Thursday, December 17, 2009

The sad state of health insurance in the US

Today a report announced that about 20% of Americans went without health insurance for some or all of last year. By contrast, in almost every other developed nation in the world, 0% went without health insurance in the same time period.
The report suggests, not surprisingly, that lack of insurance was more common amongst the unemployed. I have found myself in this situation recently, having lost a job unexpectedly and being unable to afford the premiums for a private plan once my corporate benefits ended. Most plans cost in excess of $1000 per month for a family of 4, and still have deductibles that run into the thousands. For those without regular income, this is laughable, and insurance of any kind only becomes more thinkable if one's family income is at poverty levels so you can at least get the kids signed up with Husky. Husky appears to be a comprehensive and admirable way to spend our tax dollars. Almost 40%of our children are covered with a Husky plan according to today's report with only 8% left without insurance at all. Personally, I had no idea so many children were taking advantage of government health insurance. I find it reassuring that the program is there.
For parents, life without a job is difficult. Life without health insurance, is terrifying. That's why we need health reform. Bring it on.

Saturday, December 12, 2009

Eye news
Similarities between amyloid beta deposition in the lens of the eye, and the brain-clogging features of Alzheimer's Disease point to an early detection method for the brain disease using a special florescence test to identify a telltale pattern of lens cloudiness that is different from that found in normal cataracts that are an inevitable consequence of growing old. Dr Goldstein from Brigham Young Hospital in Boston uses an internal ophthalmoscope to detect early protein deposits before any cataract has formed, and then follows up with the fluorescence test to determine whether the deposits are indeed the type associated with Alzheimer's. He figures early detection could lead to better chance of treatment but...who would want to know though? That's always been my question. Since there are no known paths to prevention or cure, knowing you have the disease at a very early stage would be worrying to say the least, if not downright disabling.
In a second eye story, a new genetic eye disease has been discovered that affects the macular and causes central vision loss similar to that seen in macular degeneration. It is surprisingly infrequent that a new genetic disease is discovered. In this case, relatives of sufferers may have other eye problems such as poor alignment of the eyes rather than the macular degeneration which has made the link more difficult to pin down. This macular disease appears to occur much earlier than age-related macular degeneration but it appears to be potentially treatable with the same drugs, VEGF-inhibitors, injected directly into the eye.
It is likely that the eyes will come under more intense focus (no pun intended, oh alright maybe it was intended) as the population ages. Still, though, there is no good way to prevent age related eye diseases that we know of. The only advice we have to live by is, wear sunglasses, eat a balanced diet, watch your blood sugar if you are diabetic, and get your eyes checked regularly. Maybe genetic testing will be added to that list. Eventually.

Monday, November 23, 2009

News on personalized medicine Craig Venter underscores the caution needed when interpreting genetic tests. While variance is almost non-existant for the number and constituency of the base pairs detected, differences in the patterns of gene expression that are used for analysis give rise to significant differences in intepretation of data. Venter finds the data encouraging for the future of personalized medicine but cautions about inappropriate conclusions to be drawn from data in these early stages of personal genome analysis. new company, Generation Health attempts to decipher genetic test results to put risk and benefit into perspective for the patient, the doctor, and the pharmacist. This comes hot on the heels of CVS announcement that they will partner with this company to define the most useful tests that may then become available through CVS pharmacies. However, the main target for Generation Health's research is the health insurance industry. The company hopes to create the compelling evidence that will encourage insurers to get behind genetic testing as a way to target medications, for better health outcomes and to reduce costs. A trick to making sense of genomic/genetic/phenotypic information is going to be the application of a robust data analysis system. News on this seems to have been a bit quiet lately so I'm off on a search to see what's going on...

Monday, November 16, 2009

Niacin scores

A couple of newsy bits today...the drug Zetia appears to be no better than niacin at reducing cardiovascular events in patient with high cholesterol and may even be worse at protecting against plaque build up. Although the small study conducted by Abbott (who make the version of niacin used in the study) cannot be considered definitive, it does create more uncertainty about the use of Zetia and the related drug Vytorin. Despite the news, Merck's shares are on the rise, partly because analysts has expected even worse news with the study, and partly because the NEJM has said the study was flawed. If it was me, I would probably opt for the niacin anyway.
Scientists are hoping to improve the body's ability to take up curcumin, the yellow ingredient in curry that has shown potential to fight several diseases including Alzheimer's, cancer and psoriasis, A recent report shows that encapsulation of the curcumin into liposomes protects the chemical from breakdown during digestion and increases their anti-oxidant activity in rats. Several of my Indian friends swear by the healing actions of turmeric, the bright yellow powder used in curries that is is rich in curcumin. Time will tell whether the rat results translate to humans, but I'm upping my curry intake anyway (any excuse...).
As drug makers put up the price of brand name drugs today, some of these more natural options are looking more and more appealing.

Sunday, November 15, 2009

Guy goes to Africa

I learned today that my friend and colleage, Guy St Clair is in Nairobi on a knowledge strategizing mission. I must admit, I was a tad envious when I heard the news. I have been a little out of the knowledge loop since my foray into medical education (I know, one would not think medical education would be out of the knowledge loop, but in my experience, strangely, it was) and am anxious to return with renewed vigor and fresh insight. Guy has begun a blog on his adventure, that you can find here: Guy's Thoughts - Sharing my Journey
I am looking forward to following his take on the African experience and also to how the knowledge effort progresses. He inspires me to do more with what I know of this space as I think about where to go next in my career. Over a week ago, I lost my job and have a little time to reflect on where I really need to be making a difference these days. Not that this reflection can take long, mortgage due and all. Nor should it though. I've been thinking about where I really fit for a really long time. The answer has always been there, but not always obvious to me. Where I fit, is the very place there is usually no spot for; ie, in the space between. I love to bridge gaps, reach across disciplines, discover the assumptions that underpin the stories we well ourselves. I suspect for most of us who try to make our place sorting out the knowledge flows that circulate around problem solving and strategy development, there is no clear place to rest our hats in most organizations. Variously, we are placed under strategy, innovation, organizational design, information sciences, libraries, informatics, or even HR. But no matter which part of the organization we work from, we always end up doing the same thing; try to establish the real problem(s) to be solved, determine the necessary understandings to be made, and then set about connecting all the key players that need to know, understand, and eventually do, what needs to be done. It's a fascinating process and I love every bit of it. While knowledge management may have become unfashionable as a term, the concept is needed more that ever as the volume of data increases and the need to translate to usable knowledge becomes more critical. Maybe we need to come up with a new term, one without the baggage that KM drags around. Whatever its name, wherever I end up fitting in an organization, I look forward to helping this field evolve, adapt and continue to make a difference. Now, I just need to find a place to do it....

Friday, November 13, 2009

Back to to the Future--2012

Image courtesy of NASA.

The movie 2010 opens today in theaters across America. For the impressive trailer click here. For a scathing review from a scientific perspective, click here.

I like the trailer, I like John Cusack, I like disaster movies in general so I'm hopeful I'll enjoy this one. I don't expect a whole lot of scientific accuracy however. And why should I? It's a movie. Sure, I will poke fun at the technical impossibilities and the scientific improbabilities just like anyone else with a science background. I will also drive my children crazy, pointing out every continuity error in a movie because that's the kind of thing I notice. I hope there is a good story with a long build-up to death and destruction; there is nothing worse than a too-soon disaster in a disaster movie. I like to see normal life going on with subtle hints of problems that we would normally explain away. Like the cold tap water being slightly warmer than usual, or the occasional clock stopping due to blips in the magnetic field for example. I like to see some people dismiss these initial signs with a genuine head-in-the-sand mentality, while others see dreadful portents in the slightest (and ideally insignificant in a red herring sort of way) happenings. Still others, recognize there is something unusual going on, and quietly prepare themselves for the unknown. In other words, a disaster movie for me, is not about the accuracy of the science (although, the more accurate, the better), but rather about the portrayal of the human reactions. 2010 in itself is hardly based on science. I just picked up a book that I that I can't wait to dig into: The 2010 Story: The Myths, Fallacies, and Truth behind the Most Intriguing Date in History. I'll report back on what I find in a later blog.

Monday, August 17, 2009

Healthcare hysteria in the USA

I'm in the middle of it and it's ugly. Obama is doing the rounds with his naughty national healthcare talk (well, almost), and folks are going quite batty with fear. First there is the ceremonial euthanasia, remisicent of Logan's Run, except the talk is that they will let us live until we are 75 rather than knock us off at 30. Second is the notion that we will be forced to see second rate doctors, and never, ever, ever, get to see our favorite family physician again (this might be true, but for different reasons; most family docs are having a hard time making it because of outrageous overheads caused by the inefficiencies in the current hopeless system. With national healthcare, we might see more of that family doc..), third is the notion that we have to wait for years to get treatment and when we finally get there, they only give us generics that don't work (partly true; the UK goes for good of the many versus good of the few, a notion worth serious contemplation as there are solid arguments for and against), fourth is simply that well, if you get really sick, then you will just be left to die (Sarah Lyall, in the New York Times last Sunday pointed out that someone had said Stephan Hawking himself would never have survived so long had he been imprisoned in the UK National Health Service. Stephan Hawking responded that, as he actually lives in the UK, the protraction of his life under such challenging circumstances was indeed due, in large part, to the UK National Health Service). A fifth topic of hysteria is the idea that once we have a National Health System (if we ever do), then we will all be forced to use it. Massachusetts didn't do us any favors here with its compulsory healthcare plan punishable by a fine if you don't buy in and get insured. In the UK, the NHS is the default. You can get any care at no cost save for the small amount of 'National Insurance' you pay each month into the big Health Care Kitty. Its taken automatically as part of taxes so no-one misses it and probably half the population don't even know they pay it. For those so inclined, there is always a private option. Most companies offer private insurance and most employees take advantage of it if only as a back up to the NHS when the waiting line is too long.
Of all the aspects of the UK that I miss the most, the NHS is probably the thing I took most for granted and now wish I had. I know people who skip physicals because they can't afford the co-pay, I know people who have lost their houses to pay for the medical expense of a serious illness. Others I know will be in debt for the rest of their lives because after a nasty car accident the insurance ran out after the first year of re-hab. There is good medicine practiced here, and there are pockets of goodness on the system, but overall, give me the NHS anyday, long waits and all.

Tuesday, May 19, 2009

CP Snow and such

What a to do recently in the science mags about the 50th anniversary of CP Snow's lecture on the "Two Cultures" in 1957 at the University of Cambridge in the UK. With the the advantage of hindsight we can critique his brave stance while agreeing or not with his contention that the failure of art and science to communicate was disastrous for society. I like to think his lecture pointed more to a lack of appreciation of the connection between the two, rather than the explicit lack of shared understanding of the complexities of each. In Nature (vol 459, 7th May 09) there are a couple of essays celebrating the anniversary and offering up the equivalent challenges of the current day. Martin Kemp believes specialization in all disciplines to be the primary hinderance to undestanding between the humanities and science (I happen to agree with him-strongly), while Georgina Ferry asserts it is the push and pull between the optimists and the pessimists that stands in the way of some common ground. My view is that true pessimism is relatively rare where either science or literature is concerned, and that science and literature are inescapably joined at the hip on account of the arguable absence of absolute truth in either. At best, all we have are beliefs at a moment in time. If we kid ourselves for one moment that we have the answers, then science has failed. The true division in this day and age, in my opinion, is the one between those that believe they know it, and those who recognize that they don't. The pessimists may be re-christened skeptics in this scenario. In our information-heavy environment it is easy to think scientists have all the answers; there is so much out there to be found. However, what we lack is a clear consensus on what the real questions should be these days. As we become more specialized we can find more solutions to those may parts that make up the whole. But is the whole any better off? How would we ever know? Our specialized systems don't allow us to easily address the question about the health of the whole. We look to the skeptics to force us to reconsider our assumptions and re-shape the terrain of scientific inquiry.

According to Ferry's article, the literary giant (and one of my favorite authors), Ian McKewan says you can't be curious and depressed. It's hard to argue with that, but the exptrapolation of optimism to hope in the essay is troubling to me. I don't see hope having much of a place is science. In the arts, yes. At the bedside, for sure. But in science, isn't hope the one aspect we systematically try to keep out of the picture? Hope is passive, surely. Science requires that we move beyond hope, and beyond current belief, to a future where something is different. Science suggest forward motion, that replaces hope with meaurable outcomes that we can believe in. At least for a while...

At the heart of CP Snow's teachings is the notion of keeping an open mind and being relevant and responsible in scienc. With the Internet, global warming, corporate greed, and the tremendous gulf between the rich and the poor, I wonder what he would think of our world today?