health and technology

bulls of nice quality

2012-09-07T13:34:00.001-07:00

bulls of nice quality

2012-09-07T13:33:00.001-07:00

sahiwal cattle

2012-09-07T13:22:00.001-07:00

Don’t Bypass Physicians

2012-05-15T02:50:00.000-07:00

By Peter W. Carmel

As physicians, our primary concern is ensuring the health and safety of our patients. The Food and Drug Administration has offered a new concept to make more prescription drugs available over the counter (OTC). Proponents claim it could improve patient health and outcomes, reduce patient costs and promote proper medication use. We are skeptical that it would achieve any of these goals.

The American Medical Association is concerned about patients taking certain drugs without physician involvement — especially patients with chronic diseases. No evidence has been offered that the innovative technologies underpinning this concept would actually allow patients with high blood pressure, high cholesterol, asthma or migraine headaches to self-diagnose and manage these serious chronic medical conditions safely on their own.

As a chronic condition evolves, treatment changes are often needed from a physician. Without physician involvement, patients might take the wrong medication or dose for their needs, potentially causing harm. Self-diagnosis and treatment conflict with the care coordination and disease management that new health care payment and delivery models are trying to achieve.

Contrary to claims that this will save patients money, out-of-pocket costs for insured individuals, including those under Medicare, would increase for drugs switched from prescription to OTC status because patients would need to cover the entire cost themselves. Higher costs would make it harder for patients to afford the medication they need.

Patients are more likely to take the medicine they need when they need it while under a doctor’s care. Physicians are one of the most important motivators in getting patients to take medication as directed. Any proposed expansion of OTC medications needs to preserve, not undermine, the patient-physician relationship.

Patients rely on physicians to provide sound diagnosis and treatment information and to help them meet their unique health needs. Expanding many prescription medications to OTC interferes with that important relationship without offering any real benefits to improve patients’ health or reduce their costs.

Peter W. Carmel is president of the American Medical Association. This post first appeared in USA Today.

Filed Under: OP-ED, THCB

Tagged: AMA, chronic diseases, FDA, Health Outcomes, OTC drugs, out-of-pocket costs, Peter W. Carmel, physician involvement, prescription medication, self-diagnosis May 13, 2012

Zen and the Art of Not Thinking Magically

2012-05-15T02:45:00.000-07:00

By Rob Lamberts, MD

Don’t assume anything.

Assumptions can kill. Assuming something regarding your own health care can cost you money, cause you pain, and yes, even kill you. Here’s my list of potentially harmful assumptions:

1. No news is good news

If you have a test done and don’t hear anything about the result, do not assume it is fine. This assumption kills people. I have too many patients with too much information flying at me every day for me to catch every important detail. Sometimes things are missed, but sometimes the results don’t come to our office. We have trained our patients to expect an email or letter with their results within a certain amount of time, so they sometimes call when the test results don’t come in. I tell them to do so in the clinical summary sheet I hand out at the end of each visit, but the assumption remains.

Always know what tests are being run, and always get the results of those tests (in writing, if possible).

2. The doctor will think I am stupid

I often have patients apologizing to me. They apologize when they have a “weird” symptom, when they “ask too many questions,” when they stop taking a medication due to side-effects, and when they are really, really worried about something. They seem afraid that I am going to roll my eyes and think of them as “one of those patients” – the kind that I complain about to my office staff.

I hate it when people apologize. Apologies assume there is some standard or expectation that a person is not meeting, and the only expectations that I have of my patients is:
a. they have or want to prevent medical problems
b. They want my help.

Why should I get mad at people for either of these things, as it is the job of a doctor to help people who need them. I know there are doctors out there who treat patients like bad kids or like they are morons, but those doctors are out of step with reality. They are the morons. I don’t apologize to the barber that my hair grew. I don’t apologize to my accountant for having tax questions. Understand your position as the paying customer; get what you paid for.

One warning on this one: viewing yourself as a customer cuts both ways. If you have the right to get what you pay for, the doctor has the right to be paid for what they give you. People often think docs should do what they do out of pure charity and kindness, which is wrong. I may expect the mechanic to be kind and charitable, but I should also expect to pay them for what they do. This means that expecting your doctor to spend 30 minutes with you and only charge you for a 5-minute visit is not fair to the doctor (or his wife and kids).

3. Doctors don’t want to be questioned

I hope I am not unusual in this, but I would rather have patients question what I do than to accept everything I say.

Patients’ questions help me in several ways. First, they let me know what I am not explaining well enough. I think people follow instructions better when they understand them, so if you don’t understand what I said, ask. Second, questions build my credibility. If I can explain the reason for my recommendations, I am more trusted. If I fear questions, then it looks like I am hiding something. Third, and most importantly, questions sometimes lead to better care. Sometimes patients ask me about something I haven’t considered. Sometimes the questions make me think things through and see my faulty logic. Sometimes questions make me look for information and learn something.

Good doctoring has a whole lot of teaching in it. Teaching is not a goal in itself, however; the goal is to get the person being taught to understand. If you don’t understand what’s being done, why you got a prescription, or what your diagnosis is, ask. If you wonder about another possible diagnosis, ask. If your doctor doesn’t like you asking questions, ask for a copy of your records and find another doctor.

4. Standard care is the right care.

Much of what doctors do is based on, or at least consistent with science; but a lot of care goes on despite that science says otherwise. A group of physician organizations recently banded together and published the Choosing Wisely Campaign, a set of “things patients and physicians should question.” The groups urge doctors and patients to choose care that is:

Supported by evidenceNot duplicative of other tests or procedures already receivedFree from harmTruly necessary

Here’s a sample of things done frequently that the Choosing Wisely campaign suggests questioning:

Getting an x-ray for people with uncomplicated back painUsing antibiotics for sinusitis lasting less than 7 daysRoutine EKG’s on average (lower-risk) peopleRoutine screening stress-testsUse of anti-inflammatory drugs (NSAID’s) in people with high blood pressure, heart disease, kidney problems, or diabetes.

There are many more recommendations on the site, but the reason this campaign was launched was because of how often these rules are broken. I must admit, I have had to change my habits in the light of some of these recommendations.

5. My doctors talk to each other

I am a primary care doctor, so I am supposed to be the hub of a patient’s care. If a patient of mine goes in the hospital, has surgery, sees a specialist, or goes to the emergency room, I am supposed to be notified. Unfortunately, this is probably not even true in of 50% of these situations. Even when patients ask specifically to have records sent to me, they often aren’t there.

Specialists also have this problem, often getting consults without a clear reason. Often this is a problem at the referring physician’s end, but we have had numerous specialists turn down offers to access our records. We have also offered access to our records by hospitalists and ER doctors, only to be been turned down. Many doctors prefer to give care with only information they gather. It is rare that any doctor has all of the information that may be helpful.

An exception to this is the integrated care system run by a hospital (usually), in which doctors all share medical records. Clearly the sharing of information in that setting is better than in my world, but being under the care of a hospital gives other disadvantages I will discuss later.

6. My doctor has accurate records

Not only do I not have much of the information that comes from other doctors, but the information I do have in my records are not always accurate. The biggest culprit in our office is old information that doesn’t get taken off. It takes a large amount of time to make sure a person’s records are accurate, and there are no insurance companies willing to pay for improved accuracy. So accuracy only happens when doctors take time away from reimbursed patient care and work to organize the records. Again, our office makes a valiant effort at keeping things accurate, but I have found that it takes a huge amount of time, planning, and energy to keep records updated.

I personally don’t think this will change until the patient becomes responsible to keep their own records. Nobody will ever care about a patient’s records as much as the patient does. In the mean-time, I recommend that you keep an updated list of your medications, surgeries, problems, and even your family/home situation and bring it with you to visits.

7. I will be notified when things are due

Are you due for a colonoscopy, thyroid lab tests, a follow-up CT scan, or a diabetic eye exam? Most people don’t know exactly when things are due, and many assume they will be notified when this is the case. Gastroenterologists do often call when the follow-up colonoscopy is due, and mammography facilities sometimes call for a follow-up, but these are exceptions to this rule. Doctors often say “repeat test in six months,” and then expect the patient to call to schedule after six months. Even patients coming into the office may not be reminded of overdue tests, mainly due to the disorganization of medical records (#3 above). If you think you might be due for something, ask. Even asking the question, “are there any tests or labs I am due to get done?” can help remind providers to check for these things. Remember, it is incredibly hard to keep records organize, so don’t assume your doctor’s office will act anything like Jiffy-Lube.

8. Hospitals care

The commercials boast of how local hospitals are “there for you when you need them most,” and “your advocate for your health.” This is horse hockey. The people in the hospital may be caring and kind. The doctors, nurses, and even administrators may want you to be healthy. But the hospital is a business which requires people to be sick and have lots of procedures done to be profitable. Most health care dollars are spent in hospitals, and many times those dollars do no good to the patient. I’ve seen end-stage cancer patients get heart catheterization, people with dementia spend weeks in the ICU, and countless other procedures are done with no benefit (other than income to the hospital).

Don’t be fooled. Your goal is to stay healthy and stay out of the hospital; your doing so is bad for the business of hospitals.

9. More is better

I have patients frequently asking for tests they don’t need. Shouldn’t people get yearly lab panels? Shouldn’t kids get their cholesterol checked? What about those screening mobile tests for carotid artery plaques or PAD? It’s hard to make my patients understand that in saying “no” to tests, I am being a better doctor. I talked about this in an earlier post, but it bears repeating. If someone has a high chance of having a condition, screening for it is useless (doing a strep test on someone with an obvious strep throat). If someone has a very low chance of having a condition, screening for it won’t reduce the risk (CA-125 screening for ovarian cancer, for example). Having more information is often not helpful, can lead to unnecessary worry or further testing, and costs a lot of money for no gain. I don’t want more information, I want the right information.

10. New is better

What about that new drug advertised on TV? What about the surgery done by robots? Should I take that antidepressant for pain? Do I have low-T? Should I go to the hospital with the brand new 200 gazillion dollar heart pavilion? Always look at advertising with a skeptical eye. The main reason businesses spend money on advertising is that they want to make more money when you use the thing they advertised. The 200 gazillion dollars for the heart pavilion has to come from somewhere. There’s a reason why you first heard of “low T” on television and not from your doctor: the company who wants to fix your T wants your money. Robotic surgery is surely cool, but it is also really expensive to buy that machine, and hospitals need you to want the “cool” surgery so they can pay for those machines.

Sometimes “new and improved” is a truthful boast, but usually it is a means into your wallet.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind). Where this post first appeared.

Filed Under: THCB, The Insider's Guide To Health Care

Tagged: Assumptions, Care coordination, Checklists, Choosing Wisely Campaign, doctor/ patient relationship, patient-doctor communication, personal health records, primary care, recommendations, standard care May 11, 2012

Red or Blue Pill for Payment Reform? Both Won’t Work

2012-05-15T02:40:00.000-07:00

By JOSHUA ARCHAMBAULT

Are the House and Senate giving us a false choice for how to control health care costs in Massachusetts? Aren’t there other options?

A few major themes have emerged from the two payment reform proposals and highlight the fact that they fail to align incentives for patients to be more involved in the purchase of their health insurance and their health care.

For example, even with full transparency of cost and quality (which is a huge lift on its own) for many patients, high-cost still correlates with higher quality in medicine. A recent report from Attorney General Coakley proved this theory wrong, but simply providing patients with cost data without placing the right incentives in their health plan to choose the low-cost high-quality provider will result in many selecting the most expensive care. As a result, these proposals will fall short of sustainably bending the cost curve.

There is another way for the Commonwealth- patient-centered health plans, see Health Affairs($) for national savings estimates. The impact would be significant in Massachusetts as less than 3% of residents are on a form of these plans, compared to 13% nationally.

Any reform of payment methods must be aware of limits on the state’s power to regulate the 53% of Massachusetts companies that are self-insured (and are therefore regulated by the federal government), and of course Medicare beneficiaries in the state. The bills do not touch long term care, prescription drugs, hospital fixed costs, health plan reserves, medical devices or insurance overhead. So what does that leave us, an awfully small pool out of the roughly $60B to cut from. From a practical standpoint, are we looking to “fix” our health care problems by laying off workers or severely reducing their pay? That is one of the few options left. Is that a long-term sustainable and innovative approach?

The media and most stakeholders have missed this point completely. Instead of debating what arbitrary reduction in growth we would like to see (if we are just making up numbers I propose GSP minus 10%). We need to be realistic and have a debate about how these proposals will play out in implementation, the unintended consequences, and how stakeholders will react to the incentives in the bill. (For example, how do we deal with those living in Massachusetts but receiving their care in another state. Or the other way around.)

My concern is that both houses of the legislature will pass their versions with some minor tweaks, and then in conference committee, behind closed doors and with lots of industry lobbying, a “compromise” will be struck taxing both insurers and providers.

From a consumer and long-term health sector perspective, this will be a raw deal.

It is built on two flawed assumptions. First that new taxes, assessments, and surcharges will not be passed onto consumers in some form. Second, that the answer to our health care problem is chasing previous flawed government intervention with more flawed government intervention. These two assumptions should not be the terms of debate for payment reform in Massachusetts. Is there a third pill to consider?

Joshua Archambault is director of health care policy at the Pioneer Institute where this post first appeared. He is also the co-author of The Great Experiment.

Activist Seeds – The Latest, Subtle Trend in Seed Investing

2012-05-15T02:37:00.000-07:00

By Jeff Bussgang

When I entered the VC business 10 years ago, I tried to keep thinking about venture capital as a business, where the key focus area was on meeting the needs of our target customers — entrepreneurs and limited partner investors.

In the case of entrepreneurs, those needs have changed radically in these last 10 years. The surge in seed investing over the last few years has been well-reported and analyzed. With advances in cloud computing, open source infrastructure, development tools and general “Lean Start-Up” techniques, entrepreneurs need less capital than ever before. And when entrepreneurs’ needs change (i.e., requiring less capital), smart investors adjust to meet those new needs. Hence, the rise of angels, super-angels, incubators, accelerators, micro-VCs and VC-led seed programs.

But as the “Great Seed Experiment” (as my partner, Michael Greeley, calls it) matures, a new trend is emerging. Entrepreneurs are beginning to learn the difference between what I’ll call Passive Seeds and Activist Seeds. And entrepreneurs are learning that the difference between the two, although somewhat subtle, matters greatly.

Passive Seeds are when a VC invests a small amount of money (for a $200-500M mid-sized fund, typically $250k or less, for a large $1B fund, perhaps $500k or less), to achieve a very small amount of ownership (typically less than 5%) to simply create an option to participate as a more meaningful investor in the future. Passive seed programs get most of the press attention because of their sheer volume.

When you ask venture capitalists about their seed programs, many will brag about how many seed investments they have made (20-40 per year is not uncommon) and how wonderful it is that so few of them “graduate” to become series A investments (perhaps 10-20%) because it shows how discriminating they are. Other characteristics of passive seeds is that one or two of the partners can make the decision to invest, rather than requiring the entire partnership to approve, and the due diligence is very light. Additionally, in a passive seed round, VCs don’t mind if 3-5 firms participate, as opposed to more tyically 1-2, and each VC partner can juggle a dozen passive seeds at any given time. Sometimes there are more VC investors than employees in a passive seed!

But entrepreneurs are starting to wise up. The conventional wisdom has emerged that Passive Seeds from VC investors are bad for start-ups and entrepreneurs. VCs who make passive seeds are not typically engaged enough in the business to add meaningful value. Further, they send a bad signal to the funding market when they don’t invest in the Series A, thus creating inappropriate leverage on the entrepreneur at the time of the Series A decision.

Seed investor/venture capitalist/entrepreneur Chris Dixon has written extensively about this issue, and I couldn’t agree with him more when he declares, based on his discussions with experienced founders, “there is no room for debate” on the issue.

Activist Seeds VC investors are a different story (which Chris acknowledges, although uses different language). From the VCs perspective, an activist seed is when the firm commits the full time, resources, and energy into the investment that they would do with a Series A. From the entrepreneur’s perspective, they truly wants to raise less capital because of all the positive Lean Start-Up trends noted below, but wants the active involvement of a value-added VC firm.

An activist seed from a VC is typically more like $250K-$1 million and the ownership is closer to 8-10%. The full partnership approves an activist seed and the due diligence, although abbreviated, is thoughtful and serious. The firm gets to know the business and the entrepreneur better and thus makes a deeper commitment in making the investment.

The conversion rate of an activist seed into a larger Series A is more like 50-75% and each VC partner dedicates as much time to an activist seed as they do a larger Series A. In short, an activist seed is nearly identical to a Series A, just smaller, slightly more streamlined, and informal – all appropriate for the stage of the business and the requirements ahead.

So next time you are discussing a seed round with a VC firm, figure out if their firm’s philosophy is activist or passive. At Flybridge, we firmly believe in activist seeds (two nice examples recently in the news are Crashlytics and ZestCash). Different firms have different approaches. Make sure you find out which is which, and make sure it’s a fit for your needs. Here are a few questions you can ask yourself to distinguish between the two:

Was the entire partnership engaged in the investment decision process? Did I meet with and pitch to the entire firm? This results in a greater sense of commitment and shared ownership.Did the VC open up her network and make a few value-added introductions to prospective talent, customers and business development partners? Again, this is an indication that the VC is willing to add value along the way and be more active than passive.Was the due diligence process rigorous? Do they seem to really understand my business and the subtelties around what it takes to win? Did they ask tough questions, check my personal references to get to know me better, put me in front of prospective customers?

Absent these elements, you are at risk of taking money from a VC that views you as “an option” rather than “an investment” – not a place a hard-charging entrepreneur who needs as many friends on their side as possible wants to be!

Jeff Bussgang is a general partner at Flybridge Capital Partners. He is the author of Mastering the VC Game, is an insider’s guide for entrepreneurs on financing and company-building. Follow him at his blog Seeing Both Sides where this post first appeared.

Filed Under: THCB

Tagged: Activist Seeds, Entreprenuership, Flybridge Capital Partners, Great Seed Experiment, Lean Start-Up, Passive Seeds, Seed investors, startup incubators, startups, venture capital May 14, 2012

Even Aetna CEO admits: We’re Toast

2012-05-15T02:32:00.000-07:00

By Joe Flower

I’ve been saying it for years (and in 3D and Technicolor in my new book Healthcare Beyond Reform): The Standard Model of Healthcare (the traditional unmodified fee-for-service, commodified, defined-benefit payment system) is broken and doomed. It’s fascinating to hear that even the CEO of Aetna, Mark Bertolini, said exactly that recently at a major healthcare technology conference — and that Forbes, a bastion of business and the private approach to everything, would publish an article on his remarks.

At Health 2.0 last fall, Bertolini said that he no longer thinks of Aetna as an insurance company, but primarily as an information company. This time, he made these main points:

The end of medical underwriting in the ACA, combined with other demographic, regulatory, and economic factors, made health insurers’ business model increasingly untenable.These changes will not go away, one way or another, no matter what the Supreme Court does, no matter who is elected in November. These changes are directly tied not just to legislation but to underlying demographic and economic realitiesThis is not a terrible thing. “We got pulled through the crucible against our will and have been reshaped because of it,” he said. “For most of what has already been implemented, it has been a pretty good thing.”Health insurers are unlikely to disappear. But their primary role in the future will be using new technologies to help accountable health systems serve their customers and drive out costs — and the health systems, not the health insurers, will increasingly be the face, the brand, of that improvement. “We can use technology to make it easier for the consumer. Convenience is the new word for quality.”

He is right on every count, and that is not news. What is news is who is saying it. When the CEOs of companies like Aetna and Cigna, and the CEOs of the many Blues that I have been working with in recent months, show that they understand the size, shape, and power of the changes we are all surfing together, that to me is one more clear sign that this change is happening. There will be no going back.

With nearly 30 years’ experience, Joe Flower has emerged as a premier observer on the deep forces changing healthcare in the United States and around the world. As a healthcare speaker, writer, and consultant, he has explored the future of healthcare with clients ranging from the World Health Organization, the Global Business Network, and the U.K. National Health Service, to the majority of state hospital associations in the U.S. You can find more of Joe’s work at his website, imaginewhatif.

Drug Data Shouldn’t Be Secret

2012-05-15T02:29:00.000-07:00

By Peter Doshi and Tom Jefferson

In the fall of 2009, at the height of fears over swine flu, our research group discovered that a majority of clinical trial data for the anti-influenza drug Tamiflu ? data that proved, according to its manufacturer, that the drug reduced the risk of hospitalization, serious complications and transmission ? were missing, unpublished and inaccessible to the research community. From what we could tell from the limited clinical data that had been published in medical journals, the country’s most widely used and heavily stockpiled influenza drug appeared no more effective than aspirin.

After we published this finding in the British Medical Journal at the end of that year, Tamiflu’s manufacturer, Roche, announced that it would release internal reports to back up its claims that the drug was effective in reducing the complications of influenza. Roche promised access to data from 10 clinical trials, 8 of which had not been published a decade after completion, representing more than 4,000 patients from every continent except Antarctica. Independent verification of the data seemed imminent. But more than two years later, and despite repeated requests, we have yet to receive even a single full trial report. Instead, the manufacturer released portions of the reports, most likely a very small percentage of the total pages. (One of us, Tom Jefferson, has been retained as an expert witness in a lawsuit relating to some of these issues.)

This is entirely within Roche’s rights. After all, regulators have never required drug or medical device manufacturers to share their data with independent researchers or academics. They are required to show the information only to the regulators themselves, who treat the data as secret.

Some may argue that, because the Food and Drug Administration approves drugs for the United States market based on these data, this is not a major cause for concern. But the actual use of drugs is often driven by assumptions about drug safety and effectiveness put forth by articles in peer-reviewed journals (sometimes written by doctors affiliated with the drug manufacturers) and clinical practice guidelines that can be entirely inconsistent with the F.D.A.’s assessments.

In the case of Tamiflu, some of these assumed properties led to stockpiling at great taxpayer expense ? more than $1.5 billion. The F.D.A. approved Tamiflu for the treatment of influenza (on the basis that it could reduce the duration of flu symptoms by about a day); not for the prevention of transmission. But other agencies are far more enthusiastic about Tamiflu’s benefits. The Centers for Disease Control and Prevention has argued that it reduces the risk of hospitalizations and serious complications like pneumonia, citing Roche-authored papers. The Department of Health and Human Services, also citing Roche, assumed in its national influenza pandemic plan that Tamiflu would cut complications. And the World Health Organization’s pandemic planning assumed that the drug would cut transmission of the virus. But here’s the rub: none of these organizations have vetted the original trial data.

The only agency in the United States that seems to have independently reviewed the original trial data never made these claims. The F.D.A.’s conclusion ? which it required Roche to print on Tamiflu’s product labeling ? is that “Tamiflu has not been shown to prevent” complications like serious bacterial infections (for instance, pneumonia). It seems that federal agencies like the C.D.C. and H.H.S., instead of conducting an independent evaluation of Tamiflu, advocated stockpiling by referencing claims in journal publications written by the drug’s manufacturer, ignoring the F.D.A.’s assessment that those very claims were unproven.

Why would they do this? Unwarranted trust in the peer-review process of medical journals probably has something to do with it. So, too, does wishful thinking; lacking good alternatives, it’s tempting to hope that the drug we have works wonders?not to mention the pervasive (but mistaken) belief that something is always better than nothing. And it’s important to remember that correcting the statements of medical journals or public health agencies falls outside the F.D.A.’s jurisdiction ? when it comes to drugs, the F.D.A. is responsible for regulating industry, not other government agencies.

But this is no way for supposedly evidence-based decision making to work, and the F.D.A. could do much more. As a result of new freedom of information policies in Europe, the Continent’s version of the F.D.A., the European Medicines Agency, has released 22,000 more pages of Roche’s Tamiflu trial reports. But even this represents an incomplete picture, as the most detailed portions of the reports are not in the European drug regulator’s files.

Nevertheless, the data point to a drug of minimal benefit. In accordance with the F.D.A.’s findings, it appears to shave a day off the duration of influenza symptoms, but we found no decrease in risk of hospitalization and no evidence that it could stop the spread of the virus. More worrisome, we found suggestive evidence that Tamiflu interfered with the body’s ability to produce antibodies against influenza ? which could affect the body’s response to influenza vaccine and its ability to fight off future influenza infections. But to do a complete analysis, including evaluating Tamiflu’s potential harms, we need the remainder of the data ? the full “clinical study report” ? promised by Roche, but never delivered for a variety of shifting reasons that we have recently detailed in an article in PLoS Medicine.

In response to our conclusions, which we published in January, the C.D.C. defended its stance by once again pointing to Roche’s analyses. This is not the way medical science should progress. Data secrecy is a disservice to those who volunteer their bodies for clinical trials, and is dangerous to those being asked to swallow approved medicines. Governments need to become better stewards of the scientific process. The European regulator’s announced intention to release clinical study reports after it finishes reviewing a manufacturer’s application is an important precedent. Their position?that “clinical trial data should not be considered commercial confidential information”?is a bold step in the right direction. But the F.D.A. ? guardian of arguably more trial data than any other entity in the world ? appears stuck in the era of data secrecy.

We should not have to wait for patients to be hurt by the medications they take, as recently happened with the diabetes drug Avandia, before reviewing this wealth of data.

Peter Doshi is a postdoctoral fellow in comparative effectiveness research at Johns Hopkins University School of Medicine. Tom Jefferson is a Rome-based independent epidemiologist with the Cochrane Collaboration, an international nonprofit research organization.

A version of this op-ed originally appeared in the New York Times on April 10, 2012.

Filed Under: Pharma, THCB

Tagged: Avandia, CDC, Clinical Trials, drug data, evidence-based decision, F.D.A., influenza vaccine, peer-review process, Peter Doshi, Roche, stockpiling, swine flu, Tamiflu, Tom Jefferson, unpublished research, WHO May 11, 2012

Making Privacy Policies Not Suck

2012-05-15T02:26:00.000-07:00

By Aza Raskin

Privacy policies are long legalese documents that obfuscate meaning. Nobody reads them because they are indecipherable and obtuse. Yet, these are the documents that tell you what’s going on with your data — how, when, and by whom your information will used. To put it another way, the privacy policy lets you know if some company can make money from information (like selling you email to a spammer).

Creative Commons did an amazing thing for copyright law. It made it understandable.

Creative commons reduced the complexity of letting others use your work with a set of combinable, modular icons.

In order for privacy policies to have meaning for actual people, we need to follow in Creative Commons footsteps. We need to reduce the complexity of privacy policies to an indicator scannable in seconds. At the same time, we need a visual language for delving deeper into how our data is used—a set of icons may not be enough to paint the rich picture of where you data is going.

With the rise of web services, your information can end up in unexpected places. To get a better understanding of some of the complexities of data flow, we sketch out how Anti-phishing works in Firefox (with help from Oliver Reichenstein).

Here’s what that looks like as a wall of text, which is the typical privacy policy mode.

The difference in understandability is huge between the text and the schematic. In fact, while we were working on creating this infographic we found a hole in our legalese and updated it accordingly.

The idea here is that by creating a visual schematic language, it is relatively painless way for a company to convert their wall-of-text into something a bit more approachable. And that the more visualization actually shines a light into the dense tangle of words, possibly highlighting flaws or trouble spots that would have otherwise remained hidden.

The visual schematic language is a descriptive way of explaining a privacy policy and helps us to understand what’s going on underneath the hood. It doesn’t solve the problem of being able to quickly figure out the guarantees a privacy policy is making on your data.

For that, we want to move from the descriptive to the proscriptive, to a set of legally-bindings icons like Creative Commons.

As an experiment, we tried a schematic form of icons. The feedback that we’ve got so far is that the schematic is over-kill and that a set of icons more similar to Creative Commons’s would be easier to scan and understand. The next step is for us to come up with a set of orthogonal decisions about what compromises the most important aspects of a privacy policy. In the end, we probably shouldn’t have more than 5 icons in the interest of simplicity.

For now here are a set of axis we’ve come up with that need to be whittled down:

Is your information…

Shared with a 3rd Party? Shared internally within the company?

Anonymized/Aggregated before being stored or used?

Personally Identifiable?

Stored for more than x number of days?

Encrypted on the server?

Monetized (sold) in some way?

Usable to contact you?

Update: Based on the feedback, we’ve decided the set of attributes people should care about.

Aza Raskin, former head of user experience at Mozilla Labs and creative lead for Firefox, now runs Massive Health, a startup that aims to help people take control of their health. This post originally appeared at his blog.

Slow Medicine

2012-05-15T02:22:00.000-07:00

By Danielle Ofri

I can’t tell you exactly when it happened, but sometime in the past two decades, the practice of medicine was insidiously morphed into the delivery of health care. If you aren’t sure of the difference between the two, then “God’s Hotel” is the book for you. It’s an engaging book that chronicles this fin-de-siecle phenomenon from the perspective of San Francisco’s Laguna Honda Hospital, the last almshouse in the United States.

Dr. Victoria Sweet, a general internist, came to Laguna Honda for a two-month stint more than 20 years ago and ended up staying. Laguna Honda was home to the patients who had nowhere else to go, who were too sick, too poor, too disenfranchised to make it on their own. The vast open wards housed more than a thousand patients, some for years. Laguna Honda was off the grid, and this, Sweet discovered, was to the benefit of the patients.

Unencumbered by HMOs and insurance companies, the doctors and nurses practiced a very old-fashioned type of medicine, “slow medicine,” as Sweet terms it. There was ample time for doctors and nurses to get to know their patients, and ample time for patients to convalesce. Many a written-off patient recovered within the comforting, unhurried arms of Laguna Honda.

Sweet realizes that the inefficiencies of this old-fashioned hospital – from the doctors who had time to fully research their patients’ complicated histories, to the nurse who knitted a handmade blanket for every charge on her ward, to the chicken that wandered regularly through the AIDS ward, bringing a spark of life to even the most demented patients – were actually its secret weapon. The inefficiencies were actually quite efficient, if your metric was healing patients.

Then arrived the consulting firm of “Dee and Tee, Health-Care Efficiency Experts.” Horrified by the rambling open wards and the old-school style of medicine, never mind the chicken, Dee and Tee quickly cut out excessive head nurses, consolidated departments, speeded up discharges and created committees, PowerPoint presentations and forms with 1,100 boxes. The consulting firm never consulted with any staff members who actually took care of patients, but they did stand to earn 10 percent of any savings engendered.

Thus Laguna Honda was rapidly schooled in the inefficiencies of efficiency, as patients without nurses grew sicker, and enthusiastically discharged patients spiraled downward, had multiple ER visits and were eventually readmitted to the hospital. Dee and Tee, of course, did not have to pony up for any additional costs the consultancy caused.

Over the course of Sweet’s 20 years as a staff physician, Laguna Honda made this painful transition from the practice of medicine to the delivery of health care, and it was the patients who suffered most, followed by their caregivers.

During this period, Sweet found solace in her doctoral studies of Hildegard of Bingen, the medieval healer, nun, mystic and composer. Hildegard’s pragmatic and thoughtful approach to medicine appealed to Sweet and even informed her own practice of medicine. Stymied by an oddly agitated patient who’d already been given a full diagnostic workup, Sweet had a What-Would-Hildegard-Do moment, and decided to simply sit with the patient.

She sat with the patient for a good long time, watching her, thinking about her, being in the moment with her. There was something frankly medieval about the patient’s twisting and writhing, as though she were trying to expel something, as though she were … poisoned.

Reviewing the chart, Sweet realized the woman was indeed being poisoned – by her own medications. A toxic brew of antidepressants, antipsychotics, pain meds and sedatives had led to serotonin syndrome. Sweet decreased the patient’s medications, and within hours the patient improved. She eventually stopped nearly all the medications, and the patient became well enough to go home.

Untangling the mass of medications that most patients arrived with became Sweet’s hallmark. She found that nearly all her patients could be relieved of a portion of their accrued medications. But this could only work in the setting of “slow medicine,” of having time to watch patients carefully over an extended period, of digging deep into the convoluted lives of these patients, of having time to “just sit” with each patient.

This, of course, is highly inefficient, if you are Dee and Tee. But it’s remarkably efficient if you are a patient and are interested in being cured, cared for and comforted.

You might not expect a book about San Francisco’s most downtrodden patients to be a page-turner, but it is. With its colorful cast of characters battling the tide of history, “God’s Hotel” is a remarkable journey into the essence of medicine.

In 1925, Dr. Francis Peabody told a graduating class of medical students that, “the secret of the care of the patient is in caring for the patient.” Simple, eh? If Peabody were practicing medicine today, he’d surely be consolidated with a midlevel provider to deliver health care with maximal quality indicators and operational excellence. Sigh …

Danielle Ofri is the author of three books, including “Medicine in Translation: Journeys with My Patients.” She is an Associate Professor of Medicine at New York University School of Medicine and editor-in-chief of the Bellevue Literary Review. She is currently writing a book about the emotional life of doctors. This post appeared in The San Francisco Chronicle.

Filed Under: Hospitals, THCB

Tagged: caregivers, Danielle Ofri, Dr. Victoria Sweet, God’s Hotel, Laguna Honda, Patient, Patient-centered care, practice of medicine, slow medicine May 11, 2012

The Lifesaving(?) Technology of Facebook

2012-05-15T02:10:00.001-07:00

By Shannon Brownlee and Joe Colucci

When most of us think about Facebook, the first phrase that comes to mind probably isn’t “good Samaritan.” Facebook is an easy way to keep in touch with friends, and it can be a gigantic time-suck, for sure, but last week the site did something that could truly benefit a lot of people. On May 1, Facebook launched an initiative to encourage users to become organ donors, and within 24 hours there had been a spike in the number of people volunteering their body parts for the good of others.

California’s registry saw almost two months’ worth of people sign up within the first day after the Facebook put up the feature.

Organ transplantation is one of the miracles of modern medicine, but there simply aren’t enough organs to go around for all the patients who need them. According to the United Network for Organ Sharing (UNOS), there are 72,900 people on active lists waiting for an organ. Compare that number to the 2,263 transplants that took place between January 2011 – 2012. Last year, more than 6,000 people died waiting for an organ.Obviously, increasing the number of organ donors could have a huge impact on the number of transplants – and on the lives of thousands of people.

Why don’t more people become donors? Some object on religious grounds, but the biggest obstacle is inertia. Most of us who sign up to be organ donors (I’m one of them) do so when we renew our driver’s license, by checking a box on a form saying we want to donate our organs. If you don’t mark the form, it’s assumed you don’t want to donate. Most people only encounter this choice every few years, when their driver’s license is up for renewal, and it’s hard to think about such a decision while standing at a Department of Motor Vehicles counter.

Some countries, such as Spain, Australia and Germany, have opt-out systems. It’s assumed that you are willing to donate unless you’ve said you prefer not to. Rates of donation in those countries are sometimes higher than in the US, although some presumed-consent countries have much lower rates. (Factors other than the number of donors, like the availability of surgical facilities and transplant surgeons, can affect the number of actual transplants in different countries.)

Another way to get more people to donate would be a “mandated choice.” This idea was proposed by behavioral economist Richard Thaler, in his book Nudge: Improving Decisions About Health, Wealth, and Happiness (with Cass Sunstein). Instead of a form that you can simply leave empty if you don’t know whether you want to donate, you have to choose between “yes” and “no.” There’s psychological evidence that even having to make that choice could get more people to think about their preferences and choose to donate. Israel has yet another incentive to get people to donate: those who are registered as donors get priority if they later need an organ themselves. Facebook’s effort depends on another psychological effect, the power of social persuasion. If your friends are all donors, maybe you should sign up, too.

Whether or not Facebook’s initiative will have a sustained effect on the number of available organs remains to be seen, but there’s a side to this issue that deserves at least a mention. Organ transplants are expensive. The surgery itself can cost as much as a million dollars, and that’s not including the drugs and other care transplant patients require for the rest of their lives. Granted, that’s money well spent in terms of lives saved. But imagine if there were enough organs for every person who needed one. We’d have to find more than $100 billion a year in addition to what we’re already paying for health care.

I’m not suggesting more organ donation is a bad idea, or that we shouldn’t do more transplants. Just the opposite. It would be money well spent. It’s also yet another reason to weed out the trillions of dollars we are on track to waste over the next decade on health care that doesn’t help patients or improve lives.

Joe Colucci is a research associate at the Health Policy Program of the New America Foundation. Shannon Brownlee, MS, is a nationally recognized award-winning journalist and author who has written for the New York Times Magazine, The New Republic, British Medical Journal and The Huffington Post, among many others. The post first appeared on the New America Foundation’s blog.

Have You Got The Persistence To Burn Fat?

2012-03-23T01:00:00.001-07:00

By Brandie Luque

The very best diet program is not the one that assures the most weight loss in the shortest period of time. In truth, any diet plan that guarantees to lose kilos very quickly is not healthy or efficient. Even though it may take persistence, the most effective diet plan is one that includes a change of lifestyle and has long lasting energy.

Oftentimes starvation diets are too limiting and people end up not being able to stay with them because they feel malnourished and deprived. Advocare 24 Day Challenge

The very best diet plans do not deprive the body of vital nutrients and do not promise intense weight loss in a short time period but a gradual weight-loss that is the result of healthy eating and proper exercise.

The Fact About Prepackaged Diet Foodstuff

If any program boasts that their diet food will aid you to drop the kilos it's not the top diet program. There are plans that come with prepackaged foodstuff in small portion sizes. Lots of people state that these limited portion sizes aid them shed pounds.

The problem with prepackaged food products is that often times the producers make use of many chemical substances and artificial ingredients to help keep the foods fresh in the mail or in their package. The limited portion sizes could help someone to shed weight but the toxins and chemicals in the prepackaged food are extremely unhealthy to consume and could trigger other health issues.

The Secret To Putting The Body In Fat Reducing Mode

The best diet program includes healthy food that is prepared from fresh ingredients. Preparing and cooking nutritious food items will assure that a person is including just fresh ingredients that don't include harsh or dangerous chemicals and preservatives.

The best way to reduce fat by eating nutritious foodstuff is to eat high protein diet foods, lots of veggies and little to no carbohydrates or refined sugars. Carbohydrate food are the body's major source of energy and when a person restricts carbohydrates the body turns to it's 2nd desired source of energy that's stored fat .

If a person keeps their diet to veggies and high proteins they will be getting all the nutrients they require and the protein they need to build muscle.

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Having less carbohydrates will put the body in maximum fat loss mode. 24 Day Challenge

Natural and Effective Remedies for Treating Bronchitis Cough

2012-03-23T00:39:00.001-07:00

By Rickey Henolap

Bronchitis causes you to have an uncontrollable cough with no relief in mind. When you have a constant reoccurring cold virus (thats how it starts) which can cause respiratory infection or sinus infection, possibly a severe sore throat and nasal congestion, your throat becomes red and irritated and you experience sinus pressure. When the lungs become in distress because of phlegm (mucus) build-up, inflammation of the air passageways occurs, your chest feels constricted, your breathing tube swells making it difficult to breathe, causing you to cough. The cough is the bodys natural way of trying to expel a foreign object inside of your body that doesnt belong.

Those suffering from acute bronchitis should drink plenty of fluids to prevent dehydration and to loosen up the secretions clogging their lungs, making them easier to expectorate. Placing a warm, but not damp, towel against one's chest also helps loosen the phlegm, and placing a warm towel around the neck can provide some comfort for the sore throat that often accompanies acute bronchitis. Drinking warm tea with honey can also help.

Do antibiotics work for either kind of bronchitis lung? No. Almost all cases of bronchitis are viral infections so antibiotics do not do anything to help cure bronchitis. Antibiotics are commonly still prescribed for bronchitis even though they can actually do more harm than good. Rest and low activity are recommended to alleviate symptoms. Usually treating the symptoms is all that can be done to help a person feel better untill the immune system can fight it off. It is very important to treat bronchitis lung as it can develp into pneumonia.

There are two different types of coughs associated with bronchitis. If you have a lot of congestion you may have a wet cough; with this type of cough, while uncomfortable, is necessary to get any mucous and liquid out of your lungs. Humidity is very effective bronchitis treatment, it helps to break up the mucous, making it easier to get it out of your lungs. Try standing under a hot, steamy shower for ten to fifteen minutes. Make sure you dry yourself and wrap up good when you get out. A vaporizer, either steam or cool mist, placed in your bedroom at night will help you to sleep better too. Put some eucalyptus oil in the vaporizer as an expectorant to help get rid of the phlegm in your chest.

Due to the widespread dissemination of this type of information in reference to antibiotics, natural alternatives are increasingly sought by growing numbers. Natural supplements have grown in popularity for this reason.

Bronovil is an herbal remedy which is effective in treating acute bronchitis. It prevents viruses and bacteria from sticking to the cells on the walls of the lungs, which helps break up mucus and prevents the virus from penetrating the cell walls, causing infection. It is derived from a plant called Pelargonium, which is a natural immune system booster. Taking Bronovil will stimulate your body's own natural defenses, boost your immune system, prevent future infections, and alleviate inflammation and the pain and fatigue that accompany it.

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Find out more about Basics in Bronchitis Detection, Conventional Treatment. Stop by our site where you can find out all about Best Ways To Recognize Bronchitis Symptoms.

What's Melanoma

2012-03-22T00:43:00.001-07:00

By Joseph Bologna

There are numerous types of cancers. One with the most common kind of cancer is referred to as Melanoma. Melanoma is really a kind of skin cancer. It begins in cells with the skin called melanocytes. To understand melanoma, it's useful to know concerning the skin and about melanocytes: specifically what they do, how they grow, and what occurs once they become cancerous.The skin is the body's largest organ.

It protects against heat, sunlight, injury, and infection. It helps regulate body temperature, shops water and fat, and produces vitamin D.The skin itself has two primary layers: the outer epidermis and the inner dermis.

The epidermis is mainly produced up of flat, scale like cells called squamous cells. Round cells called basal cells lie under the squamous cells in the epidermis. The lower component of the epidermis also contains melanocytes.

The dermis consists of blood vessels, lymph vessels, hair follicles, and glands. Some of these glands create sweat, which assist regulate body temperature. Other glands produce sebum, that is an oily substance that helps maintain the skin from drying out. Sweat and sebum reach the skin's surface via tiny openings known as pores.

Melanocytes produce melanin, that is the pigment that provides skin its natural color. When skin is exposed to the sun, melanocytes produce more pigment, causing the skin to tan, or darken. Occasionally, clusters of melanocytes and surrounding tissue form noncancerous growths called moles. (Doctors also call a mole a nevus; the plural is nevi.) Moles are very typical. Many people have between 10 and 40 moles.

Moles might be pink, tan, brown, or perhaps a color that is very close to the person's regular skin tone. People who have dark skin tend to have dark moles. Moles may be flat or raised. They're usually round or oval and smaller than a pencil eraser. They might be present at birth or might appear later on -- usually prior to age 40. They have a tendency to fade away in older people. When moles are surgically removed, they usually don't ever return.

Learn more about what is melanoma.

About the Author:

Joseph Bologna is a skin care expert and medical researcher. Learn more about what is melanoma.

Guidelines on How to Keep Your Beauty

2012-03-21T01:20:00.000-07:00

By Melvin Gracia

Loveliness can be a good thing to have no matter how much information or ability you might have regarding about it. Don't be fooled by the beauty gurus online or those makeover shows on T.V. but utilize the Meaningful beauty product. There is more to beauty than precision. Read through these tips to see the fun that can be had with it.

Don't smoke if you want to achieve true beauty. Smoking leads to wrinkles and aged skin. It can also cause yellow teeth and sallow skin. Quitting from a smoke, or perhaps not starting it from the start, will help make you stay younger as well as lively looking. Consider this before lighting up.

Rub Vaseline on your cuticles once a week. This will make your nails grow faster because it feeds your nails. It will also make your nails and cuticles look healthier. You will notice results after the first time your try this because it almost immediately makes your nails look better.

You should consider tinting your eyebrows, if you are getting through a blend of fair hair and fair skin. The eyebrows help to define and emphasize the face. In case your skin is pale and your hair is actually light, you may be losing out on the potential advantages of your own eyebrows. Use a subtle tint to improve your eyebrows' impact.

Even if you have pin-straight hair, humidity can cause unsightly frizzing and flyaway. Immediately after you moisturize your body, run your palms over your dry hair. Every remaining moisturizer or even cream on your hands can smooth the outer lining of your hair. This is perfect for people with all hair types. Better yet, keep a suitable hair product (such as a leave-in conditioner) close to your moisturizing product, and you are more likely to use it.

If you have run out of shaving cream and you don't want to use soap to shave your legs because of the drying effect, and then use hair conditioner! Filling the legs with conditioner in advance of shaving will ease your hair and make it easier to shave, allowing the legs being very soft and also silky.

Add plenty of fruits and vegetables to your diet to make your skin more beautiful. Consuming more fruits and vegetables has got benefits to every single aspect of your health, not only to skin. Raw food can not just make your skin beautiful and youthful; it can extend your life by years.

To get eyelashes that really pop, eyelash extensions are the perfect solution. It is not best to wear these every single day, but they are wonderful for a party or a wedding. They can look very natural as long as you don't go overboard, and will bring out the color of your eyes. As was previously stated, beauty can be a great thing for anyone to get into. It takes a little knowledge to learn the basics so that you can start applying products correctly, but you don't have to become a professional beautician if you don't want to. Just keep those tips in mind and enjoy yourself!

About the Author:

Melvin Gracia promotes the Meaningful beauty product as he discovered that the right skin care product was Meaningful beauty product. For more info: Please Visit. http://www.the-anti-aging-report.com/reviews/wrinkle-cream-reviews.php http://smootherface.net/hydroxatone/

Skin Care Ideas - Established Organic Strategies That work well

2012-03-21T01:13:00.000-07:00

By Vanessa Luis

Beautiful skin is often coveted over skin with blemishes. Skin care products are advertised on the Internet, television - virtually anywhere you go. It doesn't matter where you go, there will always be information on how to have great skin.

The type of skin we have makes a big impression on everybody we meet. People judge others by how their skin looks. This is why those products all sell so well. Even though there are quite a few beauty products out there, natural ingredients that you have at home can also help you maintain clear skin. Use the following tips to brighten up your complexion.

Some people have reported that after waking up, their face has become puffy. No worries! This problem can be solved. If you do have a puffy face, you can fix this quite easily. Drinking dandelion tea is an age-old remedy that will fix this issue. A face rub down is necessary when you have a puffy face - the Tanka method is definitely recommended. This will help to get your lymph nodes working and reduce your face's puffiness. There are numerous goods available which might be publicized as puffiness-reducers however drinking the actual teas along with massaging see your face are better as compared to whatever you can purchase over-the-counter.

Blackheads are another problem that many people have. The removal of blackheads is often the goal of some specialized products. Acne, dry skin, and an assortment of other skin conditions have treatments for them. To improve the way your skin looks, you should drink more water.

If you really want to have clear skin, prevent blackheads, and get a great complexion, drink half a gallon of filtered water daily. It's actually not that much water, as long as you drink it a little bit at a time. Overall, your body, and your face, will benefit from this. Have you wanted to give your skin a quick brightening up? For tighter skin that has a healthier appearance, add some aloe Vera gel with a cotton ball to shrink your pores. Applying aloe Vera gel to your face makes your face look brighter and fuller. Aloe Vera works wonders but it does have a funny smell. Using aloe Vera should be done only when you are not going to be around friends and family that will smell you.

Why spend lots of money when you don't have to? Skin high quality may be enhanced drastically without needing to invest thousands of dollars only make simple adjustments to your day-to-day routines that do not charge very much. It is just a wise decision to experience natural skin care before the additional strategies due to the fact normal is definitely very best with regards to the body. If the epidermis won't get rid of, go to a doctor regarding your skin color as soon as you can. Try to check Meaningful Beauty reviews for further tips and info regarding skin care products.

About the Author:

A woman who is great in terms of physical appears with its external beauty on it that was Vanessa Luis was and she even loves to discover new things to be merely beauty all years long. You can check more of her blog: http://www.the-anti-aging-report.com/reviews/dermapril-sp.php http://www.the-anti-aging-report.com/reviews/dermalogica.php

Learn How To Reduce Weight Safely

2012-03-20T00:33:00.000-07:00

By Ken I Smith

It is one thing to know how to reduce weight safely and another to be able to do it. There is advertising all around us telling how delicious one kind of candy bar is and how much fun kids have while eating snack chips. There are an equal number of ads telling of the latest diet fad or exercise plan. It creates a dilemma.

If you choose to exercise at home, there are television shows that offer programs to follow. You can also buy DVDs to exercise along with. There is yoga, kick boxing and tai chi. There should be something that you find appropriate for your energy level. You may enjoy jogging.

You can create your own diet by referring to the foods recommended by the government. You may choose from dozens of diet books or drink a diet supplement for one meal of the day. Skipping meals is not good since you will end up too hungry to adhere to the diet plan.

Change food items daily. Have eggs, red meat and high calorie foods only once a week if possible. Have chicken or turkey on the other six days. Try to eat fish once a week too. Some specific foods are healthy for you. For example blueberries, and tart cherry juice is the most recently proclaimed healthy drink.

Eat oatmeal with raisins or dried cranberries. Cholesterol is cleared from the blood when you eat oatmeal regularly. Nuts are good for you, however, they are high in calories. Therefore you should not consume too many of them. Dark vegetables are said to be filled with nutrients.

It is good to learn how to reduce weight slowly, approximately two pounds a week. Eat everything, but in smaller portions. Vegetables and some fruits can be eaten in large quantity without making you fat. Be sure your diet has variety or you will grow bored with it and fall off the plan. Allow a treat every weekend to keep you from being too bored with your diet.

About the Author:

Author: Ken Smith will help you choose the right weight loss strategy.
For weight loss advice; grab his free tips on how to reduce weight.. Unique version for reprint here: Learn How To Reduce Weight Safely.

Important TENS Electrode Safety Advice

2012-03-19T00:52:00.000-07:00

By Devon Millberry

A popular method in alternative medicine for managing pain that is gaining a growing following is TENS or Transcutaneous Electrical Nerve Stimulation. As a non-invasive form of pain management, various studies have attested to the effectiveness of TENS electrodes for alleviating pains brought about by post-surgical recovery, arthritis, muscles and cancer. This method works for acute and chronic pains.

But even the most risk-free methods can pose real dangers when the safety measures are not observed. It's important to follow safety precautions to the letter so that health complications and mishaps are avoided.

First of all, make sure that the TENS electrodes are placed where they should be. If you are doing treatment by yourself at home, make sure that you get clear instructions from your doctor about where the electrodes should be positioned.

The electrodes have no place near your eyes or in the front of your neck. Increased intraocular pressure can build up if you happen to place the electrodes in the vicinity of your eyes and if you put them in front of your neck, laryngospasm and hypotension can occur. Wounds and broken skin should not also be pasted with electrodes since infections could occur. Moreover, TENS should not also be used over tumors or malignant lumps since research have supported the theory that electricity can stimulate cell growth. Placing the electrodes directly above the spinal column is also prohibited. Only specialized TENS units can be used for dental, vaginal or anal use so you should never use your electrodes internally.

Individuals with pacemakers or implantable cardioverter-defibrillators are also not allowed to use TENS. These heart aids are sensitive to electrical stimulation and TENS therapy could interfere with their efficient functioning. Patients who have heart issues but do not have pacemakers or cardioverter-defibrillators are also dissuaded from undergoing TENS therapy unless supervised by the physician.

Extreme care should be observed when putting the electrodes in numbed areas of the body. Positioning the electrodes in areas of the skin where sensation can barely be felt can only result to the inability of the patient to feel the electric currents given until these are too high. When this happens, skin irritation is the likely result.

TENS therapy is also contraindicated in women who are infanticipating and in individuals suffering from epilepsy. Its effect on these conditions- the developing fetus in particular- has not yet been fully determined by exhaustive studies.

When receiving TENS in your doctor's clinic, inform him or her right away if you experience twitching in your muscles since this could signify that the signals given are too powerful for you. Tell your doctor if you also do not feel anything since he or she may need to increase the dose.

It's also important to make sure that you unplug the unit before going to sleep and not to get into the water when you still have the electrodes attached to your skin and the TENS unit is still on. Doing the latter would be tantamount to suicide.

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Lastly, remember to check out this article on TENS electrodes and this post about TENS treatment.

Tips Information On Tips Information On Getting Free Tanning Lotion Samples

2012-03-19T00:50:00.001-07:00

By Haywood Hunter

There are a variety of choices of creams and lotions to use for building and maintaining your tan today. In order to find the one that will work for you best, you might want to find free tanning lotion samples to try out. When you find one that you like, you can purchase a full size bottle.

Many different choices can help you make a decision about what you want to use. When you can try out the various options, you will find that you might like something better than the product you are currently using. If you find a different type that works better, you might consider a change.

Today people might buy something based on the way it smells. Some people prefer no scent at all while others might prefer a heavy scent and still others may prefer a lighter, fresh scent. There are many different options that can be found today.

Every manufacturer of these products uses a variety of different things to increase the effectiveness of the product. Some include special conditioners while others include ingredients that enhance the sunlight to increase the amount of your tan. When you are looking for a different product, you will find these very helpful.

Outdoors provides you with the best variety of products. However it is not always possible to build and maintain your tan outdoors due to schedules as well as the weather. When you are working on building a tan, you want to be careful not to burn as well.

Getting free tanning lotion samples will be useful to help you decide what kind you want to use or if you want to use a new product. In addition the smaller sizes are often available if you forget your regular creams or have run out and want to try something new. By using the smaller sizes you can save money by not purchasing the ones that you do not like.

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Free tanning lotion samples permit potential clients to test the product before purchasing. You can find samples of the best tanning lotion by checking online.

Digestit - To get rid of all your digestive system problems

2012-03-19T00:45:00.001-07:00

By Ashley Henchi

To get rid of your digestive system problems then nothing better than to clean your colon that can help you as it produces highly effective results.

* Are you suffering from digestive tract related problems?
* Do you want to eliminate all problems related to your digestive system?
* Do you frequently suffer from tensions and strains because of a hectic lifestyle?
* Do you have any health related issues like poor diet, lack of energy, constipation etc?

If your answer is yes to any of the above then it is a big concern and you should immediately start paying attention towards your health as these problems can convert into serious ailments in no matter of time.

A therapy for your health issues

It is genuine that digestive tract problems can lead to numerous health related issues because it is the main source of energy supply for the body. This is the reason why Digestit is the most recommended medication for the remedy of such health problems. It provides the effectiveness and efficiency to the digestive system. So to restore your health on permanent basis all you need to do is to buy Digestit colon cleanse as it provides strength to the digestive system.

What are the problems that can take place?

In medical science Colon is considered as an indispensable part of our digestive system. It is situated between caecum and rectum. Any sort of digestive system problem like constipation or bacterial infection can lead this Colon to behave erratically. This hampers the body cycle and produces various ailments.

* The food that we eat is not properly digested. The improperly digested food is deposited as fat in our body, making us obese.
* The toxic substances present in the food are not disposed off and remain in the body.
* Due to improper processing of our food, our body does not get adequate energy to perform our normal physical tasks, which makes us lethargic.

As a result of all the above effects body develops other health related problems like heart problems, blood pressure, cholesterol etc.

How can Digestit solve these problems?

Colon Cleanse product such as Digestit is a powerful product that removes all the digestive tract problems through its powerful action. It cleans the colon of all things that are restricting it from functioning properly. It helps the digestive system to regain its lost effectiveness in proper processing of food. All the toxic and foreign substances present in the digestive system are eliminated. Due to proper processing of food, adequate energy is supplied to all body parts helping them o function properly and help the body to get rid of all toxic substances. We feel more energetic and can fulfill all our physical tasks efficiently.

Digestit is not like other products that are available in the market which are composed of chemicals and substances that produces side effects afterwards. It is a natural product that keeps your body healthy in a natural way. So if you want to clean your digestive system than you must use it to experience incredible results.

About the Author:

Digestit is one of a kind product to fix digestive problems permanently. So Read the Digestit Colon Cleanse Review and use Digestit to improve your health and to live a healthy life.

Want To Get That Summer Body Back? Check These Ideas That Help

2012-03-17T00:32:00.000-07:00

By Lawrence Apricot

If you're concerned about your body's well-being but don't know quite how to begin your fitness journey, this article is a great place to start. It's perfectly normal to have questions; and, after all, knowing is half the battle! Here are some informative, easy to understand tips to guide you on your way to a healthy, physically fit lifestyle.

Whenever you perform the squat exercise, you should always keep your heels on the floor. If you cannot, the likely cause is that your hip flexors are too tight. You should strongly consider stretching them out in order to make them more flexible so that you can perform the exercise correctly.

Before you begin squatting heavy weight, you must practice squatting with proper form. First, you should stand in front of a bench. Then, as you squat down, you should imagine that you are about to sit down. As your butt touches the bench, push back up. Attempt this with a light bar and as you improve gradually increase your weight.

Long, lean muscles become less flexible as you age and exercise physiologists recommend doing longer stretches to compensate. While stretching is recommended for everyone before exercising, experts suggest it is even more important for those over 40. A good tip is to try to hold your stretches for 20-30 seconds when under 40 years old. If you are beyond 40, try to hold those stretches for 45-60 seconds. Longer stretches will keep your muscles smooth and pliable.

Don't overlook the power of situps. When done properly, they can effectively increase the body's range of motion and forces your abdominal muscles to work harder during your workout. However, do not attempt to perform situps with your feet firmly anchored in place. This may lead to strain and soreness in your lower back.

When you are working out your arms, it is advised to work on one arm at a time. By doing it this way, you will get higher quality sets. Also, working on one arm at a time allows your other arm to rest and can prevent many muscle injuries.

Hopefully this article can help you with getting into shape and your fitness goals. You want to make sure to apply all that you learned and to continue to seek information. If you feel it necessary find someone you may know that might benefit from this article and share this information with them. When you help people with fitness tips they might return the favor one day.

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How Cataract Eye Surgery Will Probably Be Conducted When Needed

2012-03-16T00:48:00.000-07:00

By Justin King

Cataract eye surgery has evolved greatly over many years, and contains been employed in a lot of a large number of operations dating back to several centuries. It really is zero completely new condition which includes hardly appear, although a common condition which regularly provides rear during registered background, along with the principles active in the surgical procedures usually are almost no modified. What's changed will be the technology utilized to undertake these kinds of functions, this also today demands the using laser treatments and what's properly keyhole surgical procedure for the face.

Previously there was only 1 technique any cataract may be removed, knowing that was using a normal medical operation including producing a cut in the eyesight themselves to complement the cataract to become drawn through. With this particular to become probable, the particular cataract needed hard and be tricky inside zoom lens in the eyesight. It is still easier to get rid of a cataract as soon as it's reached this stage, but there's almost no overall should hang on of which very long. Without modern day approaches used you possibly can conduct this operations a whole lot prior to previous to, along with the most up-to-date tactics can simply nearly provide at any time.

Certainly it is always essential to make sure that it is actually a fresh cataract you happen to be handling, however, not something important that's just providing similar signs and symptoms. The primary indicators for example seeing extreme glare by vibrant lamps or even things might be caused by other factors, making it essential to have a comprehensive assessment to ascertain the lead to. Be it any cataract, it's possible to try out applying your own personal treatments just to see how are you affected, or try a lot of the latest enhancements including eye falls which might limit the number of cases which need surgical treatment.

Typically cataract eye surgery may end up being the best way to move forward, especially if the cataract worsens to the degree where your sight is being severely impacted. In the event the globe are only able to be viewed like a cloud there is little or even silly not to make slight risk and enjoy the operation accomplished. If you live in the US or any other formulated land you may certainly be offered the potential risk of applying phacoemulsification, which could greatly reduce your chances of getting complications. This procedure utilizes highly created techniques which involve just a very small cut and light pain relievers.

Women and men moving into a lot of the world will still have the operation carried out in the traditional way, having a bigger incision converted to the eye in addition to suction utilized. There may be undoubtedly going to be much more chance on this strategy, together with an extended recuperation interval. Generally, nevertheless, the outcome is definitely the similar, and also this also type of cataract surgery are nevertheless way less dangerous as compared to the majority of the surgical treatment which usually nursing homes execute. You will only need to be more careful in the weeks immediately following this operation, although then there should be no difference.

The following part of cataract eye surgery will be putting your substitute synthetic standard contacts, which are in just a phase of progress. Using the standard contact, actually people who are in the particular most wealthy international locations will need to spend more money regarding they demand just a the most typical contact lens, which is solely efficient at just one single sizing emphasis and can't provide. The bigger quality upgraded lenses, which provide entire vision accommodation, are certainly not regarded as coated under medical health insurance programs. Hopefully in the foreseeable future the value and easy supply will produce one step forward constructive innovations throughout cataract eye surgery.

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Do you know what is cataract lens? Learn more about it on my blog and read on the cataract causes.

Can Wartrol Do The Job In Your Case?

2012-03-16T00:46:00.001-07:00

By Marcie Griffing

Does Wartrol work in removing warts? A lot of individuals looking for warts treatment ask this question every time they think about purchasing the product. There's no question why most individuals check on testimonials and reviews online regarding the product's performance even before purchasing it. Perhaps, you're also reading this article right now since you also want to know if it is really effective in removing warts. If you want to find out more relevant information about Wartrol, then stay with me.

Before we move any further, I'd just like to share why I'm writing this. About 12 months ago, I suffered from plantar warts (a typical type of wart). This type of warts is commonly found on the soles of the foot.

It is important to note that a few kinds of warts get to disappear without you doing anything about it. Other types simply go away with the help of some home remedies. In my case, although I tried a couple of home remedies, the symptoms of my plantar warts still kept coming back. Even though I religiously washed my feet with warm water and kept both my feet and footwear really clean when I was still suffering from my plantar warts, I still was not able to remove my warts. The worst part was it became painful and really uncomfortable that I had difficulty walking.

I was really irritated with what was happening. I wanted to get rid of the feelings of discomfort, pain and even embarrassment of having the condition. So, I decided to look for some forms of warts treatment online and encountered Wartrol during the research process.

I was really convinced with the testimonials and reviews I found on the internet about Wartrol that I purchased it. A lot of people said that the product absolutely works very well compared to some of those wart remedies in the market. Aside from that, I discovered that it's also FDA approved. It has been really proven to be absolutely safe and effective in removing warts.

The product is really pocket-friendly. One solution bottle just costs $49.95. Wartrol is also easy to apply. Aside from that, its manufacturer even offers a 3 months return policy in case the customers do not get satisfied with its results.

I purchased Wartrol from their official site. Knowing that they have a 90 day money-back guarantee, I chose their two month's worth supply option. Even though I was quite unsure if it would work, I still decided to get 2 bottles since most users said that the product gave them favorable results in about two months.

After a few days, I got the unlabeled package (that by the way protected my privacy) delivered at my home. I followed the instructions on how to apply Wartrol to my plantar warts. I noticed that the pain and unsightly growths on my feet disappeared slowly in as early as two weeks.

After applying Wartrol for two months, I never had any of those painful, gross and ugly looking plantar warts. You can also remove the warts that you may have by simply applying this product. So, if you are looking for a product that could really help you get rid of whatever warts that you may be suffering from right now, make sure to try Wartrol and see the great results yourself.

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With the aid of wartrol you'll be able to kill your warts pain free. It truly is simpler than ever to get ride of warts in the comfort of one's personal property now.Just buy wartrol these days and get a totally free bottle along with your purchase.

Ending Sinus Pain the Natural Way

2012-03-15T01:12:00.000-07:00

By Aneron Kepasil

What are some tips for relieving Sinusititis and what is Sinusitis? Millions of adults and children suffer from Sinusitis, an inflamation of the sinus because of a bacterial or fungal infection. Sinusitis can be painful and symptoms include cough, fatigue, headache, fever, congestion and nasty nasal discharge. Sinusitis can make daily life miserable!

However, we're not perfect and may catch it regardless, so let's examine some common ways that we can treat the symptoms of Sinusitis. Decongestants such as pseudoephedrine and phenylpherine are good temporary remedies that help drain the sinuses. Prescribed inhalers, while not decongestants, assist in healing the sinus membranes. Over-the-counter nasal sprays like Dristan and Afrin are basically 'spray' versions of decongestants and can be used for a few days or so. Humidifiers or sprays that contain salt water in them will 'melt' the infected sinuses away (so to speak).

A warm compress can work wonders. To make a compress, run hot water over a wash cloth, wring out, let cool for a moment, and then place over the face. The compress can be placed over the eyes and nose. Doing this several times a day can lessen some symptons.

A natural remedy to help reduce nasal inflammation is to use hot towels and ginger compresses on the face. These can also help to open the nasal passages and decrease the congestion connected to sinusitis. The best way to do this is to heat the towel in the microwave and put ginger in the folds before applying it to your face. This can be a very effective measure in reducing your symptoms.

If the nose is not cleared then the sinus pressure felt more strongly in the forehead and often misdiagnosed as headache becomes unbearable and relief is the only thought on the mind of the sufferer. Traditionally, people with front forehead pressure from sinusitis were told to steam their sinuses by boiling water in a kettle and by using a towel wrapped around the head to inhale the steam. Because of the location of the sinus pressure, many sufferers use aspirin that is meant for headaches and really does nothing to unplug the sinus cavities.

Treating Sinusitis naturally may be possible with a new product called SINUVIL. SINUVIL is a natural remedy, made from a medicinal plant native to South Africa, called the Pelargonium. SINUVIL claims to have the ability to naturally drain your sinuses, relieving pressure and pain, boost your immune system, enabling you to better fight off infections in the future, prevent the growth of bacteria, fungi, and viruses in your sinus cavities, preventing infection, and soothe inflamed and swollen tissues. SINUVIL is also recommended for those with weakened immune systems, such as people suffering from a chronic disease, as well as the elderly.

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