people three to six months, sometimes, to get in to see a neurologist. And we are enabling people to get support within 48 hours. The price point is also very different; it can cost hundreds and hundreds of dollars to see a neurologist or a dermatologist, and for us, our migraine service is $60 for the consultation. The medication is additional. And then for dermatology, our main consultation fee is $35, so very affordable and accessible.

LinkedIn News: You said something interesting in terms of how you compare to the traditional doctor experience. How do you work with clinicians? What's their interest in working with you?

Rao: I think we've built an amazing culture for our clinicians. We have virtually no attrition. Some of them are full-time on staff as a part of a professional medical corporation, but some of them are 1099 [contractors]. But most of them are spending over 50% of their time with us because we require that in order to be familiar with our platform and our protocols. The other thing is providers want to feel like they're really working on true health care challenges. And I think when you're working on areas like contraception, PrEP for HIV prevention, and migraine and dermatology, these are really important challenges that people are experiencing and it feels like they're making a huge impact, which they are.

LinkedIn News: Do you feel like this is the future of where medicine is going in terms of these sort of direct access points for patients?

Rao: I think that telehealth is incredibly important as the first port of entry because there are so many things that are so much more efficiently done through telehealth. And then there are also so many challenges around accessing care. Those are the reasons why I’m such a big believer in telehealth. That’s not to say that I think there isn’t an important element of meeting a provider in person as well. And so I see ourselves as being part of an ecosystem, not replacing an ecosystem. There's always going to be an interplay. 

The quality of care that's delivered through telehealth is incredibly high. And so telehealth has gone from being viewed as a second or third option to really being a primary option of choice and very trusted.

Linked News: When you say you want to be part of the ecosystem, what does that mean? Are you building referral networks or how do you tap into the larger healthcare ecosystem?

Rao: We are very clear about the kinds of cases that we can handle. We refer out cases all the time for people who really need to see an in-person provider because you know they might be suffering from something that really requires a physical exam. We have relationships with providers in the community.

Pharmacists

It's incredibly challenging right now to find all kinds of health care providers who are going to be part of a new world of health care delivery. In this new world of telehealth, pharmacists have an incredible role to play. I feel that they may have been under-appreciated in working in a lot of retail environments where you’re on your feet for 12 hours a day or more. My understanding is it can be quite unpleasant in some locales where you’ve had the opioid crisis;  they've had to handle really challenging patient interactions. And then I also think that many pharmacists may not be working to the top of their license in the sense that they’re often stuck doing a lot of administrative work. My hope is that, in this kind of new world, we can empower pharmacists with more technology and more support so that they can deliver the kind of care that most of them went to school to get training for.

Pharmacists are in a multi-dimensional environment.  Many are in large chain pharmacies such as CVS, Rite Aid, Walgreens.  These organizations will be required to incorporate telehealth into their daily operations.  This will be a synchronous match to ask questions and offer information in face-to-face interaction, much like the clinician-patient telehealth contact.  Telehealth providers offer SMS links when a telehealth appointment is desired.  The integration of SMS and telehealth provides a unique connection asset.