LETTER: Health care should be based on need

WHAT we need is a health care system that caters for the needs of all Sunraysia residents.

The facilities needed should be based on what those needs are.

Those needs should be well ­researched so that the appropriate assets to meet them can be put in place.

Jeff Kennett and his party have a philosophy that says free enterprise is the answer to all problems and we are the recipients of an ­experiment of that philosophy.

However, in the US, where there is great faith in free enterprise, the health care system costs that country twice as much as comparable developed countries who have health care systems supported and run by the state. While the US has centres of ­excellence, its general outcomes fall far short.

What we need is a well managed health system that is transparent and ­accountable to the community.

It is time the state took respons­ibility and made sure this community has the health system that we need and works for everybody.

Lindsay Leake,

Mildura

source: http://www.sunraysiadaily.com.au/story/5908686/letter-health-care-should-be-based-on-need/

 

Research: In wake of new federal rule, health care costs increase when there's more competition among insurers

OGDEN — The federally mandated practice of posting hospital prices online falls short of its intended goal, that of helping consumers shop for the best deal. And a recent analysis of how the health care system responds to typical market forces helps to explain why.

Christopher Yencha, an assistant professor of economics at Weber State University and Paula Fitzgerald, a business administration professor at West Virginia University, researched how basic economic tenets function in the health care market versus other markets. And data showed that commonly-held expectations don’t always pan out.

Their article, “A Test of Policy Makers’ Formal and Lay Theories Regarding Health Care Prices,” was published in the American Marketing Association’s Journal of Public Policy and Marketing in 2018.

“It’s super messy,” Yencha said in a recent phone interview. “And we think it has to do primarily with lack of transparency.”

As of Jan. 1, a new federal rule requires hospitals to post all prices online, and some facilities, including McKay Dee Hospital in Ogden, publish a plethora of “Chargemaster” or suggested retail prices.

But Chargemaster prices differ significantly from the more variable, negotiated payments hospitals ultimately receive for services. According to their analysis, the average total payment a hospital receives for a procedure is roughly one-fourth what it billed.

“And that’s the insurance part of the story,” Yencha said.

Fitzgerald, recently reached by phone in West Virginia, elaborated on that point, noting a market situation in play called monopsony — meaning there is only one buyer.

“When you have only one insurer in a local market, that insurer is the kingpin. Everybody’s insurance is going to run through that insurer,” Fitzgerald said. “That gives the insurer power to negotiate prices downward at the hospital.”

Other dynamics also come into play, complicating how price controls typically work. In 2016, Yengcha and Fitzgerald began poring over CMS data, scrutinizing more than seven million consumer-hospital interactions nationwide.

They found that increased competition among hospitals resulted in lower procedure prices, but more competition among insurers correlated with higher hospital prices. And while more insurers worked to decrease consumer premiums, fewer insurers in a local market helped to rein in hospital prices.

They also found that higher prices were no guarantee for higher quality of care. In fact, consumers sometimes paid more for less. While the U.S. leads the world in per capita health care spending, it ranked last of 11 developed nations in 2014 for infant mortality, healthy life expectancy at age 60 and preventable deaths before age 75.

More information needed

Kaiser Health News described the mishmash of online hospital prices as “a dog’s breakfast of medical codes, abbreviations and dollar signs — in little discernible order — that may initially serve to confuse more than illuminate.”

Yencha agreed that the posting of Chargemaster prices could be misleading.

“The policy is to try to make transparency at the price level nobody really pays in practice,” Yencha said. “It sounds like a win … but in reality it’s not the price that insurance companies or consumers internalized.”

For roughly a decade, the Utah PricePoint System has offered online tools for consumers to compare hospital procedure costs. Utah PricePoint is a joint product of the Utah Hospital Association and Utah Department of Health.

But even the Utah PricePoint website warns that several factors can affect a consumer’s final costs, including individual insurance plans, medical conditions and quality-of-care variables.

Scott Horne, who manages Health Policy and Information Systems for the Utah Hospital Association, said he’s overseen Utah PricePoint since its start.

“You can filter on our site based on complexity of the patient, and there’s some level of care in it. At the end of the day though, charges are imperfect,” Horne said. “I think there’s hope that at some point — as complex as it is — we’ll get there, particularly for things that are shoppable.”

The bottom line for consumers, Horne added, is what they’ll pay out of pocket — and that differs from what hospitals pay.

“Charges are based on the information we have, that’s the best we can do,” Horne said.

source: https://www.standard.net/news/health-care/research-in-wake-of-new-federal-rule-health-care-costs/article_77916cf5-d722-5125-ac48-e65ab00a8f0c.html

 

Democratizing artificial intelligence in health care

An artificial intelligence program that’s better than human doctors at recommending treatment for sepsis may soon enter clinical trials in London. The machine learning model is part of a new way of practicing medicine that mines electronic medical-record data for more effective ways of diagnosing and treating difficult medical problems, including sepsis, a blood infection that kills an estimated 6 million people worldwide each year.

The discovery of a promising treatment strategy for sepsis didn’t come about the regular way, through lengthy, carefully-controlled experiments. Instead, it emerged during a free-wheeling hackathon in London in 2015.

In a competition bringing together engineers and health care professionals, one team hit on a better way to treat sepsis patients in the intensive-care unit, using MIT’s open-access MIMIC database. One team member, Matthieu Komorowski, would go on to work with the MIT researchers who oversee MIMIC to develop a reinforcement learning model that predicted higher survival rates for patients given lower doses of IV fluids and higher doses of blood vessel-constricting drugs. The researchers published their findings this fall in Nature Medicine.

The paper is part of a stream of research to come out of the “datathons” pioneered by Leo Celi, a researcher at MIT and staff physician at Beth Israel Deaconess Medical Center. Celi held the first datathon in January 2014 to spark collaboration among Boston-area nurses, doctors, pharmacists and data scientists. Five years later a datathon now happens once a month somewhere in the world.

Following months of preparation, participants gather at a sponsoring hospital or university for the weekend tocomb through MIMIC or a local database in search of better ways to diagnose and treat critical care patients. Many go on to publish their work, and in a new milestone for the program, the authors of the reinforcement learning paper are now preparing their sepsis-treatment model for clinical trials at two hospitals affiliated with Imperial College London.

As a young doctor, Celi was troubled by the wide variation he saw in patient care. The optimal treatment for the average patient often seemed ill-suited for the patients he encountered. By the 2000s, Celi could see how powerful new tools for analyzing electronic medical-record data could personalize care for patients. He left his job as a doctor to study for a dual master’s in public health and biomedical informatics at Harvard University and MIT respectively.

Joining MIT’s Institute for Medical Engineering and Science after graduation, he identified two main barriers to a data revolution in health care: medical professionals and engineers rarely interacted, and most hospitals, worried about liability, wanted to keep their patient data — everything from lab tests to doctors’ notes — out of reach.

Celi thought a hackathon-style challenge could break down those barriers. The doctors would brainstorm questions and answer them with the help of the data scientists and the MIMIC database. In the process, their work would demonstrate to hospital administrators the value of their untapped archives. Eventually, Celi hoped that hospitals in developing countries would be inspired to create their own databases, too. Researchers unable to afford clinical trials could understand their own patient populations and treat them better, democratizing the creation and validation of new knowledge.

“Research doesn’t have to be expensive clinical trials,” he says. “A database of patient health records contains the results of millions of mini experiments involving your patients. Suddenly you have several lab notebooks you can analyze and learn from.”

So far, a number of sponsoring hospitals — in London, Madrid, Tarragona, Paris, Sao Paulo, and Beijing — have embarked on plans to build their own version of MIMIC, which took MIT’s Roger Mark and Beth Israel seven years to develop. Today the process is much quicker thanks to tools the MIMIC team has developed and shared with others to standardize and de-identify their patient data.

Celi and his team stay in touch with their foreign collaborators long after the datathons by hosting researchers at MIT, and reconnecting with them at datathons around the globe. “We’re creating regional networks — in Europe, Asia and South America — so they can help each other,” says Celi. “It’s a way of scaling and sustaining the project.”

Humanitas Research Hospital, Italy’s largest, is hosting the next one — the Milan Critical Care Datathon Feb. 1-3 — and Giovanni Angelotti and Pierandrea Morandini, recent exchange students to MIT, are helping to put it on. “Most of the time clinicians and engineers speak different languages, but these events promote interaction and build trust,” Morandini says. “It’s not like at a conference where someone is talking and you take notes. You have to build a project and carry to it to the end. There are no experiences like this in the field.”

The pace of the events has picked up with tools like Jupyter Notebook, Google Colab, and GitHub letting teams dive into the data instantly and collaborate for months after, shortening the time to publication. Celi and his team now teach a semester-long course at MIT, HST.953 (Collaborative Data Science in Medicine), modeled after the datathons, creating a second pipeline for this kind of research.

Beyond standardizing patient care and making AI in health care accessible to all, Celi and his colleagues see another benefit of the datathons: their built-in peer-review process could prevent more flawed research from being published. They outlined their case in a 2016 piece in Science Translational Medicine.

“We tend to celebrate the story that gets told — not the code or the data,” says study co-author Tom Pollard, an MIT researcher who is part of the MIMIC team. “But it’s the code and data that are essential for evaluating whether the story is true, and the research legitimate.”

source: http://news.mit.edu/2019/democratizing-artificial-intelligence-in-health-care-0118

 

Seventy-first World Health Assembly update, 26 May

The Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, told delegates to the World Health Assembly today that they had charted a new course for the Organization.

Closing the Assembly, he said that everything WHO did going forward would be evaluated in the light of the "triple billion" targets which were approved this week in WHO's new five-year strategic plan. By 2023 the targets aim to achieve:

  • 1 billion more people benefitting from universal health coverage
  • 1 billion more people better protected from health emergencies
  • 1 billion more people enjoying better health and wellbeing.

On the final day of the Assembly, delegates also came to agreement on maternal, infant and young child nutrition and on poliovirus containment.

Nutrition

Delegates unanimously renewed their commitment to invest and scale up nutrition policies and programmes to improve infant and young child feeding.

Member States discussed efforts to achieve the World Health Assembly Global Nutrition Targets, concluding progress has been slow and uneven, but noted a small step forward in the reduction of stunting, with the number of stunted children under 5 years falling from 169 million in 2010 to 151 million in 2017. WHO is leading global action to improve nutrition, including a global initiative to make all hospitals baby friendly, scaling up prevention of anaemia in adolescent girls, and preventing overweight in children through counselling on complementary feeding. A new report was launched on the implementation of the Code of Marketing Breastmilk Substitutes, highlighting that 6 more countries had adopted or strengthened legislation in 2017 to regulate marketing of breastmilk substitutes.

Polio

With wild poliovirus transmission levels lower than ever before, and the world closer than ever to being polio-free, discussions focused on securing a lasting polio-free world. As at May 2018, only 9 cases due to wild poliovirus had been reported globally, from just 2 countries: Afghanistan and Pakistan. Delegates reviewed emergency plans to interrupt the last remaining strains of the virus.

To prepare for a polio-free world, global poliovirus containment activities continue to be intensified, and Member States adopted a landmark resolution on poliovirus containment. In a limited number of facilities, poliovirus will continue to be retained, post-eradication, to serve critical national and international functions such as the production of polio vaccine or research. It is crucial that poliovirus materials are appropriately contained under strict biosafety and biosecurity handling and storage conditions to ensure that the virus is not released into the environment, either accidentally or intentionally, to again cause outbreaks of the disease in susceptible populations.

Member States expressed overwhelming commitment to fully implement and finance all strategies to secure a lasting polio-free world in the very near term. Rotary International, speaking on behalf of the Global Polio Eradication Initiative (which consists of WHO, Rotary, CDC, UNICEF and the Bill & Melinda Gates Foundation) offered an impassioned plea to the global community to eradicate a human disease for only the second time in history, and ensure that no child will ever again be paralysed by any form of poliovirus anywhere.

Closing remarks

In his final speech to this year's Assembly, Dr Tedros said that everywhere he went, he had the same message: health as a bridge to peace. "Health has the power to transform an individual's life, but it also has the power to transform families, communities and nations," he told delegates.

The Organization's new 5-year strategic plan, he said, called on WHO to measure its success not by its outputs, but by outcomes - by the measurable impact it delivers where it matters most - in countries.

"Ultimately, the people we serve are not the people with power; they're the people with no power," the Director-General said. He told delegates the true test of whether the discussions held in the Assembly this week were successful would be whether they resulted in real change on the ground and he urged them to go back to their countries with renewed determination to work every day for the health of their people.

"The commitment I have witnessed this week gives me great hope and confidence that together we can promote health, keep the world safe, and serve the vulnerable," he concluded.

http://www.who.int/news-room/detail/26-05-2018-seventy-first-world-health-assembly-update-26-may

 

World Briefs: Ebola outbreak in Congo may spread, says WHO

EBOLA OUTBREAK IN CONGO MAY SPREAD, SAYS WHO

GENEVA • A deadly Ebola outbreak in the Democratic Republic of Congo has a clear "potential to expand", the World Health Organisation warned yesterday, as it reported seven more cases of the disease.

"We are on the epidemiological knife edge," Dr Peter Salama, in charge of emergency response at the WHO, told a special meeting on the outbreak that has killed 27 people.

The agency issued a new toll, saying there had been 58 cases since the outbreak was declared on May 8 - an increase of seven over figures issued on Tuesday - and said it was actively following more than 600 contacts.

AGENCE FRANCE-PRESSE

METHOD FOUND TO CRIPPLE BREAST CANCER CELLS

PARIS • Scientists have identified the mechanism that allows breast cancer cells to lie dormant in other parts of the body only to re-emerge years later with lethal force, according to a new study.

In experiments with human cells and live mice, researchers showed that disabling the mechanism - with drugs or gene manipulation - crippled the cancer cells and inhibited their capacity to spread.

The discovery, reported in the journal Nature Communications on Tuesday, provides a promising target for the development of breast cancer therapies, the study said.

AGENCE FRANCE-PRESSE

104 PEOPLE JAILED FOR LIFE OVER FAILED TURKISH COUP

ISTANBUL • A court in Turkey has sentenced 104 people to life in prison for involvement in the failed military coup of 2016, handing down the heaviest penalties possible in the country.

The defendants were part of a group trial of 280 people, mostly military personnel, accused of participating in an attempt to overthrow President Recep Tayyip Erdogan.

Scuffles broke out at the sentencing on Monday as some of the defendants tried to attack two witnesses who had turned state's evidence and given details of the plan during the trial, according to Turkish news reports.

https://www.straitstimes.com/world/world-briefs-ebola-outbreak-in-congo-may-spread-says-who

 

At global health forum, UN officials call for strong, people-focused health systems

Everyone, everywhere must have equal access to quality health care, said top United Nations officials on Monday, urging greater focus on comprehensive health and well-being.

In a video message to the opening of the seventy-first session of the World Health Assembly in Geneva, Secretary-General António Guterres reiterated that the enjoyment of the highest attainable standard of health is a fundamental human right.

The World Health Assembly is the highest decision-making body of the World Health Organization, WHO. It determines the agency’s polices, supervises financial policies, and reviews and approves the proposed programme budget.

“We need strong resilient systems that place people at the centre,” said Mr. Guterres.

“Universal health coverage provides the foundation to help us overcome the inequities that continue to leave so many behind.”

Ensuring that everyone, everywhere has access to quality health care and services, is also vital for the achievement of the Sustainable Development Goals (SDGs), stressed the UN chief.

In particular, Sustainable Development Goal 3 (SDG 3), which has specific targets to ensure healthy lives and promote well-being at all stages in life. In addition, health improvements feature prominently in many of the other ambitious Goals.

Tedros Adhanom Ghebreyesus, WHO’s Director-General, also addressed the Assembly, emphasizing the importance of universal health coverage, as illustrated by the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC).

The WHO chief outlined a number of initiatives at the UN health agency to advance universal coverage and urged greater political commitment: “It’s clear that the twin messages of health security and universal health coverage resonate loudly with world leaders,” he said.

Mr. Tedros also highlighted critical upcoming events focussed on global health, including two high-level meetings; on non-communicable diseases and on tuberculosis at the upcoming session of the UN General Assembly which begins in September.

“The people who suffer from these diseases all over the world are relying on us: the people who cannot get the care they need; the people who cannot afford the care they need; the people who aren’t even aware they are infected with a potentially deadly pathogen,” he said.

“We owe it to them to ensure that we do not waste the opportunities.”

DRC Ebola outbreak: Vaccination of health workers commences

Separately on Monday, WHO announced that the vaccination of health workers in areas of the DRC effected by the Ebola virus, has begun.

Together with the Government and partner organizations, WHO is also preparing to start a so-called ring vaccination programme, whereby the contacts of confirmed cases and the contacts of those contacts will be offered immunization, using the experimental drug.

“We need to act fast to stop the spread of Ebola by protecting people at risk of being infected with the Ebola virus, identifying and ending all transmission chains and ensuring that all patients have rapid access to safe, high-quality care,” said Peter Salama, the WHO Deputy Director-General for Emergency Preparedness and Response.

While the rVSV-ZEBOV Ebola vaccine is yet to be licensed, it was highly protective against Ebola in a major trial in 2015 in Guinea, said WHO.

Earlier results have been promising with the agency reporting that among the 5,837 people who received the vaccine, no positive cases were recorded nine days or more after vaccination.

https://news.un.org/en/story/2018/05/1010272

 

The World Health Organization Just Declared War on Trans Fats

The World Health Organization has announced a comprehensive plan to eliminate industrially produced trans-fatty acids from the global food supply by 2023. It’s a good idea—but the five-year plan may be overly ambitious.

The plan, called REPLACE, urges global governments to eliminate the use of industrially produced trans fats, also known as partially hydrogenated oils (PHOs), within the next five years. It’s a logical next step given that many jurisdictions, particularly those in wealthier countries, have already taken similar measures—but the challenge now will be in getting low- and middle-income countries to follow suit, a more difficult task owing to weaker food and safety controls.

Trans fats, which are produced when vegetable oil hardens in a process called hydrogenation, can be found in margarine, ghee, and shortening products like Crisco. Margarine was super popular in the 1970s, as it was touted as a healthier alternative to butter back when saturated fats were, perhaps unfairly, linked to heart disease. Trans fats are also used in some deep frying, and can often be found in baked and processed snack foods.

The consumption of trans fats increases a person’s risk of heart disease by 21 percent and premature death by 28 percent, according to the WHO. Partially hydrogenated oils also lead to increased inflammation and endothelial dysfunction, a condition that precedes atherosclerosis and clogging of arteries. Globally, around 500,000 people die each year due to trans fat-induced cardiovascular disease. The CDC says a reduction of trans fat consumption would prevent between 10,000 to 20,000 heart attacks each year, and 3,000 to 7,000 coronary heart disease deaths annually, in the United States.

Manufacturers say PHOs extend the shelf life of foods, and that they are cheaper than the alternatives, but the WHO contests both of these claims.

“WHO calls on governments to use the REPLACE action package to eliminate industrially-produced trans-fatty acids from the food supply,” said WHO Director-General Tedros Adhanom Ghebreyesus in a statement. “Implementing the six strategic actions in the REPLACE package will help achieve the elimination of trans fat, and represent a major victory in the global fight against cardiovascular disease.”

These six strategic actions are designed to ensure the “prompt, complete, and sustained elimination” of industrially produced trans fats from the global food supply:

REview dietary sources of industrially-produced trans fats and the landscape for required policy change.

Promote the replacement of industrially-produced trans fats with healthier fats and oils.

Legislate or enact regulatory actions to eliminate industrially-produced trans fats.

Assess and monitor trans fats content in the food supply and changes in trans fat consumption in the population.

Create awareness of the negative health impact of trans fats among policy makers, producers, suppliers, and the public.

Enforce compliance of policies and regulations.

Speaking to reporters, Ghebreyesus said today’s announcement marks the first time that WHO has called for the elimination of a significant lifestyle factor responsible for a non-communicable disease.

As noted, some countries have practically eliminated industrially produced trans-fatty acids by enforcing limits on the amount that can be added to packaged foods. Some countries and jurisdictions have even taken the step of imposing bans on PHOs—the main source of industrially produced trans-fatty acids. Denmark was the first country to impose restrictions on trans fat over a decade ago, and in 2015, the US Food and Drug Administration took steps to eliminate PHOs from the American food supply by this year. New York City enacted restrictions 10 years ago, and studies suggest the move is already paying dividends in the form of reduced rates of cardiovascular disease—a claim that remains controversial.

“Banning trans fats in New York City helped reduce the number of heart attacks without changing the taste or cost of food, and eliminating their use around the world can save millions of lives,” Michael R. Bloomberg, a three-term mayor and WHO Global Ambassador for Noncommunicable Diseases, said in a statement today. “A comprehensive approach to tobacco control allowed us to make more progress globally over the last decade than almost anyone thought possible—now, a similar approach to trans fat can help us make that kind of progress against cardiovascular disease, another of the world’s leading causes of preventable death.”

Trans fats seem to be unhealthy because they increase levels of low-density lipoprotein (LDL, or “bad”) cholesterol, which has been linked to cardiovascular disease, stroke, and type 2 diabetes. At the same time, trans fats decreases high-density lipoprotein (HDL, or “good”) cholesterol, which has the beneficial effect of transporting cholesterol from the arteries to the liver for processing. Meanwhile, eating unsaturated fatty acids lowers a person’s risk of heart disease by offsetting the negative effects of PHOs on blood lipids—the fatty substances found in the blood, including cholesterol and triglycerides.

In its guidelines, the WHO recommends that people reduce their total trans fat consumption to less than 1 percent of their total daily energy intake. So for a 2,000 calorie per day diet, that’s no more than 2.2 grams of trans fats a day.

The WHO’s recommendations are exactly that: recommendations. As Walter Willett, a professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, told CNN, the WHO has no enforcement capacity, so national and local governments will have to do the heavy lifting in this regard.

“The food industry is not monolithic. Some parts of the industry eliminated trans fat proactively once the evidence became clear that this was harmful, but other parts of the industry are likely to resist unless they are legally forced to remove trans fat from their products,” Willett told CNN. “In the long run, I’m confident that industrial trans fat will be eliminated.”

Eliminating all industrial-manufactured trans fats from the global food supply by 2023 is an ambitious, perhaps unrealistic goal. It’s also important to point out that naturally occurring trans fats from cud-chewing mammals like cows and sheep will continue to appear in food products, such as milk, butter, and yogurt. But a deadline is good, as it imparts urgency. As the WHO rightly points out, there’s no excuse to keep using trans fats in products. The issue now is one of will.

source: https://gizmodo.com/the-world-health-organization-just-declared-war-on-tran-1826011682

 

 

'Serious Challenge': World Health Officials Rushing to Stop Another Ebola Outbreak After 18 Deaths

The World Health Organization said Friday they are working to prevent an outbreak of the Ebola in the Democratic Republic of the Congo.

In the past five weeks, at least 34 cases of the fatal hemorrhagic fever have been reported, with 18 deaths and 14 suspected cases, the WHO said. Three health workers have also been infected.

“WHO staff were in the team that first identified the outbreak. I myself am on my way to the DRC to assess the needs first-hand,” said WHO director-general Dr. Tedros Adhanom Ghebreyesus in a statement. “I’m in contact with the Minister of Health and have assured him that we’re ready to do all that’s needed to stop the spread of Ebola quickly. We are working with our partners to send more staff, equipment and supplies to the area.”

“It is too early to judge the extent of this outbreak,” added Dr. Peter Salama, WHO deputy director-general for Emergency Preparedness and Response. “However, early signs including the infection of three health workers, the geographical extent of the outbreak, the proximity to transport routes and population centres, and the number of suspected cases indicate that stopping this outbreak will be a serious challenge. This will be tough and it will be costly. We need to be prepared for all scenarios.”

This is the DRC’s ninth outbreak of Ebola.

The WHO is teaming with the government there on their response plan. Right now, that plan includes contact tracing, infection prevention, community engagement and the use of ring vaccinations and antivirals.

During the 2014-15 Ebola outbreak, 11,310 people died and 28,616 were infected across West Africa, the Centers for Disease Control and Prevention reported.

source; http://people.com/health/world-health-officials-ebola-outbreak-after-18-deaths-confirmed/