Pioneering Ideas

C. diff Infections: Worse Than We Thought

BY RAMANAN LAXMINARAYAN, PROJECT DIRECTOR, EXTENDING THE CURE

Infections caused by the dangerous microbe Clostridium difficile, or C. diff, are much more prevalent in hospitals and health care facilities than previously reported, according to an investigative front page story in last week’s USA Today. This bug is most often seen in hospitals, nursing homes, and other medical facilities. It causes severe diarrhea and intestinal problems that can worsen and even be fatal. The story cites a scientist from the Centers for Disease Control and Prevention who says annual fatalities may be as high as 30,000 per year, more than twice as high as some recent estimates.

The article accurately points to many reasons for this problem. Many hospital infection control programs aren’t stringent enough and C. diff reporting rates are poor. Hospitals need to be more prudent in their antibiotic use. C. diff thrives when healthy bacteria usually present in the intestines are wiped out by certain antibiotics patients take. In the absence of these healthy bacteria, C. diff can take over. 

The problem is exacerbated by the overuse of antibiotics, often in place of effective infection control. All health care providers – in health care facilities and in the community –  must use antibiotics prudently in order to slow the rate at which these powerful drugs become ineffective against C. diff, MRSA, and other dangerous bacteria.

We know that the evolutionary battle with microbes is, by nature, a losing one. Bacteria will continue to become resistant faster than our efforts to stop them. So as current antibiotics become ineffective, we need new drugs at the ready. However, efforts to bring new drugs to market need to be coupled with plans to conserve their use to maintain their effectiveness.

In order to get to the root of a problem like C. diff, we need comprehensive solutions that address not just antibiotic overuse but also infection prevention (such as vaccination) and infection control.

Check out new research from Extending the Cure showing how overuse of certain antibiotics correlates with C. diff deaths and hospitalization rates in the United States.

Read about the economics of drug resistance in a recent cover story featured in the Milken Institute Review by Ramanan Laxminarayan.

Follow Extending the Cure on Twitter @ExtendgtheCure.

Ramanan Laxminarayan is director of Extending the Cure, a research effort that examines policy solutions to address the growing problem of antibiotic resistance. The project is based at the Center for Disease Dynamics, Economics & Policy (CDDEP) in Washington, D.C., and is funded in part by the Pioneer Portfolio of the Robert Wood Johnson Foundation.

Happiness is Hot

BY PAUL TARINI, SENIOR PROGRAM OFFICER, PIONEER PORTFOLIO - @PaulTarini

Happiness is gaining currency today, particularly in relationship to health and medicine. That’s what we’ve been hearing ever since Harvard School of Public Health researchers Julia K. Boehm and Laura Kubzansky published their report “The Heart’s Content: The Association Between Positive Psychological Well-Being and Cardiovascular Health” in the Psychological Bulletin, under a grant from Pioneer. This is the first study of its kind to look closely at how positive psychological well-being—including happiness and optimism—plays a role in heart health.

The story was indeed hot – gaining attention from USA Today, The Huffington Post, TIME’s Healthland blog,WebMD, The New York Times’ Well Blog, ABCNews.com, MensHealth.com, ModernHealthcare.com, Oprah.com, and hundreds more – and being shared throughout social networks and on the web.

This review, which bases its conclusions on more than 200 studies, taps into a larger conversation going on in health care today about the role of wellness and prevention. So often in health and medicine, we look at what is wrong and try to fix it. But more recently, attention has turned toward what we can do to get and stay healthy before things start to go wrong.

Prior research has primarily focused on how risk factors, such as anxiety and depression, are associated with heart disease and cardiovascular events. This investigation is the first to establish that health assets—such as optimism and happiness—are also associated with heart health. This most recent study fits into a new concept called Positive Health, which seeks to demonstrate that people can use and strengthen these assets to achieve a healthier life. 

The intersection of happiness and health – where we flourish both mentally and physically – is where we all want to find ourselves. The findings of this study make intuitive sense: They tell us that happy people are healthy, active, and health-conscious. They also point us toward a new health care paradigm that focuses on making the most of our inherent advantages—not just on avoiding what’s “bad for us.” The next step in this field is to establish whether or not we can design interventions that help build these health assets to help people increase their chances of living a healthier, longer, and perhaps happier life.

Read more of Paul Tarini’s thoughts on the growing evidence for Positive Health.

Pioneer’s Commitment to Health Games Profiled in New Games for Health Journal

BY PAUL TARINI, SENIOR PROGRAM OFFICER, PIONEER PORTFOLIO -- @PaulTarini

I recently had the good fortune of sitting down with Bill Ferguson to discuss the Robert Wood Johnson Foundation’s pivotal role in health games research for the inaugural issue of the Games for Health Journal. In our talk, I detailed the Foundation’s early investment in the field, the challenges to advancing health games and some grantee findings to date.

Thinking about our conversation, I’m struck by how far the field has come since the early days of our health games support in 2004. Back then, there wasn’t much intersection between the games space and the health space, but Pioneer saw potential. So we worked with Ben Sawyer (@BenSawyer) of Digitalmill to do some community building within the gaming industry around health interests and funded the first-ever Games for Health Conference.   

Now, with seven conferences behind us and the eighth scheduled for June 12-14, 2012, in Boston, Pioneer can proudly claim we helped create and sustain a way for the games and health communities to come together. But we didn’t stop there.

Pioneer expanded its support to the Health Games Research national program, directed by Debra Lieberman at UC Santa Barbara (who is featured in a roundtable discussion of health games experts in the Journal), where we are seeing our 21 grantees test some fascinating ways health games can be optimally designed. They're exploring game features such as competition, collaboration, social comparison, social support, nurturing of characters, immersion in fictional worlds and alternate realities, interacting with a human-like robots to motivate exercise, using a mobile phone game as a substitute for a cigarette, and much more. And there’s more to come.

Health Games Research's work to identify a broad range of features that make for effective health games will help to further expand the creative horizons of future developers. Well-designed and well-implemented games can motivate and support prevention, lifestyle behavior change, and self-management of chronic conditions, and Pioneer is proud to be part of this work. We are excited to see a journal devoted to the research, development, and clinical application of games and health.

Check out the inaugural issue and read about the work of Pioneer’s grantees and others in this important field on the Pioneer Health Games homepage. Tell @pioneerrwjf or @gamesresearch what you think.

Pioneer Grantees Named to Forbes’ Top 30 Social Entrepreneurs List

BY BRIAN QUINN, team director of RWJF’s Pioneer Portfolio

Forbes is known for its lists – America’s richest people, most expensive zip codes, most promising companies and more. This year, for the first time in its 94-year history, Forbes released a new list – the top 30 social entrepreneurs. We’re proud to announce that Pioneer grantees made the list – twice!

Jay Coen Gilbert, Bart Houlahan and Andrew Kassoy made the list for B Lab, a nonprofit that certifies businesses as “B Corporations”—companies that adopt a legal structure requiring them to create value for a broad set of stakeholders—employees, communities and the environment–not just their shareholders.  Their hope is that certified “B Corps” will flourish by attracting consumers who are looking to support businesses that align with their values and helping investors to drive capital to higher-impact investments with greater social responsibility, as well as financial returns.  To be certified, companies must adopt the legal structure and pass an annual B Impact Assessment. Under their Pioneer-funded grant, B Lab will develop the first set of criteria to assess a corporation’s performance in areas of employee and community health and safety to be included in the annual assessment.

Sara Horowitz is listed for founding Freelancers Union, which provides affordable health insurance to freelancers, consultants and temps who don’t have access to employer coverage. Her grant from Pioneer enables the Freelancer's Union to expand its group purchasing health-benefits program from New York into New Jersey and Georgia.  A previous grant established the for-profit Freelancers Insurance Company to design a health plan model for freelancers in New York state that combines catastrophic insurance coverage with coverage for prevention and wellness services.

RWJF’s Vulnerable Populations Portfolio is also excited to see two grantees on the list. Jill Vialet made the list for founding Playworks, which improves the health and well-being of children by increasing opportunities for physical activity and safe, meaningful play. Playworks sends trained, full-time coaches to low-income, urban schools, where they transform recess and play into a positive experience that helps kids and teachers get the most out of every learning opportunity throughout the school day. Rebecca Onie is included for co-founding Health Leads, which mobilizes undergraduate volunteers to help patients fill “prescriptions” shared during provider visits for basic resources needed to be healthy, like food, heating assistance, child care or housing. Health Leads is one of many promising models addressing social needs through the health care system.

As team director of the Pioneer Portfolio, I’m thrilled to see our grantees singled out as innovative entrepreneurs. These innovators represent the kind of leadership and ingenuity that can help us tackle the tough health and health care problems we face in the U.S. Check out the story and don’t forget to congratulate Jill Vialet (@jillvialet), Rebecca Onie (@rebeccaonie), Sara (@Sara_Horowitz) and the B Lab crew (@BCorporation) on Twitter using the #Impact30 hashtag.

Drug Facts Boxes Featured in New York Times

Last week, the New York Times published an op-ed by the Dartmouth Institute’s Steven Woloshin and Lisa M. Schwartz that discussed the critical need for a redesign of something that can empower consumers to make informed decisions about their health care – the information that accompanies prescription drugs. As stated in their own words: “Bombarded with pharmaceutical ads listing what seems like every conceivable side effect, American consumers might think they are already getting too much information. But they — and their doctors — are not getting what arguably matters most: independent, plain-English facts about the medication.”

Prescription medication labels are hard to read, confusing and often leave out crucial information contained in Food and Drug Administration (FDA) review documents. Major side effects or potentially dangerous drug interactions can be hidden to patients on their medication packaging. By giving drug packages a simple makeover and creating a standardized, easy-to-read drug fact box—akin to what’s currently required for nutrition labels—information that is critical to enabling an individual to make the best health care decisions possible will be readily available to all.

Woloshin and Schwartz are leading the charge on the effort to develop these “Prescription Drug Facts Boxes.” Recognizing the opportunity for a simple design change to create better access to information and have a big impact on how people engage with their health care, we have been supporting their efforts since 2008. You can read more about that support here. This idea was simple and powerful enough to be included in the health care reform law.

Policymakers say that an additional three years of study are needed before beginning to implement the facts box. To me, it’s unclear what more they will learn in those three years. I don’t think it’s the lack of an evidence base. Woloshin and Schwartz have done a number of good studies about the efficacy and adding to them should not take three years. I don’t think it’s figuring out how to operationalize the production, a hand book is easily developable. I do think it’s a combination of two important factors: an underrepresented constituency and an overly strong concern for the potential adverse impact of any change.

The underrepresented constituency is the consumer. We are already given information about the intent of the drug and the dangers. The perception is then that the only thing the drug box adds is the ability to make a more informed choice. And that’s not seen as very important. Given that, it’s easy to see why the potential downside of the change needs so much study. If you don’t weight the value very highly, you need to be very sure that there are no “adverse events”.

That’s wrong. We’re being told (and in some cases, compelled) to take more individual responsibility for our health. Being denied access to clear and actionable information is wrong.

 

Project ECHO: A Game-Changer for Patient Care?

Note: This post originally appeared on The Health Care Blog June 14, 2011

By BRIAN QUINN, Pioneer Team Director

I met Sanjeev Arora as part of the RWJ crowd at TEDMED last year and was pretty impressed with his approach–especially given the lack of access to care in poor and minority regions. Now there’s proof his approach works –Matthew Holt

On June 1 the New England Journal of Medicinepublished a study about how primary care providers can treat very sick patients who previously did not have access to specialty care.  The piece described Project ECHO, a disruptive model of health care delivery based on collaborative practice that has the potential to transform health care.  Supported by Robert Wood Johnson’s Pioneer Portfolio and based at the University of New Mexico Health Sciences Center (UNMHSC), Project ECHO was developed by Sanjeev Arora, M.D., a hepatologist at UNMHSC and leading social innovator.

The ECHO model organizes community-based primary care clinicians into disease-specific knowledge networks that meet through weekly videoconferencing to present patient cases.  These “virtual grand rounds” are led by specialists at academic medical centers who train providers to provide specialized care, share best practices and co-manage complex chronic illness care for patients with the local care team. Under this model, primary care providers treat patients in their own communities – burdens on academic center capacity are reduced, poor access to care is eliminated  (patients are no longer limited by geography when seeking quality care), and the health care systems’ capacity to provide high quality care to more patients, sooner, is dramatically expanded.

In the NEJM study, patients with hepatitis C treated by primary care clinicians working through Project ECHO achieved results that were identical to patients treated by UNMHSC specialists.  The evaluation also showed that the ECHO model can reduce racial and ethnic disparities in treatment outcomes.

Project ECHO offers promise as a game-changer for how patients with complex illnesses are treated.  Dr. Arora describes the power of ECHO’s knowledge networks as a “force multiplier,” which “transforms the dynamics and the capacity of health care delivery and the spread of best practices.”

In an accompanying editorial, Thomas D. Sequist, M.D., associate professor of medicine and of health care policy at Harvard Medical School and Brigham and Women’s Hospital, said Project ECHO “represents an important step forward” in addressing barriers to accessing specialty care.  He notes that the NEJM study raises several issues, including the need for  adequate health information technology to implement the ECHO model successfully, the critical role of academic medical centers in supporting the model and the potential for meeting local community health care needs by extending the model to additional chronic diseases.

Sequist makes excellent points, and Project ECHO is already addressing them head-on.

The ECHO model harnesses communications technology to form truly collaborative provider partnerships that permit care in home communities.  It connects the wealth of knowledge and expertise housed at academic medical centers and the desire of primary care providers to do more for their patients.  And although the findings from theNEJM evaluation focus on hepatitis C, the Project ECHO model has spread to include asthma, mental illness, chronic pain, diabetes and cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, pediatric obesity, rheumatology and substance abuse.

ECHO represents a fundamental rethinking of how we use our limited supply of physicians, how we engage a full care team in chronic disease management, how we teach best practices and how we provide access to quality care for all.  We know we have physician shortages, an aging population and 32 million more Americans who are going to become insured in the coming years.  Dr. Arora has developed a disruptive innovation that addresses these challenges.

Through ECHO, providers – not just doctors, but nurses, nurse practitioners, physician assistants and community health workers – are teamed to work together to the benefit of patients who receive accessible, high quality care.

Isn’t that what we all are striving to deliver?

 

Are We The Source of Knowledge?

Are We The Source of Knowledge?

We started hearing about it a couple years ago: an ALS member of Patients Like Me had seen (and translated—it was in Italian) a medical conference poster with results showing lithium carbonate could slow the disease’s progression.  That study was a single-blind trial of 16 treated patients and 28 controls.  The results spread through the ALS community and soon, patients began talking their physicians into prescribing lithium carbonate off-label. PLM soon had 348 members reporting on the effects of their use of the drug.

 PLM realized they had an opportunity to study the experience of their members who were—effectively—experimenting with the drug.  PLM couldn’t randomize, so they developed an algorithm and matched 149 treated patients to 447 controls based on the progression of their disease course.

 On Sunday, the journal Nature Biotechnology published PLM’s findings showing after 12 months of treatment, lithium carbonate had no effect on disease progression.  PLM reports that subsequent clinical trials reached similar conclusions.

 What’s important here is to recognize the potential to conduct research using patient self-reported data from an online social community.  PLM’s sweet spot is social communities for ambiguous diseases (that is, diseases we’re still learning about, diseases that don’t have clear, effective treatment protocols) where the patient does a lot of care at home.  To be sure, PLM is a pretty sophisticated community, but it’s intriguing to think about where we might be in 10-15 years.

A couple of us met last week with PLM’s Jamie Heywood and Dave Clifford.  We had a ranging discussion—hard to avoid with Heywood—that included linking patient self-reported data with clinicians, conducting research with this data, and business models.  A fundamental question Heywood is exploring is “whether it’s faster to get to learning health system through the current confines of the health system or through something like PLM.”

Given the growing ability and inclination of patients to capture and share details on their own experiences, how powerful a role is there for the analysis of this sort of data in our efforts to accelerate the discovery of new treatments for disease?

ResistanceMap Shows Rise in Dangerous Bacterial Infection

This guest post was submitted to Pioneering Ideas by Extending the Cure Research Analyst Nikolay Braykov. Extending the Cure researches policy solutions to prolong the useful life of antibiotics, an approach to fighting the rising trend of antibiotic resistant bacteria that was discussed by several prominent news outlets (The Guardian, Christian Science Monitor, Health Affairs) during last week's World Health Day.

The online tool ResistanceMap has released a new video that shows the spread of a deadly microbe able to survive treatment with the newest and most potent antibiotics in the current arsenal.

That microorganism, called carbapenem-resistant Klebsiella pneumoniae (CRKP), can cause potentially fatal pneumonia, bloodstream, or wound infections among elderly hospital patients. The featured video offers a first-of-its kind geographic retrospective of the pathogen’s emergence using nationally-representative data.

ResistanceMap, is developed by Extending the Cure – a nonprofit project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio that researches policy solutions to prolong the useful life of antibiotics. This online tool, which visualizes changes in resistance levels across regions of the U.S. from 2000 – 2009, summarizes data from microbiological labs across the country that measure bacterial drug resistance – the ability of microbes to survive treatment with antibiotics.

Whereas previous ResistanceMap videos highlighted the geography of established threats like Methicillin-resistant Staphylococcus aureus (MRSA), the new video tracks CRKP since its emergence in the early 2000s and adds to existing evidence that health authorities may be up against a new epidemic unless urgent steps are taken.

As the subject of this year’s World Health Day on April 7, drug resistance has drawn substantial attention from media like The Economist or MSNBC. In many reports, CRKP is heralded as the next “superbug”, particularly following reports on its growing prevalence in Southern California. One reason is the lack of proven treatment options – when last-resort drugs like carbapenems don’t work anymore, physicians can only experiment with combinations of antibiotics, often older drugs that have been shelved because of serious side effects. Another is that, as pointed out by a report in Scientific American, gram-negative bacteria like K. pneumoniae are very common, easily share resistance genes, and have been neglected by pharmaceutical researchers.

ResistanceMap helps us put the media coverage in more context.  In comparison with MRSA or other resistant bacteria, CRKP is still a rare, localized phenomenon - fewer than 3% of K. pneumoniae showed carbapenem resistance in 2009 and the bacteria was exclusively found in hospitals and nursing homes.

Still, the maps show how an outbreak initially confined to few New York hospitals can spread to facilities nationwide in a very short time. First emerging in the Mid-Atlantic with just a few occurrences in other regions, CRKP can now be found in 36 states.

K. pneumoniae are part of the normal microbial flora in humans and like all bacteria, their populations inevitably develop resistance mechanisms as organisms adapt to survive treatment. In order stay ahead in the race between bacterial evolution and drug research, public health officials have to act now – active surveillance and adherence to the latest CDC prevention and control guidelines can curtail the spread of CRKP before it spreads even further.

Enacting sensible, timely policies depends on our ability to inform constituents about emerging threats and to analyze existing ones. Thanks in part to initiatives like Extending the Cure, there is more public awareness and scientific knowledge available to help prevent a major crisis from unfolding and letting CRKP become the next MRSA. 

 

And the Winners Are...

As I mentioned back in August, RWJF joined the Health 2.0 Developer Challenge by offering small prizes for three different challenges:  1) building apps that leveraged the Blue Button initiative; 2) apps that bring the data from County Health Rankings into everyday decisions; and 3) bringing Project HealthDesign designs to life by building apps that work on commercial PHR systems.  At the time I said that we wouldn’t know what to expect – that we might not get anything useful at all from this exercise.  WRONG!

The response was terrific.  I won’t say overwhelming, but given the modest amount of prize money (okay, Markle scored coffee with Clay Shirky, which is no small deal) and the relative short amount of time to respond (barely a month), I’d say pretty darn good.  And definitely useful.

I’m a big fan of the Blue Button initiative for two reasons:  1) it gets the data out of the health care system and into the hands of users, where a marketplace of translators, interpreters and other tools can grow around making data useful to people; and 2) it’s beautifully simple.  The response highlighted the potential of this market:  we had large companies like Adobe and Microsoft build really valuable utilities – to translate a largely unreadable ASCII text files into very nicely designed PDF documents and to import Blue Button data into HealthVault, respectively.  But we also saw smaller organizations (seven in all) like MedCommons and RememberItNow showcase more narrowly focused apps that deal with important tasks – like getting a second opinion on a radiology image or remembering to take your meds.  Adobe came out on top in the end – and deservedly so as they built a really nice app – but the key takeaway is that they’re just the tip of the iceberg of what could come.  Hats off to the Markle Foundation, CMS and the VA for bringing Blue Button so far along so quickly.

The County Health Rankings challenge drew a number of interesting submissions.  Where we live, work, learn and play dramatically affects our health.  So when you’re choosing a place to live, wouldn’t you want to look up health indicators the way parents look up data on the quality of the schools?  That’s what the challenge winner, Acsys Interactive, makes possible.  They embedded the county health rankings data into their mobile real estate app.  So now when you want to get the scoop on the house for sale you’re driving by, you point your phone at it and get both real estate data and easy access to county health data.  The challenge drew four other submissions, which also included a utility to have the data texted to your phone when you text in a zip code and a tool to help understand asthma risks in a given county.

The Project HealthDesign Developer Challenge was won by Ringful Health, which produced a really slick app for managing chronic pain.  With it, you can use your iPhone to jot down your pain levels and triggers, get feedback on frequent triggers and how effective your medications have been at controlling your pain, and generate reports that you can share with your doctor.  Ringful had been working on this app, but, inspired by the design from Roger Luckmann’s team at UMass, added several new features and then built back end integration with the HealthVault, Google Health and Dossia personal health record services.  Another competitor, CureTogether, extended their site, which helps people track their observations of daily living (ODLs) like sleep, exercise, and food intake, to include lab test data.  A third, and very intriguing, submission came from Fred Trotter, who built an open source utility to track ODLs and store them on Twitter (in a protected account) and then use Grafitter to analyze the data and display patterns.  Fred’s solution is especially interesting because he’s leveraging existing infrastructure and by building an open source tool, he’s inviting others to take it further.

So all in all, I’m quite pleased with how the challenges went.  And it makes me wonder what challenges we should put out next.  Any ideas?

Conversation Continues Around OpenNotes - Let the Researchers Know What You Think

A week after the Annals of Internal Medicine published a Perspective Paper on OpenNotes, the Pioneer-supported project is continuing to generate a robust discussion online. Notably, The New York Time’s “Doctor and Patient” columnist Dr. Pauline Chen’s piece, “Should Patients Read the Doctor’s Notes,” has catalyzed a thought-provoking discussion on the Times’ Well blog.

Although there were more than 100 comments the last time we checked, most of the debate focuses on a single theme that matches the same concerns raised in the Annals paper – the patient’s “right” to access their information vs. the doctor’s “right” to determine what information is appropriate for their patients to receive. Each “side” has a variety of reasons behind their stance, from the desire to verify the accuracy of what’s included in their medical records on the patient-advocacy side of the house, to the fear voiced by numerous doctors that sharing notes will unnecessarily worry or confuse patients not well-versed in medical jargon.

While most comments are in favor of providing access – with a few adamantly opposed to the idea – there were also those who clearly grappled with both sides of the issue.

One commenter supported the concept begrudgingly, suggesting that providing access to medical records “isn’t what patients really want;” they want doctors who “make them feel heard” and access to their records is just something that will have to do for now. One doctor, who was willing to share his notes with his patients, suggested electronic medical records — with their drop down menus and limited space to tell the “story” — have made doctors’ notes less valuable to the patient.

Another doctor summed up his perspective with the comment, “Geez, this is not easy stuff.”

“The patient is your client and entitled to your thoughts and insights. But you are also a detective, and the patient is in some sense your “perp.” There are things in the medical record which patients may not understand, and things which if they understand them they make not like. But morally and legally I think you have to come down on the side of the patient’s right to know.”

These comments demonstrate just how complex of an issue the seemingly simple act of sharing visit notes really is. That is why researchers are looking to generate as much feedback as possible, as it will help them address all the pertinent questions when the study’s results are ready to be analyzed. If you haven’t weighed-in with your opinion already, there’s still time to get involved in the conversation and let the researchers know what you think by taking the Annals Physicians OpenNotes Perspective Survey.

 

A landmark first for the Archimedes model

At the very end of March, study findings were released in the online edition of The Lancet indicating that it is more effective from a cost and detection standpoint to begin screening for Type 2 diabetes in people between the ages of 30 and 45 — 15 years ahead of what established guidelines had been recommending.  Subsequent screenings should take place every three to five years thereafter.

While this is an important result for the medical community, the most significant piece of this story, in our opinion, was not covered in the news.  What really caught our attention was the fact that this was the first time The Lancet has ever published a peer-reviewed paper for which the research was based entirely on a simulated population and treatment options existing within a mathematical model – in this case, the Archimedes model of human physiology, diseases, interventions and health care systems.

For the study, the researchers simulated a population of 325,000 nondiabetic 30-year-olds.  According to Archimedes President and CEO John Beasley, “This paper presents the results of an international study that would never have been possible using an actual clinical trial. It would have required enrolling and following more than a million people for 45 years; the cost would have been astronomical.  The study examined the criteria for deciding when to screen for diabetes and Archimedes was the only model that could conduct a clinical trial simulation at this advanced level.”

We’re excited to see validation of the strength of the Archimedes methodology at this level.  Watch the blog for more updates soon on the status of the ARCHeS project, which will make it possible for public and health policy leaders to access the model to conduct their own virtual clinical trials from their desktops.  The vision is that a wide variety of key decisions will be informed by equally strong results from the model’s predictive analyses, and the sharing of findings powered by Archimedes will become common practice in peer-reviewed journals.

Changing the Way a Clinician Views a Patient

Last week, Susan Promislo discussed the announcement of five new grantee teams selected in Pioneer’s Project Health Design second round of funding.  As she mentioned, the teams will be testing new ways to integrate patient-generated observations of daily living (ODLs) in the clinical care process.

 

Today, Steve Downs elaborates on the concept on The Huffington Post.  As Downs mentions, “wireless data networks, smartphones, low-cost sensors and minimal software distribution costs have created new opportunities to paint a person's health experience in vivid detail.” The teams will try different ways of analyzing, synthesizing and summarizing the data and they'll try to extract clinically significant information from all the bits and bytes. They'll share the information with the participants and pass information on to clinicians. In short, they will prototype a new approach to health care - one where trends can be spotted before they manifest themselves as problems, one where the effects of new treatment regimens can be readily observed and quickly adapted, one where the connections between behavior and health can be more easily demonstrated.”  

 

Is the ability for a clinician to access a patient’s ODLs a good thing? Will it enhance care or will any meaningful signals in that data be drowned out by the noise of information overkill? 

 

We want to hear what you think.  Are we on the verge of entering a new era? We encourage you to read the post and share your comments over at the Huffington Post.

 

The Government Wants You to Play with Your Food

In a move that underscores the potential for digital games to improve health and healthcare, the US Department of Agriculture together with Michelle Obama’s Let’s Move initiative announced yesterday a competition for apps and games “that encourage children directly or through their parents to make more nutritious food choices and be more physically active.”

The Apps for Healthy Kids competition will award $40,000 in prizes in two categories: Tools and Games.  All entries will be judged on their

• Potential impact on target audience;

• Quality, accuracy, and content of message;

• Creativity and originality;

• Potential for further development and use; and

• Potential to engage and motivate target audience. 

Judges include Aneesh Chopra, U.S. Chief Technology Officer, White House Office of Science & Technology Policy; Eric Johnston, Senior Software Engineer, LucasArts; and Steve Wozniak, Co-founder, Apple Computer, Inc.

 

When USDA was thinking about this contest, they pulled together a group of folks for advice, including Debra Lieberman, National Program Director for our Health Games Research Program; and, Ben Sawyer, who runs the Games for Health Conference, which we support. 

Kudos to the USDA for seeing the value of games and to Debra and Ben for their contributions.

Death Toll from Hospital-Acquired Infections Higher than AIDS, Guns or Traffic Accidents—Costs Astronomical

Since 2006, sepsis and pneumonia, two common conditions caused by largely preventable hospital-acquired infections (HAIs), have killed 48,000 patients and have cost the health care system a staggering $8.1 billion – this according to a new study in Archives of Internal Medicine by researchers at Extending the Cure.

To put this in perspective: the death toll from avoidable pneumonia and sepsis is higher than that from traffic fatalities. It's more than three times higher than that for AIDS, and roughly twice as much as annual deaths from firearms.

The study is the largest nationally representative study to date – Ramanan Laxminarayan, Anup Malani and colleagues analyzed 69 million discharge records from hospitals in 40 states – and the findings are generating a lot of buzz.  Patients who developed sepsis after surgery stayed in the hospital 11 days longer and the infections cost an extra $33,000 to treat per person – what’s worse is nearly 20 percent of those patients died as a result of the infection. While patients who developed pneumonia after surgery stayed in the hospital an extra 14 days, cost an extra $46,000 per person to treat and 11 percent died as a result of the infection.

HAIs frequently are caused by microbes that defy treatment with common antibiotics. Co-author Malani said, “These superbugs are increasingly difficult to treat and, in some cases, trigger infections that ultimately cause the body’s organs to shut down”.

Another interesting implication is that Medicare’s decision to not reimburse hospitals by preventable so-called “never” events is not having much of an impact when it comes to HAIs.  In a case of misaligned incentives, the study suggests that penalties may not be a sufficient deterrent to motivate stronger infection control if hospitals knowingly misclassify infections to avoid penalties.  It also may be that problems documenting the infections prevent adequate enforcement. Even if the Medicare rules were fully effective, though, it wouldn’t matter…according to the NPR blog, “in an analysis that's not in the published paper, the authors looked at how many deaths could be averted each year…The answer: Fewer than 100.”

Check out other coverage from ABC News, the Wall Street Journal Health Blog and NPR’s Marketplace.

If you are interested in seeing what else Extending the Cure is working on, make sure to check out their blog and twitter account. 

What Does Your Health Care Have to Do With Your Mouthwash?

I wrote last year about consumer product, service and retail companies moving more aggressively into the health and wellness space and how their customer-focused approach could be a real challenge to the more traditional medical model which is still struggling to understand and operationalize patient-centered care.  According to recent news reports in the Cincinnati Enquirer, consumer product giant Proctor & Gamble recently purchased MDVIP, the nation’s largest concierge care company.  P&G reportedly purchased a small stake in the company a couple years ago.

 

"‘We see this as a learning venture as well as a business,’ said Nathan Estruth, vice president of P&G's FutureWorks unit,” the Enquirer reported.  Here’s a link to their story.

 

The article goes on to say that P&G “does not plan to market its products through the physician offices but rather use the company as ‘an incubator for primary care medicine,’ allowing it to gather information about patients and physicians, service and prevention. In 2008, for example, MDVIP worked with California-based Navigenics Inc., which P&G owns a stake in, to test that company's genetic marker that can gauge patients' predisposition to cancer, diabetes, heart attacks and other conditions.

 

“It's also talking with General Electric to test some of GE's diagnostic machines, Estruth said.”

 

I find these developments fascinating and can only begin to imagine how they might change the nature of care delivery.

The Value of Failure

Last week we mentioned the guest series at the Center for Effective Philanthropy blog featuring Bob Hughes. Yesterday, part three of the five part series went up and it has been generating a lot of buzz.

The topic – failure and foundation effectiveness – is not an easy or comfortable one to tackle but as Bob mentions in the post it “…is beginning to gain a critical mass of attention.” He touches on why candidly evaluating and learning from failures can be valuable to a foundation and the entire field – he even shares a few categories of failure from RWJF’s experience. 

We encourage you to check the post out and share your thoughts.

Pushing Ahead with Malpractice Reform...

We encourage you to pop over to RWJF’s Health Reform Galaxy Blog to read a post from Philip K. Howard - Founder & Chair, Common Good - on the future of Health Courts and medical liability reform.

An “exaflood” of Observational Data

Today’s New York Times has a book review of THE FOURTH PARADIGM: Data-Intensive Scientific Discovery.  It’s a collection of essays edited by Tony Hey, Stewart Tansley and Kristin Tolle from Microsoft Research.  According to John Markoff’s review, “The essays focus on research on the earth and environment, health and well-being, scientific infrastructure and the way in which computers and networks are transforming scholarly communication. The essays also chronicle a new generation of scientific instruments that are increasingly part sensor, part computer, and which are capable of producing and capturing vast floods of data."

This is an area we've been interested in for awhile...our program, Project Health Design: Rethinking the Power and Potential of Personal Health Records is exploring how people with chronic conditions can improve their health and wellbeing by capturing, understanding, interpreting and acting on information they capture from the patterns of their everyday lives - Observations of Daily Living. It's also looking at how that information can be fed back to clinicians and integrated into their workflow.

The Rise of Community Acquired MRSA

Yesterday the Journal of Emerging Infectious Diseases published a study detailing a rising health threat from of both types of drug-resistant staph inside U.S. hospitals.

 

Part of a project to fight antibiotic resistance called Extending the Cure, and funded by the Pioneer Portfolio, the study found a seven-fold increase in the proportion of "community-associated" strains of MRSA in outpatient hospital units between 1999 and 2006. "This emerging epidemic of community-associated MRSA strains appears to add to the already high MRSA burden in hospitals," said Ramanan Laxminarayan, Principal Investigator for Extending the Cure.

 

This study, which will help prompt researchers to find new ways to quickly test for various strains of MRSA and treat accordingly, has been getting a lot of press attention -- which is a good thing. We encourage you to check out the article and coverage at NPR’s Health Blog and let us know what you think about the study findings.   

 

If you are interested in seeing what else Extending the Cure is working on, make sure to check out their blog and twitter account.   

 

TEDMED, 23andMe and Kaiser Permanente's RPGEH

Excitement about the power of genomics was palpable at TEDMED this year as some attendees lined up to spit in DNA vials and send it off to 23andME. Unfortunately, many may be disappointed to find out how little our genomes can tell us without research that a large population-based research program, such as we are helping to build at Kaiser Permanente, can provide. Ann Wojcicki, CEO and founder of 23andMe, stated from TEDMED stage that Kaiser Permanente plans to genotype the DNA of 100K members but does not plan to provide that information to the individuals who donated their DNA, implying that valuable information was being withheld.

We asked Cathy Schaefer, executive director of the Kaiser Permanente Research Program on Genes, Environment and Health (RPGEH), to respond.

The RPGEH is designed to conduct research on populations to improve health and medical care. The information collected, including the genotyping of 100,000 individuals for our NIH-funded grant, will enable researchers to conduct population-based research that may help them understand the genetic and environmental basis of disease, treatment response, and health.

We inform all participants about the purpose of collecting genetic and other information, and they volunteer to participate — at no cost to them — to facilitate this research, knowing their individual results will not be returned to them and that all data about them will be "de-identified." We also inform participants that if we discover something in their data or samples that may be important to their health, we will contact them to learn if they want to have the information. 

Why doesn't the RPGEH restructure so that it can return results to individuals? Because genetic information obtained through today's genome-wide studies has not been designed to be useful to individuals; it is designed for use in research. In most cases, it isn’t known whether the variants tested for are actually implicated in a disease process, or are markers for variants that play a role in disease, and results from these tests are rarely actionable.

Ann Wojcicki from 23andMe misspoke at last week’s TEDMED gathering when she said that Kaiser Permanente does not return genetic results. Kaiser Permanente Health Plan members have access to genetic testing as part of their Health Plan membership and through their physicians. Kaiser Permanente physicians order genetic testing and return genetic results to thousands of patients, for numerous conditions, when information that testing will provide could help to inform the patient’s health care, disease prevention, or future childbearing. For example, members with some cancers or HIV may have genetic testing to determine the most effective treatment. Couples considering pregnancy may also be tested to determine family histories for certain diseases that may be passed on to their children.  

Individuals who have questions about their genetic risks for various health conditions should talk to their physicians, who can provide useful information about risks and options for testing.

This Week We Are Reading About TEDMED

This year’s TEDMED conference was packed with engaging speakers, exciting presentations, and promising innovations.  If you weren’t able to attend or you just want to see what other attendees had to say then we have some links for you.

Want a comprehensive day by day rundown of TEDMED 2009? Medgadget has just what you are looking for.  Check out their recaps of Day 1, Day 2 and Day 3.

Looking for more detail on a specific speaker or innovation? Chances are that mobihealthnews has a recap for you. The future of wireless stethoscopes; the state of 23andME’s genome database; the findings from Penn Schoen Berland National Healthcare Survey for TEDMED; and  how iMeds will be bigger than iTunes.

Finally, make sure to check out twitter and YouTube to see what big ideas TEDMED participants had when asked,  “If someone handing you a blank check — what would you do to transform the future of health and health care?”  

As we mentioned last week, we don’t want to limit the conversation to the group at TEDMED – let us know how you would transform the future of health and health care via twitter -- make sure to tag your "tweets" with the #blankcheck hashtag.

A Few Links to Share...

It looks like we are not the only ones to find the research Pioneer grantees Drs. Lisa Schwartz and Steven Woloshin did on the effectiveness of prescription drug labels interesting and innovative.  Here is a round-up of some of the coverage following the release of their paper in the NEJM this week. 

Prescription Drug Labels -- What the Companies Don't Tell

Want a quick synopsis on Schwartz and Woloshin’s paper? The Baltimore Sun’s daily column, Picture of Health, has just what you are looking for. 

 

Getting the FDA to Share What it Knows About Drugs

You can learn a bit about the pilot test conducted by Schwartz and Woloshin where FDA reviewers compile “Prescription Drug Fact Boxes” that lay out the benefits and harms of a drug in an easy-to-read table, in The Los Angeles Times health blog, Booster Shots. 

 

NEJM: Drug Labels Lack Key Info

FirecePharma wonders ‘are drug labels too optimistic?’"How can I decide if the potential harms of this drug are worth the risk?” Dr. Woloshin asks “…if I don't know how well the drug works, and vice versa?"

Information Lost Between Review and Drug Label

Finally, wondering what the manufacturers think about Woloshin and Schwartz’s article?  medpagetoday.com offers comments from Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America.

 

Don’t forget to read Al Shar’s prespective – you can check it out here.

 

CBS Sunday Morning to Feature Common Good, Health Courts

This weekend, tune in to CBS Sunday Morning for its lead story on Common Good, which, together with researchers at the Harvard School of Public Health, has been analyzing and testing the viability of a system of administrative health courts to more rationally handle medical injury claims.  The CBS piece will look broadly at legal fear in America, a key thread in Common Good Chair and Founder Philip Howard's new book, Life Without Lawyers.  Interviews touched on health courts and their potential to reduce errors, boost patient safety and improve the overall quality of care, in addition to producing a more functional and effective process for resolving medical liability disputes.  Click here to find out where and when to watch in your area.

Are questionable dosing practices fueling antibiotic resistance?

This post comes to us from Patricia Geli Rolfhamre over at Extending the Cure.  More in-depth conversation about antibiotic resistance and the future of our nation's supply of antibiotics is happening on the ETC blog.

Are there ways in which we can reduce the spread of antibiotic resistance by treating patients more strategically? The dosing and duration of antibiotic treatment have been shown to be critical determinants of the likelihood of curing an infection and of the emergence of resistance.   Adjusting these factors to a patient’s individual condition instead of treating every patient with the same antibiotic regimen may be an easy step toward fighting resistance.

Research reports from the American College of Emergency Physicians annual meeting in Boston earlier this week revealed that doctors who work in hospital emergency rooms rarely adjust antibiotic doses for obese patients. The consequences are an increased risk of treatment failure and resistance development. Yet it is unclear how much this will spur the growing resistance epidemic. Given the fact that more than a third of the US population is obese - this trend is worrying. But solving the obesity problem or adjusting the doses for obese patients is only a part of the answer. The other important parameter for successful treatment and for which a one-size-fits-all approach has generally been applied is the duration of treatment.

Equity In Speciality Care: The Aravind Eye Care System

If you have been reading our interview series with David Roe and David Green about a project in San Francisco to create equity in specialty care, then you know at least a little bit about the project that inspired them – the Aravind Eye Care System.  

Like Aravind, this new pilot project is being designed to accept and treat paying patients and non-paying patients exactly the same.  For over three decades, Aravind has been successfully providing care to paying patients and using the profits to offer free care to those who cannot afford it.  

This past Wednesday, the NewsHour with Jim Lehrer featured a piece on Aravind – now the largest provider of eye care services in the world – and their successful model.  Check it out and then come back to Pioneering Ideas and check out the rest of our series with David Roe and David Green.

Can a Reduction in Hospital Acquired Infections Cut Health Care Costs?

There is no denying that hospital acquired infections (HAIs) are an expensive drain on the system and impact the lives of an estimated 1.7 million hospital patients a year – killing nearly 99,000 annually. Is it possible that simply instituting best practices in infection control can substantially reduce these infections and save the nation’s healthcare system billions of dollars a year?  Yes, according to an article in last week’s Roll Call by Ramanan Laxminarayan of the Extending the Cure initiative, a Pioneer grantee, and Ed Septimus from HCA Healthcare System.  Laxminarayan and Septimus propose several ideas and incentives, which they believe will reduce the rate of resistant HAIs and control the rise of antibiotic resistance. 

Are hospital acquired infections really the low hanging fruit that will benefit patients and cut health care costs?  Check out the article and then come back here and let us know what you think.   

 

Mix of things to check out

A bunch of things caught my eye today that may be of interest.  First, given that the Games for Health conference kicks off today and I have to sit it out this year, I was especially glad to see this article in the Syracuse Post-Standard.  It profiles one of our Health Games Research grantees, Cornell University, which has given middle-schoolers iPhones loaded with a game designed to encourage healthier eating choices.  The way they do it is pretty clever, though...the kids take care of their own virtual pet and snap photos of their food selections, which are sent to the Cornell research team.  When indicated, the virtual pet will prompt the kids to consider, say, trading in their chips for a yogurt next time.  It's more of a fun interaction than preaching, as the article points out, and it goes wherever the kids go.  I like that it shows how health is playing out apart from health care settings and encounters, and how games and game technologies may provide ways to deliver health messages to kids in ways that are so much more up their alley, and potentially so much more effective.

Second, Steve Downs and John Lumpkin blogged on June 1 on "Catalyzing an App Store for EHRs," which our friends at the Health Care Blog were kind enough to re-post.  A great conversation has kicked up around this - read the comments and add your own thoughts.

Finally, Project HealthDesign received 145 new proposals last week in response to its Round 2 CFP. National Program Director Patti Brennan talks about the breadth of ideas and wide range of observations of daily living that teams proposed - they'll be working together with patients managing multiple chronic diseases to capture and analyze health data generated in the course of daily life and test how it can be integrated in to clinical care workflows.

The Need to Disrupt the Patient Gown: New Research, New Thinking

The efforts of Pioneer grantee North Carolina State University to redesign the current hospital gown are featured on the front page of today’s Wall Street Journal.  Congratulations to Blan Godfrey, Traci May Lamar and the NCSU team – it’s great to see prototype designs emerging from their comprehensive research to determine the needs, constraints and priorities of players up and down the hospital gown supply and demand chains.

 

The article takes a light touch with the subject matter.  True, most everyone hates the gown because it’s an unmitigated fashion disaster…ugly, flimsy, see-through, ill-fitting, inconvenient, hard to tie or fasten, and often thoroughly humiliating in its, er, exposure.  I’ve searched for who is buzzing about this story so far, and it’s been highlighted on the (presumably official, but who knows) Twitter stream of French fashion house Givenchy – I’m thinking this is an RWJF first.

 

But this project was always designed to go deeper, and there’s a real vision and potential for change in health and health care that motivated Pioneer’s decision to support this work.  Indeed, it’s interesting to think about it in the wake of Clay Christensen’s visit last week.  The current patient garment is a classic, ubiquitous example of a job that is not getting done for patients or, as the NCSU research shows, care providers either.

 

Between the survey research and focus group findings at the heart of this project, we’ve learned some interesting things about the gown, how people feel about it, and its impact on care.  The upshot is that it’s never been about just looks: 

• 87% of caregivers felt the current gown sometimes interferes w/ administering IVs, catheters, feeding tubes or other devices. 

• 88% responded that the gown sometimes or always affects the emotional wellbeing of patients.  66% thought it sometimes or always affected patients’ physical well-being.

• 74% of nurses are involved in the gowning process; patients are not comfortable with how to put the gown on when confronted with it, so that even if they’re not seriously ill or impaired, they typically ask nurses for help.

• Some patients confessed that they may limit their mobility becaused they are concerned about being overly exposed in areas outside of their hospital rooms – people don’t just lie in bed anymore to get well. 

• Patients tend to use a second gown as a robe to cover them from the back, which effectively doubles the cost and time of collecting, laundering and stocking gowns.

• There is the perception that nicer, more dignified gowns may help patients feel better emotionally and be more active, boosting their prospects for and pace of physical healing and recovery.  Patients are struck by their loss of dignity and control in the hospital experience..."If I have this gown, I’m really sick.”

It seems that there are certain things in medicine that we do because they’ve always been done that way; such is the case with the patient gown.  It’s become institutionalized as part of the status quo and has gone unchallenged for decades.  It seems so simple and obvious to change the gown and bring it in line with 21st-century care requirements and patient needs and preferences – however, if it were that simple, it would have happened.  As NCSU’s Traci May Lamar states in the article, "We thought that it would be a much easier problem to tackle."

Update: Positive Deviance & MRSA Reductions on NYT Lede Blog

Kevin Sack interviewed the CDC's John Jernigan about the effects of the Plexus Institute's positive deviance MRSA prevention partnership and wrote a post on the New York Times "Lede" blog.  Check it out and comment away, either there or on Pioneering Ideas.   

CDC: Positive Deviance Helps Reduce MRSA Infections

We've written several times before here on the blog about MRSA (methicillin-resistant Staphylococcus aureus) infections, their impact on lives and on hospitals, and the Pioneer-funded work of the Plexus Institute to explore "positive deviance" as a method to cut a hospital's MRSA infection rate. 

This past Saturday, at a special late-breaker session during the Society for Healthcare Epidemiology of America's 19th Annual Scientific Meeting, RWJF and Plexus announced the results of a study conducted by the Centers for Disease Control and Prevention (CDC) of whether the positive deviance approach does, in fact, work on MRSA.

We were thrilled to see that the answer is a resounding yes: significant reductions in MRSA incidence ranging from 26 to 62 percent at participating hospitals.  You can read more about the study and its results here.

And because a picture is worth a thousand words, you might also want to see how CBS News reported the story on Sunday night: 

Guest Bloggers: the Drug Box Meets the FDA

A few weeks ago, Al Shar told us about the work of Lisa Schwartz, Steve Woloshin and Gilbert Welch on a simpler way to communicate information about prescription drugs in direct-to-consumer advertising. Recently, the researchers met with the FDA to discuss their work, and then provided us with this report:

"The drug box was very positively received at the FDA's Risk Communication Advisory Committee meeting (February 27, 2009).  We described the history of the drug box (it was inspired by the FDA nutrition facts box), reviewed four studies demonstrating that consumers want, understand, and are influenced by drug efficacy and side-effect data, and summarized our pilot work to date with the FDA (funded by the RWJ Pioneer program).

We made the following recommendations to the committee:

1. FDA should start producing drug facts boxes as part of the review process for  new drugs now - either in a stand-alone form or as part of other CMI efforts.
2. Consumers want and understand data on drug efficacy and side-effects as presented in drug facts boxes.
3. No one is better positioned than FDA reviewers to write boxes.
4. Drug facts boxes are an effective way for FDA to ensure that it communicates what it knows about drugs to the public.

Following several hours of discussion, the committee voted unanimously that 'FDA should adopt the Drug Facts Box format as its standard' in communicating essential information about prescription drugs. While the vote was extremely gratifying for us, the committee's recommendations are not binding.  At this point we simply do not know how the FDA will respond.  And we may not know for some time:  many important policy decisions will be on hold until the new FDA Commissioner is named."

Our thanks to Lisa, Steve and Gilbert for this update.  We'll keep you posted on future developments.

Could a Virtual Nurse or Doctor Be Your Future Facebook Best Friend?

Microsoft and their partner Intel have an understandable interest in promoting new computing fields. So the recent reference to a Jetsons-style future with a virtual personal assistant, named Laura, coming out of Microsoft makes sense – Laura can tailor responses and decisions to your personal situation and visual presentation.

 

The challenge for Laura gaining a significant following in the long run may be the number of people any of us can have a meaningful relationship with. As estimated by the Anthropologist Robin Dunbar, humans can have about 150 connections in a stable social network. Recent analysis of Facebook data by Cameron Marlow reinforces the hypothesis, along with the observation that the number of friends a person frequently interacts with is typically quite small. At the upper end, when you go much beyond the 150, the cognitive limits of our species become a constraint. Now all this is far from precise, but the main point is that we do have limits, and preferences among possible types of friends. So what kind of person might make the list?

 

How about one that knows your health history, routine behaviors, and likes and dislikes. One who you can trust unconditionally, who could give you advice about how you could make your life more fulfilling, more healthful? In short, how about someone with the qualities that we often wish our nurses and doctors had? Could Laura be your future doctor or nurse and make it into your Dunbar 150? Might Laura be your best friend in 2020?

When Simple Works

Good health information ideas that work don’t have to be complex, use lots of technology and be hard for the user to understand. That’s the way I read the article “Communicating Drug Benefits and Harms With a Drug Facts Box: Two Randomized Trials” by Lisa M. Schwartz, MD, MS; Steven Woloshin, MD, MS; and H. Gilbert Welch, MD, MPH that appeared in the newest issue of the Annals of Internal Medicine. If you don’t want to read the whole thing, USA Today ran a good summary of the study outcomes.

 

The idea is fairly simple: replace the brief summary page that accompanies print advertisements for prescription drugs with a “drug facts box,” a table that quantifies outcomes with and without the drug. The idea is similar to the nutrition information that is standard on foods sold in supermarkets. The article discussed two trials, a symptom drug box trial using direct to-consumer ads for a histamine-2 blocker and a proton-pump inhibitor to treat heartburn, and a prevention drug box trial using direct-to-consumer ads for a statin and clopidogrel to prevent cardiovascular events. Since the pharmaceutical industry spent more than $5 billion on these ads in 2007 – more than twice the total U.S. Food and Drug Administration (FDA) budget – finding a way to help inform consumers is important.

 

The results were impressive. In the symptom drug box trial, 70% of the drug box group and 8% of the control group correctly identified the PPI as being “a lot more effective” than the histamine-2 blocker (P 0.001). In the prevention drug box trial, 72% of the drug box group and 9% of the control group correctly quantified the benefit of the statin. (See left for a sample).

Last August Pioneer helped fund a collaboration between this research team and the FDA in the development of 10 prototype boxes. Unfortunately, right now the FDA seems absorbed with, once again, studying the “best” way to work. Sometimes striving for perfection impedes actions that can have a positive effect right now. This might be one of those times.

Is the country ready for health reform?

Health reform seems to be on everyone’s mind these days – and why not? Our system doesn’t deliver great value overall, it is inequitable, and the economic crisis promises to make it much worse unless we can do something about it.

I came across two views of health reform Sunday – one by David Leonhardt and the other by Janet Rae-Dupree – both in the New York Times. Leonhardt placed health reform in the context of big picture economic strategy over decades; Rae-Dupree brought the lens of disruptive innovation to health reform. Leonhardt singles out health because it is such a daunting fiscal problem, even in the context of the worldwide economic crisis. The future unfinanced obligations under Medicare plus a distinctly inefficient system makes the future price tag of health reform bigger than the estimated bailout. That is not what most people have in mind when they think of health reform – they think of more people having insurance coverage and improving the care people get.

Rae-Dupree applies Clayton Christiansen’s concept of disruptive innovation to health care, drawing on his book The Innovator’s Prescription, and holds out this pathway for getting beyond the current gridlock of inefficiencies. She describes promising examples, some based on emerging scientific discoveries that point the way.

Both views underscore the need for fundamental changes. But I can’t escape the feeling that much of the country isn’t really prepared for the consequences of health reform that would address some of the basic problems with our system. Disruptive innovations replace existing business models, they would change the way care is delivered – when, who, how, where, costs, and perhaps even our very conception of health-improving services. Health reform may have to combine these two views, addressing the looming budget challenge and encouraging disruptive innovations. Figuring out what the country will do about future Medicare obligations may just require a system that fosters the benefits that disruptive innovations can bring. It will certainly test the country’s resolve to improve health through reform at a time when all of us will be called upon to sacrifice.

Where's the revolution?

In Sunday’s Washington Post, Health Reporter David Brown wrote a very interesting thought piece, We All Want Longer, Healthier Lives. But It's Going to Cost Us. He outlines the “steady, predictable, relentless growth” we’ve seen in health care costs since the end of World War II. He says the time of cheap innovations that can produce the longer, healthier lives we all desire—clean water, vaccines, antibiotics—is past. Citing work by David Cutler at Harvard, he writes, “In the 1970s, it took $46,870 to add a year to the life expectancy of 65-year-olds. By the 1990s, it cost $145,000.” The next gains, Brown suggests, will come at even greater price.

There are some things we could do to shift the curve down, to save some money. Bringing down administrative costs, for instance. Or prevention, thought he notes prevention hasn’t been demonstrated to be any cheaper in the long run. Ultimately, though, on our current path, “We are on a collision course between our wish to live longer, healthier lives and our capacity to pay for that wish.”

Unless…

Brown suggests the current collision course sounds similar to that proposed by English Parson Thomas Malthus in the 18th century. Malthus published "An Essay on the Principle of Population as It Affects the Future Improvement of Society,” in which he projected a point in time where population growth would outstrip food production capacity. His analysis made a lot of people nervous.

But there were two things Malthus failed to imagine: “The first was that scientific agriculture would eventually double, triple and quintuple crop yields,” Brown writes. “The second was that when industrialization pulled huge numbers of people out of poverty, infant mortality fell, women became more educated, and the value of their labor rose. The net result was a huge decline in birth rates. This is known as the "demographic transition," and virtually every region of the planet has gone through it.”

We need a similar revolution in healthcare to avoid the collision between our desires for long and healthy lives and what those lives will cost, Brown says. Where it will come from, he doesn’t know.

So: Where will that revolution come from? Advances in genomics? Proteomics and diagnostics? New business models ala Clayton Christensen’s recent book, The Innovator’s Prescription? Any and all thoughts welcome.

Positive Deviance named an "idea of the year!"

The New York Times Magazine for Sunday, December 14 contains its 8th annual wrap-up of the ideas that "helped make the previous 12 months, for better or worse, what they were." The ideas are listed alphabetically, and there among the "p"s is an idea Pioneer's been exploring for some time, Positive Deviance.  In fact, Curt Lindberg, of our grantee Plexus Institute (also noted in the Magazine's short essay), wrote an introduction to P.D. here on the blog back in July, 2007.  Faithful readers can now say they knew it when...   

Vote Now: Two Pioneer Reports In the Running for RWJF's Top Research of 2008

Every year, David Colby, RWJF's vice president for research and evaluation, showcases 10 RWJF-supported research projects that have contributed to greater understanding of an issue or can help inform policy discussions.

This year, he's doing things a little bit differently. He's opened up a poll on RWJF.org so people can cast their votes for the most influential RWJF-supported research of 2008.

We're pleased he's included two papers supported by the Pioneer Portfolio among his 25 finalists:

The Collective Dynamics of Smoking in a Large Social Network
Using data from the Framingham Heart Study, Nicholas Christakis and his colleagues reconstructed the social networks of more than 12,000 individuals and found that smoking cessation occurs in network clusters. The study, published in The New England Journal of Medicine, also concludes that the chances of continuing to smoke decrease significantly for an individual when a spouse, friend or even sibling quits smoking.

In a blog post, "The promise of social network analysis," Lori Melichar wrote about this study and the potential for social network analysis:

Christakis’ research findings have the potential to drive a fundamental rethinking of health policy, clinical care, research and evaluation, and public health campaigns. If social network analysis continues to produce promising new results and becomes widely used – and if it helps us to think differently about how we design health interventions and health campaigns that ultimately achieve greater success – then we will have achieved a key breakthrough in the health and health care of all Americans. 

Most recently, Christakis and his colleagues published a study in BMJ about the social spread of happiness, which Susan Promislo blogs about here.

Administrative Compensation of Medical Injuries: A Hardy Perennial Blooms Again
In this article, published in Journal of Health Politics, Policy and Law, a team from Common Good and Harvard School of Public Health looks at the history of administrative compensation proposals over the last 30 years and examines the success of the administrative compensation model in fields like worker's compensation, vaccine injuries and automobile injuries. The authors conclude that establishing pilot projects, particularly through a voluntary or contractual approach, is likely the most practical way to realize the potential of this model for medical injuries.

Abbey Cofksy wrote a blog post about the latest work from this project in October:

Common Good and their collaborators at the Harvard School of Public Health continue to build the research base and policy consensus for a new system of specialized administrative health courts. An innovative alternative to our nation's current medical liability system, health courts would apply rational, consistent standards to resolving medical liability claims and compensating injury patients.

To vote for the top 10 RWJF-supported studies, visit the RWJF Year in Research 2008 poll. Voting is open until December 23.

RWJF will announce the winners in the new year through an RWJF Content Alert. To receive notification of the winners, subscribe to one or more of RWJF's Content Alerts.

(And to see what's been highlighted in the past, read the 2007 Year in Research here, which featured the work of Pioneer grantee Extending the Cure).

"Happy Friday!" Takes On Added Significance with New BMJ Study

I'm happy today, which is likely to mean that my friends and family are happy, and their friends and family are feeling right with the world too.  So say grantees Nicholas Christakis of Harvard Medical School and James Fowler of UC-San Diego -- the latest study from their ongoing analysis of health effects in social networks finds that happiness, like smoking- and obesity-related behaviors, is a social contagion.  The article, "Dynamic Spread of Happiness in a Large Social Network," came out today in BMJ and has been getting a good deal of attention in the LA Times, Washington Post, NPR and elsewhere. 

As with earlier studies to come out of this line of research, Christakis and his colleagues used data from nearly 5,000 individuals enrolled in the Framingham Heart Study over a period of 20 years, and find a three-degree flow of influence when it comes to spreading the cheer. The graphic above shows the spread across the network.  Check out this finding from the release:

"...when an individual becomes happy, a friend living within a mile experiences a 25 percent increased chance of becoming happy. A co-resident spouse experiences an 8 percent increased chance, siblings living within one mile have a 14 percent increased chance, and for next door neighbors, 34 percent.  But the real surprise came with indirect relationships. Again, while an individual becoming happy increases his friend’s chances, a friend of that friend experiences a nearly 10 percent chance of increased happiness, and a friend of that friend has a 5.6 percent increased chance—a three-degree cascade."

Interestingly, the effect is not seen if you're unhappy -- that sentiment does not seem to spread the same way.  And it doesn't exist among co-workers.  Apparently, this may come in to play when we don't all exude joy in the same way as that dear colleague who just got the big promotion. 

Finally, Christakis and Fowler propose implications for health policy and health care:

"To the extent that clinical or policy manoeuvres increase the happiness of one person, they might have cascade effects on others, thereby enhancing the efficacy and cost effectiveness of the intervention...illness is a potential source of unhappiness for patients and also for those individuals surrounding the patient. Providing better care for those who are sick might not only improve their happiness but also the happiness of numerous others, thereby further vindicating the benefits of medical care or health promotion."

So, happy Friday, indeed -- here's hoping the feeling carries right through your weekend and to everyone in your networks.

Do you flu Yahoo!?

Google.org may have grabbed headlines last week with the announcement that search term activity on its engine may forecast real-life flu activity, but grantees Phil Polgreen and Forrest Nelson are releasing the first peer-reviewed journal article that documents this trend.  Together with partners at Yahoo! Research and Harvard, they published a study in Clinical Infectious Diseases that finds that frequency of Web searches on flu and influenza (excluding searches related to avian flu, vaccines and other outlier terms) predicted increases in cultures positive for influenza one to three weeks in advance.  Their study, and a quote from Phil, were cited in the New York Times cover story on the Google flu trends service.

Given the ultra-real-time nature of Web information, and the fact that 8 million people search for health information every day, it’s perhaps not surprising that this is a potentially rich avenue for exploring whether people’s hunt for information online signals their health concerns, experiences, conditions, behaviors, expectations and even outcomes.  This has sparked privacy concerns -- also not surprising.

Polgreen, Nelson and colleagues examined the relationship between influenza culture data and Yahoo! searches at the national level, breaking searches down in to 9 Census regions and tracking activity over time.  They reported a statistically significant relationship between intensity of flu-related queries and levels of flu cases and even deaths.  The methodology has some limitations due to the fact that data only go back four years and other reasons, but it’s another potentially valuable tool in public health professionals’ toolbox.  And given the reality that current CDC surveillance activities identify disease activity only as or after it occurs, any advance jump on an outbreak seems like a good thing. 

This is what drives Polgreen’s and Nelson’s other Pioneer-funded work to test the use of electronic prediction markets to forecast domestic and avian flu activity.  The premise being that more knowledge, gained more quickly, fuels wiser policy and resource allocation decisions, better prevention and treatment actions, and hopefully less incidence of disease with less harmful effects. 

Search term surveillance may yield trendspotting clues for public health officials fighting emerging and reemerging infectious diseases, changes in phenomena tied to chronic illnesses or trends in STD infections ahead of official reports of disease activity.  It’s fascinating to think of the potential that exists in mining aggregate data from the ways we digitally engage in the world in the course of our everyday lives, and how that collective information may be applied to improve public health and health care practices.  This is an area that Pioneer might explore more down the road – we’d like to hear what you think about this, and how it might be applied.

Interesting things, here and there...

Thanks to Jerry Michalski of Sociate for telling us about a massively multiplayer online game hosted by Institute for the Future called Superstruct.  The folks who do IFTF's 10-year forecasts put together a game in which anyone and everyone can figure out what life might be like in 2019, and help invent the future of society as it relates to 5 different scenarios.  One is directly about health -- the QUARANTINE category states that outbreaks have become a common element of our existence.  It focuses on a respiratory infectious disease called ReDS and challenges players to consider all the implications and figure out how to respond.

The other game scenarios have important implications for health as well, as they immerse you in envisioning a world in which we're:

• RAVENOUS - the food chain is broken and we have to reinvent ways to feed ourselves
• in a POWER STRUGGLE - the world is caught up in "Alternative Fuel" wars over what will take the place of oil
• facing GENERATION EXILE - our neighbors have become climate and economic disaster refugees in search of new places to live, or
• an OUTLAW PLANET -- In 2019, the mobile internet and sensor networks we rely on to hold our societies together are being hacked, griefed, and gamed.

The site today reports that there are 4,905 players with a collective score of 4,911.  What this means is that the current survival horizon, based on all of these superthreats and how we deal with them, is through 2047.  The game started on Oct. 6 and runs for 6 weeks -- check it out and sign up to play.

Another item worth reading is eFuturist Douglas Goldstein's take on the future of video games and health, posted today on The Health Care Blog.  He has this to say:

"It may be surprising to some that the health care industry has been among the first to recognize the ‘game-changing’ potential of games in business and other environments.  Leaders in the health care sector are now embracing video games as an integral part of a digitally enabled health culture."

He also points to an October 2008 market report from iConecto that identifies health games as a growing field.  Right now, they estimate that the health games market stands "at approximately $7 billion during the next 12 months including the markets for brain fitness ($267M), exergaming ($6.4B+) and other Health eGames on the consumer and professional side ($250M+).  An expanded executive summary of the report can be obtained here.

Modern Healthcare Reports on Pioneer's Work on Games

Recently, Modern Healthcare highlighted Health Games Research, Games for Health and Pioneer's overall interest in exploring games as a health care innovation. The magazine described the work of our grantees and reported on recent research into the interaction of games and health. We thought you'd like to see what they had to say:

The Games Patients Play

Whether it's for treatment, prevention or even provider education, health care is becoming more and more interactive. An article by Modern Healthcare.

By Jessica Zigmond

Improving 21st century healthcare is, unquestionably, an expensive, complex and vital endeavor for the U.S. But can it also be fun?

Researchers, hospitals and insurers think so, which is why they’re investing time and money to develop interactive games that could change behavior—and perhaps help cut costs—in healthcare.

The Robert Wood Johnson Foundation, a not-for-profit philanthropy that focuses on the country’s most pressing healthcare needs, is leading these efforts through Health Games Research, an $8.25 million project funded through the foundation’s Pioneer Portfolio. Established about five years ago, the Pioneer Portfolio considers innovative ideas that could “break the current paradigms of healthcare,” says Chinwe Onyekere, a program officer at the foundation who works with the Pioneer team. In May, the foundation awarded more than $2 million to help bolster the evidence base that supports the development and use of interactive games for health purposes. A dozen institutions were granted up to $200,000 each to lead one- to-two-year studies of games that engage players who range in age from 8 to 98.

“We’re gaining insight into how people learn,” says Debra Lieberman, director of Health Games Research and a lecturer in the department of communication at the University of California at Santa Barbara, which is the program’s headquarters. “What I love is that people do this willingly. These games are so well-received,” she says, adding that it’s fun to watch how hard people try when playing a game.

Lieberman says she conducted a study of children ages 6 to 11 and asked if they preferred learning from a book, a video or a video game. She found that 49 of the 50 kids said they preferred a video game because it “lets you try things out.” She’s now trying to pull the over-30 generation into this world. “People say this will sugar-coat learning,” she says. “Learning is fun. Everyone loves to learn, but they need a reason to learn.”

The article continues after the jump.

Sports4Kids -- Winning Through Play

We've written a lot about competitions that RWJF has sponsored with Ashoka's Changemakers, but here's a great piece of news coming out of a  competition that was not tied to us.  Yesterday, Sports4Kids, a Bay Area-based program supported by RWJF's Vulnerable Populations Portfolio, was voted by the Changemakers online community to be one of  three winners in the "Sports for a Better World" competition, sponsored by Nike. 

I've lucked out by getting to work with Sports4Kids in the past, and their model is revolutionizing recess and reintroducing play in to the lives of low-income kids.  Founder and Ashoka Fellow Jill Vialet is a dynamic force in bringing the power of play to change kids' lives, improve school environments, and build family and community engagement.  Check out the video to get a sense of the program's impact and why it's exciting to see this program gain wider recognition. 

Congrats to Sports4Kids, and to Changemakers for another successful competition that has elevated the efforts of leading social entrepreneurs throughout the world.

Medical records make WIRED's list of "things that suck"

You’ve got to hand it to Wired for calling things as they see them.  In their February cover story they explore the banes of our existence – the “33 Things That Drive Us Crazy”.  Not far from the top is the header:  “Medical Records – They’re a Mess!”  It’s a pretty strong condemnation, especially when you consider that other items on the list include junk mail, air travel, commuter traffic, magazine subscription cards, and my personal pet peeve:  the hard plastic packaging that can only be opened by an arsenal of dangerous kitchen implements.  It’s a good rant and it raises some cautionary points about believing that electronic medical records will solve everything.  It also offers an exhortation for people to pressure their doctors to accept a more transparent system. 

So this of course leads to me ask what else about health and health care drives you crazy?  EOB statements?  Having to pay more for your drugs when they go from prescription to over the counter?  Send us your rants.

We thought it was pretty cool, too...

At the end of every year, David Colby, RWJF’s Vice President of Research and Evaluation puts together “the list”- ten articles from the Foundation’s top research and evaluation projects that had a real impact in the policy arena, helped shape the Foundation’s thinking and work, or stood out in other ways during the year.

This year, the work of Pioneer grantee, Extending the Cure, made it to the list.

We’ve spoken about Extending the Cure before on the blog. Paul Tarini introduced Pioneer’s work with its parent, Resources for the Future, back in March, highlighting the innovation involved in treating antibiotic resistance as an economic problem. Ramanan Laxminarayan was a guest blogger later that month and wrote about Extending the Cure’s analytic process. And then Laxminarayan’s colleague Eili Klein joined us just a few weeks ago to describe the actual findings that made it to the “top ten” list.

Extending the Cure’s staff, and their research to understand trends in staph and MRSA infections, and the risks of antibiotic resistance, have generated a lot of excitement both in the field and here at the Foundation.  We expect their voice will be a key one as the conversations around MRSA and hospital-acquired infections continue to unfold.

Check out David’s list – it is an impressive collection of work and it will certainly offer some fascinating conversation starters for all of your holiday parties!

Guest Blogger: Eili Klein on Antibiotic Use and MRSA

Eili Klein, of Pioneer grantee Resources For the Future, is lead author of an article in the most recent issue of Emerging Infectious Diseases on hospitalizations and deaths in the U.S. caused by Methicillin-Resistant Staphylococcus Aureus, or MRSA. We asked Eili to comment on the article, its findings and their implications, and he responded:

Recently, it has been impossible to turn on the news without seeing another report about MRSA, an antibiotic-resistant form of a common bacterial infection. It was a feature on CBS’s 60 Minutes, and the subject of countless local news reports that the so-called “superbug” had become rampant in high school locker rooms and caused serious illness and some deaths in elementary school-aged kids.

                                    

While news coverage of local events has been extensive, there had been, until recently, a lack of data at the national level to assess the magnitude of the problem and its trend. My colleagues and I at Extending the Cure, a project of Resources for the Future, have just published a study that finds that resistance to drugs traditionally used to treat MRSA has increased significantly.

Based on data compiled from national records of hospitalizations and resistance, our study showed that the number of people hospitalized with MRSA infections more than doubled, from 127,000 to nearly 280,000, between 1999 and 2005. We also found that as many as 17,000 people infected with MRSA die each year.

In addition to this steady growth in the number of infections found among hospital patients, we also found a dramatic increase in the rate of minor skin and soft tissue infections – often looking like pimples or boils - commonly caused by another strain of MRSA that is generally acquired in the community.

This new infection pattern suggests that as the epidemic of drug-resistant infections in hospitals continues unabated, more and more MRSA infections requiring hospitalization also are being transmitted in the community.

Our study is the first to examine recent trends in staph and MRSA infections. In combination with a recent report in the Journal of the American Medical Association that provided a detailed snapshot of MRSA’s impact in 2005, this research suggests that the problem of MRSA should be a national priority.

Of particular interest to us at Extending the Cure is the potential for MRSA to increase the  pressure on our waning antibiotic arsenal; treatment of MRSA, after all, requires the use of antibiotics of last resort like vancomycin, and the prospect of MRSA developing resistance to this drug is scary, indeed.

It is for reasons just like this that we at Extending the Cure recommend incentive-based policy solutions that engage all parties with a stake in the continued existence of effective antibiotics. In the specific context of hospitalizations involving antibiotic-resistant infections, policies might include not only increasing surveillance and reporting but also making this information more widely available and linking hospital reimbursements to successful outcomes from infection control programs. Our research on MRSA, its growth and spread and the risk it poses, only reinforces the need to take action.

Active Games - A Less Intentional, More Effective Workout?

Last week, New York Times reporter Tara Parker-Pope explored the consumer appeal and health benefits of active games.  The Wii and Fisher Price's Smart Cycle are some of the hottest sells this holiday season.  Learn why, after the jump, in the full article, for your reading pleasure.

More Attention for MRSA

Today's release in the Journal of the American Medical Association of the Centers for Disease Control and Prevention's study of the prevalence of MRSA is getting a lot of press attention, and this is a good thing.  The study found that annual deaths from MRSA infections may "exceed those attributed to HIV-AIDS, Parkinson's disease, emphysema or homicide each year," as The New York Times puts it (note registration may be required to view article). Scary stuff, indeed. 

We've spoken before about MRSA on this blog and have also highlighted the work of Pioneer grantee Plexus Institute, currently in the middle of a study of the effectiveness of Positive Deviance approaches to the reduction of MRSA infection rates.  The folks at Plexus tell us they may have some verified results to report in the next month or so, and we'll let you know about them as soon as we can. 

In the meantime, we draw your attention to this preliminary report of Plexus' work at the Pittsburgh VA Hospital, and remind you of Plexus' Curt Lindberg's comment on one aspect that contributed to the successful reduction of MRSA in Pittsburgh:

"Encouragement of conversations and connections among a diverse group of people who ordinarily do not work on quality issues together but whose work bears on the problem (like hospital clergy, environmental workers, unit secretaries, nurses, transport staff in the case of MRSA)."

Given the squabbling about strategies for MRSA reduction reported in the Times article, this reminder of the need for collaboration may be useful.

Your Comments on HealthVault, Brazil, Health 2.0 and Second Life

We've had a number of great comments come into Pioneering Ideas recently. Here are a few:

From Mark Singh, MD about HealthVault and Project HealthDesign:

Having a large company like Microsoft leading this effort, I believe there will be more opportunities for independent developers to create new healthcare applications. I know many think Microsoft is trying to "take over" healthcare, but I'm trying to take the positive view. We'll just have to wait and see.

From Gordon Knox about What if Brazil's Technology Goal Happened Here?

Interestingly Gil is working with a group of Silicon Valley leaders to move his open-access digital-culture project to the US. One of the interesting aspects being examined in these discussions is that moving the 'up-load prior to down load' mentality to the US is MORE difficult than developing that sort of consciousness in Brazil. In the US we need to 'un-learn' the passive consumer relationship with the digital world before we can engage with that realm in the positive socially empowereing way that digital culture is applied in Brazil.

From Sam Ash on Health 2.0: The Doctor is Not Ready to See You Yet:

As a member of the "facebook generation" and a current third-year medical student, I think I can safely say that many of us, myself included, are anxious to be a part of Health 2.0. It's important to remember though, that the health care provider (physician/nurse/PA etc.)-patient relationship is at least two sided and that my generation will soon not only be providing medical care but also receiving it. Both sides, I think, will be important in continuing to push for "Health 2.0".

In addition, the increasing complexity of medical care, with the shift from a physician-patient relationship to a medical team-patient relationship, as well as the continued onslaught of new research makes it difficult for a solo practitioner to know everything about any one patient and his/her diseases. This means that "Health 2.0" must also be capable of integrating a patient's care and wishes using all the expertise available. Whether we'll be able to make it all work without "crashing the system" we'll just have to wait and see.

UPDATED with a comment from John Norris on A Real Dose of Second Life:

I've been touring various healthcare areas within Second Life. (See my travels- http://tinyurl.com/yry364)

I think many people are still figuring out what works, and doesn't, but the educational and support communities seem to be a natural fit.

Many of the issues discussed in Second Life are about real life health, and others are more issues that are specific to Second Life...but its always real people behind the keyboard.

As always, we appreciate your comments. A reminder: if you read the blog via RSS, be sure to pick up the RSS feed of comments as well.

MRSA in the UK: Fashion Police and Other Strategies

There have been some interesting announcements from the UK over the past two weeks about efforts there to tackle hospital-acquired infections.

The government’s proposal to fight these infections with a stricter dress code got quite a bit of attention from US media and hospital administrators. Some may argue that a doctor’s tie or watch are unlikely culprits in the spread of hospital infections, but the UK’s Department of Health states that, “ties are rarely laundered, but worn daily…they perform no beneficial function in patient care and have been shown to be colonized by pathogens.”

Come 2008, ties, white coats, watches, and other “below the elbow” styles are out for British docs. And those of you who have been paying attention to hospital fashion this season know that there is a huge effort to re-develop the patient gown, even to the point of showing how gowns containing silver can be MRSA-resistant. Maybe the medical staff should be considering such attire as well.

But the British are going beyond fashion in their search for MRSA abatement strategies.

Blog and Press Accounts of Games for Health Day

There's a great recap of several Games for Health Day-Seattle presentations on Mark Danger Chen's blog...it's always good to get the perspectives of a self-confessed gamer in academia.  Thanks, Mark...from one who was writing about this event from her desk in Jersey, this was nearly as good as being there!  The Seattle Post-Intelligencer also ran a story on the event in today's paper.  Games for Health director Ben Sawyer had this to say:

"There's this caveman logic that it's all about kids and games, but there are so many other people we can reach....We can get the (health care and gaming) worlds to crash together and apply the different ideas in new and innovative ways."