TRANS- FATTY ACID AND HEALTH PROBLEMS

Karthika & Sheela PaulDietitians - MVH 

There has been a lot of focus on the need to avoid  trans-fatty acids . To understand why you should avoid trans-fats, it's important to understand what they are and what they can do to your overall well-being. 

 They are unsaturated fats that contain trans-isomer fatty acids which in turn are a by-product of the hydrogenation process. When unsaturated

Can We Have an Informed Discussion About Healthcare Reform?

One of the responsibilities that I enjoy a great deal and take most seriously as an educator is getting people to think about and to look at issues from all perspectives. Yes I do have my own opinions about many things, but I genuinely try to get people to form their own opinions based on an informed analysis of the facts. I am also willing to change my opinions when the facts no longer support them.

In this vein, I find the national debate in the US about healthcare reform very frustrating. While I admittedly support the Affordable Care Act (aka, Obamacare), I also know it is imperfect. If any healthcare policy wonk were designing healthcare reform from scratch, they would likely not come up with Obamacare. Yet I also recognize that healthcare reform is a political process, and that political outcomes, based on compromise and tradeoffs, never completely satisfy anyone. In addition, we cannot forget why we need healthcare reform in the first place, which is because our current healthcare system is wasteful, harmful, and not sustainable. Doing nothing is not an option, and I believe that Obamacare is preferable to maintaining the status quo.

One of the biggest ironies about Obamacare is that while most Americans oppose the overall law, they support most of the provisions in it, particularly the requirements denying lifetime limits on coverage or on preexisting conditions. They also see changes to their own health insurance plans, changes that would have come with Obamacare or not and are usually at the behest of their employers facing continued premium increases, and blame them on Obamacare. (And clearly those who have fundamental disagreements with Obamacare, or just want to see the President fail no matter what, exploit this to their advantage.)

Probably the main reason why I find the healthcare reform debate so frustrating is that most Americans do not understand many of the core issues around healthcare delivery and finance. In particular, they do not understand the difference between health insurance and healthcare expenditures. Very few Americans, only the very wealthy, can afford to pay for all healthcare costs. Instead, we all pay for healthcare insurance. Furthermore, free markets do not really work in most areas of healthcare, and it is debatable whether we should even try to make them work, as I noted in this blog during the height of the debate over healthcare reform legislation.

This ignorance is best exemplified by postings such as one on an anti-Obamacare site. The quote at the top of the women's healthcare portion of the site (reproduced as a picture below in case the site changes) lays bare how badly people misunderstand health insurance (private or public): “I had a hysterectomy, I have no need for maternity coverage, but I have to now pay for it. I have to pay not only my own premium but I have to subsidize everybody else.” (Kudos to JD Kleinke for pointing out this site in one of his blog postings. I also agree with another posting of his that Obamacare is more conservative, i.e., less liberal, than Medicare.)

The person quoted on this site obviously misunderstands the concept of health insurance. How many people not needing a hysterectomy subsidized this woman's hysterectomy? She obviously does not understand that the whole idea behind insurance is that we "subsidize" each other's needed care, so that when we need it ourselves, it is available for us. If we start lopping off this condition or that procedure from health insurance, then we soon lose the whole concept of insurance. (This is one of the reasons why most Obamacare insurance exchange plans will be more expensive than cut-rate plans that offer meager coverage and can be terminated at any time.) Carrying this woman's logic to an extreme, does she now no longer support paying for women who need a hysterectomy, since she no longer needs one?

Another manifestation of this thinking concerns Medicare. The famous quote "keep your government hands off my Medicare" (last couple paragraphs of this Washington Post article) best demonstrates how little many people truly understand about Medicare. Less blatantly, however, many elderly people who think nothing of demanding anything and everything from Medicare are the same people who are opposed to other forms of government-run health insurance, especially Medicaid for the poor. Yet these seniors do not realize that they are getting severalfold more benefits from Medicare than the contributions they have made over their lives (Fried, J (2008). Democrats and Republicans - Rhetoric and Reality: Comparing the Voters in Statistics and Anecdotes. New York, NY, Algora Publishing.).

But I do agree with those who argue that we cannot provide unfettered access to any and all types of care to everyone, seniors or otherwise. We do need to make some decisions as a society about what constitutes adequate healthcare coverage, and who should pay what. There are some areas where competition and free markets work in healthcare, and those should be encouraged. But the notion that we can buy less costly insurance policies, covering only this or that, really does not make sense.

I am willing to explore all the possible options for healthcare reform. Some conservative ideas make sense. But before we can have those discussions, a good proportion of the population needs to understand some basic realities about healthcare and its financing, and be willing to have an honest discussion about them.

CHOOSE FISH WISELY

Aardarsh –Dietitian, MVH

Mercury occurs naturally in the environment but it’s also an industrial pollutant. Once mercury is released into the water, fish absorb it. Larger, longer-living predatory fish such as, swordfish, shark, and many types of tuna end up with the most mercury. Cooking fish does not affect its mercury content.




• Eating high-mercury fish regularly can result in its build-

Basic Statistics Should Be a Core Competency of Every Citizen of the World

A medical educator recently argued in her blog that medical school admissions requirements should minimize requirements in math and science topics, especially areas like calculus and physics. There is no question that medicine, and even informatics for that matter, require knowledge and competency in many areas beyond math and science.

However, the problem with the math we teach to potential healthcare professionals and informaticians, indeed to everyone in society, is that we teach the wrong math. I took three semesters of calculus in college and can say that I have almost never used any of it. On the other hand, I had almost no education in statistics, a type of math I use not only in my work, but also in my function as an informed citizen. Indeed, most healthcare professionals, whether clinicians or researchers, use statistics daily. Likewise, as thoughtful citizens in society, we also encounter statistics daily in the news and other aspects of our lives.

For these reasons, I believe that statistics should be a core competency of every citizen in the modern world.

It is not even the mathematics in statistics that are most important, but rather the concepts and the thinking they engender. Every citizen in the world should understand the basic concepts of inferential statistics and be able to answer such questions as:

• What does statistical significance mean? How is it different from a clinical (not necessarily in the medical context) significance?
• What is the difference between absolute and relative risk? What is the meaning of large relative risk differences in the setting of small absolute risk?
• In health-related topics, how do we discern and compare different types of health risks?
• Also in health, what do sensitivity and specificity of diagnostic tests mean, and how does prevalence impact the risk of disease in the face of positive or negative diagnostic tests?

One of the most articulate advocates of this view is John Allen Paulos, whose books Innumeracy and A Mathematician Reads the Newspaper inform us why basic numeracy and statistical competency are so important. These kinds of engaging writings, and basic education about statistics, should be a part of every high school education, not to mention in the education of clinicians and informaticians.

Hyperbaric Oxygen Treatment

Hyperbaric Oxygen Treatment (HBOT) for Healing Wounds

HBOT has for long been used for treating decompression sickness, gas gangrene, and carbon monoxide poisoning. It is finding wider application in the quick healing of severe wounds in people with diabetes, burn injuries, crush injuries and healing of skin grafts among others.

Keeping pace with the latest developments, MV Hospital for

Universal EHR? No. Universal Data Access? Yes.

A recent blog posting calls for a "universal EMR" for the entire healthcare system. The author provides an example and correctly laments how lack of access to the complete data about a patient impedes optimal clinical care. I would add that quality improvement, clinical research, and public health are impeded by this situation as well.

However, I do not agree that a "universal EMR" is the best way to solve this problem. Instead, I would advocate that we need universal access to underlying clinical data, from which many different types of electronic health records (EHRs), personal health records (PHRs), and other applications can emerge.

What we really need for optimal use of health information is not an application but a platform. This notion has been advanced by many, perhaps most eloquently by Drs. Kenneth Mandl and Isaac Kohane of Boston Children's Hospital [1,2]. Their work is being manifested in the SMART platform that is being funded by an ONC SHARP Award.

Mandl and Kohane point to the iPhone as an example of building a platform on top of a common data store. I see this in action every day on my iPhone, when different applications make use of various data stores built into the phone, such as its GPS data. (Android and other phones offer similar functionality.) Not only Google Maps uses this data, but also my LA Fitness app that tells me where the nearest club is located when I am in a different city and hoping to find a gym.

A common data store, on top of which a thousand flowers (or apps) can bloom, is the ideal situation to the health information system "ecosystem." This will allow new ideas and innovations to flourish, while insuring that interoperable data will be accessible by all apps that have appropriate and authorized access. It will insure competition and a healthy marketplace to bring out the best in health information technology.

References

1. Mandl, KD and Kohane, IS (2009). No small change for the health information economy. New England Journal of Medicine. 360: 1278-1281.
2. Mandl, KD and Kohane, IS (2012). Escaping the EHR trap--the future of health IT. New England Journal of Medicine. 366: 2240-2242.

The Workforce Group of the ONC Health IT Policy Committee Makes Its Recommendations

For the last nine months, I have had the opportunity to be part of a workgroup of the ONC Health IT Policy Committee focusing on the health IT workforce issues. This week, Larry Wolf, co-chair of the workgroup made a presentation of the group's recommendations to a meeting of the full Health IT Policy Committee.

The recommendations of the workgroup can be summarized as follows:

1. ONC should summarize and publicize the results of the several workforce development programs it has funded.
2. ONC should summarize and widely disseminate the core competencies for members of the workforce that it has identified.
3. ONC should publicize the resources and best practices that they and other organizations have made available.
4. There is an emerging need for soft and hard skills related to team-based care, population health and patient engagement. ONC should recommend new program development and funding to address these needs.
5. ONC should learn from what is happening with the current workforce. It should do this by recommending funding of studies on the impact of health IT on the workforce, such as turnover, enrollment in healthcare vocations (schools), and new jobs, such as nurse informaticists.
6. The current Standard Occupational Classification (SOC) does not address health IT. ONC should host an SOC input process from the health IT community.

While I agree with all of the recommendations that our group made, I would have added two additional recommendations, which actually build on the fourth and fifth recommendations in the list. The first of these emanates in part from the slide presentation, which might be read by some to imply that informatics and IT jobs in healthcare are "technician" jobs. While healthcare organizations certainly need well-trained health IT technicians, this ignores the larger role that informatics will play as advanced health IT is adopted and used as an integral part of efforts such as quality measurement and improvement, accountable and coordinated care, and biomedical advances such as personalized medicine. Health IT is not merely a support function, but a critical component of our armamentarium to achieve the triple aim of improved health, better care, and lower cost.

My second additional recommendation builds on the recommendation for learning about the current workforce. In light of the larger role for health IT described in the previous paragraph, we need a much more comprehensive understanding than just impact on the current workforce and new jobs. We need to better understand not only of current workforce practices but also how to develop and educate the best workforce going forward into the new era of accountable and coordinated care and new advances such as personalized medicine.

I look forward to the continued efforts of the workgroup and our academic program at Oregon Health & Science University is certainly incorporating this forward-looking view as we revise and augment the curricula of our programs.