Last week at Health 2.0, Alexandra Drane and Matthew Holt launched a movement asking everyone to take two minutes at the end of each presentation to show just one slide. The slide asks if you can answer for yourself and your loved ones 5 simple questions about what you want for care at the end of your or their life.
Matthew and Alexandra ask that you download the slide, start a viral movement, have these conversations and transform end-of-life care. To learn more visit Engage with Grace, where you can download the one slde, register for free, learn how to start the conversation and store your answers to the questions.
The questions are very morbid, but deal with an important issues: will your wishes be followed in the event of a terminal illness, do you have an advocate, where do you want to die, do you have a living will, power of healthcare attorney.
Visit the website, think about these questions, answer them and spread the word.
Thank you.
Friday, October 31, 2008
Real Cost of Medication Non-adherence for Diabetics
So I write about the importance of medication adherence on this blog, on Twitter and speak to people everyday about dangers of medication non-adherence and the affect it has on 50% of the patients in the US.
Recent Guidline research published by MedAdNews found that 6 in 10 Americans are now non-adherent to their medications. Now lets talk about what this really means in cost for diabetes patients and the strain medication non-adherence has on the US healthcare system.
The June 2005 issue of Medical Care, a journal by the American Public Health Association, published a study demonstrating that Diabetes patients who are highly compliant with their treatment programs have a 13% hospitalization risk for a diabetes-related problem, but patients with low compliance have more than twice the risk at 30%.
The same study stated the combined drug and medical costs for the most compliant patients average $4,570, which is almost 50 percent below the $8,867 cost for the least compliant group.
A recent report from the CDC states that diabetes rates are rising in the US. More than 23 million Americans have diabetes, with about 1.6 million new cases diagnosed among adults last year.
So currently, according to all these estimates, 13.8 M diabetics are non-adherent to their medication regimes, and cost the healthcare system $122 BILLION. With proper medication adherence, this figure can be reduced in half.
And this number is only going to go up, with almost 1M non-adherent diabetes added each year at a cost of $8.8 Billion.
And this is for one chronic disease.
There are several factors related to why patients are non-adherent to their medications and I do not mean to beat up on diabetics, but I just wanted to illustrate the real costs associated with not taking medications properly.
Recent Guidline research published by MedAdNews found that 6 in 10 Americans are now non-adherent to their medications. Now lets talk about what this really means in cost for diabetes patients and the strain medication non-adherence has on the US healthcare system.
The June 2005 issue of Medical Care, a journal by the American Public Health Association, published a study demonstrating that Diabetes patients who are highly compliant with their treatment programs have a 13% hospitalization risk for a diabetes-related problem, but patients with low compliance have more than twice the risk at 30%.
The same study stated the combined drug and medical costs for the most compliant patients average $4,570, which is almost 50 percent below the $8,867 cost for the least compliant group.
A recent report from the CDC states that diabetes rates are rising in the US. More than 23 million Americans have diabetes, with about 1.6 million new cases diagnosed among adults last year.
So currently, according to all these estimates, 13.8 M diabetics are non-adherent to their medication regimes, and cost the healthcare system $122 BILLION. With proper medication adherence, this figure can be reduced in half.
And this number is only going to go up, with almost 1M non-adherent diabetes added each year at a cost of $8.8 Billion.
And this is for one chronic disease.
There are several factors related to why patients are non-adherent to their medications and I do not mean to beat up on diabetics, but I just wanted to illustrate the real costs associated with not taking medications properly.
Monday, October 27, 2008
Medication Adherence and Asthma Symptoms Abstract
Today's Medication Adherence related abstract comes from The HighWire Press. My comments are at the end.
Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. BG Bender, A Rankin, ZV Tran, and FS Wamboldt
BACKGROUND: Although it is known that most patients do not consistently take controller medications every day, the impact of non-adherence on asthma control is not well documented.
OBJECTIVE: To establish the relationship between medication adherence and symptom control in adolescents and young adults with asthma.
METHODS: A total of 756 adolescents and young adults diagnosed as having mild to moderate asthma on entry into the original study underwent 6 monthly telephone interviews as an ancillary project to the Childhood Asthma Management Program Continuation Study. Participants were queried about medication use and symptom control within each 1-month interview window. Strategies adopted to improve self-report accuracy included use of repeated interviews, confidential reporting to staff unknown to the participants, and use of questions focused on recent behavior.
RESULTS: Only participants who were consistently on inhaled corticosteroids (ICSs) for the entire 6-month study interval were included. Three groups of patients were contrasted: those not on ICSs (n = 420), those on ICSs with high adherence (> or = 75% of medication taken, n = 90), and those on ICSs with low/medium adherence (< 75% of medication taken, n = 148). Participants in the low/medium adherence group reported, on average, less symptom control and more variability in wheezing, awakening at night, missed activities, and beta2-agonist use during the 6-month period, although most in this group perceived their asthma to be under good control.
CONCLUSION: Despite extensive patient education and support, diminished ICS adherence was frequent and undermined symptom control in this group of adolescents and young adults with mild to moderate asthma.
MY COMMENTS
This is another one of these, uh really? abstracts relating to poor medication adherence and lack of symptom control, but supports the fact that if you do not take your controller medications, you will not be able to control your symptoms.
My feelings about adolescents and asthma medication is that they will not take their ICS unless they are having an attack. Forgetfulness and stigma, I believe, are the two drivers of this non-adherence. It would have been nice if the researchers had added the question: "Why didn't you take your ICS"?, but they will probably have to do another study to get this question answered.
Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. BG Bender, A Rankin, ZV Tran, and FS Wamboldt
BACKGROUND: Although it is known that most patients do not consistently take controller medications every day, the impact of non-adherence on asthma control is not well documented.
OBJECTIVE: To establish the relationship between medication adherence and symptom control in adolescents and young adults with asthma.
METHODS: A total of 756 adolescents and young adults diagnosed as having mild to moderate asthma on entry into the original study underwent 6 monthly telephone interviews as an ancillary project to the Childhood Asthma Management Program Continuation Study. Participants were queried about medication use and symptom control within each 1-month interview window. Strategies adopted to improve self-report accuracy included use of repeated interviews, confidential reporting to staff unknown to the participants, and use of questions focused on recent behavior.
RESULTS: Only participants who were consistently on inhaled corticosteroids (ICSs) for the entire 6-month study interval were included. Three groups of patients were contrasted: those not on ICSs (n = 420), those on ICSs with high adherence (> or = 75% of medication taken, n = 90), and those on ICSs with low/medium adherence (< 75% of medication taken, n = 148). Participants in the low/medium adherence group reported, on average, less symptom control and more variability in wheezing, awakening at night, missed activities, and beta2-agonist use during the 6-month period, although most in this group perceived their asthma to be under good control.
CONCLUSION: Despite extensive patient education and support, diminished ICS adherence was frequent and undermined symptom control in this group of adolescents and young adults with mild to moderate asthma.
MY COMMENTS
This is another one of these, uh really? abstracts relating to poor medication adherence and lack of symptom control, but supports the fact that if you do not take your controller medications, you will not be able to control your symptoms.
My feelings about adolescents and asthma medication is that they will not take their ICS unless they are having an attack. Forgetfulness and stigma, I believe, are the two drivers of this non-adherence. It would have been nice if the researchers had added the question: "Why didn't you take your ICS"?, but they will probably have to do another study to get this question answered.
What I Am Reading - Health 2.0 Conference Wrap-ups
What a way to kickstart the week by finding out what I am reading today!
I know, it is very exciting - contain yourself!
There are still blog posts surfacing from last week's Health 2.0 Conference, and I'm sure more to come:
- Matthew Holt, the co-founder, muses about his final thoughts and addresses criticism on the conference at The Healthcare Blog.
- Jane Sarasohn-Kahn from the Health Populi blog reflects on her personal experiences around the conference as a moderator, panelist and participant.
- A medical librarian's review of the health search engines featured at the conference on the AltSearchEngines blog. Reading this has inspired me to once again revisit and tackle writing a post about the various health search engines and their results for medication non-adherence.
- Amy T from Diabetes Mine writes a brief post about her Health 2.0 experiences with a diabetes focus of course!
John from Chilmark Research did a great job of covering Health 2.0 and is now covering The Center for Connected Health's 2008 Symposium. This Boston symposium also features a number of speakers who were at Health 2.0.
Alexandra Carmichael, from CureTogether, proposes an Open Source Health Research Plan.
Cary Byrd from eDrugSearch comments on a study that found higher drug costs in poorer neighborhoods.
John Halamka (who is a localvore) from Life As A Healthcare CIO writes about the ROI for EHRs.
Enjoy!
I know, it is very exciting - contain yourself!
There are still blog posts surfacing from last week's Health 2.0 Conference, and I'm sure more to come:
- Matthew Holt, the co-founder, muses about his final thoughts and addresses criticism on the conference at The Healthcare Blog.
- Jane Sarasohn-Kahn from the Health Populi blog reflects on her personal experiences around the conference as a moderator, panelist and participant.
- A medical librarian's review of the health search engines featured at the conference on the AltSearchEngines blog. Reading this has inspired me to once again revisit and tackle writing a post about the various health search engines and their results for medication non-adherence.
- Amy T from Diabetes Mine writes a brief post about her Health 2.0 experiences with a diabetes focus of course!
John from Chilmark Research did a great job of covering Health 2.0 and is now covering The Center for Connected Health's 2008 Symposium. This Boston symposium also features a number of speakers who were at Health 2.0.
Alexandra Carmichael, from CureTogether, proposes an Open Source Health Research Plan.
Cary Byrd from eDrugSearch comments on a study that found higher drug costs in poorer neighborhoods.
John Halamka (who is a localvore) from Life As A Healthcare CIO writes about the ROI for EHRs.
Enjoy!
Wednesday, October 22, 2008
Health 2.0, LLC Launches Health 2.0 Advisors
One of the first announcements to come out of the Health 2.0 Conference is the formation of Health 2.0 Advisors, "an advisory service formed by four principals with national reputations at the nexus of health care and technology."
From their Press Release:
"The mission of the new advisory service is to partner with clients to critically evaluate the continuing evolution of the Health 2.0 marketplace and how its tools and processes can maximize business value."
"The firm is a joint venture between Health 2.0, LLC, and a team of four individuals: Matthew Holt, a Health 2.0 pioneer and co-founder of the Health 2.0 Conference; Brian Klepper, an expert in change dynamics in health care; Michael L. Millenson, an author, consultant and expert in quality of care and consumerism; and Jane Sarasohn-Kahn, a respected health economist and founder of THINK-Health."
This is an amazing combination of talent in the Health 2.0 space and will certainly help large Health 1.0 organizations identify the value in adopting Health 2.0 technology.
Several critics have recently been complaining about the problems of monetizing Health 2.0 and signaling the end of the movement. Obviously with the 1000+ attendees at the Health 2.0 Conference (including Google, Microsoft, and Yahoo!), it doesn't seem to be ending anytime soon!
Matthew has consistently advocated for larger healthcare organizations to adopt the technology of the smaller, more nimble emerging Health 2.0 companies. Hopefully Health 2.0 Advisors will help bridge the gap between what is not working in the current healthcare system and the new technology that can effect a positive change, improve outcomes and reduce costs.
"Across health care, a wave of innovation has begun in earnest," said Holt. "For stakeholders in the health care industry, understanding Health 2.0 has become absolutely mission critical. At Health 2.0 Advisors, we're about ROI and guiding our clients to unlock the tremendous value of Health 2.0."
Well said sir! I wish them the best of luck with their new venture.
From their Press Release:
"The mission of the new advisory service is to partner with clients to critically evaluate the continuing evolution of the Health 2.0 marketplace and how its tools and processes can maximize business value."
"The firm is a joint venture between Health 2.0, LLC, and a team of four individuals: Matthew Holt, a Health 2.0 pioneer and co-founder of the Health 2.0 Conference; Brian Klepper, an expert in change dynamics in health care; Michael L. Millenson, an author, consultant and expert in quality of care and consumerism; and Jane Sarasohn-Kahn, a respected health economist and founder of THINK-Health."
This is an amazing combination of talent in the Health 2.0 space and will certainly help large Health 1.0 organizations identify the value in adopting Health 2.0 technology.
Several critics have recently been complaining about the problems of monetizing Health 2.0 and signaling the end of the movement. Obviously with the 1000+ attendees at the Health 2.0 Conference (including Google, Microsoft, and Yahoo!), it doesn't seem to be ending anytime soon!
Matthew has consistently advocated for larger healthcare organizations to adopt the technology of the smaller, more nimble emerging Health 2.0 companies. Hopefully Health 2.0 Advisors will help bridge the gap between what is not working in the current healthcare system and the new technology that can effect a positive change, improve outcomes and reduce costs.
"Across health care, a wave of innovation has begun in earnest," said Holt. "For stakeholders in the health care industry, understanding Health 2.0 has become absolutely mission critical. At Health 2.0 Advisors, we're about ROI and guiding our clients to unlock the tremendous value of Health 2.0."
Well said sir! I wish them the best of luck with their new venture.
Following The Health 2.0 Conference
Unfortunately am not able to attend this year’s Health 2.0 Conference in San Francisco, but I am monitoring it off and on via live blogs and Twitter for the following two days.
The official Health 2.0 Conference blog is a little slow to update as all the contributors are currently making the event run smoothly, however I believe they will update it throughout the conference.
Craig Stoltz is posting on his Web 2. Oh…Really?blog as well as cross posting on The HealthCare Blog.
I was told the Ozmosis Community blog is also updating throughout the conference.
On Twitter, some people are using the "Health 2.0” tag others are using the "#health20con” tag. Either tag shows up in a Twitter Search for either term. You can even search for a product that is demoing or person who is speaking at the conference to see who is tweeting about them.
NOTE: You do not have to have a Twitter account to see these feeds or to search.
Others are not using tags, but providing great coverage:
Scott Shreeve from Crossover Healthcare, Mark Schrimshire, Unity Stoakes from OrganizedWisdom, Dr. Greene, Robert Hendrick from change:healthcare, and Carlos Rizo.
I apologize if you are also blogging or twittering and I do not mention you. Please comment if you want to be included and I will update at the end of the day to add your feed.
Thank you and enjoy the conference!
UPDATE: Bob Coffield compiled a RSS Feed and a Search Feed for all of the Twitter tags. Much easier to follow. Thanks Bob!
The official Health 2.0 Conference blog is a little slow to update as all the contributors are currently making the event run smoothly, however I believe they will update it throughout the conference.
Craig Stoltz is posting on his Web 2. Oh…Really?blog as well as cross posting on The HealthCare Blog.
I was told the Ozmosis Community blog is also updating throughout the conference.
On Twitter, some people are using the "Health 2.0” tag others are using the "#health20con” tag. Either tag shows up in a Twitter Search for either term. You can even search for a product that is demoing or person who is speaking at the conference to see who is tweeting about them.
NOTE: You do not have to have a Twitter account to see these feeds or to search.
Others are not using tags, but providing great coverage:
Scott Shreeve from Crossover Healthcare, Mark Schrimshire, Unity Stoakes from OrganizedWisdom, Dr. Greene, Robert Hendrick from change:healthcare, and Carlos Rizo.
I apologize if you are also blogging or twittering and I do not mention you. Please comment if you want to be included and I will update at the end of the day to add your feed.
Thank you and enjoy the conference!
UPDATE: Bob Coffield compiled a RSS Feed and a Search Feed for all of the Twitter tags. Much easier to follow. Thanks Bob!
Tuesday, October 21, 2008
InfoMedics Announces New Patient Adherence Survey and Launches Adherence Driver™
InfoMedics recently announced the results from a new survey examining the behaviors of patients on prescription medications. These results were presented at the 2nd Annual Digital Pharma Conference October 15th, and also coincide with the launch of InfoMedics Adherence Driver™, which they will demonstrate at the 5th Annual Patient Adherence & Persistence Summit USA at the end of this week on October 23rd.
Smells like Conference season, considering the Health 2.0 Conference launches tonight, and there are four more events on the horizon in the next two weeks!
While the results are not groundbreaking, they further reinforce the disconnect between patients and doctors regarding medication adherence.
1,017 responded to Zoomerang's invite to participate in InfoMedics, Inc.'s 2008 "Following Doctor's Orders: Patient Prescription Behaviors" survey. All had taken prescription medications, with no particular demographic breakdown.
Survey Says (my comments are in BOLD):
34% do not always fill a new prescription from their doctors; another 5 percent said they never fill those prescriptions.
The latest poll I saw was around 30% - getting higher, wonder if economy affected this answer? Probably too early.
46% said there is a chance they would not tell their doctor if they stopped taking a medication or decided not to fill a prescription. This is bad. Obviously if a doctor doesn't know you are not taking your medication, they will not know how to effectively treat your ailment. Good thing there is blood work to determine medication levels.
67% forget to take their medication at times. Last figure I have from 2007 is 87% - so that is a pretty steep decline.
9% said they would keep taking a medication if they started feeling worse. Not a very engaged population number.
34% sometimes, often or always stop taking medication if they feel better. This number sounds low.
46% are careless at times when taking medications. Sound about right.
32% are always motivated to take a newly prescribed medication. Better than 30%!
When asked for multiple responses about where they go for medication information, 51 percent of respondents said they look to the Internet for this information; 49 percent said they ask their pharmacists and 37 said they ask their doctors.
This follows Manhattan Research's Cybercitizen® Health v8.0 report that stated 53% of patients prefer to look online for health information.
Overall this survey is pretty representative of the current research, with a good indicator that adherence rates are not going above 50%. I am looking forward to seeing the whole survey when it is published.
Smells like Conference season, considering the Health 2.0 Conference launches tonight, and there are four more events on the horizon in the next two weeks!
While the results are not groundbreaking, they further reinforce the disconnect between patients and doctors regarding medication adherence.
1,017 responded to Zoomerang's invite to participate in InfoMedics, Inc.'s 2008 "Following Doctor's Orders: Patient Prescription Behaviors" survey. All had taken prescription medications, with no particular demographic breakdown.
Survey Says (my comments are in BOLD):
34% do not always fill a new prescription from their doctors; another 5 percent said they never fill those prescriptions.
The latest poll I saw was around 30% - getting higher, wonder if economy affected this answer? Probably too early.
46% said there is a chance they would not tell their doctor if they stopped taking a medication or decided not to fill a prescription. This is bad. Obviously if a doctor doesn't know you are not taking your medication, they will not know how to effectively treat your ailment. Good thing there is blood work to determine medication levels.
67% forget to take their medication at times. Last figure I have from 2007 is 87% - so that is a pretty steep decline.
9% said they would keep taking a medication if they started feeling worse. Not a very engaged population number.
34% sometimes, often or always stop taking medication if they feel better. This number sounds low.
46% are careless at times when taking medications. Sound about right.
32% are always motivated to take a newly prescribed medication. Better than 30%!
When asked for multiple responses about where they go for medication information, 51 percent of respondents said they look to the Internet for this information; 49 percent said they ask their pharmacists and 37 said they ask their doctors.
This follows Manhattan Research's Cybercitizen® Health v8.0 report that stated 53% of patients prefer to look online for health information.
Overall this survey is pretty representative of the current research, with a good indicator that adherence rates are not going above 50%. I am looking forward to seeing the whole survey when it is published.
Monday, October 20, 2008
AlignMap Betters My Robotic Posts
As has happened in the past, Dr. Showalter from AlignMap has written a better and more thoughtful post about the future of robotic medication adherence assistance than I did last week.
Dr. Showalter's post reminds me (as our emails about blogging have in the past) that I sometimes only "report" what I find, not adding anything of merit with my own thoughts, observations, etc.... Also that I do not add any visuals.
I thank Dr. Showalter for his great additions to my previous two posts regarding medication adherence and healthcare robots, as well as adding a personal real world context for the use of these aids.
He also referenced his own blog post about a Tamagotchi-style Pill Pet reminder that I never saw. It alerts patients when to take their pills and when to go to the MD. If the patient is not adherent, the Pill Pet get sicks and eventually dies. This aids adherence by hopefully making the patient care more about the health of a robotic pet than their own.
I will close with Dr. Showalter's favorite compliance program:
1. RoboCop (Dr. RoboCop to you) presents the healthcare instructions.
2. RoboCop enhances compliance with his trademark line, which also serves as the Program’s slogan: "You have 20 seconds to comply."
Of course it is cooler and has more effect on the AlignMap blog as he has visuals and audio!
He also referenced his own blog post about a Tamagotchi-style Pill Pet reminder that I never saw. It alerts patients when to take their pills and when to go to the MD. If the patient is not adherent, the Pill Pet get sicks and eventually dies. This aids adherence by hopefully making the patient care more about the health of a robotic pet than their own.
I will close with Dr. Showalter's favorite compliance program:
1. RoboCop (Dr. RoboCop to you) presents the healthcare instructions.
2. RoboCop enhances compliance with his trademark line, which also serves as the Program’s slogan: "You have 20 seconds to comply."
Of course it is cooler and has more effect on the AlignMap blog as he has visuals and audio!
Friday, October 17, 2008
Ryan Haight Online Pharmacy Consumer Protection Act to Become Law
President Bush signed the Ryan Haight Online Pharmacy Protection Act (H.R. 6353) on October 15th making it a law. Congrats to this administration for seeing this act through.
Most people believe that online pharmacies are scams selling fake or illegal pills at high rates for ED, and oxycontin. With the passing of this law, hopefully more legitimacy will be given to online pharmacies in the public view.
Also helping to make online pharmacies more respected are Health 2.0 companies like eDrugSearch which "brings together the world’s most highly respected online pharmacies through a comprehensive, easy-to-use search engine."
They vet all the pharmacies their search engine queries and also provide "up-to-the-minute price search, detailed drug information, and other advanced features that make it the premier portal for online prescription medication shoppers. Our advanced search features enable members to identify pharmacies with specific licensing requirements, third-party accreditations, Better Business Bureau memberships, and more."
eDrugSearch's founder, Cary Byrd, an impassioned advocate of safe online pharmacies, wrote a great summary of the Ryan Haight Online Pharmacy Protection Act's provisions last month on his blog.
Here is the condensed version. Thanks again to Cary for for the succinct write-up.
- Amends the Controlled Substances Act to prohibit the delivery, distribution, or dispensing of controlled substances over the Internet without a valid prescription. Exempts telemedicine practitioners.
- Defines “valid prescription” as a prescription that is issued for a legitimate purpose by a practitioner who has conducted at least one in-person medical evaluation of the patient.
- Adds definitions to the Controlled Substances Act relating to online pharmacies and the issuance of prescriptions over the Internet.
- Imposes registration and reporting requirements on online pharmacies.
- Authorizes the Attorney General to issue a special registration under this Act for telemedicine practitioners.
- Increases criminal penalties involving controlled substances in Schedules II, IV, and V of the Controlled Substances Act.
- Authorizes states to apply for injunctions or obtain damages and other civil remedies against online pharmacies that are deemed a threat to state residents.
Patients have cited access to medications as being a barrier for medication adherence. If you have trouble getting your meds and affording them, look to online resources like eDrugSearch to provide you with the best prices and services that will deliver you scripts to your door.
I hate to sound like an advert, but with the economy the way it is, medications should not be sacrificed in this dire time, and there are less expensive alternatives than going to your local pharmacy. I am all for supporting small, locally owned businesses (we go to a druggist in Southport where my wife got penny candy as a girl), however one's health and medication regime come first - if you cannot afford to pay for small town service, look for alternatives.
Most people believe that online pharmacies are scams selling fake or illegal pills at high rates for ED, and oxycontin. With the passing of this law, hopefully more legitimacy will be given to online pharmacies in the public view.
Also helping to make online pharmacies more respected are Health 2.0 companies like eDrugSearch which "brings together the world’s most highly respected online pharmacies through a comprehensive, easy-to-use search engine."
They vet all the pharmacies their search engine queries and also provide "up-to-the-minute price search, detailed drug information, and other advanced features that make it the premier portal for online prescription medication shoppers. Our advanced search features enable members to identify pharmacies with specific licensing requirements, third-party accreditations, Better Business Bureau memberships, and more."
eDrugSearch's founder, Cary Byrd, an impassioned advocate of safe online pharmacies, wrote a great summary of the Ryan Haight Online Pharmacy Protection Act's provisions last month on his blog.
Here is the condensed version. Thanks again to Cary for for the succinct write-up.
- Amends the Controlled Substances Act to prohibit the delivery, distribution, or dispensing of controlled substances over the Internet without a valid prescription. Exempts telemedicine practitioners.
- Defines “valid prescription” as a prescription that is issued for a legitimate purpose by a practitioner who has conducted at least one in-person medical evaluation of the patient.
- Adds definitions to the Controlled Substances Act relating to online pharmacies and the issuance of prescriptions over the Internet.
- Imposes registration and reporting requirements on online pharmacies.
- Authorizes the Attorney General to issue a special registration under this Act for telemedicine practitioners.
- Increases criminal penalties involving controlled substances in Schedules II, IV, and V of the Controlled Substances Act.
- Authorizes states to apply for injunctions or obtain damages and other civil remedies against online pharmacies that are deemed a threat to state residents.
Patients have cited access to medications as being a barrier for medication adherence. If you have trouble getting your meds and affording them, look to online resources like eDrugSearch to provide you with the best prices and services that will deliver you scripts to your door.
I hate to sound like an advert, but with the economy the way it is, medications should not be sacrificed in this dire time, and there are less expensive alternatives than going to your local pharmacy. I am all for supporting small, locally owned businesses (we go to a druggist in Southport where my wife got penny candy as a girl), however one's health and medication regime come first - if you cannot afford to pay for small town service, look for alternatives.
Wednesday, October 15, 2008
Blog Action Day 2008: Poverty
To honor Blog Action Day 2008: Poverty I have read several blogs about the issue and have been touched by some personal stories, Global Poverty Facts and Stats and this MSNBC article which summarizes a report by The Working Poor Families Project which might change your perceptions of the poverty line in the US.
"The report defines a low-income working family as those earning less than twice the Census definition of poverty. In 2006, the most recent year for available data, a family of four earning $41,228 or less qualified as a low-income family. The number of jobs with pay below the poverty threshold increased to 29.4 million, or 22 percent of all jobs, in 2006 from 24.7 million, or 19 percent of all jobs, in 2002."
This obviously means there is a problem with the rise of poverty in the US.
"This was a time when we had solid and robust economic growth," said Brandon Roberts, co-author of the report.
"The number of low-income families rose to nearly 9.6 million, or 28 percent of the total population, in 2006 from 9.2 million, or roughly 27 percent, in 2002, according to the report. The number of children in low-income families rose by roughly 800,000 during the same period, climbing to 21 million from 20.2 million."
And it is not as if these people are not working. "72 percent of low-income families work, with adults in low-income working families working, on average, 2,552 hours per year in 2006, the equivalent of one and one-quarter full-time jobs."
So how does this relate to medication non-adherence? If patients are finding it difficult to pay for food and clothing for their family, medications are very low on their priority list. I wonder what the cross reference of the people in low income working families to those who are uninsured?
So take today (scratch that, everyday) to remember how fortunate you are, even if you have lost a lot of money in the stock market. Almost half the world — over three billion people — live on less than $2.50 a day, and at least 80% of humanity lives on less than $10 a day.
Go make a donation to your local foodbank or donate to Heifer International which provides you the opportunity to donate small amounts of money towards larger purchases of livestock to transform entire communities in 53 countries and 28 US states.
Please do something if you can. Thank you.
"The report defines a low-income working family as those earning less than twice the Census definition of poverty. In 2006, the most recent year for available data, a family of four earning $41,228 or less qualified as a low-income family. The number of jobs with pay below the poverty threshold increased to 29.4 million, or 22 percent of all jobs, in 2006 from 24.7 million, or 19 percent of all jobs, in 2002."
This obviously means there is a problem with the rise of poverty in the US.
"This was a time when we had solid and robust economic growth," said Brandon Roberts, co-author of the report.
"The number of low-income families rose to nearly 9.6 million, or 28 percent of the total population, in 2006 from 9.2 million, or roughly 27 percent, in 2002, according to the report. The number of children in low-income families rose by roughly 800,000 during the same period, climbing to 21 million from 20.2 million."
And it is not as if these people are not working. "72 percent of low-income families work, with adults in low-income working families working, on average, 2,552 hours per year in 2006, the equivalent of one and one-quarter full-time jobs."
So how does this relate to medication non-adherence? If patients are finding it difficult to pay for food and clothing for their family, medications are very low on their priority list. I wonder what the cross reference of the people in low income working families to those who are uninsured?
So take today (scratch that, everyday) to remember how fortunate you are, even if you have lost a lot of money in the stock market. Almost half the world — over three billion people — live on less than $2.50 a day, and at least 80% of humanity lives on less than $10 a day.
Go make a donation to your local foodbank or donate to Heifer International which provides you the opportunity to donate small amounts of money towards larger purchases of livestock to transform entire communities in 53 countries and 28 US states.
Please do something if you can. Thank you.
Tuesday, October 14, 2008
Microsoft to Join Scripts, Navigenics and Affymetrix in 20 Year Genetic Screening Test
I read a blurb in ePharmaceuticals about Microsoft teaming up with Scripps Translational Science Institute, Navigenics and Affymetrix "to study the impact of genetic screening on individuals' behavior. The aim is to determine what effect, if any, information about one's chances of contracting a particular disease has on how people live their lives."
"Researchers will study the genomes of up to 10,000 employees and family members of the Scripps Health system in San Diego who volunteer for the project and will monitor changes in their behavior over a 20-year period. Under the plan, Affymetrix will scan participants' genomes and Navigenics will interpret the results and provide participants with guidance on how to lessen the chances of contracting diseases to which they may be genetically predisposed. Participants will be able to store their tests results, and related data, in a Microsoft HealthVault account."
This study is pretty significant to me and I'm sure to the Genomics community - too bad we will have to wait 20 years to see the results. I have had a few conversations, online and off, about the importance of genetic testing and what it will really do to change patient behavior.
One person claimed genetic testing has to be covered by insurance to determine risk factors to enable behavioral change - ie. if you are at risk for diabetes, control your weight and diet. Another person thought that no matter what people know about their "health future" and possible conditions, they will do little to change their behavior.
I am on the fence about testing on a personal level, but feel that people who want to have it done and can afford it, should have it done. 23andMe now offers a $399 personal genetics service - which is pretty hard to pass up. I know that if I found out something horrible, and shared it with my wife, she would want /make me to change my lifestyle to reflect what "might" happen - so that is a deterrent. On the hypocritical flip side, I would like to have my children tested for just that reason.
Last month, Sergey Brin (co-founder of Google and husband of Anne Wojcicki, 23andMe's co-founder) wrote on his personal blog about 23andMe and his higher risk of developing Parkinson's. This created a lot more buzz around 23andMe, genetic testing and PD - bringing the issue back into the national forum. I wonder if Google Health and 23andMe will launch their own study?
I am very interested to see what becomes of Scripts study and to see if people will change their behaviors based on their genetic makeup. Perhaps they will start reporting at the 5 year mark to give us a taste of what how patients are trending? Unless there are incentives provided, I doubt many people will change their behavior. ie. people smoke for years, knowing it can kill them, but as soon as their company /health plan offers them an incentive to quit, they try to quit.
I already know I am at risk for diabetes, cancer and heart disease, based on my family history - but one day soon I will get tested to see everything else that is in my DNA. Perhaps it will be this year's Christmas present to the family.
"Researchers will study the genomes of up to 10,000 employees and family members of the Scripps Health system in San Diego who volunteer for the project and will monitor changes in their behavior over a 20-year period. Under the plan, Affymetrix will scan participants' genomes and Navigenics will interpret the results and provide participants with guidance on how to lessen the chances of contracting diseases to which they may be genetically predisposed. Participants will be able to store their tests results, and related data, in a Microsoft HealthVault account."
This study is pretty significant to me and I'm sure to the Genomics community - too bad we will have to wait 20 years to see the results. I have had a few conversations, online and off, about the importance of genetic testing and what it will really do to change patient behavior.
One person claimed genetic testing has to be covered by insurance to determine risk factors to enable behavioral change - ie. if you are at risk for diabetes, control your weight and diet. Another person thought that no matter what people know about their "health future" and possible conditions, they will do little to change their behavior.
I am on the fence about testing on a personal level, but feel that people who want to have it done and can afford it, should have it done. 23andMe now offers a $399 personal genetics service - which is pretty hard to pass up. I know that if I found out something horrible, and shared it with my wife, she would want /make me to change my lifestyle to reflect what "might" happen - so that is a deterrent. On the hypocritical flip side, I would like to have my children tested for just that reason.
Last month, Sergey Brin (co-founder of Google and husband of Anne Wojcicki, 23andMe's co-founder) wrote on his personal blog about 23andMe and his higher risk of developing Parkinson's. This created a lot more buzz around 23andMe, genetic testing and PD - bringing the issue back into the national forum. I wonder if Google Health and 23andMe will launch their own study?
I am very interested to see what becomes of Scripts study and to see if people will change their behaviors based on their genetic makeup. Perhaps they will start reporting at the 5 year mark to give us a taste of what how patients are trending? Unless there are incentives provided, I doubt many people will change their behavior. ie. people smoke for years, knowing it can kill them, but as soon as their company /health plan offers them an incentive to quit, they try to quit.
I already know I am at risk for diabetes, cancer and heart disease, based on my family history - but one day soon I will get tested to see everything else that is in my DNA. Perhaps it will be this year's Christmas present to the family.
Another Home Robot to Improve Medication Adherence
I found this blurb in the Journal of Telemedicine and Telecare about another home robot to improve medication adherence:
"We have developed a prototype home robot to improve drug compliance. The robot is a small mobile device, capable of autonomous behaviour, as well as remotely controlled operation via a wireless datalink. The robot is capable of face detection and also has a display screen to provide facial feedback to help motivate patients and thus increase their level of compliance. An RFID reader can identify tags attached to different objects, such as bottles, for fluid intake monitoring. A tablet dispenser allows drug compliance monitoring. Despite some limitations, experience with the prototype suggests that simple and low-cost robots may soon become feasible for care of people living alone or in isolation."
Like my previous post about the Carebot, this is pretty creepy, but it can be the future of home eldercare. Think of I, Robot. I do not see how this can work right now, unless a trust level is developed between the patient and the robot. I can imagine a patient ignoring the robot, unless the patient is already engaged in their medication regime, and needs the help to remember.
I'll be interested to see how this rolls out and how their clinical trials improve medication adherence.
"We have developed a prototype home robot to improve drug compliance. The robot is a small mobile device, capable of autonomous behaviour, as well as remotely controlled operation via a wireless datalink. The robot is capable of face detection and also has a display screen to provide facial feedback to help motivate patients and thus increase their level of compliance. An RFID reader can identify tags attached to different objects, such as bottles, for fluid intake monitoring. A tablet dispenser allows drug compliance monitoring. Despite some limitations, experience with the prototype suggests that simple and low-cost robots may soon become feasible for care of people living alone or in isolation."
Like my previous post about the Carebot, this is pretty creepy, but it can be the future of home eldercare. Think of I, Robot. I do not see how this can work right now, unless a trust level is developed between the patient and the robot. I can imagine a patient ignoring the robot, unless the patient is already engaged in their medication regime, and needs the help to remember.
I'll be interested to see how this rolls out and how their clinical trials improve medication adherence.
Death of Health 2.0? Let's Start With A Business Model
There have been a number of blog posts over the last few weeks about the demise of Health 2.0, many of which use the death /merger of Revolution Health signaling the end, as well as a few blog posts supporting the future of the movement. There was some intense debate between esteemed members of the H2.0 community through said blog posts, comments on blog posts and more blog posts - all of which I decided not to comment on because those that were commenting and creating the posts know more about the space than I do.
However, I saw two posts today that I thought summed up the economic situation as it relates to Web 2.0 and the health of Health 2.0.
The first of which was written by Dmitriy Kruglyak, from Trusted MD, a healthcare blogging network that FD I have been a member of since July of 2007.
It includes the famous Sequoia Capital presentation to their portfolio companies, quotes from TechCrunch signaling the "ignoble end of Web 2.0", and Dmitriy's own analysis on how this effects Health 2.0:
"I am not going to beat this dead (dying?) horse. If you paid attention to this blog over last two years you would not be surprised at this turn of event. I will just say that an "average" Health 2.0 company that gets mentioned in the news is typically orders of magnitude lower in terms of traffic, engagement and monetization than their Web 2.0 cousins......As I said time and again, Web 2.0 is becoming just as toxic as dotcom (or subprime mortgages and credit default swaps). Conventional wisdom takes a while to form but this process is picking up pace. You can take a guess what will happen with derivative (copycat) ideas, like Health 2.0."
Doesn't sound very promising. Yet it is true. How can a movement and companies sustain momentum in a down-turned economy if there isn't a sound business model? VCs have been throwing money at companies that are cool, but do not have a sound plan or any intention of making money. I look to Twitter, which is valued around $25M (maybe more now), but does not have a business model, and doesn't plan to make any money in the next couple of years. They just received another round of financing this summer. Granted Twitter is very cool and I use it, but there must be something more going on that I am missing here. The value of the community is how Twitter is valued and what they might be able to make from that. Sounds like Facebook, which was valued at $15B at one point from $150M in earnings.
Same with Health 2.0 companies. Lots of them are very cool, but rely on ad revenue or a freemium package. I signed up for a 60 day trial of a PHR to check it out, but when it came time to "buy" a year subscription, I said "no thanks". There wasn't enough offered for the paid service that I could not get from a free service.
This brings me a post from Ben Heywood, Co-Founder and President of Patients Like Me from last week on the PLM "Value of Openness" blog: "I believe we, as the eHealth community, need to focus on two major goals: 1) solve patients’ problems, and 2) create business models that allow us to do #1....I don’t want to prognosticate about what types of business models will work for all Health 2.0 companies as the industry evolves (because, ultimately, this is an evolution). It’s up to each company to figure that out. I do believe that there’s no wrong path when you keep both those goals in your sights."
And this sums up what needs to happen to keep the Health 2.0 movement alive.
PLM's business model is very straightforward: "We build online communities where patients share structured information about their disease to help themselves and others. In turn, we make money by selling that data." PLM is very transparent, and tell their members this upfront, and members encourage the selling of data, as this will help the pharma companies and device manufactuers improve their offerings to patients. PLM also received $5M in VC financing, so that gives them a bit of a cushion until they turn a profit.
Some Health 2.0 companies have gone under, others (like ZocDoc) are still receiving VC funding. It is an interesting time to be in the infancy of the Health 2.0 movement. I have faith that it will continue as long as the innovators create a needed product and can monetize without charging the consumer in a time when patients are having difficulty paying for their healthcare at the Health 1.0 level.
However, I saw two posts today that I thought summed up the economic situation as it relates to Web 2.0 and the health of Health 2.0.
The first of which was written by Dmitriy Kruglyak, from Trusted MD, a healthcare blogging network that FD I have been a member of since July of 2007.
It includes the famous Sequoia Capital presentation to their portfolio companies, quotes from TechCrunch signaling the "ignoble end of Web 2.0", and Dmitriy's own analysis on how this effects Health 2.0:
"I am not going to beat this dead (dying?) horse. If you paid attention to this blog over last two years you would not be surprised at this turn of event. I will just say that an "average" Health 2.0 company that gets mentioned in the news is typically orders of magnitude lower in terms of traffic, engagement and monetization than their Web 2.0 cousins......As I said time and again, Web 2.0 is becoming just as toxic as dotcom (or subprime mortgages and credit default swaps). Conventional wisdom takes a while to form but this process is picking up pace. You can take a guess what will happen with derivative (copycat) ideas, like Health 2.0."
Doesn't sound very promising. Yet it is true. How can a movement and companies sustain momentum in a down-turned economy if there isn't a sound business model? VCs have been throwing money at companies that are cool, but do not have a sound plan or any intention of making money. I look to Twitter, which is valued around $25M (maybe more now), but does not have a business model, and doesn't plan to make any money in the next couple of years. They just received another round of financing this summer. Granted Twitter is very cool and I use it, but there must be something more going on that I am missing here. The value of the community is how Twitter is valued and what they might be able to make from that. Sounds like Facebook, which was valued at $15B at one point from $150M in earnings.
Same with Health 2.0 companies. Lots of them are very cool, but rely on ad revenue or a freemium package. I signed up for a 60 day trial of a PHR to check it out, but when it came time to "buy" a year subscription, I said "no thanks". There wasn't enough offered for the paid service that I could not get from a free service.
This brings me a post from Ben Heywood, Co-Founder and President of Patients Like Me from last week on the PLM "Value of Openness" blog: "I believe we, as the eHealth community, need to focus on two major goals: 1) solve patients’ problems, and 2) create business models that allow us to do #1....I don’t want to prognosticate about what types of business models will work for all Health 2.0 companies as the industry evolves (because, ultimately, this is an evolution). It’s up to each company to figure that out. I do believe that there’s no wrong path when you keep both those goals in your sights."
And this sums up what needs to happen to keep the Health 2.0 movement alive.
PLM's business model is very straightforward: "We build online communities where patients share structured information about their disease to help themselves and others. In turn, we make money by selling that data." PLM is very transparent, and tell their members this upfront, and members encourage the selling of data, as this will help the pharma companies and device manufactuers improve their offerings to patients. PLM also received $5M in VC financing, so that gives them a bit of a cushion until they turn a profit.
Some Health 2.0 companies have gone under, others (like ZocDoc) are still receiving VC funding. It is an interesting time to be in the infancy of the Health 2.0 movement. I have faith that it will continue as long as the innovators create a needed product and can monetize without charging the consumer in a time when patients are having difficulty paying for their healthcare at the Health 1.0 level.
Wednesday, October 8, 2008
InnovationRx Announces Medication Adherence Awareness Month
I found this press release earlier in the week from InnovationRx, announcing a pilot program in CA for their pharmacy based adherence programs. I saw their presentation at the DM colloquium earlier this year and found their services to be very similar to Intelecare's, however InnovationRx is a paid service, not a free service to patients like Intelecare's consumer offerings. Also in the announcement was the declaration of Medication Adherence Awareness month, co-sponsored by the American Pharmacists Association, the FDA OWH and the Pharmacists Planning Service.
Of course I was very excited to hear about Medication Adherence Awareness Month, however I could not find any information on any of the aforementioned partner websites, nor on InnovationRx's website either. I emailed my medication adherence enthusiast buddy Dr. Showalter from AlignMap, and looked at his blog, but no info there either. I even did a Google Search, but could only find InnovationRx's press release (excerpt below).
Every month for me is Medication Adherence Awareness Month, as everyday I educate patients, caregivers, industry executives (Health 2.0 companies, health plans, pharmacies, non-profits, etc...) on the pandemic that is medication non-adherence.
QUICK STORY: My wife and I were at a wedding last weekend for one of her best friends, and inevitably the question of "what do you do" came up. I hate to bore people in social situations about healthcare issues (most of the guests were in the fashion industry and artists, musicians, etc...), but found that everyone I spoke with had no idea the impact medication non-adherence has to patients and the US economy. And they were interested. I even spoke with a heart surgeon, who said "sure I know about medication non-adherence, but I did not know it was so rampant".
So here is a salute to Medication Adherence Awareness Month! Please spread the word and stay adherent to your medications, and let others know about the importance of their doctor's prescribed care plan. 1 in 2 patients does not take their medications as prescribed, costing the US $300 BILLION annually in unnecessary healthcare costs and lost revenue. 84% cite simple forgetfulness as the reason for their non-adherence.
Medication non-adherence is America's Biggest Drug Problem, but it need not be.
From BusinessWire:
"InnovationRx, a wholly owned subsidiary of Innovation Group (UK:TIG: news, chart, profile) , today launched a medication adherence awareness campaign targeting pharmacists and patients in California. The campaign, a pilot for a nationwide effort, aims to provide pharmacists with resources that will help their patients to achieve medication adherence and improve health. InnovationRx is collaborating with the American Pharmacists Association (APhA), the Food and Drug Administration's Office of Women's Health (FDA OWH), and Pharmacists Planning Service, Inc. (PPSI) for this campaign.
Medication non-adherence is a costly and prevalent problem in the United States. As part of Pharmacy/Medication Adherence Awareness Month, InnovationRx and its partners will raise awareness of the consequences of non-adherence and showcase programs that are available to help patients simplify their medication regimen and build reminder systems."
Of course I was very excited to hear about Medication Adherence Awareness Month, however I could not find any information on any of the aforementioned partner websites, nor on InnovationRx's website either. I emailed my medication adherence enthusiast buddy Dr. Showalter from AlignMap, and looked at his blog, but no info there either. I even did a Google Search, but could only find InnovationRx's press release (excerpt below).
Every month for me is Medication Adherence Awareness Month, as everyday I educate patients, caregivers, industry executives (Health 2.0 companies, health plans, pharmacies, non-profits, etc...) on the pandemic that is medication non-adherence.
QUICK STORY: My wife and I were at a wedding last weekend for one of her best friends, and inevitably the question of "what do you do" came up. I hate to bore people in social situations about healthcare issues (most of the guests were in the fashion industry and artists, musicians, etc...), but found that everyone I spoke with had no idea the impact medication non-adherence has to patients and the US economy. And they were interested. I even spoke with a heart surgeon, who said "sure I know about medication non-adherence, but I did not know it was so rampant".
So here is a salute to Medication Adherence Awareness Month! Please spread the word and stay adherent to your medications, and let others know about the importance of their doctor's prescribed care plan. 1 in 2 patients does not take their medications as prescribed, costing the US $300 BILLION annually in unnecessary healthcare costs and lost revenue. 84% cite simple forgetfulness as the reason for their non-adherence.
Medication non-adherence is America's Biggest Drug Problem, but it need not be.
From BusinessWire:
"InnovationRx, a wholly owned subsidiary of Innovation Group (UK:TIG: news, chart, profile) , today launched a medication adherence awareness campaign targeting pharmacists and patients in California. The campaign, a pilot for a nationwide effort, aims to provide pharmacists with resources that will help their patients to achieve medication adherence and improve health. InnovationRx is collaborating with the American Pharmacists Association (APhA), the Food and Drug Administration's Office of Women's Health (FDA OWH), and Pharmacists Planning Service, Inc. (PPSI) for this campaign.
Medication non-adherence is a costly and prevalent problem in the United States. As part of Pharmacy/Medication Adherence Awareness Month, InnovationRx and its partners will raise awareness of the consequences of non-adherence and showcase programs that are available to help patients simplify their medication regimen and build reminder systems."
Friday, October 3, 2008
New Medication Adherence Blog
I discovered a new Medication Adherence blog called Medication Adherence Group 7. Almost as catchy as the title of my blog ;). It appears to be run by "Group 7, University of Texas at Arlington". UT of A also has a two other groups on Blogger: Group 12 and Calvino Saputra which also write blogs.
So far Group 7 have only posted a few posts which mention the causes of non-adherence and what you can do to help stay adherent.
I look forward to seeing how their blog develops.
So far Group 7 have only posted a few posts which mention the causes of non-adherence and what you can do to help stay adherent.
I look forward to seeing how their blog develops.
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