Insurers Add 4th Tier to Prescription Pricing–Higher Costs for Patients–Attack of the Killer Algorithms Part 31 As That is What Calculates the Cost

Well we all know that once you leave tier one and two the costs go up tremendously so when does tier five appear one might ask?   The one man quoted in the article states that his HIV drugs went from $80 a month to $450 a month.  One state, New York has banned tier four plans.

There has to be some give and take between pharmaceutical companies and insurers and in this instance the insurers are not completely the bad guys as they usually are with risk analysis comparisons.  In some areas there are no tier one and two drugs available and so tier three and four are the only ones available.  Research and development is expensive for drug development as well, so where does all of this hit the road for consumers?  We already know that in the US we pay more for our drugs than any other country and basically somewhat subsidize the lower costs that others get.  It’s all about the math and profits here and granted a certain amount of profit is needed to keep companies alive but let’s face it the big huge profits of the pharmaceutical business can stay forever.  BD

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Thousands of patients in California and across the nation who take expensive prescription drugs every month for cancer, rheumatoid arthritis and other ailments are facing sticker shock at the pharmacy.

Until recently, most of these patients typically paid modest co-pays for the advanced drugs. But increasingly, Anthem Blue Cross, Aetna and other insurers are shifting more prescriptions to a new category requiring patients to shoulder a larger share of the drug's cost.
To help lower their costs, health plans are changing their approach to drug coverage, often expanding from a three-tier to a four-tier plan. The first tier would be generic drugs at a $10 co-payment, for instance, the second tier preferred brand-name drugs at a $30 co-pay, the next tier non-preferred brand-name drugs for $50, and the top tier would be dozens of specialty drugs costing patients 10% to 30% co-insurance or $150 co-pays.

http://www.latimes.com/business/la-fi-expensive-drugs-20120529,0,2965274.story

Medical Quack Will Be Back Blogging Soon

I have just moved after 28 years in one house and what a move it was to include a nice spider bite from a brown recluse.  I am lucky there that it is healing and didn’t leave a hole in my arm.
Thanks again for all who visited the Quack during my absence here and you can again look forward to some new blog posts soon as I am finally getting myself back in order to resume very soon! 
28 years of stuff collected and the Salvation Army and Veteran’s Charity did very well at my old address. 



Stay tuned! 

Barbara Duck

Do Sugar and/or Saturated Fat Make You Stupid?

Two more heavily publicized papers came out in the past week or so, just in time to be fodder for questions at my talk on Evolutionary Psychiatry and Alzheimer's Dementia in the upcoming week.

Have you ever heard the Adagio from Spartacus? Hang in there for a little bit. Around 1:09 you get the early rendition of one of the more romantic themes in classical music, repeated with greater power later in the ballet (2:47 and 7:04). The Russian composers really knew how to sock it to you with a good theme.

Can we say the same of rat researchers from UCLA?  Well, excepting our own good friend and AHS president Aaron Blaisdell, the jury is still out… These researchers pulled out some interesting things, though, in their little study on 24 rats.

"'Metabolic syndrome' in the brain: deficiency in omega-3 fatty acid exacerbates dysfunctions in insulin receptor signaling and cognition."

This paper combines everything awesome and evil all at once.  Rat study.  Fructose!  DHA.  Mazes.  The authors even begin the paper not with an abstract but with highlighted Key Points:  We provide novel evidence for the effects of metabolic dysfunctions on brain function using the rat model of metabolic syndrome induced by high fructose intake.  Etc.

So… we have some rats.  There are two diets and two drinks.  Group 1 gets regular rat chow with omega 3 and water to drink.  Group 2 gets regular rat chow with omega 3 and a 15% fructose drink instead of water.  Group 3 gets water and omega 3 deficient diets (and I doubt it is so easy to make a human in the wild quite so omega3 deficient as these rats), and group 4 gets the double whammy of an omega 3 deficient diet and the 15% fructose solution.  The diets go for 6 weeks, and in that time, we have a pretty remarkable change in the fructose-slurping rates.

The fructosed rats drink a lot more than the plain water-drinking rats, and even though they eat less food than the plain water rats, they take in more calories.  By the end of the 6 weeks, the fructosed rats have high glucose and insulin levels, and the triglyceride levels of poor group 4 (given fructose and omega 3 deficient diet) are over twice the levels of group 1 (omega 3 food + water).  The researchers found that the omega 3 in the diet seemed to protect the group 2 rats a little from the fructose, with less weight gain and less rat metabolic syndrome.

These rats had also been trained to go through a maze, and the fructose-poisoned omega 3 depleted rats did worse than any of the other groups in remembering how to get through the maze.  They lost the maze race, big time.  Again, the rats who had fructose and omega 3 had relatively preserved maze-solving abilities.

The researchers measured very specific elements in the rats' bodies and brains after the experiment.  Measures of energy metabolism were decreased in poor group 4, whereas omega 3 seemed to increase energy metabolism.  Other chemicals known to be important in the ability of the nerves to adapt and change according to different stimuli (called synaptic plasticity) were very decreased in the omega 3 deficient rats, and very much decreased in the fructose-poisoned omega 3 deficient rats.  Group 2 rats (+ omega 3, + fructose) had, again, some protection from the bad effects of the fructose.

And, not surprisingly, the omega 3 deficient rats had a decreased amount of DHA in the brain and an increased amount of omega 6 fats and their metabolites, like arachidonic acid.

Fructose in excess is well known to cause metabolic syndrome (hypertension, hypertriglyceridemia, and hyperinsulinemia are typical symptoms).  Did you know that metabolic syndrome affects the brain as well?  Of course you do. There are plenty of rat studies showing that downing vast quantities of coca-cola fructose is a pretty lousy idea, if one cares about one's liver or brain.  (I recommend this segment of the HBO Weight of the Nation series about the liver, and a good bit halfway through the next segment about sugar-sweetened drinks.)

So, we've now proven that fructose is bad (in the context of an excess calorie diet), and omega 3 is protective, and the main point is to not deprive your rats of omega 3.

Sugar can indeed make you dumb (in the context of an excess calorie diet).  Eating lab rat chow completely devoid of omega 3 can make you even dumber.  I don't recommend it.  But you can see how a modern processed food diet can mimic these changes.  Soda or juice or red bull or sweetened beverage of your choice and a lack of omega 3 does not a happy liver or brain make, and the changes occur quickly.

And now the second diet and dementia study of the week (involving actual humans! However, it is another observational study from the hospital where I'm academically attached).  Participants in the Women's Health Study (about 39,000 female health care professionals) filled out a food frequency questionnaire at baseline, and beginning five years later, an older sub cohort (about 6000 women over 65) underwent serial cognitive testing via telephone over the course of an additional four years. Data was gathered and statisticians went to work.

The women underwent cognitive testing three times, with the time between the 1st and 3rd test being an average of 4 years.  Women tended to do better the second time than the first time (having learned what the tests were going to be), but at the end of the four years, the scores dropped for most women from the second to the third test.  It declined the most for women who ate the most saturated fat, and actually test scores continued to improve for women who consumed the most monounsaturated fat.

There were no associations between total fat, trans fat, and polyunsaturated fat (which is mostly omega 6) and cognitive change.

By the time you pull out covarites you have a mell of a hess.  Saturated fat intake was associated with lower rates of high cholesterol, by the way (statinization??  This part of the study occurred from 1998-2002.  Statins came out in the late 80s and lipitor, the biggest-selling one I believe, was released in 1998. Though it is hard to tell if women on statins would have automatically been put into the "hypercholesterolemia" group or if just total cholesterol was used to make this group.  There are many frustrating things about the way the data is presented in this study).  MUFA (olive oil) consumption was also correlated with lower total cholesterol.  Women with known cardiovascular disease (history of a myocardial infarction, stroke, coronary artery bypass or stenting) were taken out of the data and the trend remained similar.  More total fat intake was associated with lower exercise, smoking, and higher BMI.  Previous epidemiology studies all linked saturated fat intake to poorer cognitive function over time.  The main difference in this study is that these health care professionals had much lower total trans fat intakes than the average American.  Trans fats have been previously associated with poorer cognitive function in other epidemiological studies, and trans fat consumption tracks with saturated fat consumption.

The paper is a little too brief and too heavy on statistical mumbo-jumbo to bother much with coming up with any mechanisms.  It does recommend a Mediterranean diet at the end, and immediately classifies PUFAs and MUFAs as "good fats" and saturated fats and trans fats as "bad fats" in the discussion.

I think when it comes down to it, we will find that these women who were chowing down on the saturated fats in the 1990s are going to be women who were less likely to take care of their health in other ways.  The olive oil fans were also more educated (even then olive oil was starting to be popular) and likely to take the best care of themselves.  I'm not surprised to see these correlations.  I still can't figure out how saturated fat all on its own can cause cognitive decline, mechanistically.  I find it very interesting that the highest saturated fat eaters had lower levels of hypercholesterolemia in this large group, and the paper makes no attempt whatsoever to explain this finding.  Hmmmm.

Former FDA Commissioner Andrew Von Eschenbach Joins Another Board–Banyan Biomarkers

Banyan Biomarkers provides analytical services to pharmaceutical companies, biotechnology companies and investigators at academic research institutes.  The company has a focus on traumatic brain injury and developing assays to qualify biomarkers.  BD 

Former FDA leader von Eschenbach Named to Viamet Board of Directors

Former FDA Commissioner, Dr. Andrew von Eschenbach Finds a Home on the Board of HistoSonics

Former FDA Chief Dr. Andrew von Eschenbach Appointed to the Board of Directors For BioTime and OncoCyte

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ALACHUA, Fla.--(BUSINESS WIRE)--Banyan Biomarkers, Inc. today announced that Andrew von Eschenbach, MD, former Commissioner of the Food and Drug Administration (FDA) and former Director of the National Cancer Institute (NCI), was elected to its Board of Directors.

“Banyan Biomarkers is developing a technology that would revolutionize how we diagnose and evaluate the traumatic brain injuries that are taking a devastating toll on soldiers, athletes, and accident victims. I am eager to contribute to Banyan Biomarkers’ efforts to rapidly bring such hope for a better outcome to so many in desperate need,” stated Dr. von Eschenbach.
http://www.businesswire.com/news/home/20120509005103/en/Banyan-Biomarkers-Announces-Andrew-Von-Eschenbach-Joins

Mom's Wheat Sensitivity and Offspring's Schizophrenia Risk

In the midst of all the chaos this week came a very interesting diet/mental illness risk paper.  Particularly good because it comes from the premier psychiatry journal (that we in the biz call the "Green Journal" because the cover is… well…anyway): The American Journal of Psychiatry (and looks like the full text is available for free) --- Maternal antibodies to dietary antigens and risk of nonaffective psychosis in offspring.

"Nonaffective psychosis" are psychotic disorders not related to major depressive disorder or bipolar disorder (both of which can cause psychotic symptoms during severe episodes).  The most common primary nonaffective psychosis will be schizophrenia, though there are a few other rarer disorders, such as delusional disorder.

Lest we forget who the enemy is, it is inflammation.  Yes, our immune system, in the context of our modern lifestyle is often like an group of soldiers armed to the teeth with too much to do on one hand (all these modern epidemics of infections) and too little on the other (wherefore art thou, old friends?).  Lest we forget, without inflammation, we will die.  Our immune system is necessary, just like an army from time to time.

To put the screws on schizophrenia risk, let's say now, with relative surety, that there is no single cause.  Schizophrenia isn't even a single disorder, but rather a variety of disorders with similar enough symptoms to be lumped together by that most imperfect of documents, the DSMIV.  But, a few things come up over and over when we look at the suspicious characters, and these things all go back to the immune system (inflammation), genetic risk, and those contributions to the pathology of schizophrenia (ultimately brain damage of a particular kind, a neurodegenerative disease).

Risk factors for developing schizophrenia that I've heard over the years:

Family history
Urban
Advanced paternal age (and to a lesser extent, advanced maternal age)
Infections (particularly toxo and herpes)
Birth in the winter months (could be associated with infections or…)
...Low vitamin D at birth
Complications during pregnancy or birth
Cannabis use, particularly at a young age

(before I forget, it's a beautiful day… Punching in a dream by Naked and Famous)

So we get the usual hodgepodge of genetic risk (family history) plus environmental stress (particularly severe stressors that occur when the brain is forming) = increased risk of developing the disease(es).  Ultimately at a certain stage of development (typically late adolescence for men and about 10 years later for women), brain cells begin to die, signals misfire, and we end up with the typical symptoms.

It makes perfect sense that if we have a sensitivity to something in our diet, inflammation will increase, and that risk for all sorts of autoimmune conditions and other chronic diseases will increase.  And, as we already know, there is an association between schizophrenia and celiac disease, and schizophrenia and weird wheat antibodies.

So now, the new paper in the Green Journal.  It's one of those cool studies that are only possible in Scandanavian countries where you pay 70% of your income in taxes and the government keeps tab on all your health information from birth to death.  In this case, the neonatal blood samples of a whole population of folks were collected (everyone in born Sweden since 1975) and a sample of folks later diagnosed with schizophrenia and matched healthy controls were analyzed.  IgG antibodies (immune response) to gliadin (from wheat) and casein (from milk) were measured.  Newborns have immature immune systems and do not make IgG antibodies.  These antibodies must have been made by the mother and passed through the placenta in the late stages of pregnancy to the baby.

Don't all run out and get expensive IgG tests to see if you are "sensitive" to foods.  I've never seen anything compelling to show me these tests were a reliable indicator of allergies.  Wheat is so commonly eaten that almost anyone with an inflamed or "leaky" gut will have IgG antibodies floating around… however, in this study, it was the 10% of folks who had the highest IgG signal to gliadin whose offspring had increased risk of schizophrenia.  IgG antibodies to casein were not linked to any increased risk.  If only the 5% of babies with the very highest levels of IgG antibodies to gliadin were consider, the odds ratio of developing schizophrenia later in life jumps to 2.5.  Don't get me wrong, the absolute risk will still be pretty low, but any time an odds ratio jumps to >2 one should prick up one's ears as it is an interesting finding.  These findings were not attenuated by adjusting for confounders.

In general, a highly positive IgG test to gliadin means you have a risk of having celiac disease (though it is not one of the standard tests, which are typically measures of types of HLA genes, anti tissue transglutaminiase, and IgA to gliadin).  Did the moms with the highest IgG in this study have untreated celiac disease, and thus a fully flowered autoimmune disease with all the inflammation on board, affecting mom as well as fetus?  Sure, except full blown untreated maternal celiac disease is typically associated with malnutrition and small birth weight, whereas in this study there was no correlation between high anti-gliadin IgG and low birth weight.  In addition, while 90% of folks with celiac will have the HLA-DQA*0501 and DQB*0201 alleles, these alelles are not increased among folks with schziphrenia. 


All told, once again we have a link between wheat and schizophrenia, one not explained by celiac disease alone.  More unveiling of the connection needs to be done.

MyMedicalRecords PHR 30 Day Account To Be Offered at Mickey Fine Pharmacy Chain in California

Who says the old traditions don’t mix with the new, and here’s an example of what is said to be the last pharmacy with a soda fountain in the store.  If you under around 40 years old, you won’t know what one looked like as pharmacies today don’t have them any longer.  MMR Global as you all know gained nationwide recognition over stocks and shares and the Hollywood suicide that occurred.  Sometimes people say any publicity is good but in this case with getting the financials in order the company did get some press.  At any rate if you have never heard of Micky Fine it’s in Beverly Hills and is a landmark.  The Medical Quack has pretty large section all about PHRs and it goes back to the beginning of when both Google and Microsoft began their programs and as we all know now Google Health is no longer around and at one point MMRGlobal connected with Google Health as well.  BD 

MMR Global PHR Law Suits and Patents–Company That Drew Attention With the Russell Armstrong Suicide in Hollywood

 

A very good target market for personal health records is seniors and I know that for a fact as a few years ago when I was guest speaker at the Computer Friends Group in Newport Beach, a senior tech group (and yes they exist) that was one of the first questions they asked about was having access and copies of their medical records, and let’s face it a we get older, more of us might see the importance as well.  The second most important topic the seniors asked me about if you look at the link below will tell you they wanted to know about speech recognition and mind you this was back in 2008 and my friends at Nuance will appreciate that plug for sure as look where we are today. 

Microsoft Speech Recognition Presentation - Computer Friends at the Oasis - Newport Beach, CA

I have mine and my mother’s records all together and with all of her medications and documents in one spot it sure is convenient for me since we don’t live real close. Today is the first day of offering, May 10th. In addition to their interest in medical records the company also is diversified with some biotech holdings as well working in the area of clinical trials.   BD

Favrille Biotech and MyMedicalRecords.com, Inc. Announce Merger Agreement

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QualityStocks would like to highlight MMRGlobal, Inc., a publicly traded company. Through its wholly-owned operating subsidiary, MyMedicalRecords, Inc., the company provides secure and easy-to-use online Personal Health Records ("PHRs") and electronic safe deposit box storage solutions, serving consumers, healthcare professionals, employers, insurance companies, financial institutions, and professional organizations and affinity groups. The MyMedicalRecords PHR enables individuals and families to access their medical records and other important documents, such as birth certificates, passports, insurance policies and wills, anytime from anywhere using the Internet.

In the company’s news last week, MMRGlobal announced it will begin offering its MyMedicalRecords PHR at the Mickey Fine Pharmacy chain in Beverly Hills beginning May 10, 2012.

MMRGlobal pointed out Mickey Fine Pharmacy’s established presence in the Los Angeles area, attracting many movie stars, athletes, business leaders, and politicians. MMRGlobal’s program offer Mickey Fine customers a 30-day MyMedicalRecords.com PHR account, which covers up to 10 family members, including pets, and incorporates the company’s MyEsafeDepositBox so that users can securely store important documents, accessible from any Internet-connected device.

http://www.virtual-strategy.com/2012/05/08/qualitystocks-news-mmrglobal-launches-mymedicalrecords-program-mickey-fine-pharmacy

Blue Cross Venture - Blue Health Intelligence Proving to Be Very Costly And Received Another 9 Billion From Undisclosed Source–Subsidiary Watch

So far according to this article it has been hard to quantify the real dollar amounts that have been saved.  We all know there’s a lot more data out there of course with the creation of the venture.  Recently it was announced that the firm that manages the Blue Cross venture was moving to San Francisco to start up an incubator so is this a sign of perhaps where some of the funding may have come from?  With starting an incubator this is a sure sign that they are looking for more code for analytics. 

Sandbox VC Firm that Manages Blue Cross/Blue Shield VC Funds Is Moving to San Francisco–An Incubator for Some New Coders To Write Algorithms for Profit?

 

We also recently had this purchase from the Venture division.  BD 

WellPoint & Partners Buy Bloom Private Health Insurance Exchange From Their Own Venture Capital Company (Sandbox) –Subsidiary Watch

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(Crain's) — A venture of the Blue Cross & Blue Shield Association that analyzes health care information on 110 million people has raised more than $9 million in equity, as insurers comb patient records for ways to cut costs and improve medical care.

Blue Health Intelligence uses claims data that has been stripped of identifying information to study health care trends, using records covering nearly one-third of the U.S. population.

Founded in 2006, the venture is backed by the Chicago-based association and 18 of the 38 insurers that use the Blue Cross name, which is licensed to them by the association.

Despite showing promise, Blue Health Intelligence has proven to be a costly endeavor, with $31 million in revenue and $43.6 million in expenses in 2010, the most recent year available, according to the tax return for the nonprofit association.

The $9.4 million in capital was disclosed last month by Blue Health Intelligence in a filing with the U.S. Securities and Exchange Commission, which does not identify the source of the money. The funding still leaves the venture short of its goal of raising $13.1 million, according to the filing.

http://www.chicagobusiness.com/article/20120503/NEWS03/120509903/blue-cross-association-raises-9-4-million-for-data-venture/healthcare

Pebble Watch–Companion for iPhone and Android As a Companion for mHealth Apps With Crowd Source Funding (Video)

This entire story is interesting in going just beyond what the watch does in the fact that it was funded by a company called Kickstarter.  You can review the page and see the folks that pledged money to get the project off the ground here and this relates to the hot topic of crowd funding. 
All it took to contribute was a dollar and 283 backers jumped in.  The watch supports blue tooth and connects to your phone, so just convenience with being on your wrist to check emails, get alerts, and so on shows how this will probably be a big hit.  It is water resistant.  There have been smart watches out before and this is not the first but the design and connection to the cell phone might be the trick here.  If you were receiving alerts as an example to remind you to take your meds, this would be convenient as one example to not have to reach for your phone.  Battery life is stated to be about 7 days, less time than charging your phone.  You can listen to music, take it on the golf course and it will track GPS information from your bike, which of course is right into exercise.  I like the fact that you can shake your wrist to dismiss a message too.  A watch with apps! 
The watches have all sold out and will ship in September with “backers” getting the option to buy first, smart marketing there.  It has a built in accelerometer which by now we all know what that does.  Interesting and I can see this with mHealth Apps for sure.  BD

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Apps bring Pebble to life. We're building some amazing apps for Pebble. Cyclists can use Pebble as a bike computer, accessing the GPS on your smartphone to display speed, distance and pace data. Runners get a similar set of data displayed on their wrist. Use the music control app to play, pause or skip tracks on your phone with the touch of a button. If you're a golfer, feel free to bring Pebble onto the course. We're working with Freecaddie to create a great golf rangefinder app for Pebble that works on over 25,000 courses world-wide. Instead of using your phone, view your current distance to the green right on your wrist. These apps will be the first, with more in the works!  

http://www.kickstarter.com/projects/597507018/pebble-e-paper-watch-for-iphone-and-android

One Hundred Years of Solitude

I hate the impracticality of magical realism.  It seems like hubris to swallow the laws of time and physics in poetry but expect a reader to care about the story.  And yet sometimes there is a phrase or paragraph of such power, such wisdom, that you feel gut-punched.  Your breath is gone.  For that reason a book like One Hundred Years of Solitude should be read.  Here is how it begins:

Many years later, as he faced the firing squad, Colonel Aureliano Buendia was to remember that distant afternoon when his father took him to discover ice.  At that time Macondo was a village of twenty adobe houses, built on the bank of a river of clear water that ran along a bed of polished stones, which were white and enormous, like prehistoric eggs.  The world was so recent that many things lacked names, and in order to indicate them it was necessary to point.

In the village (and later dazzling city of mirrors) Macondo, one can seemingly invent the world according to one's own perceptions.  It's a dizzying history, fragmented and timeless.  Ultimately, hubris and lack of self reflection lead to the downfall of the Buendia family and of Macondo.

This weekend, something terrible happened to Dr. Jack Kruse.  No innocent person should be summarily escorted off a cruise ship and dumped at Galveston harbor by Carnival security and the FBI.  I wouldn't wish such a thing on anyone.  In fact, six months ago I myself was questioned by Homeland Security, and for a while it seemed certain my computer was going to be confiscated by the feds, though the computer and myself were about 2000 miles away when the actual crime took place.  I was a bit shaken up; ultimately there was no way I could possibly end up in trouble, facing the accusation of the federal authorities was an awful experience.

Why am I writing about the Low Carb Cruise event?  Well, less than 24 hours after it happened, in a series of tweets and emails and blog posts and facebook posts (some of which are noted on Evelyn's blog), I had learned that *my* name was being circulated as a possible "perpetrator," though Evelyn's has been featured far more prominently and a woman from NY (who could only be Evelyn) was mentioned in a local news story by Kruse himself.  There was ugly finger-pointing.  "Perpetrators" were being threatened with 15-20 years federal prison time, civil suits, and other nastiness.

I did follow the parody twitter feed (whose tweet about explosives and legionnaire's disease and an "epic bio-hack" was apparently and very unfortunately misinterpreted by Carnival security, though it was obviously a reference to Jack's use of dynamite at his Paleo-Fx talk and his alleged self-injection with MRSA).  I even retweeted the feed several times.  I thought it was funny, and sometimes the quotes referenced me, for example one about how dangerous bananas can be.  I had guesses about who the owner of the feed might be, but did not know.  Nor do I have any clue who called (or emailed?  The reports differ...) Carnival and apparently pointed security in the direction of Jack Kruse.  That person is truly malicious.

How could a relatively mild-tempered psychiatrist who was minding her own business on a Sunday without much of a thought about neurosurgeons, cruises, or microbiology suddenly have her friends email her with forwards of alarming and threatening messages?

I opened the door.  I went to Free the Animal not too terribly long ago and engaged Richard Nikoley on his own turf.  I made it clear in no uncertain terms that I felt that injecting oneself with MRSA prior to surgery was a stupid and unethical thing to do.  Nor do I consider such a statement to be that far out on any limb, or to be that controversial.  I'm guessing that if you lined up 10 (non-biohacking neurosurgeon) surgeons and asked them about the incident, 10 out of 10 would say they thought the incident was made up or that the perpetrator was off his rocker.  Ultimately I felt that rendering my opinion on the subject was the right thing to do, as silence in the blogosphere is too often associated with approval or assent.

Thereafter things got uglier than usual over at Richard's blog.  He publically thrashed Melissa McEwen,  and I decided I was sick of the whole scene.  I thought I would stick to science and forgo any ranting for a while, and I unfollowed FTA on twitter and on this blog, just as I had previously unfollowed Kruse's twitter and facebook feeds.

A rather peaceful few weeks ensued.  But I opened the door.  And as much as one can seal it and try to block out any cracks of light, sometimes the door will burst open.  It's not the worst thing.  A psychiatrist should not shy away from aggression.  Aggression has to be met.  Actions do have consequences, and when something bad or unpleasant happens, the first thing one should do is reflect upon how one might change the situation, or whether one could have done something differently.  What a terrible situation, to be so polarizing and to have engaged in such behavior that someone would actively seek to have you removed from a cruise ship and searched and questioned by homeland security, for example.  So angry about what happened, which was indeed a terrible thing, no question, that you bring news cameras to your home and proceed to threaten and bluster even random commenters on David Csonka's website (linked above) who vaguely criticize, and list the telephone number on a public blog of the FBI agent who is investigating the case!  No thought of how other innocent people might be irresponsibly blamed or troubled, as it seems Jack was irresponsibly treated by the cruise ship security.

…in that flash of lucidity he became aware that he was unable to bear in his soul the crushing weight of so much past…he admired the persistence of the spiderwebs on the dead rose bushes, the perseverance of the rye grass, the patience of the air in the radiant February dawn.  And then he saw the child.  It was a dry and bloated bag of skin that all the ants in the world were dragging toward their holes along the stone path in the garden…The first of the line is tied to a tree and the last is being eaten by the ants.

Truth sometimes is strange and awful.  Self-reflection can be painful, but helps us to grow.  If we do not see it in time, the world we thought we had vanishes, a mirage.  No matter how loud or threatening or how aggressive we are, ultimately we return to the earth, and we are only the measure of what people remember.

Dr. Kruse will always have his followers, his believers.  They will jump with him off the shore and into the icy waters, and pay the fees for what I consider to be very dubious writings, and all the best of luck to them.

I prefer more solid and boring ground: eat healthy, exercise, sleep, relax, don't invite too much drama upon oneself... though my morbid curiousity is a definite failing.  Another weakness to reflect upon, no doubt.  There are many.

Congress Drops the Ball While Children Can’t Get Their Drugs for Cancer Treatment–And Many of the Cancers Can be Cured–Shame on Boehner’s Response–For 14 Months the Bill Has Been In the Works

Over a year ago the bills started and today drug shortages are still looming.  The bill is stuck in the Senate, why does it take 14 months before anything begins to happen.  The FDA commissioner, Dr. Margaret Hamburg  has called for the law to put through so they can be notified when there are drug shortages looming.  Watch the video and see what Boehner has to say, he respect the system..boy are in bad shape if that’s the case.  Many of the drugs in short supply are generic as some companies are no longer making them due to not enough profit. 

The bill needs a full vote of the Senate to become law and that’s where it has been stuck so one more tarnish on the GOP lawmakers for sure.  Harry Reid said they should have it on the floor shortly and his response was “it’s always been that way here, slow”.   We all know different and have seen things hit the floor and get passed, it just seems to depend on who has a sense or urgency and concern for their fellow man and children. There’s all this talk about saving money with cancer care, well not too long ago I had this story about UCLA spending two hours out of every day, calling around to borrow or work with suppliers to ensure their cancer patients when they come in for treatment, that the drugs will be there.    As long as this goes on who can even think about cost savings it goes right out the door and patients may or may not get their cancer drugs.  What is also ironic is that the Cancer facility at UCLA is making some breakthroughs with cancer research and targets.  BD 

Drug Shortages Continue–UCLA Spends 2 Hours A Day Checking on Cancer Drug Availability–ASHP Website Lists All Current Shortages

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Fifteen months ago today, Republicans and Democrats introduced bills to solve to problem. The Preserving Access to Life-saving Medications Act would require drug companies to notify the FDA if a shortage is coming. Both parties and the President support the bills, yet they haven't passed.

CBS News medical correspondent Dr. Jon LaPook found out more about the shortage and then traveled to a place he'd never worked before -- the U.S. capitol.

"I've been in Congress for 16 years," Degette said to CBS News. "I have never seen a Congress more difficult to pass legislation. I think you should call the leadership and ask them why they haven't brought this bill up for vote!"

http://www.cbsnews.com/8301-201_162-57429527/life-saving-cancer-drugs-for-children-stuck-in-federal-legislative-limbo/

ReWalk Robot Enables Patients with Lower Limb Paralysis to Walk In Downey, CA–Only Hospital in the West That Has the System

This is very cool and it is FDA approved but costs a few dollars for sure.  The hospital was lucky as they were the recipient of a donation to make this happen.  You can read the back article below. and visit the news website here to see it in action.  BD 

FDA Approves “Rewalk” Device That Enables Paralyzed Individuals to Walk

ReWalk

DOWNEY, Calif. (KTLA) -- An amazing new exo-skeleton robot is enabling patients with lower-limb paralysis to walk again.
Rancho Los Amigos National Rehabilitation Center in Downey is the only hospital in the Western U.S. to get the ReWalk system.
The ReWalk robots were donated to the facility, and they're worth about $85,000 each.

http://www.ktla.com/news/landing/ktla-exo-skeleton-robot,0,2433207.story

Illegal Drugs Smuggled Out of China Containing “Powdered Humans” or “Flesh Pills” Contain Bacteria and Are Dangerous–South Korea Steps Up the Fight to Battle With Documentary

This is just a yucky story all the way around but the summary of this is that the pills are supposedly sold/marketed at performance drugs and the Korean government even made a documentary about the topic.  It is not known if any of these pills made it to the US.  The flesh contained is from the fetuses of aborted babies and can contain a high degree of bacteria as there is nothing known about how the pills are made.  The pills are being found in tourists luggage.

It’s an old Chinese belief that a human fetus can cure disease so thus came the pills I assume.  So far no comment from the Chinese government.  MRSA, e coli, salmonella and other bacteria could be present.  Hepatitis B is also incredibly high in China.  BD 

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South Korean customs officials are boosting efforts to stamp out illegal smuggling of drugs that are allegedly coming from China. Reason: The drugs supposedly contain human flesh.

Since August, Korean authorities have discovered nearly 17,500 of the human flesh capsules in the luggage of tourists and in international mail, the state-run Korea Customs service said in a statement Monday.

The pills, disguised as performance enhancement drugs, have been smuggled in by ethnic Koreans living in northern Chinese cities and contain so-called super bacteria that is hazardous to human health, the statement said.  The documentary claimed that DNA tests verified that the pills were made from powdered humans.

The Korean customs announcement comes less than a month after China’s drug regulators announced the suspension of sales of 13 drugs (11 Chinese traditional medicines and two antibiotics) after finding they were encased in gelatin capsules that contained excessive levels of chromium. According to China’s state broadcaster, CCTV, the toxic drug capsules were believed to originate from factories in China’s coastal Zhejiang province and had been made using scraps of leftover leather.

http://blogs.wsj.com/chinarealtime/2012/05/07/south-korea-steps-up-fight-against-human-flesh-pills-from-china/

Some New Observational Studies and Alzheimer's Dementia

I'm gearing up for a talk later this month for the Massachusetts Psychiatric Society Geriatric Interest Group, which means I'm trying to keep abreast of all the latest diet and dementia studies.  A couple new big ones came out, both from groups with which we are familiar.  The first is from the Nurse's Health Study which purports that eating berries can protect us from cognitive decline via the magical power of flavinoids.  The second paper is from the same group who linked consumption of organ meats with dementia in northern Manhattan in one of those dreaded dietary pattern studies.

They have similar designs.  Follow a large group of people without dementia at baseline for a number of years, tracking demographic and dietary information along the way. Track new diagnoses of dementia or test people with basic cognitive screens on a regular basis.  In addition, the members of the Washington Heights/Hamilton Heights Columbia Aging Project (WHICAP) had plasma beta amyloid peptide measured.  It is thought that blood levels of beta amyloid correlate with brain levels, and other studies have shown that higher beta amyloid in the plasma correlates with the onset of dementia.

In the WHICAP crew, those who had higher intake of omega 3 fatty acids had lower levels of plasma beta amyloid, even after adjusting for confounders.  This finding would make biologic sense, as omega 3 fatty acids in lipid rafts help cleave amyloid precursor protein (APP) into harmless bits, whereas arachidonic acid in the same place allows for APP to be made into beta amyloid, the component of those plaques that build up in the brain.  However, the dietary sources of omega 3 PUFAs are listed as "salad dressing, fish, poultry, margarine, and nuts," which, excepting the fish, are generally terrific dietary sources of omega 6 PUFA, not omega 3.  To get an idea of the confounders, "Participants with higher plasma levels of [beta amyloid] peptide were older and less educated and had lower intakes of omega 3 PUFA, omega 6 PUFA, and MUFA…" and "Participants with higher omega 3 PUFA, higher omega 6 PUFA, or higher MUFA intakes had a higher education, were more likely to be white or black and less likely to be Hispanic."

The researchers tried to adjust for subtype of omega 3 PUFA (bless their hearts, considering they were working from food frequency questionnaires) and "none of the subtypes of omega 3 PUFA was significantly associated with the level of beta amyloid, suggesting that overall intake of omega 3 PUFAs might play a more important role."  (Or maybe it all just suggests that people who eat "healthy" in general eat fairly healthy who are also better educated and wealthier have a lower risk of dementia and less inflammation on board, as plasma beta amyloid is linked with inflammation and oxidative stress.)

In rodents models, a bit of omega 3 in the chow can reduce plasma beta amyloid by a whopping 70% in a matter of weeks compared to "low DHA control chow" and plaque burden in the brain is "reduced by 40.3%."  In human experiments (only one of which measured plasma beta amyloid and have been small), there hasn't been much benefit to adding omega 3s in folks with dementia, though those with mild cognitve impairment might be helped.  I'm guessing that it is difficult for a human to be quite as depleted of omega 3 and topped off with omega 6 as much as those lab rats with their shudder-worthy processed rat chow.

In the Nurses Health Study, blueberries and strawberries take center stage.  Nurses who admit to eating buckets of them (chock full of the antioxidant anthocyanidin) had better cognitive scores as the study went forward over the decades.  And while according to Walter Willett the confounders are easily accounted for, you may not be surprised to know that the berry eating nurses were wealthier, more likely to exercise, more likely to eat fish, and more likely to eat more calories period.

But, in the interest of some discussion, yes, bioflavinoids are very sexy.  In the Nurses Health Study, the riches sources were strawberries and blueberries, but tea, oranges, and apples are also common sources.  The anthocyanidins in the berries, in particular, are known to be able to cross the blood brain barrier and work in the hippocampus, a central brain area of learning and memory.  Not only are they antioxidants, but might also directly deactivate cellular inflammatory mechanisms.

In short, I concur that fish and berries are good for you.  However, these studies were not designed to prove that by any means, but rather to point out some interesting population trends as related to dementia and cognitive decline.  Consider them pointed out.

I'm a bit sick of these sorts of studies, to be honest.

Cutting Healthcare Costs Massachusetts Governor States Using Insurance Plans That Cut Out Some of the Harvard Teaching Facilities (Video)

This is an interview asking the Governor how they are decreasing cost and he addresses the premium costs and states they are making progress.  Fee for Service is discussed as it is all over the country.  Limited networks plans encourage people to go to community settings he states.  Not all of Harvard Teaching facilities are on the “high”list though and some of the community hospitals ended up on the high list too.  On the Blue Cross Study, Massachusetts General was on the “high” list.  Limited Network Plans mean a smaller network of providers, in other words those with contracts that are acceptable.  BD 

Massachusetts Governor

Blue Cross Launching New Health Coverage Option in Massachusetts-Encourages Consumers Via Employer Plans to Avoid 15 Named High Cost Hospitals

Massachusetts Governor Patrick discusses how they are cutting healthcare costs by encouraging limited network plans that do not include Harvard and other teaching hospitals, as well as getting away from fee for service.

http://currentmedicine.tv/2012/other-categories/policy/how-to-cut-healthcare-costs-in-massachusetts-ban-harvard-from-insurance-plans/

Prime Healthcare Cited for Violating Patient Privacy

I think we all remember this story from a short while back with the CEO responding about a patient and making a little too much information available relative to her diabetes records.  They were responding to a news report and it also ended up in the Los Angeles Times.  Prime was already being watched for the Kwashiorkor Malnutrition billing codes they were using.  I’ve done other posts too on billing software and the algorithms used for billing so there’s a little of both involved here with input and how the software does the ultimate coding as well.

Prime Healthcare Responds to Billing Practices–Flawed Data and Algorithms Once Again-Who Got Sold a Bill of Goods as Kaiser, Stanford & Other Hospitals Had a Ton of Kwashiorkor Malnutrition Billings

The patient just wanted restitution and wanted her records correct, which every patient should demand if they find errors.  In the meantime the hospital has it’s ongoing issues with Blue Cross.  What hospital today doesn’t have billing issues with at least one insurer.  BD 

Shasta Regional Hospital In California Suing Blue Cross/Blue Shield for Unpaid Medical Bills

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A Prime Healthcare Services hospital in Redding broke state law when it publicized a patient’s confidential medical files in an effort to discredit a California Watch news report, state regulators say.

The state Department of Public Health on Tuesday issued five "deficiencies" against Shasta Regional Medical Center for what were described as repeated breaches of patient confidentiality last year.

At one point, the hospital CEO sent an e-mail to 785 people – virtually everyone who worked at the hospital – disclosing details from a 64-year-old diabetes patient’s confidential files, state investigators found.

The disclosures occurred as Prime was attempting to rebut a California Watch story on a supposed outbreak of a Third World nutritional disorder called kwashiorkor at the Redding hospital. The hospital had billed Medicare for treating more than 1,000 senior citizens for kwashiorkor over a two-year period, records show. 

http://californiawatch.org/dailyreport/prime-hospital-cited-violating-patient-confidentiality-16049

UnitedHealthCare Found a New Way to Market Health Insurance – “High Performance Networks”

Well this is a new press release that came out and gee I thought everyone today was high performance so where are the low performance folks? I guess those are the ones who are not under contract?  The official name is “SignatureValue Alliance” in California so I guess this means the doctors and hospitals have signed on the dotted line <grin>.  It mentions evidence based medicine and for what I see most are already practicing that way and have for years.  The rating algorithms come in here and again we all know how ratings go these days and depends on who’s algorithms are being use and the integrity of the data collected along with accuracy. 

Being this is in California it kind of looks like a revival of the old PacifiCare HMO type of contract if you ask me.  United bought them years ago and tons of Orange County employers were strapped a while back to find new HMO insurance policies for employees as the rates when up quite a bit.  This goes back to 2010 with HMO agreements.  Beckman was given as one of many companies who were scrambling. 

Employers in Orange County Looking for New HMO Contracts as St. Josephs and Some Others Begin Cancelling Agreements with Pacificare (UnitedHeatlhCare) – Employer Capitation Contracts

 

With this new plan several IPAs are already enrolled including Monarch Healthcare which they own. 

United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County

 

Again it sounds like a version of Pacificare all over again and  ratings doesn’t make much difference anymore as so many reports are skewed as sometimes it’s like comparing Apples to Oranges as demographics and other such items can’t play out fair for all.   If you read here often enough then you know for an example how bad the data was and may still be on HealthGrades as I found my former doctor who had been dead for 8 years still alive and kicking on their ratings. 

“High-performance networks, which include physicians rated both on quality and efficiency measures, are becoming increasingly popular as a way to improve outcomes and more effectively manage costs.”

I wonder if the hearing aides are coming next to California too?  In looking at all the insurance first quarter reports all seem to be down except United so I guess marketing, algorithms and huge slew of subsidiaries works for shareholders.  BD 

United HealthCare Gets In the Medical Device Business–Distributing Cheap Hearing Aides Sold Via Hi HealthInnovations Division –Subsidiary Watch

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UnitedHealthcare is offering "SignatureValue Alliance" in California, a new health benefits plan featuring high-performance care provider networks committed to delivering effective, evidence-based and cost-efficient care.

The SignatureValue Alliance plan enables employers and plan participants to save on their health care costs through lower premiums while still having access to a wide range of traditional and deductible HMO plans.

The Alliance network includes six large physician groups in Southern California and parts of Northern California that include 90 hospitals and about 26,000 physicians and specialists. Participating Alliance physician groups include: HealthCare Partners Medical Group, Heritage Provider Network, Monarch HealthCare Medical Group, PrimeCare Medical Group, Sante Community Physicians, and Scripps Health.

http://www.marketwatch.com/story/unitedhealthcare-offers-new-health-plan-featuring-high-performance-networks-in-california-2012-05-03

Woman Buys A Box of Tampons at Close Out Bargain Store and Finds Cocaine–Obviously Not for Internal Use On This Box

This is one of those stories from the beyond and I worked in logistics for years and transportation companies used to have sales as such on lost products, damages, and so on relative to freight claims.  After the company paid a claim for goods that could not be sold as new, this is very common to recover a portion of the money.  This box came from the UK and had a “Boots Label” which is a British drug store and this will be interesting to see how this moves along for sure with tracing how the product got there and through any distributors for sure and see if there’s any more like this out there.  Last year the NHS talked about using the Boots chain to deliver chemotherapy to patients…hmmm..something else to keep close track on and I’m sure all will be looking at Boots all the way around and their distributors. 

NHS-Health Secretary Submits Plan for Patients to Receive Chemotherapy at Local Retail Boots Store as Part of Reorganization

Perhaps this is a new way of smuggling drugs? The white powder tested positive for cocaine.  The box showed no signs of tampering either so again this one of those to be tracked and solved.  The store is probably clue less of course as they buy products to liquidate and hopefully we have no “blind shipping” documents here, which is where a point of origin is not shown, but the common carriers, if this is the case can track it through and find all that information out.  BD 

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Cindy Davidson is good at sniffing out bargains, so when the Salt Lake City mom saw tampons on sale last Saturday, she didn't exactly turn up her nose at a good deal.

However, inside the box, along with the tampons and the applicator was something extra: Cocaine.

"I didn't look like it was tampered at all," she told KTVX-TV. "There was cellophane filled with white powder."

The box of Boots tampons -- a British brand -- was supposed to contain 16 tampon. She noticed, however, some inconsistencies in they way they were packed. When she found the suspicious little package inside, her heart began to race -- and it certainly wasn't the euphoria coke users experience.

http://www.huffingtonpost.com/2012/05/04/cocaine-tampons-accidenta_n_1477321.html?ncid=edlinkusaolp00000003

Novartis Buys Generic Dermatology Company Fougera Pharma for $1.5 Billion

Sandoz is the generic division of Novartis and the acquisiton of Fougera will reside within this division it appears.  The two companies already service some of the same accounts.  BD

Novartis is buying specialty dermatology generics firm Fougera Pharmaceuticals for $1.525 billion in cash. The Swiss drug giant says adding Fougera to its Sandoz generics business will transform the latter into the world’s biggest generic dermatology medicines operation, with estimated annual global sales approaching $620 million.

“

The addition of Fougera’s leading portfolio further strengthens Sandoz’ differentiated products strategy,” comments Jeff George, global head of Sandoz. “Fougera brings us valuable technical capabilities in the area of topical dermatology products, particularly in the development and manufacturing of semisolid forms such as creams and ointments.”

http://www.genengnews.com/gen-news-highlights/novartis-to-buy-dermatology-generics-firm-fougera-for-1-525b-cash/81246720/

Researcher At San Francisco VA Medical Center Dies After Handling Rare Strain of Bacteria–Was Working On a Vaccine for Meningitis

All who worked at the lab have all been vaccinated to protect as well as family members but according to the story here the vaccine would not have helped in his situation.  This was fast as he woke with a rash and then died on the way to the hospital from a heart attack.  Cal-OSHA is investigating and stated they are verifying that this was the same bacteria he was working with.  Back in 2001 we had an ex-Pfizer researcher speak out about safety in labs as she suffered exposure due to unsafe working conditions.  BD

Ex-Pfizer Scientist wins $1.37 Million in Lawsuit Against Pfizer in Biotech Viral Exposure Lawsuit

Lab workers at the San Francisco Veterans Affairs medical center will be urged to get vaccinations for the diseases they study as a precaution as investigators continue looking into a researcher's death after he handled a rare strain of bacteria, officials said Thursday.

Richard Din, the meningitis research associate who died Saturday in a possible lab exposure, wasn't vaccinated for the illness despite Centers for Disease Control and Prevention recommendations to the contrary. Nonetheless, the VA's Harry Lampiris said a vaccine may not have protected Din, 25, because he was helping to develop a vaccine for a meningitis strain resistant to vaccine.

"Laboratory-acquired infection represents an occupational hazard unique to laboratory workers, especially those in the microbiology laboratory," Kamaljit Singh of Chicago's Rush University Medical Center concluded in a 2009 scientific paper published in the journal Clinical Infectious Diseases. Singh estimated that 500,000 lab workers handle dangerous germs in the United States.

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2012/05/03/national/a160829D91.DTL

Class Action Lawsuit Filed Against Allscripts For Misleading Investors With Merging Data Systems–Too Much Code and Not Enough Time – Attack of the Killer Algorithms Chapter 30

Let’s start out with this, if one is a developer/coder this is probably not a great atmosphere to be in right now, I would not want to be

working there writing code to integrate.  I don’t know the entire insides and outs to intelligently talk specifically on some of this but do know we had 2 very differently constructed system that needed to come together with the merger of the two companies for an even more powerful system for medical records.

  I wonder if somebody got sold a bill of goods here?  When you have management involved they are basically “magpies” as far as knowing what the whole job entails as they rely on the “hands on” folks for accurate information. 

On the other hand too, you cannot push the coders and get good algorithms and software and the average person is not really cognizant of how massive these system have become with all the working parts that need to integrate and support each other.  When I did my little integration on the desktop with client server with billing software, that even took me a while but I had the same data product for the back end and I’m sure on the two products merged here.  With existing clients, some would need to be migrated if they are different, the way data works and when as a consumer you sit down and see the magic, you have no clue on all the coding work that goes into the system, you just want it to work. 

According to this article the join in date expires on 2012 for investors to stake their claim.  Sometimes you can’t put developing on a schedule as there’s always something that comes up that is not expected and will take extra time, especially with writing to HIPAA standards and security which is of course a major concern and component with any medical records system.  This was the news a few days ago.  Investors, better ask more questions and in cases with complex software like medical records, don’t think we have web fairies out there flying around.  Just with some of the small stuff I do I have people thinking oh you just sit down for a couple hours and like magic you have their project done..not so. 

Allscripts CFO Resigns Along With A Few Other Key Individuals, Board Fires Chairman–1st Quarter Had Lower Sales And Net Earnings Down–Long Haul to Get Software Technologies Merged So They Work

Let’s go back in time a little further as I have been around this business for a while to Misys Memory Lane when Misys and Allscripts merged in 2008, this was done once with integrated code, so a few years later here we go again and new compilers, etc. to bring in.  I don’t know how much or if any of the old Misys code is left but they grew by integrating and buying up other software so before Allscripts even came along you had integrated code to work with, so one wonders how much more can it go before you scratch and write a new system or considerably revamp big portions of the entire program.  This stuff takes time.  Remember these 2 guys telling us how great it would be and it did work but again we don’t know the back side and now it’s lot more expensive as there’s a lot more code. 

Misys-Allscripts merger is all about SaaS

Misys Sells Allscripts Shares to Enable Eclipsys Merger – Medical Records

Misys is still around but they don’t do medical records any more.  Last year they were even working with Humana to give doctors discounts to buy and again this was the original Allscripts system as the merged system had not arrived.

Revenue projections were based on the successful integration here-so much for business intelligence projections if the code is not all done.  I hope we get to hear more on this topic as folks dig in.  Investors beware of what some software folks claim when you have projects of a big magnitude as this.  I don’t think that maybe they lied outright, they may not have said anything as heck investors and consumers buying this kind of stock don’t understand it anyway and how it all has to come together, they just want money. 

The creative projecting with clients and revenue though I would think that some curious tech minded analysts might have asked about, and they are pretty sharp but when you get down to asking about “real” work in progress and don’t nail down the right specific questions, nobody’s going to tell you. 

So due to this fact and usually it’s the consumers getting bit by the algorithms and this time investors based on this lawsuit so we have the Attack of the Killer Algorithms (or lack of in this case) that came to bite.  Analysts with some IT background might want to think about making some on premise visits in the future you think?  That could or could not help though if they are not shown the entire picture and saw a lot of “virtual” work.  You just don’t know.  If you would like to read more about the other Killer Algorithm Chapter, use the link below or scroll down to the bottom left hand side of my blog for more every day examples on how the Killer Algorithms function today along with a ton of flawed data accumulating out there.   BD

 

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 3-11-2012

 

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Levi & Korsinsky announces that a class action lawsuit has been commenced in the United States District Court for the Northern District of Illinois on behalf of investors who purchased Allscripts Healthcare Solutions, Inc. (“Allscripts” or the “Company”) (Nasdaq: MDRX - News) securities between November 9, 2010 and April 26, 2012.

The Complaint alleges that the Company made materially false and misleading statements in regards to its progress in assimilating both Allscripts’ and Eclypsis’ disparate systems and its ability to translate its fragmented product lines into revenue. In particular, the Complaint alleges that defendants concealed from the investing public that: (a) the process of developing a unified product offering after the Merger had suffered debilitating setbacks which ultimately resulted in the loss of key personnel and harmful upheaval in Company leadership; (b) a material portion of Allscripts' revenue and net income was based on the successful integration of these systems and substantial business relationships had been destroyed by the inability to make material progress in this area; and (c) as a result of the foregoing, Allscripts lacked a reasonable basis for its claims of progress in post-Merger integration and continued growth.

http://finance.yahoo.com/news/law-firm-levi-korsinsky-notifies-221000244.html

Komen Public Relations Vice President In Charge of Public Relations, Branding and Marketing Resigns–Business Intelligence Decisions/Marketing Not Popular With Consumers–Algorithm Attack #10 Revisited

I think we have reached a stage to where consumers are a bit tired of hearing “it was business decision” when those decisions cut care and funds that helped people.  Sure it exists in other businesses but right now with the war on women’s health, not popular and myself I took their link off and replaced it with Planned Parenthood.  This was the second strike though as a year ago they suing other non profits who also helped people for using the name “cure”. 

Susan G. Komen Foundation Attacking Other Charities Over Use Of The Word 'Cure'

Ok so the lady resigning today, was that her call too?  Inquiring minds asking questions here.  I talk a lot today about the imbalance of using business tools today for intelligence and we don’t have enough people sometimes with enough common sense on how to use them.  Komen found out the hard way about “unintended outcomes” and again you have very unsympathetic public with the economy in it’s current state. 

Komen Foundation Cuts of Funds to Planned Parenthood - Wall Street Was Lit up in “Pink” Last Week For Fund Raising from Hedge Funds and Other Financial Companies

I have said it many times that when you have folks in positions without a little bit of tech background that make decisions you are in  trouble.  No doubt we will see more of this as we are reaching a crossing point of where decision hurt and nobody seems to care and that is sad.   I watched the women struggle with this on the videos they put out and it was not enough.  I keep using this picture of the New York Stock Exchange as a reminder for all as to where some philanthropy efforts are going. 


The Komen Foundation made the number 10 spot on my Attack of the Killer Algorithm series.  I suppose when you can’t justify in words any longer to meet with approval form the public, it’s time to move on.  BD 

Komen Reverses Decision With Planned Parenthood–Hard Lesson on How Business Analytics Are Misunderstood And/Or Abused–Attack of the Killer Algorithms Chapter 10

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Another key executive at Susan G. Komen for the Cure’s national headquarters is leaving the organization after a public relations debacle regarding funding to Planned Parenthood of America.

Leslie Aun, who as vice president of marketing and communications served as the lead spokesperson for the organization, will leave Komen May 15 to become vice president of communications at Venture Philanthropy Partners (VPP).

She will become at least the sixth executive to leave the organization, either at headquarters or at the affiliate level, since the Planned Parenthood controversy exploded four months ago.

As vice president of marketing and communications, Aun was responsible for directing Komen’s public relations, branding, advertising, interactive marketing and event planning teams. Prior to joining Komen in March 2011, Aun was vice president of communications for the World Wildlife Fund (WWF) and chief communications officer for Special Olympics.

http://www.huffingtonpost.com/2012/05/03/leslie-aun-susan-g-komen-resigns_n_1475587.html?ncid=edlinkusaolp00000003

Johnson and Johnson Acquires First Medical Device Company In China - Guangzhou Bioseal .

As the press release reads, this is a product used in China only and not in the US.  The company will fall under the Ethicon division of J and J and produces a sealant used for adjunct hemostasis undergoing surgery, controls the bleeding when other methodologies are not sufficient.

Ethicon biosurgery brands already on the market in China include SURGICEL® and SURGIFLO®.  J and J is not new to China as they have had other interests there for years and have a Chinese website.  BD 

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Health care giant Johnson & Johnson (NYSE:JNJ) made its 1st acquisition in China this week, picking up Guangzhou Bioseal Biotech for an undisclosed amount.

J&J has been doing business in China for more than 25 years, including last year's launch of a medical device and diagnostics innovation center there.

"This transaction reinforces our commitment to China and delivering innovative medical device solutions to the Chinese market," J&J's Chinese medical president Xie Wen Jian said in prepared remarks. "We are very pleased to add the Bioseal brand to our growing portfolio of hemostasis products in China and we look forward to working with our new Bioseal colleagues to bring their innovative products to more physicians and patients."

https://www.massdevice.com/news/jj-nabs-its-1st-chinese-device-maker-wall-street-beat

Depression, Antidepressants, and the Endocrine System

It's all connected.  I know it, you know it.  Hormones and mood and the brain and inflammation… precisely how and precisely what to do about it?  Well, that is surely the sticking point.

Santigold: LES Artistes (right click to open in new tab)

I'm working from a paper today (as always) but it is not the world's greatest paper (1).  A small study hardly worth mentioning, but the discussion and conclusions have some interest.  So put your mind in an open frame but don't believe too much what you are reading.

Depression.  Not just a state of mind, really.  Can I tell you how common it is for someone to come in to see me, having just experienced a major loss (job or death in the family) and tell me: "My antidepressant isn't working.  I'm really sad."

I don't know why it is we are blessed and cursed with emotions.  There's some good explanation about how hominids survived via groupings and attachment and all that.  We are left with the baggage, as it were.  We love.  We hate.  We murder, and we grieve.  Sometimes if you sit outside and let the humid air in through your nose and watch the leaves flicker in the wind you can forget all that for a moment, and just exist, where dying is tomorrow, or yesterday, and not important.  Outside of the moment we are left with hopes, ambitions, failures, and loss.

My 9th grade biology teacher, Mr. Turner (who abandonned the profession to become a forest ranger) said to us once:  "Evolution is a fact.  Deal with it."

We have a hormonal system to deal with trauma of all kinds.  Emotional, physicical, present, past.  The lack of differentiation is the problem, frankly.  But it is what it is.  And folks suffering from  major depressive episode frequently have activation of the hypothalamic-pituitary-adrenal axis along with an increase in insulin resistance and increased accumulation of visceral fat.  Things go to hell in a handbasket pretty quickly.  There are elevations in inflammatory cytokines, not just in the brain, but all over the body.

In the traditional medical model, we add antidepressants to the mix.  I know there is no such thing as a serotonin or norepinephrine deficiency but bear with me.   Long ago, the tricyclics, which can indeed improve depression symptoms but result in an increase in body weight and possible worsening of diabetes.  The newer agents of SSRIs (prozac and the like) are actually associated with an improvement in glycemic control.

(Classical music, some of the best ever: Beethoven: Symphony No 7, II)  Classical not your drug of choice?  Sleigh Bells, Comeback Kid, ads up front.  Sorry about that.)

Weirdly, the old fashioned antidepressants who cause weight gain and dry mouth are known to decrease cortisol, whereas the new ones with fewer weight gain side effect have no immediate effects on the HPA axis.  (The wizened psychiatrists who sit in the front row of grand rounds always bemoan the lack of use of the old fashioned antidepressants in favor of the SSRIs.  But no one wants to be fat and dry-mouthed, not to mention the death in overdose so possible with the tricyclics).

Wht could be going on?  Cortisol from stress centrally increasing craving for high-caloric, palatable food… and increasing the secretion of resistin, an adipokine that causes decreased insulin sensitivity and an increase in fat storage and diabetes? In rats that is probably true.  In humans?  Not so clear.

Resistin is typiclly released in rats due to inflammatory and obesigenic influences.  But what about adiponectin, the supposedly antiinflammatory and anti-obesity hormone release in humans in response to stress or excess sugar… In humans, adiponectin is higher in women than in men, and are reduced in obesity and insulin resistance.

In the small study in the paper I've linked, free cortisol levels (STRESS) were strongly associated with levles of resisin in depressed patients.  In follow up, those who were on medicine and had decreased symptoms also had decreased levels of resistin.  There were no changes in hormone levels for those who did not improve on antidepressant treatment.  BMI was correlated with resistin also.

What do we learn?  Depression = increased cortisol secretion = increased resisitin = increased obesity.  Direct or indirect mechanisms may be unknown.  In mice, increased resistin increases fasting glucose in insulin resistance.  This may be true in depressed humans and may explain the link between depression and diabetes.  We don't know for sure.

Adiponectin concentrations didn't change during the six weeks of measurements of these depressed patients on or off antidepressants.  Only resistin measurements were statistically significant.

The endocrine system is always a bit of an investment in reading, and it doesn't always deliver.  That's why we read the Hunger Games Trilogy instead of books about the thyroid.  I get it.  Peeta v. Gale is more interesting than resistin and adiponectin.  That's not hard to understand.  We're human, after all.  We love, we hate.  We let go, we give in.