Legionairres Disease Outbreak in NYC...

A sign hangs outside Lincoln Medical Center where a cooling tower has been tested and disinfected following a deadly outbreak of Legionnaires' disease in the South Bronx region, New York August 7, 2015.
REUTERS/LUCAS JACKSON

The New York City Council voted unanimously on Thursday to pass legislation that mandates strict regulations of cooling towers, a move that comes in response to the current outbreak of Legionnaires’ disease in the South Bronx. The Council voted 42-0 in favor of new regulations that will require all cooling towers be registered, tested and then disinfected if they’re found to contain Legionellabacteria. Cooling towers are used to regulate temperatures indoors and are part of ventilation systems in many modern residential buildings. Failure to comply with the law could cost a property owner as much as $25,000 in fines and a year in jail.

The current outbreak of the potentially fatal bacterial pneumonia has killed 12 people and sickened more than 100 in the South Bronx. The victims contracted the illness after breathing in contaminated water vaporized through cooling systems.

“We must do everything we can to proactively prevent outbreaks of Legionnaires’ disease, which is why legislation requiring regular inspections and testing of cooling towers is extremely important,” Jumaane Williams, city council member and chair of the committee on housing and buildings, said in statement. “Without proper maintenance, cooling towers can accrue an overgrowth of Legionella,causing what has proven to be a fatal outcome for far too many New Yorkers.”

What is Legionnaires Disease?

The illness was originally called " Pontiac Disease",  named after an outbreak in Michigan. It was associated with steam cleaning of water turbines.

Microscopic view of Legionela pneumophila

The bacteria are the long cylindrical figures. The cells are leucocytes, macrophages (single nucleus) polymorphonucleophages (multilobed nucleus) The nucleus is the darkly stained structure near the center of each cell. It takes up the stain more intensely since the nucleus contains DNA.

Startups Vie to Build an Uber for Health Care -

The uberization of health care access in the United States is a real  possibility.

Given the enormous change in the business of health, and it's rapid adoption of new technologies the trend may bein place for this to occur.  Insurers are desperate to control costs,and providers seem to have become pawns in the chess game of health care management.

There has already been a reduction in hospital admissions and penalties for readmissions. Outpatent care reigns, and that too will come under scrutiny.  The house call may return with the assistance of wearables, remote monitoring of cardiac EKG, thermal imaging and technician ultrasound, (technicians already perform these tests in office). Results can be electronically transmitted and analyzed remotely by a provider and other  certified mobile devices that measure blood chemistry, urine analysis. external photography, including diabetic eye screening for diabetic retinopathy.

Most of these procedures can be reimbursed for the service and provider interpretation. Insurers may w ish to contract directly with mobile health services for efficiency and to reduce administrative burden on  provider facilities.
Many rapid micro-analytic devices are in the FDA approval pipeline.

In the coming decade medicine and health care routines may become unrecognizable compared to today's practice patterns.

Eve Rorison, a nurse who works for Pager, conducts a wellness check for Facebook executive Kunal Merchant at his New York offices. Services like Pager are putting a high-tech spin on old-fashioned house calls. PHOTO: MELINDA BECK/THE WALL STREET JOURNAL

Can providers and regulatory bodies survive the change as providers and patients demand patient centered medicine.  Perhaps forward looking boards and licensing organizations will become leaders.

But don't hold your breath.  Current and past behavior runs counter to this change..  The synergy of HIT,increasing utilization, and the mandates of the Affordable Care Act will conspire to accelerate the process of change.





tartups Vie to Build an Uber for Health Care - WSJ

We're overdosing on medicine – it's time to embrace life's uncertainty

The more we learn about the problem of too much medicine and what’s driving it, the harder it seems to imagine effective solutions. Winding back unnecessary tests and treatments will require a raft of reforms across medical research, education and regulation.

But to enable those reforms to take root, we may need to cultivate a fundamental shift in our thinking about the limits of medicine. It’s time to free ourselves from the dangerous fantasy that medical technology can deliver us from the realities of uncertainty, ageing and death.

We’re all ill now

A growing body of evidence shows that when it comes to health care, we may simply be getting too much of a good thing. In the United States, it’s estimated that more than US$200 billion a year is squandered on unnecessary tests and treatments. In the United Kingdom, senior medical groups are calling on doctors to reduce all the wasteful things they do. And in Australia, the Choosing Wisely campaign recently kicked off with lists of unnecessary and harmful health care.

Not only are we overusing pills and procedures, we’re creating even more problems with “overdiagnosis” by labelling more and more healthy people with diseases that will never harm them.

Screening programs targeting the healthy can detect potentially deadly cancers and extend lives. But they can also find many early abnormalities that are then treated as cancers, even though they would never have caused anyone any symptoms if left undetected.

The common ups and downs of our sex lives are often re-labelled as medical dysfunctions. Older people who are simply at risk of future illness – those with high cholesterol, for instance, or reduced kidney function, or low bone mineral density – are portrayed as if they were diseased.  Have we set the threshold for illness and/or disease too low?

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The more we learn about the problem of too much medicine and what’s driving it, the harder it seems to imagine effective solutions. Winding back unnecessary tests and treatments will require a raft of reforms across medical research, education and regulation.

But to enable those reforms to take root, we may need to cultivate a fundamental shift in our thinking about the limits of medicine. It’s time to free ourselves from the dangerous fantasy that medical technology can deliver us from the realities of uncertainty, ageing and death.

We’re all ill now

A growing body of evidence shows that when it comes to health care, we may simply be getting too much of a good thing. In the United States, it’s estimated that more than US$200 billion a year is squandered on unnecessary tests and treatments. In the United Kingdom, senior medical groups are calling on doctors to reduce all the wasteful things they do. And in Australia, the Choosing Wisely campaign recently kicked off with lists of unnecessary and harmful health care.

Not only are we overusing pills and procedures, we’re creating even more problems with “overdiagnosis” by labelling more and more healthy people with diseases that will never harm them.

Screening programs targeting the healthy can detect potentially deadly cancers and extend lives. But they can also find many early abnormalities that are then treated as cancers, even though they would never have caused anyone any symptoms if left undetected.

The common ups and downs of our sex lives are often re-labelled as medical dysfunctions. Older people who are simply at risk of future illness – those with high cholesterol, for instance, or reduced kidney function, or low bone mineral density – are portrayed as if they were diseased.

The doctors expanding disease definitions and lowering the thresholds at which diagnoses are made are often being paid directly by the companies that stand to benefit from turning millions more people into patients.

Fundamental shifts in thinking

Indeed, intolerance of uncertainty has been suggested as among the most important drivers of medical excess. Doctors order ever more tests to try, often in vain, to be sure about what they’re seeing – to be more certain. But disease and the benefits and harms of treating it are inevitably fraught with uncertainty because we’re trying to apply knowledge derived from populations to unique individuals.

More broadly, uncertainty is the basis of all scientific creativity, intellectual freedom and political resistance. We should nurture uncertainty, treasure it and teach its value, rather than be afraid of it.

No matter how much the marketers of medicines try to make us feel broken by the

mere passing of time, ageing is not a disease. Disease definitions that equate “normal” with being young are fundamentally flawed and require urgent review.

Everyone must die and everyone, patients and doctors alike, is more or less fearful of dying. So, it’s perhaps not surprising that we so often turn to biotechnical approaches rather than paying real attention to the care of the dying – a core purpose of medicine.

But, there are many positive signs of change within medicine. The Choosing Wisely campaign mentioned above is a partnership between doctors and wider civil society. And it’s now an international movement to wind back excess medicine.

A new approach called shared decision making is promoting much more honest conversations between doctors and the people they care for, embracing uncertainty about benefits and harms, rather than peddling false hopes. Another new approach among GPs called quaternary prevention is urging doctors to protect people from unnecessary medical labels and unwarranted tests and treatments.

Quaternary prevention is a group of measures taken to prevent, decrease and/or alleviate the harm caused by health activities. Health activities not only generally produce benefits, but also harm. That is to say, although medical intervention is mainly favourable, there is a dynamic balance that requires continuous assessment of the clinical situation as naturally only those health activities that achieve more benefit than harm at the end are justified. Quaternary prevention is the avoidance of unnecessary medical activity, such as "check-ups". In another example, quaternary prevention is the recommendation of preventive measures of proven efficacy. As regards diagnosis, quaternary prevention is, for example, the avoidance of screening without foundation, such as in prostate cancer. The appropriate use of antibiotics in upper respiratory tract infections serves as an example of quaternary prevention in the field of treatment. Another example is the application of the correct rehabilitation techniques in non-specific low back pain, such as swimming and maintaining an active life as much as possible. Not to forget other important "non-classic" aspects in the elderly, such as to limit the harm that can be caused by physical movement restriction devices. These and other examples in daily practice are considered in this article to encourage the continual assessment of quaternary prevention, the classic primum non nocere "first, do no harm".



We're overdosing on medicine – it's time to embrace life's uncertainty

Small Businesses Face New Obamacare Threat - Forbes

Small Businesses Face New Obamacare Threat - Forbes

Health IT Cyber Thieves have their own "ENIGMA"` machines

Veterans of World War II will remember the efforts to crack the Japanese encryption used for military communication during WWII.

Enigma was invented by the German engineer Arthur Scherbius at the end of World War I.^[1] Early models were used commercially from the early 1920s, and adopted by military and government services of several countries, most notably Nazi Germany before and during World War II.^[2] Several different Enigma models were produced, but the German military models are the most commonly recognised.

The mechanical/electrical components of the device were easily duplicated. The secret sauce was in the encryption method. 

German military messages enciphered on the Enigma machine were first broken by the Polish Cipher Bureau, beginning in December 1932. This success was a result of efforts by three Polish cryptologists, Marian Rejewski, Jerzy Różycki and Henryk Zygalski, working for Polish military intelligence. Rejewski reverse-engineered the device, using theoretical mathematics and material supplied by French military intelligence. Subsequently the three mathematicians designed mechanical devices for breaking Enigma ciphers, including the cryptologic bomb. From 1938 onwards, additional complexity was repeatedly added to the Enigma machines, making decryption more difficult and requiring further equipment and personnel—more than the Poles could readily produce.

On 25 July 1939, in Warsaw, the Poles initiated French and British military intelligence representatives into their Enigma-decryption techniques and equipment, including Zygalski sheets and the cryptologic bomb, and promised each delegation a Polish-reconstructed Enigma. The demonstration represented a vital basis for the later British continuation and effort.^[3] During the war, British cryptologists decrypted a vast number of messages enciphered on Enigma. The intelligence gleaned from this source, codenamed "Ultra" by the British, was a substantial aid to the Allied war effort.^[4]

What does this have to do with health information technology and mobile health in particular?

Ask Google, since they are planning regular weekly updates to the android operating system.

Google's comment regarding the 'stagefright' hack, 

"This vulnerability was identified in a laboratory setting on older Android devices, and as far as we know, no one has been affected. As soon as we were made aware of the vulnerability we took immediate action and sent a fix to our partners to protect users...As part of a regularly scheduled security update, we plan to push further safeguards to Nexus devices starting next week. And, we'll be releasing it in open source when the details are made public by the researcher at BlackHat."  How to see if your Android Device is vulnerable to the Stagefright hack ?

Google's Android Blog  "Nexus devices will continue to receive major updates for at least two years and security patches for the longer of three years from initial availability or 18 months from last sale of the device via the Google Store."

In recent months many breaches have been reported by health insurers. In most instances medical records were not accessed other than an attempt to gather consumer identification and credit information. Identity theft is a major concern.

The moral of the story is that security breaches will be present for a long time. Thieves are inventive.

Catch and Release - Finding Life in Death: Michael Fratkin at TEDxEureka

Dying is not a medical Condition



The Boundaries of Living and Dying, is discussed by Michael Fratkin describing his first experience with death as a six year old, and his anger with  adults keeping a secret about dying from a child.

A palliative physician manages his fear that he would fail a family.   Story telling and laughing replace the handwringing at death. The family reconnects in a way never possible before.

He reviews the stages of dying, as set to stages by  Elizabeth Kubler-Ross. Anger, Bargaining  Depression, Denial, & Acceptance








"We prepare for birth, but rarely prepare for death."  .
Manage yourself to be present at death.

Dr Michael Fratkin practices in Humbholdt community, Eureka, California.  Listening to a SoundCloud Presentation audio file, Dr Fratkin discusses one of his major goals to help people dying where there is no hospice and few trained cancer specialists (oncologist)

Dr. Fratkin developed a Crowdfunding Campaign to support these services, for patients who could not afford these types of services.

Closing Music on Dying (Alex Fox) Soundcloud audio file

Clinton Meets With Home Care Workers - California Healthline

As we struggle towards nominating conventions Hillary Clinton addresses home health care.

Democratic presidential hopeful and former Secretary of State Hillary Clinton speaks during a Service Employees International Union event with home care providers in Los Angeles on Thursday. Getty Images

This subject will become more important as  health care transitions to lower cost and patient-centered care....in the home with remote monitoring, wearables, telehealth and home care organizations.

Home care has a spectrum of tiers

1. Professional certified care givers, RNs LVNs Hospice, Domestic aides, and family or friends.
2. Private agencies
3. Public agencies, which may contract with any of the above for patients with Medicaid.

Caregivers in general are paid very poorly. If we rate the importance of health care at home according to reimbursement, then it is abysmally unimportant both economically and in terms of quality of care.

A succession of home health caregivers and some recipients of that care told their stories to Clinton and they spoke generally about the changes needed in home care.  

Sumer Spika, a caregiver from Minnesota, said when she first started, she entered a profession with low pay, no benefits, no retirement, no overtime and no paid time off.

Home care workers are advocating for a $15 minimum wage, which would approach a living wage, they say. Lizabeth Bonilla said she has been a caregiver for 42 years, the last 23 of them in Nevada, where she made $10 an hour when she first came to Nevada 23 years ago -- and, she said, she still makes the same $10 an hour. This amounts to a huge decrease in real income, when the consumer price index has risen more than 250 % in those intervening years. What that means is that to buy $ 100.00 of merchandise in 1980 would cost $289.00 today in 2015.

Clinton commented, ""The work you're doing actually saves Medicaid money," she said. "People do better when they get care at home. That's good medicine." "If you think about the fact that we're going to have more and more elderly in this country, we are going to face a care crisis," Clinton said. "If we don't think through that, I don't know how we're going to be able care for people. Our highest obligation we have is to take care of each other. At the end of the day, I don't think anything matters more."

This economic chasm will be even more difficult to close with the emphasis on cost containment by the Affordable Care Act.

Clinton Meets With Home Care Workers - California Healthline