inequality, Scarcity of oil, scarcity of water maps the cartography of conflicts

10 Apr

I want to share with my followers this incredibly sensitive talk of my cousin (the introduction is a little bit long but you can jump to Tho’s intervention at the 6.14th minute). Enjoy and above all meditate about what the true nature of mankind is.

Geography is destiny in medicine

6 Apr

Heraclitus of Ephesus (Ἡράκλειτος, Herakleitos; c. 535 BC – 475 BC), a Greek philosopher, is known for having said: character is destiny (otherwise said A man’s character is his fate.)
The two main reasons why the derived adage “geography is destiny” applies to medicine are first that exposure to diseases risk factors varies from one region to another in a same country with the same health services and health insurance coverage :

http://earthsky.org/human-world/bill-davenhall-your-doctor-needs-to-know-your-place-history

and second that the pattern of care chosen by practitioners to treat the population for a given condition also greatly varies depending of the place of abode (still at a same health services and health insurance coverage level):

“A study of the geographic distribution in elementary school children discloses no correlation between Tonsillectomy and any other factor, such as overcrowding, poverty, bad housing, or climate. In fact it defies any explanation, save that of variation of medical opinion on the indications for operation.”

Quoted from:

http://proceedings.esri.com/library/userconf/health09/docs/plenary/goodman.pdf

There is tremendous unexplained variation in rates of surgical procedures from hospital catchment area to hospital catchment area, and region to region that cannot be explained by epidemiologic factors. For example, colleagues and I discovered in 1992 (see Spine, 1992) that the 15 fold difference in surgical procedures on the spine in Washington State was inexplicable by almost all population and diagnostic factors.

Quoted from:

https://depts.washington.edu/geog/2011/03/in-health-care-geography-is-destiny/

From the citations quoted above we could even go further in completing the adage by saying: in medicine geography is not only destiny it is also the caregiver.

Pitfalls of retrospective database studies

30 Mar

As you know a part of my work consists to participate in studies based on the extraction from retrospective databases and the analysis of the informations thus retrieved. The eligibility of the beneficiaries to the provision that represents the study’s outcome is always a major concern. There is two explanations for a beneficiary not having access to a care according to the data retrieved from the reimbursement base: either a real lack of access or a non eligibility of the care for a record in the reimbursement data base (for example if the insured is covered by another insurance or has lost his coverage and has exited from the health plan)*. I have always to keep in mind that I work on secondary data which are only a reflection of the primary data the reality of which I try to apprehend.
The dilemma is pretty well addressed in this article:

http://onlinelibrary.wiley.com/doi/10.1046/j.1524-4733.2003.00242.x/full

*as always there is a third possibility: the data concerning the care has been erased from or not yet recorded in the base. The timeline of the refreshment of the base (ie the loading and the purifying of the data) must be precisely described in the methodology of the study.

Article cited:
1)- Motheral, B., Brooks, J., Clark, M. A., Crown, W. H., Davey, P., Hutchins, D., Martin, B. C. and Stang, P. (2003),

A Checklist for Retrospective Database Studies—Report of the ISPOR Task Force on Retrospective Databases.

Value in Health, 6: 90–97. doi: 10.1046/j.1524-4733.2003.00242.x

Two other articles address the pitfalls of inferring from secondary data extracted from a retrospective data base:

2)- Berger M, Mamdani M, Atkins D, Johnson M.

Good Research Practices for Comparative Effectiveness Research: Defining, Reporting and Interpreting Nonrandomized Studies of Treatment Effects Using Secondary Data Sources: The ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report—Part I.

Value in Health 2009 ; 12(8) :1044-52
3)-

The use of claims databases for outcomes research : Rationale, challenges, and strategies. Annual international meeting of the Association for Pharmacoeconomics and Outcome Research.

Philadelphia, Pennsylvania (USA), 1996/05/12. CLINICAL THERAPEUTICS, vol. 19, n° 2, 1997, pages 346-366, 74 réf., ISSN 0149-2918, USA. MOTHERAL (B.R.) *, FAIRMAN (K.A.). Outcomes Research. Express Scripts. Inc. Maryland Heights. USA

Full text of the article here:

http://ehealthecon.hsinetwork.com/Motheral_ClinTher_1997.pdf

 

The Decrease of life expectancy.

18 Mar

For the first time in history life expectancy decreases in a industrialized country as shown in the study below:

content.healthaffairs.org/content/31/8/1803.abstract

The New York time reported one of the key result of the study in a article entitled “Life Spans Shrink for Least-Educated Whites in the U.S.”here:

http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html?pagewanted=all&_moc.semityn.www&_r=0

These data must be integrated to the social policies that are based on the assumption that the upcoming generations will live longer.

Paul Krugman, the Nobel prize of economy, explains this reversing trend by the increase of income inequalities at a macroeconomic level here:

http://www.healthypolicies.com/2012/09/paul-krugman-america’s-greatest-public-health-champion/

Lessons from Medicare

17 Mar

Are disease management, patient education or value based payment cost efficient?

In the medicare experience results were mitigated and barely paid the program’s fees. You can read the brief that has been issued by the  Congressional Budget Office‘s health and Human Resources division:

http://www.cbo.gov/sites/default/files/cbofiles/attachments/01-18-12-MedicareDemoBrief.pdf

and the blog that discusses the report:

http://theincidentaleconomist.com/wordpress/can-the-better-care-lower-cost-act-live-up-to-its-name/

In France  a program of disease management and care coordination has been implemented. Its name is Sophia and it targets two chronic diseases, asthma and diabetes mellitus. More information here:

http://www.ameli-sophia.fr/le-service-sophia

But I can’t find any evaluation of the kind of the CBO report that searches if the health care cost savings, inherent to the program, balance the program’s fees. If you have found such a report let me know.

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The French national medical Board incites physicians to produce content on the internet

16 Mar

The French national Medical Board declares in its last Newsletters that Physicians, as a reliable source of information, should be encouraged to produce contents on the Internet. The ethic is the same as in a patient-physician relationship but the advantage is that the patient can takes his time to apprehend and deepen the information given to him by the physician by consulting his website. The National Board incites physicians to be present on the Web as professionals. But Doctors can also have their blogs like every citizen, provided that they do not discredit the profession and its digital reputation. And provided also that they do not use their blog for advertising and for falsely flattering their skill! The Board recommends also the Doctors to stay sober in their presentation and not to request fees in their websites, but I think that that went without saying.

http://www.conseil-national.medecin.fr/sites/default/files/livre_blancdeontoweb2012.pdf

http://www.conseil-national.medecin.fr/sites/default/files/charte_internet_cnom2014.pdf

http://www.conseil-national.medecin.fr/newsletter/2014/3

Drunksouls

14 Mar

An epic band from Marseille, the lyrics will make you shiver, especially the song “revolution”. If it is true that artists reflects the moods of peoples, stakeholders of our developed societies are allowed to be worried. How long the youth will support what the democracies are offering for their futur.

http://brooklynrocks.blogspot.fr/2012/04/drunksouls-revolution-cd-review.html

How we pay our Doctors

2 Mar

Before the health insurances era Doctors were often payed in nature with eggs, chicken or other farm products. Needless to say that they were often poorly paid, furthermore people called them so lately that the care was unable to keep them alive and the doctors lost their patients in the same time. Once the Doctors and the people they cared got the health insurances to be created Doctors received currencies for their services and could see more than once their patients. The issue of payment was transferred to the insurer. In the beginning insurers reimbursed with a fee for service model like the patients did previously. But the increasing amount of money needed made them think of an alternative payment model. And here came the Pay for Performance model.

France has already put in place such a payment model here:

http://www.csmf.org/upload/File/Conv_med/conv_med_annexes_110726.pdf

USA will implement this mode of payment in 2019 here:

http://www.medpagetoday.com/PublicHealthPolicy/Medicare/40568

Developing countries have already experienced these kind of payment here:

http://www.esciencecentral.org/journals/impact-of-pay-for-performance-on-utilization-of-health-services-and-quality-of-care-in-low-and-middle-income-countries.hccr.1000116.pdf

Below are other links related to the way Doctors will be payed in the future:

http://theincidentaleconomist.com/wordpress/can-the-better-care-lower-cost-act-live-up-to-its-name/

http://advocacyblog.acponline.org/2013/07/house-sgr-bill-promotes-medical-homes.html?utm_source=twitterfeed&utm_medium=twitter&utm_campaign=Feed:+AcpAdvocateBlog

http://advocacyblog.acponline.org/2013/04/does-measurement-improve-performance.html

http://doctorscaucus.gingrey.house.gov/news/documentsingle.aspx?DocumentID=364922

http://energycommerce.house.gov/markup/markup-committee-print-amend-title-xviii-social-security-act-reform-sustainable-growth-rate

Trop de blabla

23 Feb

Ils ont Partagé le MONDE !!! Tiken Jah Fakoly… par Darwin_Kayser

How to write a good (bad) title ( abstract)

20 Feb

Here below is a link toward an interesting post on the qualities that a title should have (in fact half of the post gives the recipe of an empty uninformative, useless title, in an ironic way, with the intend to be more pedagogic).

http://blogs.lse.ac.uk/impactofsocialsciences/2014/02/05/academics-choose-useless-titles/

And the same author in another post, with the same sharp irony shows us how to write a bad abstract :

View story at Medium.com

By the way the title of my post is not informative enough according to the standards here above. At least a cue of what the response to the question is should have been inserted.

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