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© 2011, 2012 Health Futures Digest
The current good health of the US healthcare industry contains the seeds of its own destruction, say some analysts – and it will
drag the rest of the US economy down with it, unless other sectors mobilize to wrest control from the powerful healthcare lobby.
Growing corporate support for government-mandated universal care may be a start. One pundit thinks the forces have conspired to tip the US down the slope toward some form of
universal care, and that providers may be caught by surprise by the high degree of accountability, transparency, and automation this will impose on them.
Another thinks that
hospitals are not well prepared for technology-driven changes already unfolding.
We wonder whether the case of a
US doctor illegally admnistering stem cell therapies to patients is the tip of an iceberg, or at least the start of an inevitable trend. The doctor himself points out that it is happening in other countries. This is not to endorse the practice; it is merely to highlight the possibility of a trend.
The Bush administration has chosen to read into a published study that which the study’s author explicity warned against – that
amniotic cells are a substitute for embryonic stem cells (ESCs). On the other hand, it does seem finally to have warmed to genetic anti-discrimination legislation – long stalled by Republicans – and there is renewed hope for passage of a bill.
Meanwhile the British, who have handled the ESC issue rather more rationally than the US, are nevertheless balking at a proposal to “pharm” ESCs from eggs produced by
Not all pharming is quite so controversial: Chickens and their eggs have now joined the growing ranks of transgenic animals likely to be “pharmed” – used to
mass-produce human therapeutic proteins– in the future.
A decade after the virtual elimination of stomach ulcers was enough to induce them in gastroenterologists, the specialty faces another crisis in the rapid evolution of
colonoscopy innovations that don’t involve it. Its national association is foresighted enough to recognize and address the issue, and we predict that other specialties will soon be in the same boat, as disruptive innovations mount.
Other practice.policy-related news:
The adoption of
RFID technology in hospitals is behind even EMRs, but it is getting there. The Mayo Clinic is the latest to report encouraging results from a pilot project.
The spread of infectious diseases through surface contamination could be significantly reduced by the discovery that
surfaces coated with polymer spikes annihilate bacteria and viruses.
Healthcare Train Wrecking the Economy
The notion espoused by some prominent economists (among others) that increased healthcare spending will continue to drive a strong US economy is wrong, write Brian Klepper of the nonpartisan Center for Practical Health Reform, and Stanford University professor Alain Enthoven. It is, rather, as one healthcare insider put it, “a train wreck everyone knows is just around the corner.” It would be possible only if funding remains stable – but it will not. Except for basic care, healthcare will remain a “voluntary buy,” yet “there’s every indication that group purchasers are quietly abandoning the market.” They cite the following statistics:
- Between 1999 and 2004, premiums grew 5.5 times general inflation, 4.0 times workers earnings and 2.3 times the growth of business income.
- Between 2001 and 2006, the percentage of employers offering coverage fell 10.3 percent – from 68 percent to 61 percent – over five years, a 2.1 percent annual erosion rate.
- Between 2001 and 2006, the percentage of employees with coverage dropped from 65 percent to 59 percent (private sector workers, service workers, and retail employees were particularly affected.)
- Between 1996 and 2004, 132,000 small employers (with 50 or fewer employees) in Florida stopped offering health coverage (a 53 percent drop), while enrollees in small group plans fell by 760,000 individuals (42 percent, or 5.25 percent annually.) The state’s population grew by three million during this period.
- In 2005, coverage costs for a family of four averaged $12,214, but one-third of families made less than $35,000.
“How,” they ask, “can mainstream Americans stay in a game that’s stacked like this,” and equally important, how can the system itself survive with fewer coverage dollars and fewer Americans able to afford healthcare services and products? While nonprofit hospitals might survive by cutting staff, equipment, or programs, publicly traded companies like Pfizer, United Healthcare, Medtronic or HCA will face negative impacts on margin, stock price, market capitalization, and credit.
But wait, there’s worse. Healthcare, they remind us, is 1/7th of the economy and 1/11th of its job market. Disruption in this sector “could cascade to and destabilize others sectors, threatening the national economic security.” Yet despite “the handwriting on the wall,” the powerful healthcare lobby “remains profitable and resistant to collaboration on the structural compromises that are essential to re-establish stability and sustainability.”
“The only option for meaningful change,” they conclude, “lies in leadership from non-healthcare business, which stands to suffer from the tidal wave of healthcare’s turmoil.”
Universal Care Past the Tipping Point
“The land,” writes health futurist Joe Flower, “abounds in a sense of impending catastrophe about health care, a ‘perfect storm’ on the way, a meltdown, a ‘tipping point’ beyond which the imagination cannot extend.” Is this pessimism justified?
Yes, he answers. With the real economy – that in which all but the wealthiest American must live – tottering and public confidence waning, the drive for consumerist healthcare doesn’t make sense. Health savings accounts may be growing in number, but the accounts themselves are “anemic, averaging only $1,200 to $1,400 each.” Universal coverage is going hardly anywhere and slowly at that, and powerful technological and economic currents (such as cream-skimming by ambulatory clinics, pharmaceutical interventions replacing hopsital-based interventions, the growing near-monopoly power – and knowledge – of health plans, and medical tourism) are undercutting the ability of hospitals to finance their operations and to bargain with payers.
While “it is difficult to see the exact nature of the coming singularity, and nearly impossible to see beyond it,” he nevertheless predicts a complex kind of universal coverage delivered through existing health plans, like the new Medicare drug coverage, but with “counter-balancing ‘break the system’ price pressures [that will force] detailed accountability, transparency and fully networked automation on providers at far greater speed and thoroughness than most of us can imagine.”
Source: Molly Joel Coye, M.D., MPH: “Jogging Into the Sunset.” H&HN Most Wired online, November 10, 2006.
“Health leaders,” writes Molly Joel Coye in H&HN Most Wired , are not well prepared for “the clinical innovations that are now being shaped in dozens of university and private research laboratories, and for the sensor- and communications-based technologies that will increasingly shift care from hospital settings to ambulatory centers and the home.” Among the new technologies she cites are “virtual villages” populated by “health care professionals, support groups, care coordinators, friends and distant family, Web-enabled care plans, personal health records (PHR), electronic diaries and transitional care models.”* By “shap[ing] consumers’ understanding of their own health and their expectations for health information and clinical services,” these networks will foster behavioral change.
She also cites “bionic” extensions of current physical capabilities such as advanced joint replacements, artificial lumbar disks, heart valves, axial VAD pumps, and cochlear implants, for which demand “is growing rapidly and may well be insatiable” in part as a result of direct-to-consumer marketing and more subtle product placement in TV shows and movies. And there are more “spectacular advances” to come in this sphere. But hospitals will not be ready to handle bionic patients with potentially multiple implants that could go wrong, unless they equip their emergency departments as “’pit stops’ . . . where patients with multiple external and implanted devices will have to be rapidly assessed, repaired and sent back out.” Technology will come to the rescue of seniors as their disability and dependence increases with age. Home and body sensors will detect problems, and domestic robots will do the household chores and serve as a go-between between patient and caregiver.
Whether our aging boomers will be able to afford these technologies is one of the questions Coye will address in a future article in H&HN Most Wired.
[* Dr. Coye says “think ‘FaceBook for Seniors,” but we prefer to think of “Second Life” for seniors – see my article on that topic in H&HN Online – David Ellis.]
Doctor Implants Stem Cells Without Approval
Last November a Las Vegas doctor was warned by the US Food and Drug Administration to stop implanting stem cells harvested from placentas into patients with multiple sclerosis, muscular dystrophy, and other diseases. The FDA said the doctor failed to properly obtain, store, test and process the placentas, failed to screen both the suitability of the donors and the patients, failed to obtain or even seek federal approval to carry out the procedures, and refused to allow an FDA investigator to see and copy records on his implant patients.
The doctor claims on his website (which was still up as of February 16, 2007) to have carried out 42 stem cell implants on patients with MS, Alzheimer’s, muscular dystrophy, cerebral palsy, and other disorders, as well as to combat the effects of aging.
To deflect anticipated public criticism of President Bush’s expected veto of an embryonic stem-cell bill working it way through a newly Democratic congress, his administration is trying to promote methods of developing stem cells that don’t harm embryos and has been working on a possible executive order related to stem-cell research, reports Sarah Lueck in the Wall Street Journal .
As of the date of Lueck’s article, the White House’s Domestic Policy Council was to have released a report highlighting progress in nonembryonic stem-cell research, including a recent finding that cells in the amniotic fluid of pregnant women have embryonic stem cell characteristics. The Coalition for the Advancement of Medical Research called it “a political fig leaf,” noting that while noteworthy, the amniotic study did not represent a major breakthrough and was not enough to justify continued failure to fund embryonic stem cell research.
The author of the study himself issued a public letter stating that his work on amniotic stem cells was complementary to, but not a substitute for, embryonic stem-cell research. That did not stop the anti-abortion Family Research Council from claiming otherwise – that amniotic stem cells present an alternative that “increases the promise of treatment without destroying human life.”
Bush Backs Genetic Anti-Discrimination Bill
In January 2007 President Bush urged Congress to pass long-stalled legislation to safeguard genetic privacy. “We want medical research to go forward without an individual fearing personal discrimination,” he said. A so-called genetic discrimination bill that passed the Senate unanimously in 2003 but died in the House was reintroduced to a more sympathetic (Democrat-controlled) House in January.
Hybrid Embryos for Stem Cell Research
The British government proposes to prohibit scientists from creating chimeras – human-animal hybrids made by implanting human genetic material into a host animal egg, which is then allowed to grow to a very early embryo stage in the lab and serve as a source of stem cells for research into cures for human diseases. Human eggs are in short supply, the process for obtaining them is cumbersome, and chimera eggs are claimed [without explanation in the BBC News source article] to yield “better results.”
Kings College London researchers have applied to the Human Fertilisation and Embryology Authority for a licence to use chimeras for stem cell work on Motor Neuron Disease and Parkinson’s, and Newcastle University researchers have applied to research how different tissues grow in the body.
They accuse the HFEA of stalling their applications until the law is decided. A spokesman for the Department of Health stressed that the proposed law would contain a clause allowing for the possibility that this type of work should be permitted in the future.
Scientists at the Roslin Institute in Scotland, where Dolly the Sheep was cloned, have genetically modified chickens to lay eggs containing proteins needed to make cancer-fighting drugs (specifically, miR24, a type of antibody with potential for treating malignant melanoma, and human interferon b-1a, which can be used to stop viruses replicating in cells.) So far five generations of birds, numbering about 500 in total, have been created.
Producing therapeutic proteins in this way is expected to be much less expensive than traditional methods, though trials of drugs containing egg-produced proteins are probably at least five years away. Therapeutic proteins such as insulin have long been produced in bacteria; and more complex proteins have been made in the milk of genetically modified sheep, goats, cows, and rabbits. Chickens’ short but virile lifespan enables relatively rapid ramp-up to mass production levels for a given protein.
End of Colonoscopy — and GI? — In Sight
Gastroenterologists have become so dependent on using colonoscopy to screen for cancer that many do little else, writes Gina Kolata in the New York Times , but new methods of detecting colon cancer – such as virtual colonoscopies conducted by radiologists using CT, “pill-cams,” or new stool tests — could put them out of a job. The American Gastroenterological Association is pondering what to do, as it did a decade or so ago when, “for reasons that are not entirely clear, Helicobacter pylori, the bacterium that causes most ulcers, began to disappear,” eliminating work for those gastroenterologists who relied on chronic ulcers for a living. Careers were saved as the baby boomers started showing up for well reimbursed cancer-screening colonoscopies. Other gastroenterological conditions, such as hepatitis and irritable bowel syndrome, don’t pay nearly so well.
“Things change very quickly,” a member of the AGA committee studying the issue told Kolata. “Dependence of a specialty on a single procedure is always a concern.”
Options for gastroenterologists, the committee suggests, include getting into obesity treatment, focusing more on liver disease, treating colon cancer instead of just finding it, and even learning to read virtual colonscopy CT scans. Cardiologists invented a new subspecialty – interventional cardiology – to do angiography rather than just hand the business over to radiologists, and now the interventional cardiologists are expanding into vascular surgeons’ territory as well.
Some disagree that virtual colonoscopies will necessarily replace most traditional colonoscopies, and by whatever method a polyp is found, a colonoscopy is needed to remove it. One optimist said: “We have a lot of organs . . . The esophagus, the stomach, the small bowel, the liver, the pancreas. I think we’ve got a lot to do [and] will still be able to make a comfortable living.”
The Mayo Clinic will expand a five-month pilot project that tested the use of radio-frequency identification (RFID) tags and scanners to track patients’ endoscopy tissue samples collected in five operating rooms to its entire suite of 41 operating rooms, where 20,000 endoscopy and colon procedures were performed last year.
The results in terms of reduced paperwork and fewer data-coding errors “were compelling enough … that we saw an interest to expand it and to continue to quantify those results,” a vendor representative told Dee DePass of the Star Tribune .
Mayo nurses bottle patients’ tissue samples and label them with a microchipped RFID tag that contains an ID number for the patient and the number of tissue samples slated for the lab. The tag number and patient data are keyed into a computer in the operating room. Each plastic sample container is swiped across an RFID tracking scanner before it is sent to the lab. At the lab, the samples are swiped across an RFID scanner there, which confirms that the samples are where they are supposed to be.
MIT researchers have found that a spiky coating of polymer chains applied to surfaces killed E. coli, S. aureus, and the influenza virus with 100 percent effectiveness They think the spikes rupture bacteria and virus particles on contact. The team suggest their findings could help to fight the spread of diseases.
Since many diseases are spread through surface contamination, the coating could have a significant impact if widely adopted. However, it is not yet known how long the coating retains its effect.
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