In The VR Voice Hot Seat - Dr. Walter Greenleaf, Stanford University

In The VR Voice Hot Seat - Dr. Walter Greenleaf, Stanford University – Crowdcast:

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The past 24 months have brought Virtual Reality and Augmented Reality to the public's attention.  Virtual Reality has already been in use in Surgical Robotics and has been implemented by several medical device companies and is in  use in many operating rooms.

Clinicians in behavioral health have developed treatment protocols for depression,  and others.  Some are using it for diagnostics as well as treatment.  The field is ripe for study. PubMed.com  is a valuable resource for my readers.

Our source for information in today's post is Dr. Walter Greenleaf (Stanford University). sponsored by Crowdcast a live streaming application.

Virtual Reality shares the limelight now with another superstar, Artificial Intelligence. Undoubtedly the two will join forces, merge and become Virtual Intelligence or some other eponym as an eye catcher for engagement.  At the least our lexicon is changing rapidly.

Walter Greenleaf is a behavioral neuroscientist and a medical technology developer working at Stanford University. With over three decades of research and development experience in the field of digital medicine and medical virtual reality technology, Walter is considered a leading authority in the field.  Dr. Greenleaf has designed and developed numerous clinical systems over the last thirty-three years, including products in the fields of: surgical simulation, 3D medical visualization, telerehabilitation, clinical informatics, clinical decision support, point-of-care clinical data collection, ergonomic evaluation technology, automatic sleep-staging systems, psychophysiological assessment, and simulation-assisted rehabilitation technologies, as well as products for behavioral medicine.

As a research scientist, Dr. Greenleaf’s focus has been on age-related changes in cognition, mood, and behavior.  His early research was on age-related changes in the neuroendocrine system and the effects on human behavior.  He served as the Director of the Mind Division, Stanford Center on Longevity, where his focus was on age-related changes in cognition. He is currently a Distinguished Visiting Scholar at Stanford University’s MediaX Program, a Visiting Scholar at Stanford University’s Virtual Human Interaction Lab, the Director of Technology Strategyat the University of Colorado National Mental Health Innovation Center, and a member of the Board of Directors for Brainstorm: The Stanford Laboratory for Brain Health Innovation and Entrepreneurship.

As a medical technology developer, Dr. Greenleaf’s focus has been on computer supported clinical products, with a specific focus on virtual reality and digital health technology to treat Post-traumatic Stress Disorder (PTSD), Anxiety Disorders, Traumatic Brain Injury and Stroke, Addictions, Autism, and other difficult problems in behavioral and physical medicine.

Dr. Greenleaf founded and served as CEO for Greenleaf Medical Systems, a business incubator; InWorld Solutions, a company specializing in the therapeutic use of virtual worlds for behavioral health care; and Virtually Better, a company that develops virtual environments for the treatment of phobias, anxiety disorders, and PTSD.  In addition to his research at Stanford University, Walter is SVP of Strategic & Corp. Affairs to MindMaze and Chief Science Advisor to Pear Therapeutics. He is a VR technology and neuroscience advisor to several early-stage medical product companies, and is a co-founder of Cognitive Leap.

CVS to complete Aetna merger after clearing final hurdle | TheHill

CVS to complete Aetna merger after clearing final hurdle

The $69 billion merger between CVS and Aetna will close imminently after New York signed off on the deal Monday.

The deal is now expected to close Wednesday. Aetna and CVS say that the merger will improve health-care outcomes and reduce costs immediately.

They have plans to turn CVS’s 10,000 pharmacies and clinics into community-based sites of care with nurses and other health professionals available to give diagnoses or do lab work.

The merger also means that there will no longer be any independent pharmacy benefit managers in the U.S.

The deal was cleared by the Department of Justice in October, and New York was the last state regulatory approval that the companies needed.

As part of New York’s approval, CVS and Aetna agreed to some concessions, including enhanced consumer and health insurance rate protections, privacy controls, cybersecurity compliance, and a $40 million commitment to support health insurance education and enrollment.

CVS to complete Aetna merger after clearing final hurdle | TheHill: The $69 billion merger between CVS and Aetna will close imminently after New York signed off on the deal Monday.

Health Care Providers And Researchers Have An Obligation To Expose The Horrors of Gun Violence

On the heals of a shooting in an emergency room at a Chicago  Hospital 
the NRA has criticized doctors for making guns a public health issue. 

An emergency room physician was mortally wounded along with two other persons. 

NRA told 'anti-gun doctors' to 'stay in their lane' hours before mass shooting

The tweet was published hours before a hooded gunman killed 12 people at the Borderline Bar and Grill in Thousand Oaks, California.

"Someone should tell self-important anti-gun doctors to stay in their lane," the tweet read, specifically calling out the Annals of Internal Medicine. The controversial tweet linked to an article critical of medical papers that advocate for gun control.

Those on the frontlines of health care in communities across the U.S. are well aware of the horrors of gun violence: prehospital care providers, emergency room (ER) doctors, trauma surgeons, nurses, and so many others who have the grave misfortune to see how bullets ravage the human body and soul.  The kind of tragedy that once witnessed can’t be unseen.

Perhaps this explains the outrage over a National Rifle Association (NRA) Tweet posted on November 8th that read “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

Reducing Firearm Injuries and Deaths in the United States: A Position Paper From the American College of Physicians 

The article is based upon a peer reviewed article from the American College of Physicians. along with a number of suitable references from other professional sources.

Health Care Providers And Researchers Have An Obligation To Expose The Horrors of Gun Violence: Health Care Providers And Researchers Have An Obligation To Expose The Horrors of Gun Violence

Google to bring on Geisinger’s CEO to direct its healthcare efforts

The merger of leadership between Google and Geisinger Medical Clinic portends the development of artificial intelligence in the electronic health record.

Geisinger President and CEO David Feinberg plans to step down from the health system to take charge of the healthcare efforts at Google, according to reports.

The health system, which services more than 1.5 million patients in Pennsylvania and New Jersey across 13 hospital campuses, confirmed that Feinberg would leave the company Jan. 3, 2019. Geisinger’s executive VP and chief medical officer, Jaewon Ryu, M.D., will take over as interim president and CEO starting Dec. 1, before a month long transition period.

According to CNBC, Feinberg would report to Google’s artificial intelligence head, Jeff Dean, while working closely with CEO Sundar Pichai to develop a cohesive strategy for Google’s various health and health-adjacent enterprises, including through home automation and wearables.

During Feinberg’s tenure at Geisinger over the past four years, the health system pursued several programs to integrate big data, electronic health records and genomics into its care, including through collaborations with pharmaceutical companies.

Geisinger has also been working with Merck & Co. on two EHR programs designed to boost medication adherence, reduce drug errors and help connect patients and providers, and it has been in talks with health IT companies to roll them out to a larger marketplace.

Teams from Geisinger and Merck will work together to improve patient adherence, increase the role of patients in making decisions to help manage their conditions, share information among extended care teams, and improve clinical care processes. The first tool being developed is an interactive web application designed to help primary care clinicians assess and engage patients at risk for cardiometabolic syndrome. Cardiometabolic syndrome is a clustering of various risk factors that put an individual at risk of developing type 2 diabetes and cardiovascular disease.

Google to bring on Geisinger’s CEO to direct its healthcare efforts

The lowly appendix may play a surprising role in the development of Parkinson’s disease - Los Angeles Times

 The appendix has long been dismissed as an organ that has outlived its usefulness in human evolution. But new research suggests it may play an active — and detrimental — role in the development of Parkinson’s disease.

Healthy appendixes contain alpha-synuclein (shown in red), a protein that is a constituent of the Lewy bodies observed in Parkinson's disease. (B.A. Killinger et al. / Science Translational Medicine)

The appendix has long been dismissed as an organ that has outlived its usefulness in human evolution. But new research suggests it may play an active — and detrimental — role in the development of Parkinson’s disease.

In a finding that extends the link between gut and brain health in a surprising new direction, scientists found that people who had their appendix removed were 20% less likely to develop the neurodegenerative disorder than people who did not have appendectomies.

What’s more, surgical removal of the appendix seemed to forestall the appearance of Parkinson’s symptoms, which include tremors, movement difficulties and signs of dementia. Among older patients in whom Parkinson’s disease was eventually diagnosed, those who’d had their appendix removed experienced their first symptoms 3.6 years later, on average.

Dr. Viviane Labrie - Appendix identified as a potential starting point for Parkinson’s disease

Aggregated alpha-Synuclein is visible in the neurons of the appendix. (Van Andel Research Institute)

The lowly appendix may play a surprising role in the development of Parkinson’s disease - Los Angeles Times:

How Good a Doctor Are You?

Are you in a quandry how to select your doctors?  Should you rely on your insurance company's list of providers?  Do internet websites such as healthgrades provide useful or credible information?  What about those "Best Doctors in America" or your local version of the same.  How about those fancy shiny magazines in your own . doctors reception area?  Did you know that those listing are purchased, and should only be considered as self-serving advertisements. What about celebrity endorsements ?

This opens a 'can of worms'.

Besides political news and gossip healthcare also is a prime topic for print and news media. It affects all of us.  At least in politics one gets to vote.  This is not true of health care.  The old fashioned way of choosing you doctor was by a personal referral.  Today that method is used far less.  The majority of new patients select a doctor from the provider list of their insurance plan.

"Every physician strives to do their best for patients, but are we doing enough? Currently, there is no way to truly know how our outcomes compare with others, which also makes it impossible to know if we are “up to standard.” Implementation has begun on systems that measure individual physician outcomes and then base reimbursement upon them; such systems are a desirable replacement for fee-for-service because they could reduce unneeded care and improve the care that is delivered – but the devil is in the details…

Current methods do not truly assess our success as doctors. Detailed case-by-case oversight only occurs when there is an accusation of malpractice or negligence, and although devastating complications are sometimes reviewed at morbidity and mortality conferences, these do not measure routine care. Infrequent board exams might test a minimum standard of knowledge, but they cannot measure its application in daily practice. And although self-described Centers of Excellence may publish case series with success and complication rates, reports of general results in the wider community are rare.

The overall upshot? When selecting a surgeon for ourselves or a family member, it’s very difficult to objectively determine who is best – or even who is adequate. Online voting polls and magazines listing “Top” doctors receive much attention (mostly in advertisements for those voted highest), but are based on subjective responses from unknown respondents. One popular assumption is that a doctor who frequently performs a certain procedure or frequently treats a specific condition must be better than one who seldom does – and there is considerable evidence that this is correct. (1). However, the fact that surgery rates for a procedure vary dramatically by region of the country suggests that more surgery may not be better for patients (2). More research would be helpful to study the need for surgery and its quality, including its effect on patient quality of life (QoL).

There are many reasons why doctors and patients should favor standardized, publically available data on medical outcomes. For physicians, such data can improve the overall quality of care because it could help identify the methods that are most successful. For patients, it could provide reassurance that their medical team is competent.

The challenge is to develop outcome criteria that represent objective, quantifiable, and valid measures of the results of care. With the advent of electronic medical records (EMR) and national databases generated for billing purposes, some initial attempts have been made to do this. Unfortunately, the big databases that are available are not designed to assess outcomes, but rather to mimic paper charts and to record details for billing purposes. From them, one can determine how often tests, exams, or procedures were performed – but not whether they were appropriate, interpreted correctly, or had a reasonable outcome. The outcomes reported so far have been “process measures” – how many have you done?  These data have been compared with Preferred Practice Patterns of national organizations, which are generated by consensus, but rarely validated by prospective studies. As big database studies can derive provocative findings – for example, the recent report that fewer elderly hospitalized patients die under the care of female internists than male internists (3) – prospective validation is vital for such work.  If one does a google search for PPP (preferred practice patterns you will not find much except for Ophthalmology and Physical Therapy. In any case these patterns are set by the National organization for each specialty.  The reasons are that medicine evolves and patterns change sometimes very quickly.  Most specialty organizations are loath to list them since they  could be comprehended as 'facts, set in stone'

Inexperience attorney often refer to patterns as legal documents, for which they are not.

To use a specific example, consider how to assess the quality of care provided to a glaucoma patient. It is fashionable to propose that the best measure of outcome is the patient’s perspective, because patient-oriented outcomes are not routinely captured in clinical measures (acuity, visual field tests etc.). However, although QoL questionnaires theoretically measure the patient’s viewpoint, individual expectations and mental state can affect the correlation between clinical measures and reported QoL: the more depressed a person is, the worse they rate their visual function – even when it is normal. Furthermore, because diseases such as glaucoma have minimal disease-related symptomatology until late in their course, the inevitable side effects of standard eye drop treatment – even when performed perfectly in accord with recommended practice – might lead patients to conclude (legitimately) that their quality of vision or life is either no better or even worse after treatment. How many of us can think forward 10 years to what would have occurred had such treatment not been given?

Currently, well-validated QoL questionnaires are not included in commercial EMRs. Medicare may have implemented post-visit questions for patients, but these deal in the “experience” during a visit (“how quickly were you seen?” or “did the staff treat you well?”). And though these may maximize service quality, they do not assess medical outcome. For instance, a 2012 Archives of Internal Medicine report demonstrated that respondents in the highest patient satisfaction quartile had a higher likelihood of hospital admission, greater expenditures, and higher mortality (4). And there may be other negative consequences – one possible contributing factor (among many) for the current opioid epidemic could be Joint Accreditation reviews that emphasized patient reports of inadequate pain relief (5).

“The healthcare system has never really stressed the things that are important to patients.”

Instead of QoL questionnaires, what standard clinical measures would be good benchmarks? Visual acuity after cataract surgery? Visual field progression rate for glaucoma? These exist in EMRs, but they may conflict with the patient’s view of their desired outcome. Patients who want uncorrected distance vision and need glasses after IOL implants are unhappy with uncorrected 20/20, just as few glaucoma patients appreciate that the dramatic slowing of field worsening with successful therapy is “better” than their natural course. To select a field criterion for glaucoma patients we need to know the rate of slowing that is compatible with best present outcome. It may not be “no” worsening, but an “acceptable” rate, adjusted by the distribution of case severity and patient demographics. If knowledge of physicians’ ranking is effective, it could produce a shift toward better overall outcomes, as in the cardiac surgery example mentioned above.

There has been a rush to produce outcome measures that are “practical” – data easily gleaned from the EMR. One such “quality measure” recently suggested was a particular IOP lowering after laser angle treatment for glaucoma… Compared with recently published data, the particular success criterion selected (from one 20-year-old clinical trial) is far too strict. Rather than picking immediate standards that later must be amended, studies are needed to estimate reasonable outcomes based on data from a variety of practice settings.

In my view, the healthcare system has never really stressed the things that are important to patients, and we need to develop methods to accurately benchmark if we are doing a good job for our patients. It is past the time when we can act as if someone else will make this transition meaningful – we all need to be productively involved."

By Harry Quigley, A. Edward Maumenee Professor of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University .  The author reports no conflicts of interest relevant to the content of this article.

How Good a Doctor Are You?: Your income may depend on it… but we have no real way to measure what actually matters to patients.

Trump administration gives insurers power to lower Medicare drug prices

Insurers participating in Medicare Advantage will be able to negotiate directly with drugmakers in an effort to lower the cost of prescription medications under a new policy announced by the Trump administration.

The policy aims to allow Medicare Advantage plans access to the same tools as private insurers to try to lower the costs of treatments delivered in a physician's office or hospital under Medicare Part B.

The change will impact more than 20 million people enrolled in Medicare Advantage plans. In 2017, Medicare Advantage plans spent $11.9 billion on Medicare Part B drugs, according to the Centers for Medicare and Medicaid Services (CMS).

Administration officials said the new policy will help increase competition and help lower the price of prescription drugs. It’s a key part of President Trump’s blueprint to lower drug costs, which he released in May.

“By allowing Medicare Advantage plans to negotiate for physician-administered drugs like private-sector insurers already do, we can drive down prices for some of the most expensive drugs seniors use,” Health and Human Services Secretary Alex Azar said in a Tuesday statement.

Government programs often pay higher prices than necessary for drugs because they lack the tools needed to negotiate discounts, HHS said in a fact sheet. For many physician-administered drugs covered by Medicare Part B, private insurance plans negotiate discounts of 15 to 20 percent or more, while Medicare essentially pays full price.

Under the new guidance, health plans will be able to require patients try cheaper drugs first, and will cover more expensive ones only if necessary — a process called step therapy.

According to CMS Administrator Seema Verma, this can create leverage for insurers to push for higher rebates from manufacturers in exchange for not steering patients to cheaper treatments from rival companies.  

Plans will be allowed only to apply step therapy to new prescriptions, not to people who already use the drug. Patients will also be able to ask their plan for an exception if they feel they need access to a specific drug.    

Plans will be required to pass on to patients more than half of the savings generated from the negotiations. Patients can receive benefits in the form of gift cards and other rewards programs, Verma said.

TAGS DONALD TRUMP MEDICARE NEGOTIATING DRUG PRICES

https://thehill.com/policy/healthcare/400808-trump-administration-gives-insurers-power-to-lower-medicare-drug-prices?utm_source=Galen+Email+Alerts+%26+AHC&utm_campaign=e63708b7ba-EMAIL_CAMPAIGN_2018_08_10_15_25&utm_medium=email&utm_term=0_93ad194d45-e63708b7ba-171570337&mc_cid=e63708b7ba&mc_eid=9b2d81fde3

Americans are brainwashed about Universal Care, which is not the same as socialized medicine.

He moved to New Zealand.

I am an American. In 1998 my 44 yo wife died of colon cancer after her medical insurance was not renewed because she was being treated for pre-existing condition. I lost everything to the disaster, decided I had had enough and got on a strangers sailboat at 48 yrs old. No plans just to have an adventure and clear my mind. We eventually wound up in New Zealand after sailing from Seattle to Panama. I am a clinical psychologist and children’s mental health hospital director, or was. I loved New Zealand and decided to see if could get work. I took a job as a teacher’s aide and the rest is history. Little did I know I had a serious medical condition that would kill me. in 1967 I left America because I was not going to become involved in the horrible Vietnam war. I went to Mexico and received my BA with honours. I wanted to be an anthropologist so I spend many months in Yucatan studying Mayan sites. While doing so I contracted malaria. Got over that and went on to run some wonderful programs in America. I passed my physical for residency here and life was good. in 2007 I began to get sick. That’s when I found out in a foreign country that I had terminal liver failure from the Malaria. New Zealand gave me, yes for free gave me a new liver. I paid nothing not even the 3 months my wife had to stay in Auckland while I recovered. Not a penny for travel or anything. In about 2014 I received a complete knee replacement again not cost whatsoever to me. I have had countless surgeries for skin cancer free of course.

Our tax responsibility is lower than America and my medical bills are free for life.

America you are being brainwashed. You could provide healthcare for everyone far easier than we can.

By the way, if anybody thinks countries like us have inferior doctors look up the Name “Dr. Ed Gane”. Do you know anybody that has or had Hepatitis C? Ed is my doctor. He discovered the cure for Hepatitis C. Wake up people our docs are as good and better than America. The treatment costs $85,000 in America. Here… yes totally free.

You are being sold down the drain for the gain of the rich.

My only regret leaving America is not leaving sooner.

BioNews Services – WE ARE RARE serving the rare disease community

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A RARE APPROACH

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BioNews Services – WE ARE RARE:

"Hey, Charlie" app supports those struggling with opioids A novel use of social media

 A smartphone app developed by MIT alumna Emily Lindemer uses social contacts and location information to give recovering opioid addicts gentle reminders about how to stay clean.

In the spring of 2016, while Emily Lindemer was working toward her PhD at MIT, she was also struggling with something closer to home: watching someone she knew well fall in and out of recovery from opioid addiction.

Like many people in recovery, Lindemer’s friend had his ups and downs. There were promising periods of sobriety followed by relapses into old habits. As the months went by, Lindemer began to see patterns.

For example, when he lost his driver's license — a common occurrence for people struggling with substance abuse who have run-ins with police — he had to call his friends to give him rides to work. If the friends he called for a lift were also people he used drugs with, Lindemer says, he’d relapse within a week.

“His relapses were predictable almost to a T, just based on the people he was associating with — who he was talking to, calling, texting, and hanging out with,” she says.

This realization turned out to be an inspiration. What if, she thought, there was a way to provide gentle moments of pause to people struggling with substance-abuse disorders? And what if those reminders could come through a smartphone application that monitors users’ contacts, location, and behaviors — and, using the information it gathers, offers encouragement when they are communicating with risky people or when they’re near a trigger area?

Lindemer, then a PhD student in the Harvard-MIT Health Sciences and Technology program, formed a team, which started thinking through the basics of what would become an app called Hey, Charlie. She knew of dozens of existing apps to help people in recovery. Some, like MySoberLife, offer simple lifestyle tracking services. Others, like reSET, are prescription-only and share patients’ responses to questionnaires with doctors. But none addressed the primary trigger Lindemer saw for relapses: social contacts.

Lindemer and her team participated in MIT Hacking Medicine, a worldwide event in which people have a short time to come up with solutions to health care-related problems. They emerged from that experience with sharper ideas, and with a clear sense that they would need funding and more advice. So Lindemer applied to the MIT Sandbox Innovation Fund, a program that provides seed funding for students’ ideas. The team received $25,000 and was connected to mentors with relevant experience. Lindemer and her team streamlined the application and designed a business model, and recently they ran a successful usability pilot.

The Hey, Charlie app works on several levels. When someone downloads it, it prompts them to enter general information about a few of their contacts, including questions that might prove helpful on the road to recovery, for example: “How often does this person express doubt about your ability to continue your recovery process?”

“They are objective questions, not subjective, and they aren't stigmatizing,” Lindemer says. “They do not ask the person in recovery to incriminate anybody. We try to figure out things like, is this a person that even knows that you are struggling with substance abuse disorder? Is this a person who contributes to stress levels in your life? Or is this the type of person who encourages your sobriety?”

The app also asks new users for a unique set of spatial information. Where are the areas of their city or region that could be triggers for users — locations where they bought drugs, or where their friends who use drugs are living? The app's users identify a particular point and then drag a wider circle depending on the size of the area. As they users go about their day, if they approach a place they have identified as risk-related, the app sends a notification: “Hey, I know you’re near a risky area. You can do this.”

Even when users aren’t engaged with the app, Hey, Charlie collects data on their activity and interactions — very, very securely, says Lindemer.

“Anything that gets sent into the cloud for Hey, Charlie is encrypted,” she says. “What we get is anonymized communication data. So we might know this user is talking to five unique risky people, but we have no idea who those risky people are, what their phone numbers are, or anything. It’s not the specific people and places that are necessarily important. It is the volume of communication with people that are helpful versus unhelpful.”

Christopher Shanaha, the director of Hey, Charlie’s recent usability pilot at Boston Medical Center and Mattapan Community Center says the app’s nudges can help patients stay engaged with their recovery when they’re outside of the clinic.

“As clinicians we only see patients in the clinic 15 or 20 minutes a week, and yet patients have to live 24 hours a day and deal with their addictions all of the time,” Shanahan says. “This is one small way to support our patients in those interim time periods.”

During the pilot, which tracked 24 people using the app over the course of the month, Shanahan says he was surprised at how enthusiastic the responses were — users felt positively toward the app and indicated they would use it again in the future.

Michael Barros, an advisor on Hey, Charlie’s user interface who has been in recovery for heroin addiction, told Lindemer that many treatment facilities are run using old methods that are often ineffective.

“One of the most interesting thing about Hey, Charlie is having PhDs like Emily working to bring some science into a part of medicine that is still running on pen, paper, and hunches about what worked for people in the past,” Barros says. “The data that can be collected with an app like Hey, Charlie is badly needed.”

contact . https://twitter.com/EmilyLindemer

"Hey, Charlie" app supports those struggling with opioids | MIT News:

Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model

Calvin Brown doesn’t have a primary care doctor — and the peripatetic 23-year-old doesn’t want one.

Since his graduation last year from the University of San Diego, Brown has held a series of jobs that have taken him to several California cities. “As a young person in a nomadic state,” Brown said, he prefers finding a walk-in clinic on the rare occasions when he’s sick.

“The whole ‘going to the doctor’ phenomenon is something that’s fading away from our generation,” said Brown, who now lives in Daly City outside San Francisco. “It means getting in a car [and] going to a waiting room.” In his view, urgent care, which costs him about $40 per visit, is more convenient — “like speed dating. Services are rendered in a quick manner.”

Brown’s views appear to be shared by many millennials, the 83 million Americans born between 1981 and 1996 who constitute the nation’s biggest generation. Their preferences — for convenience, fast service, connectivity and price transparency — are upending the time-honored model of office-based primary care.

Many young adults are turning to a fast-growing constellation of alternatives: retail clinics carved out of drugstores or big-box retail outlets, free-standing urgent care centers that tout evening and weekend hours, and online telemedicine sites that offer virtual visits without having to leave home. Unlike doctors’ offices, where charges are often opaque and disclosed only after services are rendered, many clinics and telemedicine sites post their prices.

A national poll of 1,200 randomly selected adults conducted in July by the Kaiser Family Foundation for this story found that 26 percent said they did not have a primary care pr
ovider. There was a pronounced difference among age groups: 45 percent of 18- to 29-year-olds had no primary care provider, compared with 28 percent of those 30 to 49, 18 percent of those 50 to 64 and 12 percent age 65 and older. (Kaiser Health News is an editorially independent program of the foundation.)

A 2017 survey by the Employee Benefit Research Institute, a Washington think tank, and Greenwald and Associates yielded similar results: 33 percent of millennials did not have a regular doctor, compared with 15 percent of those age 50 to 64.

“There is a generational shift,” said Dr. Ateev Mehrotra, an internist and associate professor in the Department of Health Care Policy at Harvard Medical School. “These trends are more evident among millennials, but not unique to them. I think people’s expectations have changed. Convenience [is prized] in almost every aspect of our lives,” from shopping to online banking.

So is speed. Younger patients, Mehrotra noted, are unwilling to wait a few days to see a doctor for an acute problem, a situation that used to be routine. “Now,” Mehrotra said, “people say, ‘That’s crazy, why would I wait that long?'”

Until recently, the after-hours alternative to a doctor’s office for treatment of a strep throat or other acute problem was a hospital emergency room, which usually meant a long wait and a big bill.

Luring Millennials

For decades, primary care physicians have been the doctors with whom patients had the closest relationship, a bond that can last years. An internist, family physician, geriatrician or general practitioner traditionally served as a trusted adviser who coordinated care, ordered tests, helped sort out treatment options and made referrals to specialists.



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Viagra no more: The changing face of drug ads on TV

What happened to those TV ads for Viagra and Cialis?

There's a reason the Trump administration wants to require drugmakers to include list prices in advertisements for prescription medicines on TV: It's where the money is.

In recent years, direct-to-consumer advertising has touted to consumers prescription medicines for relatively common ailments like high cholesterol or impotence. Think Lipitor (atorvastatin) or Viagra (sildenafil). While pharma has never liked the idea of price disclosure, the cost of drugs previously most familiar to the American public are nowhere near the cost of the most commonly advertised products today.

Patent expirations, along with the rise of specialty drugs and biologics, have shifted the line-up of drugs consumers are likely to see hawked on TV.

In 2018, a traditional 60-second spot is likely to come from one of a handful of large pharmas and feature a specialty medicine approved for sale in the past five years. Gone are the twin bathtubs and little blue pills, replaced instead with promotions for new psoriasis biologics and cancer drugs.

Spending, though, remains high. Through the first nine months of this year, pharma companies have spent more than $2.8 billion on TV drug ads, up from around $2.5 billion through the same time period last year, according to analytics firm iSpot.tv.

Here are five common themes among the top ranks of pharma TV advertising:

A handful of drugmakers account for the lion's share of drug ads on TV

In proposing to mandate inclusion of prices in drugs ads last week, the Department of Health and Human Services estimated its rule would affect roughly 25 drugmakers that air about 300 commercials a quarter.

Data from iSpot.tv, though, shows that the number of pharma companies putting up serious money on television drug ads is an even narrower group.

Spending by Pfizer, Eli Lilly, AbbVie and Bristol-Myers Squib, for example, represented about 40% of the $2.81 billion spent on TV drug ads through the first nine months of 2018, according to an analysis of iSpot.tv numbers

AbbVie's investment in promoting its blockbuster drug Humira (adalimumab) made up 8.5% of the total just by itself.

Top 5 spenders on TV drug ads, first nine months of 2018

Company	TV ad spending for top drugs	Drugs advertised	Number of ad spots
Pfizer	$481 million	Lyrica, Xeljanz, Ibrance and Eucrisa	24
Eli Lilly	$318 million	Trulicity, Jardiance, Taltz and Verzenio	15
AbbVie	$236 million	Humira	15
J&J	$113 million	Xarelto	4
Celgene	$104 million	Otezla	2

Note: Pfizer's figures above don't include Eliquis, which it co-promotes with Bristol-Myers Squibb SOURCE:Data from iSpot.tv

Viagra no more: The changing face of drug ads on TV | Healthcare Dive: Healthcare

The Food We Eat

Food is more than nourishment. It's a source of pleasure — and guilt — and an agent of change. This episode, TED speakers explore our deep connection to food, and where it's headed.

This, from NPR

 

TED Radio Hour : NPR

Follow along and learn how we arrived at this place in the foods we eat, where we are guided by economics and marketing,