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In NEJM: Protection or Harm? Suppressing Substance-Use Data

16 Apr

This post is jointly authored by Nicholas Bagley and Austin Frakt. Yesterday evening, the New England Journal of Medicine released a Perspective piece that

via In NEJM: Protection or Harm? Suppressing Substance-Use Data.

The value of identifiable research data

16 Dec

Joel Kallich of Big Health Data wrote me: Over the last 30 years, the government has been reluctant to release identifiable information, first on an

via The value of identifiable research data.

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:

Click to access 01-18-12-MedicareDemoBrief.pdf

and the blog that discusses the report:

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:

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 footprint of America

14 Oct

The footprint of America is strong worldwide; be it during wartime or peacetime. And childs are among the most impressionable receptors.



Photo credit (in that order)

Anger or gratefulness it’s up to you

15 Aug

Gratefulness could be the best way to happiness and to avoid child’s mental health problems in case of a pathogenic infancy. In France our psychologists developed the concept of resilience. Anglo-Saxon world put the accent on gratefulness as a tool for resilience, paving the way for the happening of a state of mind conducive to happiness. Listen to how Nancy Floy, an acupuncturist from Chicago, got through a very difficult childhood thank to her grand mother’s teaching of gratefulness for yet being still alive after a night of alcoholic chaos perpetrated by her own genitors.
Gratefulness is a very good way of conducting once life, don’t you think? Anyway my three dogs already behave according to this precept: they manifest energetically their joy, eyes full of gratefulness whatever the littlest good I do for them (like for example just giving them a little cup of water when they are thirsty, or appearing in the evening after a full day of absence, nothing more than that makes them very happy 😉

Thanks to the media HUMANKIND for broadcasting such interesting programs.

The interview of Nancy Floy

The public radio HUMANKIND.

The mayor of Paris is a cardiologist

2 Aug
Anand Giridharadas - PopTech 2011 - Camden Mai...

Anand Giridharadas – PopTech 2011 – Camden Maine USA (Photo credit: poptech)

The mayor of Paris is a cardiologist who fixes the heart of his citizens at least as it is stated by the fabulous story-teller, Anand Giridharadas.
And as if it was not sufficiently distinctive he also practices Islam and is of Pakistani origin. His fellow citizen appreciate their Mayor a lot. Just a detail Paris in that case is not the capital of France but a little town located in the state of Texas USA sheltering 25 000 souls. And by the way, the municipality can hardly find enough money to buy the new fire truck it urgently needs.

Read the full story here.

My husband, your president

6 May

Presidential election: a meeting at the Virginia Commonwealth University.

Today France votes for electing its president. We have seen a lot of discourses and meeting an debates by our beloved French candidates. But let’s take a look at how a candidate to the presidential election expresses his program in a foreign country like the US of America for example.
A one and a half hour-long broadcast of a Barack’s and Michelle Obama’s speak in Virginia yesterday (May 5th 2012) in view of the November election in North America. The meeting begin with good sound (soul and rock music) and good vibe, then a lecture by Michelle, the spouse of the current president. We believe that in this country nobody should be bankrupted because he is sick 23 she says among other thoughts. And at the end of her speak, she says: Virginia I introduce to you my Husband and your president: President Barack Obama 32: 59.

In his program he puts education in the first place and then he makes choices for a cleaner energy than oil. He wants to end the war in Irak and Afghanistan after a decade of war. For budget balance he wants the healthiest Americans to pay a little bit more. He wants to allow young people to stay covered by their parents health care insurance. He wants an affordable birth control.

He also says: “We want our businesses to succeed but corporations aren’t people, people are people, in this country people succeed when they have a chance to get decent education and learn new skills 47:54. And by the way so do the businesses that hire those people or the companies that those people start. Our country is stronger when we can count on affordable health care and medicare and social security 49:20”

Near the end of his intervention Barack Obama declares that his campaign is about hope, changes and ordinary people 1:10
He concludes by God bless you and god bless the United States of America 1:12 and Michelle joins him on stage and makes some steps of rock and roll dance. And finally they leave the congress hall together, shaking hands. What a wonderful couple!

It seems that exactly like the two French candidates does in May the 6th, Barack will need a little help of his supporters in November the 6th.

Note: the numbers spread all over the text are the minutes (and hour in the end) of the video’s time counter.

Californian court rules nurses can give anesthetics

4 Apr

Nurse Anesthetists Do Not Need Doctor Supervision according to Schwartzy

nurse anesthetist students at UH

nurse anesthetist students at UH (Photo credit: UMDNJ School of Nursing)

Governor Arnold Schwarzenegger.

Governor Arnold Schwarzenegger. (Photo credit: Wikipedia)

Arnold Schwarzenegger, LA, USA

Arnold Schwarzenegger, LA, USA (Photo credit: Wikipedia)

Thanks to Arnold Schwarzenegger, the Austria origin actor, the state of California is now in quasi bankruptcy while the richest of its citizens are more and more rich and the others are very poor, even homeless. This is a good example of what might become Europe if the ongoing right-wing policy is to be continued.

A solution that the CEOs and health care policy makers have found to cut spendings in hospital cares is to let nurses make the job of medical doctors. It is particularly frightening when it happens that those doctors in question who have been replaced by nurses are the anaesthetists.
Will the next step be to replace pilots by hostesses in Californian airplanes?

Well spending cuts is now directly threatening the patient health in the aim to protect the tax payer wealth!

More content:

Top US court weighs ‘Obamacare’

26 Mar

Will the patient protection and affordable care act die in front of the supreme court? The health of millions of Americans entering in the donut hole, is at stake. The chronology of this law is resumed here.

Agent Orange the shameful legacy

25 Feb

Between Washington and Hanoi the issue of lingering impacts of dioxin contained in the Agent Orange has been a thorn in otherwise friendly ties in recent years.

Defoliant spray run, part of Operation Ranch H...

Image via Wikipedia

English: Map showing locations of U.S. army ae...

Image via Wikipedia

In 1994 USA lifts its embargo on Vietnam; in 1995 the two countries normalize political relations; in 2001 they sign a Bilateral Trade Agreement (BTA); in January 11th, 2007, Vietnam formally become the 150th member of the World Trade Organization (WTO); in June 2007 another USA-Vietnam bilateral Trade and Investment Framework Agreement (TIFA) is signed as an initial step toward developing a full-scale bilateral free trade agreement; also in 2007 president Triết and President Bush meet and agree that they would try to work together on environmental remediation; the same year the American congress vote a budget line to help Vietnam on this issue; in December 30th, 2010, at Da Nang Airport site, the governments of Vietnam and the United States sign a memorandum of intent (MOI) paving the way for cleanup of dioxin at Danang Airport.

So the two countries have been able to move closer to each other and improve their relations leading at the end of the day Vietnam and USA to tighten their partnership in part because Vietnam did not ask at the time and to date for any direct financial compensation for the Orange Agent issue nor intended any lawsuit in national or international court. As a result the economical improvements consisted in “US investments in the country and lowering of the average tariff on U.S. imports from Vietnam from an average of 40 percent to 4 percent, essentially opening the vast U.S. market to Vietnamese exporters literally overnight”. Consequently “the United States has become Vietnam’s largest market for exports and one of Vietnam’s largest suppliers of investment, while Vietnam has become one of the fastest-growing markets for U.S. exports” end of quotation. Beside, and on another level, Hanoi and Washington have also cooperated in fighting HIV/AIDS and avian flu. And finally as argue the US ambassador Michael Michalak: “The United States and Vietnam have achieved a level of cooperation that would have been unthinkable just a few years ago” and he notes that the dioxin cleanup in Danang is “an excellent example of our ability to work together constructively to resolve war legacy issues and to build a partnership that continues to grow stronger.” The US Ambassador says also in December 2010 that “the U.S. Government since 2007 has provided $23.3 million for environmental, health, and disabilities activities in Danang in addition to other programs throughout Vietnam and in 2010 has appropriated $16.9 million to commence a $34 million project to remove dioxin from the soil in Danang” (end of quotation).

But as an impartial observer I can say that, in fact, in one hand, to date the US government has always denied his direct legal responsibility for the birth defects of three generations of Vietnamese and in an other hand, indeed, notwithstanding the moral responsibility of the USA, Vietnamese government has never to date sought a compensation or a reimbursement by the USA of its allowance to its citizens suffering from Agent Orange consequences. In fact it has been a pragmatic politic between the two nations of non direct individual compensation of Agent Orange pollution pledged on bilateral trade agreements and assistance in environmental remediation.

But the reality is that this is the third Vietnamese generation that has been victim of the defoliant’s dioxin, the agent being held for responsible for the country high level of genetic defects.

Laura Kyle, an Alljazeera presenter had interviewed in 2009 various personalities on the topic (video of the 2009 interviews are here enclosed). I try to resume these interviews below.

Nguyen Trong Nhan from the Vietnam Association for victims of Agent Orange claims for reparation. A Japanese study showed that Vietnam’s areas spread with the chemical defoliant undergo three fold more mental disabilities prevalence than those where no spraying took place. US government pledged only 6 Million Dollars so far (in 2009) for the victims of Agent Orange which seems like a drop in the sea with regard to the needs attached to three generations of disabled. The United State department’s money along with the New York-based Ford Foundation philanthropy aids helped to purify the polluted soils in Da Nang which was the former location of the big US military base where the Agent Orange was stored by the Americans and whose airport was the busiest airport in the world during the Vietnam War (reaching an average of 2,595 air traffic operations daily). But nothing was done to address the issue of the Vietnamese government’s spending to give monthly compensation allowances to the disabled, for a lack of scientific proof of causality between the polluted soil and the diseases striking the population. USA recognize the lethal potential of dioxin pollution (and so agree to clean it up) but do not recognize the direct and exclusive causality link with the deaths or the disabled (and so denies to their family the legitimacy to a lawsuit)! Charles Bailey from the Ford Foundation says that these six million dollars are only a start and will be followed by more money. But Thao Griffiths of the Vietnam Veterans of America Foundation feels that it is a small amount of money compared to what is needed to be done in Vietnam for people affected by Agent Orange. Twenty eight hot spots have been identified as highly contaminated. USA left them behind and now should be in the moral obligation to clean up with regard of the presumed responsibility in Vietnamese children brain deficiency. Every year the government of Vietnam spends 115 million dollars in monthly allowances to the victims as disabled citizens which is a lot of money for a developing country. Researches on the link between Agent Orange and children disabilities still observed nowadays in Vietnam have been implemented by Canadians, Germans, Vietnamese, and American scientists. They resulted in widely published articles. Michael Michalak, US ambassador to Vietnam in 2009 explains how the 6 Million Dollars from US government were spent after President Triết and President Bush met and agreed that they would try to work together on some environmental remediation in 2007. The government of America as accepted to remove and clean up the remains of Agent Orange in ancient USA bases areas notably in Da Nangh but still wait further scientific demonstration of the causality link between Agent Orange and health effect like heart disease or severe deformities because to date there are only presumption according to the ambassador. Beside he said he is working very well with the government of Vietnam for addressing the environmental remediation issue.

But finally my conclusion will be to note the absence of amenity between the two ex belligerent countries which calmly are searching a way to solve the humanitarian problem in a sound dialogue trying to move closer to each other with a scientific basement and leaving any ideological consideration apart (an attitude sufficiently rare in other ex belligerent countries to be noted). And indeed we must recognise that it is not a problem of the past but a problem of today and tomorrow as Dioxin is not degradable and its impact, at the opposite of war memory, is not influenced by the passage of time.

Documents consulted:

Aljazzira: Agent Orange still haunts Vietnam

Vietnam US embassy
Assessment of the Five-Year Impact of the U.S.-Vietnam Bilateral Trade Agreement on Vietnam’s Trade, Investment, and Economic Structure
Agent Orange cleanup to start at former US base in Vietnam

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