Pulitzer Award on Opioid Abuse

Here is a series of articles related to our topic this week. Rather than add it to our readings, I thought we could comment here. Click on the author and Gazette-Mail link for access to the three articles. I'll post some thoughts below.  But you can do the same.

INVESTIGATIVE REPORTING

Eric Eyre, The Charleston Gazette-Mail

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Mr. Eyre (pronounced AIR), 51, won the award for a series of articles about the opioid abuse epidemic in West Virginia. Mr. Eyre, the paper’s statehouse reporter, began his multipart series with these words: “Follow the pills and you’ll find the overdose deaths.” It took Mr. Eyre years to acquire the documents most important to his reporting, and he did it “in the face of powerful opposition,” according to the Pulitzer citation. A lawyer defending a drug wholesale company said that it was vital to protect crucial court records “from the intrusive journalistic nose of the Gazette-Mail.”

From the first article, it's about collusion of the nation's largest drug wholesalers flooding notorious “pill mill” pharmacies in West Virginia's smallest towns and poorest counties with hundreds of thousands of painkillers, according to court records the companies had sought to keep secret for more than a year. Moreover,

  West Virginia has the highest drug overdose death rate in the nation, and the deaths are climbing. Oxycodone and hydrocodone are the most widely abused prescription painkillers, and contribute to more overdose deaths in the state than any other drug.  West Virginia spends more than $430 million a year on problems caused by prescription drug abuse, according to the state's lawsuit.  

The series uncovered how small towns of 392 people were devastated from opioid overdoses.  Look at the data, read the series, and comment. 

Should 15,000 Steps a Day Be Our New Exercise Target?

Based on our discussion of the Quantified Self and other ways to track data about ourselves, I read this article and found it to be quite relevant (also see other related links).

It begins by noting that the 10,000 daily steps, incorporated as a goal into many activity monitors today, has not been scientifically validated as a way to lessen disease risk. So how much exercise might be needed in order to avoid heart disease has remained very much in question?

In a new study, which was published this month in The International Journal of Obesity, researchers at the University of Warwick in England and other institutions decided to examine postal workers in Glasgow, Scotland.

The Glaswegian mail carriers generally cover their routes on foot, not by driving, and spend many hours each day walking, the scientists knew. But the mail service’s office workers, like office workers almost everywhere, remain seated at their desks during the bulk of the workday.  [So for the same group of employees, there are those who walk a lot and those who sit a lot. -sw]   This sharp contrast between the extent to which the workers move or sit during the day could provide new insights into the links between activity and health, the scientists felt. 

The researchers began by recruiting 111 of the postal-service workers, both men and women, and most between the ages of 40 and 60. None had a personal history of heart disease, although some had close relatives with the condition.  They then measured volunteers’ body mass indexes, waist sizes, blood sugar levels and cholesterol profiles, each of which, if above normal, increases the chances of cardiac disease.

The variations turned out to be considerable. Some of the office workers sat for more than 15 hours each day between work and home, while most of the mail carriers barely sat at all during working hours.   But the greatest benefits came from the most exaggerated amounts of activity. Those mail carriers who walked for more than three hours a day, covering at least 15,000 steps, which is about seven miles, generally had normal body mass indexes, waistlines and metabolic profiles. Together, these factors meant that they had, effectively, no heightened risk for cardiac disease.

The implications for what this means and how to get people to walk 4 miles an hour (and steps to achieve that) are discussed in the article.  

How likely is it that people who think 10,000 steps are hard to do will increase it, when they learn it's not enough?  More importantly, why did the industry think 10,000 steps was a good goal?  Did one company start it and the rest followed?

Taxonomy of Burden

In a couple of weeks, we will discuss alternative ways to treat patients.  As I was following e-patient Dave's website, I found this graphic, called the Taxonomy of Burden (click on it to get a better view, and download it, share it.  It's “Creative Commons Share-Alike with Attribution” – anyone is welcome to reuse it, as long as the credit is carried with it),  Then I read further...

You can download the pdf here.

Dave learned about the graphic you see here, which was published last year as part of a paper in the journal BMC Medicine. 

I love it. At the very center is one item: the word “burden.” Coming out from it are three dots:

• Healthcare tasks: the things you’re told to do.
• Consequences of healthcare tasks imposed on patients. (See above!)
• Factors that worsen the burden of treatment: communication problems, getting to and from the doctor’s office, etc etc.

Then, extending from each, are additional realities: under Tasks are paperwork, understanding the illness, follow-up, rearranging life etc etc; under Consequences are impact on work, financial impact, etc etc; under Factors that worsen are the many many things that just plain get in the way of doing the right thing.

Why do I love this graphic? That whole thing could be printed out as an outline list, many pages long, but that has no “all at once” impact: you browse a list item by item, but this visualizes it all at once, making you realize: “Holy crap! Look at all this!”

I felt the same way.  It's worth looking at it in some detail.  It provides a sobering view of all the reasons why healthcare is so darn complex.  But you knew that!

The diagram is from this article in BMC Medicine: bit.ly/TaxonomyOfBurden, by Viet-Thi Tran , Caroline Barnes, Victor Montori, Bruno Falissard and Philippe Ravaud.

I then looked up Victor Montori because he thanked Dave for the post, and learned about The Patient Revolution, which fit the book we will read later, When Doctors Don't Listen.  The first 2 of their 8 pillars are about the patient telling their story.    This is an important part of The Patient Revolution.  You can find videos there, too.   More on that later.

Check out Dave's Resources link.  The Communities link is especially interesting, but so is his blog.  As you can see, I enjoyed reading it.  Thought you might find it useful, too.  😊

Dr. Victoria Sweet, March 29

Here is the info on the talk by Dr. Victoria Sweet, author of God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine.    She is talking right after our class, and with a dessert reception.  It's at the Marriott University Park at Main Gate, so it's pretty close by.  (The link above is to her website).

Here is a brief article in the Huffington Post about her book.    Her ted talk is found on her homepage.
Comment below if you would like to attend.  I'll add you to the rsvp as a guest.

New Approach to Addiction

I just found this brief article on Cigna's CEO changing approach to treatment of addiction. In 2014 alone, opioids killed 30,000 Americans becoming the number 1 cause of accidental death just surpassing car crashes. The importance of treating opioid misuse is identifying that behavioral health must be treated differently than physical health, and an alcoholic anonymous style treatment isn't the best solution. It goes back to what we learned about the importance of preventative health care, and avoiding opioid misuse in the first place. I recommend the reading! It's super quick but interesting.

Article Link : Rehabbing Our Ideas About Addiction 

John Oliver on Obamacare, Parts 1 & 2

Part 2: Here is a follow-up on this video after the new Healthcare bill (aka Trumpcare??) was proposed (again, language warning):


 

Part 1:  Some of you may have seen this, but as only John Oliver can do, here is probably the best overview of what the Republicans are thinking about when they say "repeal and replace" Obamacare. (Warning: language, etc.)

Moving Patient Data Is Messy, But Blockchain Is Here to Help

I interrupt the healthcare debate with a brief discussion of blockchain, which in some convulated way is related to the debate, but also to discussion of data sharing.  The article in Wired, starts by saying the new Secretary of Health and Human Services, Tom Price, came out against electronic health records, the digital histories patients make every time they see their doctor or go to the hospital. “We’ve turned physicians into data entry clerks,” he said, arguing that the burdensome recording systems need an overhaul.

As  you should know by now, for decades (even before the ACA, but certainly after), many hospitals are still struggling with  EHRs to address standardization and high quality health care. But while federal laws and incentive programs have made health care data more accessible, the vast majority of hospital systems still can’t easily (or safely) share their data.

Enter blockchains. While blockchain is probably best known for powering bitcoin, it’s really a generic tool to keep secure data in a distributed, encrypted ledger—and control who has access to that ledger.  This one shared ledger is spread across a network of synchronized, replicated databases visible to anyone with access. Which gives it unprecedented security benefits. Hacking one block in the chain is impossible without simultaneously hacking every other block in the chain’s chronology.

“Now is probably the right time in our history to take a fresh approach to data sharing in health care,” says John Halamka, chief information officer at Boston-based Beth Israel Deaconess Medical Center.  “The EHRs may be very different and come from lots of different places,” Halamka says, “but the ledger itself is standardized.”   Halamka gives a simple example: prescriptions. Say that one medical record shows a patient takes aspirin. In another it says they’re taking Tylenol. Maybe another says they’re on Motrin and Lipitor. The problem today is that each EHR is only a snapshot; it doesn’t necessarily tell the doctor what the patient is taking right now. But with blockchain, each prescription is like a deposit, and when doctor discontinues a medication, they take a withdrawal. 

So, looking at a blockchain, a doctor wouldn’t have to comb through all the deposits and withdrawals—they would just see the balance.  The software timestamps each validated block and adds it to a chain of older blocks, in chronological order. The sequence shows every transaction made in the history of that ledger (a chain of blocks - blockchain).  And crucially for patient privacy and security, hospitals and pharmacies don’t have to send data back and forth to see it. They just all have to point to the same common ledger.

Feel free to add what you know about blockchains in other industries or businesses, or other details.