‘App Store for DNA’ Fizzles as Health Startup Shifts Strategy -

There's an app for that.......... maybe!

Genetic-testing startups are finding that selling consumers insights on their risk of getting cancer may not be as easy as telling them about their Irish roots.





 

23andMe Inc. and Ancestry.com LLC have capitalized on the public’s insatiable appetite for discovering their family trees. However, consumers have balked at paying other companies for health analysis of their DNA. 

Some testing firms are finding it works better when health-care providers are more directly involved. That way patients are better able to understand test results and integrate them into their care.

Helix, which launched in 2015 with $100 million from genome-sequencing giant Illumina Inc., had planned to sell tests directly through an “app store’’ for DNA. Instead, it’s now looking to partner with health-care providers. Illumina said on April 25 that it would no longer hold equity or participate on Helix’s board, ending the partnership.

Are health care providers ready or prepared to offer this service? 

Color Genomics has also changed course. It began by offering doctor-prescribed tests to consumers, but in January it said it would shift focus to partnerships that incorporate genetic testing into primary care for large numbers of patients. And recently 23andMe has drawn criticism for cancer tests that critics say can mislead consumers without a professional’s input.

A major barrier to this is the lack of coverage for an over the counter test. The price point of the test also may be a barrier to the patient and/or health plan.  The value and efficacy of a broad panel of genomics could lead to prevention, if possible, or optimizing other screening tests (imaging or invasive biopsy) i.e., BRCA for breast carcinoma.

When Helix rolled out its “app store’’ in 2017, the idea was that customers would pay Helix to sequence their DNA. They would then purchase DNA apps from other companies selling products on the Helix platform, depending on whether they were curious about ancestry or health, or perhaps in the market for custom socks printed with their own genetic code.  (A far-out marketing idea for clothing manufacturers. 

Changing Course

But now Helix is shifting gears. It deemed a partnership last year with the Healthy Nevada Project to sequence DNA of state residents so successful that it announced a similar deal with AdventHealth in Florida last month. In both arrangements, Helix sequences DNA and screens for specific genetic conditions then passes that information along to its health-care partners, which follow up with patients. For Helix, the arrangements give it access to large pools of customers in one fell swoop.

Color Genomics has also moved toward selling its services to companies that offer health care to large numbers of people. In January, it inked a deal with NorthShore University HealthSystem in the Chicago area to offer its kits to more than 10,000 patients. It also sells its services to several employers, which offer DNA testing as a benefit alongside insurance.

Color, which requires a doctor’s prescription and has always offered genetic counseling alongside test results, said the shift has been mostly about reaching larger numbers of patients in order to make precision medicine widely available. At the same time, it stopped its focus on recruiting individual patients to order tests through its website.

Recently, 23andMe has demonstrated the peril of offering nuanced and complicated health information directly to consumers. Critics argue that its tests for breast cancer could mislead people about their health. Because 23andMe tests only for a few of the many harmful genetic mutations to the BRCA genes associated with breast-cancer risk, one recent study by a competitor found nearly 90 percent of participants who carried a BRCA mutation would have been missed by 23andMe’s test.

Stephen Montgomery, a geneticist at Stanford University who criticized Helix when it launched, said the pilot seemed like a good idea. For most people, he said, the health information delivered by consumer genomics companies just doesn’t seem that useful. The biggest DNA testing company, Ancestry, doesn’t offer health testing at all.

“It’s not precise enough to be able to be actionable for most people,’’ said Montgomery. “The best way to deliver that information to people is a partnership with clinicians who know how to use it.’’







‘App Store for DNA’ Fizzles as Health Startup Shifts Strategy - Bloomberg:

State Bans Pesticide Linked To Developmental Problems | California Healthline

California officials announced a ban on chlorpyrifos, a widely used pesticide that has been linked to lower IQs, lower birth weights and other developmental issues in children, even as the federal government fights to protect it.







California will ban the use of a widely used pesticide in the face of “mounting evidence” that it causes developmental problems in children, state officials announced Wednesday.

Several studies have linked prenatal exposure of chlorpyrifos to lower birth weights, lower IQs, attention deficit hyperactivity disorder and autism symptoms in children.

The chemical is mostly used on crops — including citrus, almonds, and grapes — but is also applied on golf courses and in other non-agricultural settings.

The ban “is needed to prevent the significant harm this pesticide causes children, farm workers, and vulnerable communities,” Jared Blumenfeld, secretary of the California Environmental Protection Agency (CalEPA), said in a statement. California’s ban comes as federal regulators fight to keep the chemical on the market. Almost two decades ago, the U.S. Environmental Protection Agency, which regulates pesticides at the federal level, prohibited the sale of chlorpyrifos for residential use.

Some states aren’t waiting for the federal government to act, California Healthline reported last month. The New York legislature last week sent a proposed ban to Democratic Gov. Andrew Cuomo for consideration. A bill in the California legislature to ban chlorpyrifos was pending at the time of the CalEPA’s announcement. Oregon and Connecticut lawmakers also are considering bans.

Hawaii was the first state to enact a state ban last year.

“Because the science is pretty clear that this a dangerous chemical, it’s long past time to get it off the market,” said Virginia Ruiz, director of occupational and environmental health at the Washington, D.C.-based nonprofit Farmworker Justice. “There’s momentum now, and people and policymakers are becoming better educated about chlorpyrifos.”

Chlorpyrifos can be inhaled during application and as it drifts into nearby areas or ingested as residue on food. People also can be exposed through drinking water if their wells have been contaminated by it.

Globally, several companies make chlorpyrifos products. In the U.S., the most recognized brand names are Dursban and Lorsban, manufactured by Corteva Agriscience, formerly known as Dow AgroSciences.

Corteva Agriscience did not respond to requests for comment.

California citrus growers are among the groups that oppose the ban. They worry that eliminating chlorpyrifos could result in disease outbreaks among their fruit trees.

Casey Creamer, president of California Citrus Mutual, pointed to the Asian citrus psyllid, a tiny insect that feeds on citrus leaves that can transmit a disease known as Huanglongbing, or citrus greening, as one risk.

The task to defeat HLB may be made easier by Trained dogs actually smelling the bacteria within a few weeks after infection, Tim Gottwald, a U.S. Department of Agriculture plant pathologist, said during a presentation at the Riverside conference. In Florida they’ve been 99% accurate, and in tests in December and February under challenging conditions (such as distractions from homeowners’ dogs) in Southern California backyards, they were right more than 92% of the time, he added.

If the canines are right, HLB may be more widespread than standard tests show. Two years ago, the dogs signaled infections in 72 trees at UC Riverside and in four trees in two commercial groves in Kern County. The trees continue to appear negative on molecular tests, but this method typically lags infection. Some California scientists maintain, and hope, that the dogs are wrong, perhaps because they’re smelling something else in the trees, but only time will tell. Now researchers and farmers are racing to fend off the disease. This month, more than 500 scientists from around the world gathered in Riverside at the sixth International Research Conference on Huanglongbing, meeting in California for the first time. Their findings show that although the disease is spreading rapidly in the Southland and no breakthrough is imminent, a host of new detection methods and strategies could help California avert the kind of disaster that destroyed almost three-quarters of Florida’s citrus production.

Huanglongbing originated in Asia a century or more ago. It is caused by a bacterium, Candidatus Liberibacter asiaticus, transmitted by a tiny insect, the Asian citrus psyllid, which feeds on young citrus leaves. HLB clogs citrus trees' phloem, a vascular tissue that transports sugar from the leaves; this causes the most symptomatic fruit to become small and bitter, and eventually makes trees unproductive or kills them.

Candidatisus a budding yeast-like fungus, carries by the insect, the tiny  Asian citrus psyllid, which feeds on young citrus leaves. 

“The impacts are potentially significant,” he said. If farmers “don’t have the tools to effectively manage the psyllid, people are going to switch out or stop growing citrus.”

The agency added that its decision to ban chlorpyrifos “follows mounting evidence… that the pesticide causes serious health effects in children and other sensitive populations,” even at low levels of exposure.

The California Farm Bureau Federation warned that food may get pricier as a result of the ban, leaving state residents more dependent on produce grown in states with less stringent regulations.

The group most at risk are immigrant farmworkers, who are exposed as an occupational hazard. These workers bring home the pesticide on their clothing and skin which is contaminated.  This places their children and families at risk.

State Bans Pesticide Linked To Developmental Problems | California Healthline: 

9 Ways You Can Fight Addiction including Video Gaming Disorder

Opioid addiction is the new buzzword as rates of addiction have soared.  A less-known addiction is to video gaming. Studies have revealed an identical response to video gaming by teens, children and young adults.

Understanding Pornography Addiction (free e-book)

Withdrawing from any addicting substance will make you crave for more.  You might be clean from your addiction for weeks or months, but you can still have the craving at any point.  These cravings can be relentless, and they find you during a weak point. A desire to return to your addictive habit can be so convincing that you have no choice other than giving in.

This is due to a response in the pleasure center in the brain. A brain hormone, endorphin is released during pleasurable activities, ranging from gambling, pornography, cigarette smoking, marijuana, heroin, crack, methamphetamines, and even video-gaming, or internet use. Health addictions such as running or intense physical activity also produce endorphins.  Some addictions are beneficial in terms of health and wellness. Addictions are not necessarily harmful, some are beneficial.

The good news is that the model for treatment is very similar for any addiction.

Ways to Cut the Craving and Fight Addiction

The following points can help you fight addiction. Just choose the right thing for you and keep your mind at it:

Cognitive Behavioral Therapy

Cognitive behavioral therapy opens up several techniques that help you cope with cravings when they arise. They include distraction, redirection, visualization, and more. When you have a craving, you might choose to redirect your mind onto something else. You can also distract your craving by doing something better or by sticking to your a goal. The visualization technique helps you relax down and let you imagine your life will be without addiction.  Cognitive behavioral therapy helps you spot cognitive distortions in your mind. The kind of distortion also includes drug craving known as catastrophizing. When you experience a drug craving, you might catastrophize the situation by imagining that you’ll never get through this. The techniques are supposed to de-catastrophize your brain and look at things more objectively.

NAD Brain Restoration Therapy

Nicotinamide adenine dinucleotide (NAD) is present all through the cells of our body and helps to maintain metabolic reactions. Without NAD, our cells cannot metabolize carbs, amino acid or fats. It plays an essential role in gene expression and is linked to aging diseases.

NAD in Georgia offers brain restoration therapy by using innovative and effective treatments to promote healing of body and mind. It not only helps you fight addiction about also restores cellular production and protects DNA from damage. It is perfect for people who are majorly addicted or have relapsed several times.

Self-Talk

It could be one of the most underrated aspects in this list, but every other remedy starts with this one. If you are consciously addicted, self-talk can open up a new direction for you. When you come to terms with the fact that you need to get over an addiction, you’re already one step ahead. By talking to yourself and controlling your mind, you can give you brain logical reasons to control addictive activities.

Cravings are often blind and prevent you from looking at the bigger picture of its deadly results. You can write down a list of things you should or shouldn’t do and keep it handy. Keeping notes in front of you can curb your cravings too. The list can also incorporate reasons why you chose to quit and why you need to stick to it. Don’t forget to add the negative consequences that keep your brain away from taking it up again.

Get a Hobby

Hobbies aren’t just activities that you enjoy but also shape the person you are. It is one of the best ways to distract and concentrate on productivity. Cravings often arise when you’re bored, and you want to fill the void with something. A hobby is a perfect way to fill such emptiness.

Surf Your Urge

Instead of forcing yourself to stop the craving, Surf the Urge. Urge Surfing is a mindful technique that lies on the principle of accepting desires for what it is.

When you feel a craving, you must stop and acknowledge how you feel. Sit down with closed eyes and observe what your mind has to say, feel the sensation within your body, and then decide what to do. The process helps you verbally recognize your thoughts and emotions during the experience.

For instance, you can talk to your mind and remember the the destruction that drugs cause. You might have sweaty palms, a faster heartbeat, but you should pause to feel it. Describe your thoughts through the sensations till you don’t feel the craving anymore. The processes of Urge Surfing can help you realize the cravings and wave it off when you question yourself.

Self-Care

People who make up their mind to eat healthily and exercise every day soon start avoiding things that harm them. It is a smart way of improving health and emotional well-being and slowly takes you away from bad habits. You need the determination to maintain it once you start.

Know The Triggers

At the time of recovery, some people, places, or things will draw you into using drugs. When you can consciously figure out such triggers, then you can avoid those triggers to help keep you on the right track.  You can make a list of things that trigger you to take drugs. You must also recognize the inevitable things that will always pull you down. Once you know what they are, you can work towards dealing with them and fighting it out.

Reach Out to People Who Care

If you know that there are people who can help you come out of your condition, you must talk to them. Recovery needs people around to make sure you’re sober. It could be your family, your friends, or just one person you respect. They can make things much better for you and help you persevere.

Ignore Bad Memories

Several therapists work on Memory Reconsolidation that keeps craving away by removing memories that relate to drug use. You will need expert help for these, but it effectively prevents the urge at bay.

These are some of the ways to get out of an addiction. If you’re conscious enough to understand the damage, it does to you, start with self-care and self talk to stay healthy.

9 Ways You Can Fight Addiction

A Mysterious Infection, Spanning the Globe in a Climate of Secrecy - The New York Times

The Creature from the Black Lagoon-- Candida Auris

If you are as old as I am you may remember this walking fungus from an early horror film. Now we have a new fungus threatening many hospitals.  Candida auris is becoming prevalent and is highly resistant to most antifungal drugs.  The increasing use of fungicides for crop management has caused the development of drug-resistant strains.

Last May, an elderly man was admitted to the Brooklyn branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. Doctors swiftly isolated him in the intensive care unit. The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.  “Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”

The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.  Nearly half of patients who contract C. auris die within 90 days, according to the C.D.C. Yet the world’s experts have not nailed down where it came from in the first place.

Recently C. auris reached New York, New Jersey, and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”

How does this occur? Microbes divide quickly and each division allows a possible mutation. Some of these mutations allow the microbe to metabolize an antibiotic to which the strain has been exposed.

Antibiotics are not foolproof and that is why so many new ones are brought to market, to replace those that are no longer effective.  It is not an inexpensive process. Each one must be approved by the Food and Drug Administration, an expensive process, along with clinical trials, a time consuming multi-step process requiring multiple stages of an investigation.

Yet as the problem grows, it is little understood by the public — in part because the very existence of resistant infections is often cloaked in secrecy.

With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs. Even the C.D.C., under its agreement with states, is not allowed to make public the location or name of hospitals involved in outbreaks. State governments have in many cases declined to publicly share information beyond acknowledging that they have had cases.

“It is a creature from the black lagoon,” said Dr. Tom Chiller, who heads the fungal branch at the C.D.C., which is spearheading a global detective effort to find treatments and stop the spread. “It bubbled up and now it is everywhere.”

The blatant lack of transparency should cause an outcry from the public and must be investigated.


A Mysterious Infection, Spanning the Globe in a Climate of Secrecy - The New York Times: The rise of Candida auris embodies a serious and growing public health threat: drug-resistant germs.

Microsoft HealthVault service to end November 20, 2019

IMPORTANT NOTICE ABOUT YOUR MICROSOFT HEALTHVAULT SERVICE

This notice contains important information from the HealthVault team at Microsoft. Please read this notice immediately; it contains time-sensitive information that may require you to take action.

We are reaching out to you because you are a registered user of the HealthVault service. We are providing you this notice to ensure you are aware of an important development:

• The Microsoft HealthVault service will be shut down as of November 20, 2019.
• Data you have in your HealthVault account wil

  Microsoft HealthVault service to end November 20, 2019

  l be deleted effective November 20, 2019. If you wish to keep the data in your account, you need to take action now to transfer that data from your HealthVault account.

Please take appropriate action to move your data or information you may have stored in your HealthVault account. To help customers that wish to transfer their data out of HealthVault, several options are available and described below.

If you are using an Application (mobile, web, etc.) that is dependent on the HealthVault service, such applications may also stop working once the HealthVault service is shut down. Please reach out to the Application provider for information on their plans.

We appreciate your use of the HealthVault Service. If you have questions regarding this communication please do not hesitate to reach out to HealthVault Customer Support.

The HealthVault Team
Microsoft Corporation

Questions:

• What date will the HealthVault service become unavailable?
  The HealthVault service will become unavailable on November 20, 2019.
• Will I be able to access or add new data to my HealthVault account after November 20, 2019? 
  No, when the HealthVault service is shut down on November 20, 2019, your account will be closed. You will no longer be able to access the account or any data in it. If you want to keep the data that you currently have in your HealthVault account, please take action now to either download your data or transfer that data to another record keeping service or your data will be deleted on November 20, 2019.
• Can I delete my account and/or the data in it before November 20, 2019? 
  Yes, you may proactively delete your account before November 20, 2019, if you choose to do so. For help, view the HealthVault Help section, Your HealthVault Account - "How do I close my HealthVault Account?"
• Can I obtain a copy of or download my data before November 20, 2019? 
  Yes. You can download your data by logging into your account and choosing to export your data. Details on how to export data can be found under the HealthVault Help section, Health Information - "How do I export and save health information from HealthVault?". Once you have exported your data you have the option to take it to another record keeping service of your choice (for example, a Personal Health Record (PHR) service).
• Is there an option for me to transfer or export my data to another Personal Health Record (PHR) provider?
  The following companies should be able to provide you with a streamlined option to export your data to one of their PHR services. If you would like to use one of these services, you will need to authorize the HealthVault application to export your data to that service. You can find more information for these options here:
  • How do I export my data to Get Real Health's Lydia? (US and International Customers)
  • How do I export my data to FollowMyHealth®? (US Customers Only)
  
  Please be aware that these companies are not affiliated with Microsoft, so if you export your data to them Microsoft will no longer be responsible for that data or its safekeeping. Because your data instead will be governed by the terms of service and privacy and security policies and practices of these companies, you should familiarize yourself with those terms, policies and practices before exporting your data to these companies.
• What happens to my data if I do not wish to download or transfer it or if I don't take any action before November 20, 2019? 
  If you do not wish to download or transfer your data, you may proactively delete your account and the data contained within before November 20, 2019. If you do not take any action then your data will be automatically deleted when the HealthVault service is shut down on November 20, 2019.
• Will I or my provider be able to access my HealthVault emergency profile after November 20, 2019? 
  No, your HealthVault emergency profile will not be accessible by you or others after November 20, 2019.
• I have set up devices like a blood pressure cuff to send data to my HealthVault account. What happens to these connections? 
  On November 20, 2019, HealthVault will stop accepting any new data from all devices. Until then, you may continue to send data to your HealthVault account using your devices (unless you have closed your account).
• I currently use HealthVault Connection Center to connect my device with my HealthVault account. Will HealthVault Connection Center continue to work past November 20, 2019? 
  HealthVault Connection Center is also being decommissioned and will no longer be able to send data to your HealthVault account once the HealthVault service is stopped on November 20, 2019.
• How do I stop getting notifications about the deprecation of HealthVault? 
  You may delete your HealthVault account now to stop receiving these notices.
  For more information on how to delete your account, see the HealthVault Help section, Your HealthVault Account - "How do I close my HealthVault Account?".
• I use an Application on my phone that sends my data to HealthVault. Will this Application still work after HealthVault is gone? 
  That will depend on what the Application does. There may be some limited functionality that the Application can still perform, or it may stop working completely as it will no longer be able to access the HealthVault services. For technical problems with a specific Application, you should contact the Application Provider.

Why No Single Health Incentive Works | Launching a Nudge Unit | Promise of Patient-Reported Outcomes

Health plans, Medicare has for the past ten or more years attempted to incentivize patients to do what is best for them.  Wellness programs, membership to sports gyms, Cooking classes, education on illnesses, prevention, dietary advice, free coupons for compliance with medications, and a potpourri of rewards.  

Some even use penalties for non-compliance.  Some plans monitor the use of remote monitors, such as CPAP machines and if they find it is not in use will remove the device and/or refuse to reimburse for it.

Patient engagement initiatives come in a variety of forms. While insurers, employers, and providers all use financial incentives and penalties for engagement, improvement in health outcomes has been elusive

Patient Engagement Survey Why No Single Health Incentive Works
Charlene Wong, MD, MSHP Duke University
Namita Seth Mohta, MD NEJM Catalyst

We surveyed members of the NEJM Catalyst Insights Council — who comprise health care
executives, clinical leaders, and clinicians — about patient engagement incentives that do and
don’t work. The survey explores the most effective approaches to engaging patients to realize
health goals, sources of financial awards to realize health goals, sources of a financial penalty when
goals are not realized, the effectiveness of financial rewards from various sources, activities for which
financial rewards are the most effective, the effectiveness of financial rewards and penalties to engage
patients, and whether health care provider organizations should incentivize patients. Completed
surveys from 607 respondents are included in the analysis.

Initiatives to improve patient engagement come in a variety of forms. While insurers, employers, and health care providers are all involved in using financial incentives and penalties for engagement efforts, improvement in health outcomes has been elusive. Achieving that ultimate goal will usually require a combination of financial and social approaches.

Responses to a survey of NEJM Catalyst Insights Council members in January 2019 suggest that financial incentives alone are not enough to move the needle to realize patients’ health goals. The most effective approach to engaging patients to realize health goals is family/friends support (chosen by 35% of respondents), followed by education (30%), clinician support (30%), and financial rewards for healthy behaviors (27%).

There are many competing methods to obtain patient engagement. In the past most patients would ask a friend or family member for a physician referral. Now online methods have gained a strong foothold to find a physician.  Yet, patients still verify with their friends their choice made online. They will schedule a visit, and if disatisfied with their choice they will find another provider.

The patient remains supreme in making most choices when allowed.

NEJM Catalyst Connect: Why No Single Health Incentive Works | Launching a Nudge Unit | Promise of Patient-Reported Outcomes: 

Chronic Disruptions to Circadian Rhythms Promote Tumor Growth, Reduce Efficacy of Cancer Therapy—But How? – PR News

"Our findings strongly indicate that environmental or physiological disturbances of circadian rhythms such as shift work, abnormal sleep timing, or irregular psycho-sociological stresses can affect variability in both cancer growth and response to cancer drugs,” said first author Yool Lee, a research associate in the Sehgal Lab. “Given this, it is reasonable to expect that resetting of the body clock by scheduled light-exposure, meal-times, or exercise, alongside a carefully timed chemotherapy regimen, would improve anti-tumor treatment. Taken together, our study identifies the mechanisms behind tumor growth following circadian disturbances, and highlights the importance of judicious application of cancer chronotherapy.”

While it’s reported that chronic disruptions of circadian rhythms, or internal body clocks, can lead to an increased risk of cancer, the underlying mechanisms by which the disturbances promote tumor growth had been largely unknown.

The findings also suggest that “chronotherapy”—the delivery of treatment timed to the host’s circadian rhythm—can improve disease outcomes of drugs that inhibit tumor growth in mice. Researchers found that one drug used for the treatment of breast cancer, Palbociclib, was more effective when taken in the morning than at night. Delivery of drug at a time of greater efficacy is expected to reduce the dose required, and thereby reduce side effects. However, chronic circadian disruption—which researchers achieved by simulating frequent jet-lag—reduced the efficacy of the therapy in human cultured cells, a finding that was validated in mice.

To identify the cellular and molecular mechanisms driving this change, researchers used the hormone dexamethasone to chronically advance daily rhythms in human cultured cells, mimicking frequent jet-lag. They found the treatment altered expression of multiple genes, and increased expression of a cell-cycle control protein called cyclin D1. Cyclin D1, in turn, activated cyclin D-dependent kinase 4/6 (CDK4/6), proteins that are a part of a cell-cycle regulatory pathway. In this case, CDK4/6 halted the cell from growing larger and caused it to synthesize new DNA, which led to accelerated cell division rates.

"Our findings strongly indicate that environmental or physiological disturbances of circadian rhythms such as shift work, abnormal sleep timing, or irregular psycho-sociological stresses can affect variability in both cancer growth and response to cancer drugs,” said first author Yool Lee, a research associate in the Sehgal Lab. “Given this, it is reasonable to expect that resetting of the body clock by scheduled light-exposure, meal-times, or exercise, alongside a carefully timed chemotherapy regimen, would improve anti-tumor treatment. Taken together, our study identifies the mechanisms behind tumor growth following circadian disturbances, and highlights the importance of judicious application of cancer chronotherapy.”

Chronic Disruptions to Circadian Rhythms Promote Tumor Growth, Reduce Efficacy of Cancer Therapy—But How? – PR News: 

How going digital can transform the patient experience

In today’s environment of rapid disruption, every healthcare company must go through a digital transformation to survive and develop a strategy that will align its evolution to rapidly changing patient expectations. But what lies beyond the buzzwords? Join us for the real talk. The way we work and how we engage our customers has to fundamentally change but how can you make actual progress and drive transformation?

Webinar Registration

In this session we will explore:

Real lessons and learnings from people who are actively walking the path of digital transformation
How to change the way you think so you can change what you do
The role of people, process, and technology in digital transformation
How to think about partners, performance, and key activations
How to deliver connected patient experiences that deliver impact, build trust and promote loyalty
No matter where you are on your transformation journey this session will present valuable information on how you can create an ecosystem of connected patient experiences.

Register now.

This goal applies to all providers, pharma, and the health ecosystem. Connecting the dots is more important than ever.

What if you can deliver the next generation of healthcare?

How Technology Is Helping (and Hurting) Health Care

Technology is everywhere in health care — and for many reasons, that's a good thing. It's fast, it's efficient, and it can reduce errors. And yet, technology is not a cure-all. It can make people complacent, introduce new errors, and get in the way of meaningful face-to-face interactions.

Technology is here to stay and we need to learn how to get the most value from the digital world that health care increasingly relies upon. That was the focus of our conversation on the June 1 WIHI, The Digital Transformation: How Technology Is Helping (and Hurting) Health Care. 

How Technology Is Helping (and Hurting) Health Care

The Digital Health Care Transformation


Insurers' message on 'Medicare for All': We're part of the answer | Healthcare Dive: Healthcare

National Nurse's Day

These are the ones who are on the front lines. Nurses make doctor's days better !  Nurses care more ! Take a nurse to lunch, bring in some snacks (healthy ones) to the nurse station.  Thank a nurse today, bring a flower.  Where would we all be without nurses ?

On behalf of the editorial staff here at Health Train Express

HHS To Deliver Value-Based Transformation in Primary Care | CMS

HHS To Deliver Value-Based Transformation in Primary Care

The CMS Primary Cares Initiative to Empower Patients and Providers to Drive Better Value and Results

Medicare and CMS have been emphasizing their role in revising our health system to advantage primary care, and to increase reimbursement to primary care physicians.  The health care reimbursement system heavily favors specialists whose fees are heavily weighted for procedures. In the past family physicians, some internists, and pediatricians have been at the bottom of the pay scale.

In the past several years this has improved. The statistics just released in early 2019 reflect the improvement .


“For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision,” said HHS Secretary Alex Azar. “Building on the experience of previous models and ideas of past administrations, these models will test out paying for health and outcomes rather than procedures on a much larger scale than ever before. These models can serve as an inflection point for the value-based transformation of our healthcare system, and American patients and providers will be the first ones to benefit.”

Empirical evidence shows that strengthening primary care is associated with higher quality, better outcomes, and lower costs within and across major population subgroups. Despite this evidence, primary care spending accounts for a small portion of the total cost of care and is even lower for patients with complex, chronic conditions. Primary care clinicians serve on the front lines of the healthcare delivery system, furnishing services across a wide range of specialties, from family medicine to behavioral health to gerontology. For many patients, the primary care clinician is the first point of contact with the healthcare delivery system. CMS’s experience with innovative models, programs and demonstrations to date have shown that when incentives for primary care clinicians are aligned to reward the provision of high-value care, the quality and cost-effectiveness of patient care improves.

Base upon maximizing the value of health care, HHS has proposed the following new categories of payment using several new criteria.

Primary Care First and Direct Contracting.

The five payment model options are:

Primary Care First (PCF)
Primary Care First – High Need Populations
Direct Contracting – Global
Direct Contracting – Professional
Direct Contracting – Geographic

Readers should refer to these details for each category


















HHS NEWS: HHS To Deliver Value-Based Transformation in Primary Care | CMS: HHS To Deliver Value-Based Transformation in Primary CareThe CMS Primary Cares Initiative to Empower Patients and Providers to Drive Better Value and Results

Overdose Attempts Skyrocket Among Teens, Young Adults

Suicide attempts by drug overdoses and other "self-poisonings" more than doubled among U.S. youth in the last decade, a new study reveals.

And attempts by girls and young women more than tripled during that time period, according to the analysis of National Poison Data System information.

Most of the self-poisonings "are drug overdoses, but they use a lot of over-the-counter meds [such as] acetaminophen, antihistamines, along with their prescription meds," explained study co-author Henry Spiller. He directs the Central Ohio Poison Center at Nationwide Children's Hospital in Columbus.

The findings showed that there were more than 1.6 million intentional self-poisoning cases among 10- to 24-year-olds nationwide between 2000 and 2018 -- more than 71% (1.1 million) involving females.

Suicide is the second-leading cause of death among Americans in that age group. While more males die by suicide, females attempt suicide more than males. Self-poisoning is the most common method in suicide attempts and third-most common method of suicide in teens, the researchers said.

"In youth overall, from 2010 to 2018, there was a 141% increase in attempts by self-poisoning reported to U.S. poison centers, which is concerning," Spiller said.

In a hospital news release, he added that "the severity of outcomes in adolescents has also increased, especially in 10- to 15-year-olds."

The study was published online May 1 in The Journal of Pediatrics.

Study co-author John Ackerman is the suicide prevention coordinator at the Center for Suicide Prevention and Research at Nationwide Children's Hospital.

"Suicide in children under 12 years of age is still rare, but suicidal thoughts and attempts in this younger age group do occur, as these data show," he said in the news release.

Ackerman called on parents and caregivers not to panic, but to talk to their children and undertake suicide prevention strategies, such as storing medications safely and limiting access to things that could be deadly.

"There are many resources and crisis supports available around the clock to aid in the prevention of suicide, and suicide prevention needs to start early," he said.

Parents should regularly ask children how they are doing and if they ever have thoughts about suicide, Ackerman advised. That's especially important if parents detect warning signs, such as social media posts about feeling hopeless or wanting to die; a young person giving away prized possessions or suddenly becoming calm or cheerful after a long period of depression.

"There is no need to wait until there is a major crisis to talk about a plan to manage emotional distress. Actually, a good time to talk directly about suicide or mental health is when things are going well," Ackerman suggested.

If you or your child need immediate help due to suicidal thoughts, go to your local emergency department immediately or call the Nationwide Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). You can reach the Crisis Text Line by texting "START" to 741-741.

If you suspect an overdose, call the national Poison Help hotline at 1-800-222-1222.






























ReachMD

Why Can't I Get My Prescription Filled

Electronic health records offer a function called CPOE *Computerized Order Entry" which provides an electronic means for ordering medications and tests within the hospital. EHRs also allow prescriptions to be sent to a pharmacy.  However many drugs require prior authorization (PA).

That has been a manual process. The provider is required to send a form detailing what medications have already been tried and failed due to ineffectiveness, side effects or a complication. The authorization is then sent manually from the health plan to the pharmacy manually.  The process is inefficient and is repeated many times a day, occupying time which can be better used caring for patients.

A critical process is still performed manually ten years after the implementation of the EHR. This arduous and repetitive process often causes the prescriber to write a prescription that may be less expensive even though it will be less effective to avoid the bureaucracy of requesting a PA.

Prior Authorizations (PAs) have become increasingly burdensome for providers — they contribute to 92 percent of care delays and an estimated 77 million are submitted manually each year. In fact, the process has become so burdensome that many physicians get fed up with the process end up writing for less-effective prescriptions because they know the preferred drug will require prior authorization.

Regardless of the decision, this is a problem that has yet to be resolved despite the development of new technology and software — such as electronic prior authorizations (ePAs) — that have tried to streamline the process. While these solutions have helped, they are temporary at best, as their lack of widespread adoption still leaves physicians and their staff responsible for the time and financial commitment associated with PAs.


What if there was a way to remove the responsibility from providers’ shoulders entirely? I believe there is, and it’s as simple as making prior authorizations a pharmacy responsibility.

Why should PAs be a pharmacy responsibility?

The answer is simple: they’re the pharmacy’s to lose.

There is no financial incentive for a provider to file a PA. Instead, they do so out of moral obligation to their patients (and because that’s the way it’s always been done, since providers are the only ones with access to the patient information needed to complete the PA). Pharmacies, on the other hand, have all the financial incentive to become principal participants in the process. After all, the faster a prescription is approved by an insurance company, the sooner (and more frequently) those prescriptions can get filled.

The problem is, most pharmacies don’t identify PAs as a financial incentive. The process can be time-consuming and tedious — as providers know well — so most pharmacies haven’t even considered it as an option. Of those who have, few choose to take on such a task, opting instead to let the system run its course and simply take whatever prescriptions come in organically. This leads not only to delays in patient care but also to alarmingly lengthy gaps between getting prescriptions filled. But the fact remains approvals (or denials) of PAs ultimately affect a pharmacy’s ability to bring in prescriptions and revenue, so pharmacies should be more proactive in participating with physicians in the care process.

Why hasn’t this been considered before?

The biggest roadblock to efficiently dealing with PAs is the pharmacy’s lack of access to relevant and necessary patient information. By default, providers have been assigned the responsibility for filing PAs simply because they have access to all the information required to submit them. Pharmacies, on the other hand, only have part of the information needed. Software companies like CoverMyMeds help to fill in some of the gaps, but PAs still ultimately find their way back to providers for missing patient information and submission. And since there’s no financial incentive for providers to complete them, PAs get put on the backburner, piling up until finally time is set aside to complete them.

What the industry ultimately needs is a solution that removes the burden from providers entirely, while still giving pharmacies secure and confidential access to the information they need from the get-go.

Pharmacies can do this by proactively coordinating with providers to obtain the information necessary to correctly and completely fill and submit a PA, perhaps through (read-only) access to the provider’s electronic medical records (EMR) system. Doing so creates a touchless system for providers that decreases downtime in the prescription-filling process and ultimately gets patients the best prescriptions, faster.

The Tufts Center for the Study of Drug Development most recently estimated the cost of bringing a new drug to pharmacy shelves at $2.7 billion. But that cost only increases when PAs enter the picture.

Physicians often hesitate to prescribe new drugs (even if they’re the best option) because of PA requirements, making it more difficult for a new medication to enter the market and for patients to get the prescriptions they need. By shifting the responsibility of PAs from providers to pharmacies, physicians can feel more confident in prescribing the medication they want the first time, making it easier for new medications to make it from shelves to homes, and ultimately driving healthcare costs down.

In the end, prior authorizations can never be a single party’s responsibility — a successful solution depends on the partnership of pharmacies and providers who work together for the benefit of patients. In doing so, pharmacies and providers can build stronger working relationships and, together, provide patients with a better quality of care.






The answer to your prior authorization problem is simpler than you think: Pharmacies and providers can build stronger working relationships and, together, provide patients with better quality of care.

Health insurance deductibles soar, leaving Americans with unaffordable bills - Los Angeles Times

Soaring health insurance deductibles have strained family budgets, saddled many with debt and driven millions to skip care. It's the result of a revolution that has transformed U.S. health insurance, shifting a growing share of costs to workers and their families.

A medical crisis has largely been ignored by the media and Congress for the past year or more during the turmoil of investigations and congressional polarization during non-productive investigations of self-interest groups in Congress

Soaring deductibles and medical bills are pushing millions of American families to the breaking point, fueling an affordability crisis that is pulling in middle-class households with health insurance as well as the poor and uninsured.

In the last 12 years, annual deductibles in job-based health plans have nearly quadrupled and now average more than $1,300.

Yet Americans’ savings are not keeping pace, data show. And more than four in 10 workers enrolled in a high-deductible plan report they don’t have enough savings to cover the deductible.

One in six Americans who get insurance through their jobs say they’ve had to make “difficult sacrifices” to pay for healthcare in the last year, including cutting back on food, moving in with friends or family, or taking extra jobs. And one in five says healthcare costs have eaten up all or most of their savings.  Those are among the key findings of a Times examination of job-based health insurance — the most common form of coverage for working-age Americans — which has undergone a rapid transformation, requiring patients to pay thousands of dollars out of their own pockets.

The conclusions are based in part on a nationwide poll conducted in partnership with the nonprofit Kaiser Family Foundation, or KFF. Two Washington-based think tanks — the Health Care Cost Institute and the Employee Benefit Research Institute — provided supplemental analysis.

How the LA Times/Kaiser Family Foundation poll was conducted »

The Times also interviewed doctors, business leaders, researchers and dozens of Americans with high-deductible coverage and reviewed scores of studies and surveys of health insurance in the U.S.

At a time when healthcare is poised to be a central issue in the 2020 presidential election, these sources provide a comprehensive look at changes that have profoundly reshaped insurance.

The explosion in cost-sharing is endangering patients’ health as millions, including those with serious illnesses, skip care, independent research, and the Times/KFF poll show.

The shift in costs has also driven growing numbers of Americans with health coverage to charities and crowd-funding sites like GoFundMe in order to defray costs.

Health insurance deductibles soar, leaving Americans with unaffordable bills - Los Angeles Times: