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Jay Parkinson — Fri, 26 Aug 2011 12:48:30 +0000

I bet celebrities and other VIPs (as they’re known in hospitals) get some of the worst healthcare in America. And, when I mean worst, I mean the most. I did my residency in the West Village in NYC. There seemed to be a new celebrity in the ER every other day. “Oh my god, Lindsay Lohan is in bed 3!” I took care of my fair share of them— I won’t say who. But there was always this understanding from everyone in the hospital that “they were VIPs” and needed extra special treatment. The problem with extra-special treatment in our healthcare system is that it almost always means more care than anyone else would get. For example, celebrities often get every test imaginable done on them in order to rule absolutely everything out. A hospital doesn’t want to be known as the one that killed Lindsay Lohan. This of course leads to more tests and sometimes, more procedures. More procedures can often equal more complications. You get the deal. One hundred thousand people in America die every year due to medical mistakes, unnecessary surgeries, hospital-acquired infections, and drug complications. And they’re not VIPs. Everyone in the health community is speculating on what happened to Steve Jobs, so here’s the rough timeline:

Some time in the second half of 2003: Jobs undergoes some sort of scan which finds an incidentaloma, which actually later that evening, it was biopsied and found out to be a pancreatic neuroendocrine tumor, a slow growing kind of pancreatic cancer.
The next nine months: Jobs tries a special diet hoping to kill or slow the cancer’s growth. Either it doesn’t work and the cancer grows or the doctors convince Steve that there’s more evidence for a Western medicine intervention than a special diet.
July 31, 2004: Jobs undergoes surgery to remove the tumor.
June 2009: Jobs undergoes a liver transplant. It’s unclear why.
August 24, 2011. Jobs steps down as Apple’s CEO because he is unfit for his duties.

As a physician, it’s our job to do something. We can prescribe pills or we can perform some sort of procedure on you. When we find something abnormal, it’s in our nature to do something about it. Sometimes, it’s in your best interest to actually not do anything about it. The problem is, we don’t know when we should not do something because we don’t always know how you and your body will handle something abnormal. All we have are stats from population-level studies, an intuition, personal experience, and some labs or imaging. I learned from a professor in medical school that we all get cancer a few times a day. Out of tens of trillions of cells in our body, it makes sense that a few of them will occasionally go haywire. But, there are very elegant processes in our body that ensure these mutated cells actually kill themselves (see Knudson’s Hypothesis). Steve Jobs’ had an incidentaloma. It may have taken this tumor 15 or 20 years to cause symptoms. However, it may have taken 1 month. We won’t ever know. We do know that incidentalomas sometimes simply go away without rhyme or reason. And we do know that, in Jobs’ case, the doctors intervened with two major surgeries and, now, 8 years later, his health is severely compromised. Maybe if his doctors actually did nothing for him, he’d still be just fine today. There’s no real way to know. I do think that his docs did the right thing as competent doctors, but, again, there’s no way to know if they were competent in Steve Jobs’ case nor will we ever know that if they just left him alone, he would have been just fine. He probably doesn’t have many years, if not months, to live. And that makes me very, very sad. He was one of our heroes. But I’ve got to wonder to myself, how were his doctors affected by the fact that they had Steve Jobs as a patient? We’ll, of course, never know. But I surely wouldn’t want to be his doctor. For further reading, please read The Atlantic article, How American Healthcare Killed My Father.

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Jay Parkinson — Thu, 03 Feb 2011 02:47:53 +0000

A few months ago, I discovered that my stove was broken. I've lived in the same apartment for over three years. I never cooked. I always went out to eat at restaurants in my neighborhood. I live in Williamsburg, Brooklyn. We've got some of the best places to eat in all of NYC. I ate fresh, whole foods, just cooked by someone else for an obvious price premium. I formed relationships with people who worked at my favorite places. They knew me as Dr. Jay, the regular. But about four months ago, my life changed. I started spending a lot of time with someone who loves to cook. She bought Jamie Oliver's book, Cook, and we set ourselves loose trying to cook as much as we could. Then the holidays happened, and my best friend realized my new interest in cooking and bought me Mark Bittman's Kitchen Express while she got Mark Bittman's How to Cook Everything from her family. And I invested in kitchen equipment I should be able to keep for the rest of my life. I now eat out once a week. Over the summer, I visited Grant in London. Grant is a regular cyclist. He had an idea-- we'd rent a bike for me in London instead of using taxis or the tube. I fell in love with biking. But not only did I fall in love with biking, I fell in love with biking with someone else as we moved from point A to point B and chatted in between. I bought a Brompton during the next visit to London and now have a portable, stylish bike I travel with all over the world. I go to the gym 3 or 4 times a week and lift weights. About two months ago, I simply got bored with weights and jumped on the stair machine. I seriously sweated at the gym for the first time of my life. I'm now at the gym 6 days a week. I decided to up the ante on my life and push my body. In the past 4 months, I've changed my life for the better in three significant ways. Why? My relationships changed, and thus my everyday changed. I began eating with someone who ate differently than me. I adopted her eating habits, which spurred me to change how I ate. I also spent more time with Grant, who introduced me to the world of urban cycling. I adopted his lifestyle and his interests. And then I changed myself and started pushing my heart in the gym. My friends were kind enough to give me the best parts of their life and I was savvy enough to implement them into my own life. On a related note, Atul Gawande's latest piece in The New Yorker, The Hot Spotters, answers the question, "Can we lower medical costs by giving the neediest patients better care?" In other words, can we lower medical costs by changing the everyday lifestyle of the neediest patients? Dr. Jeffrey Brenner in Camden, NJ found that:

Between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million.

Brenner started finding these high cost patients and forming relationships with them. He wanted to know what the problems were and what creative, personalized solutions he could use to fix their medical problems. He found that what's traditionally been thought of as medical problems, non-compliant patients, were really social problems. One chronically ill patient Brenner "treated" was a person he called Frank Hendricks:

But, out in the world, Frank's life was simply another hospitalization waiting to happen. By then, however, Brenner had figured out a few things he could do to help. Some of it was simple doctor stuff. He made sure he followed Hendricks closely enough to recognize when serious problems were emerging. He double-checked that the plans and prescriptions the specialists had made for Hendricks’s many problems actually fit together—and, when they didn’t, he got on the phone to sort things out. He teamed up with a nurse practitioner who could make home visits to check blood-sugar levels and blood pressure, teach Hendricks about what he could do to stay healthy, and make sure he was getting his medications. A lot of what Brenner had to do, though, went beyond the usual doctor stuff. Brenner got a social worker to help Hendricks apply for disability insurance, so that he could leave the chaos of welfare motels, and have access to a consistent set of physicians. The team also pushed him to find sources of stability and value in his life. They got him to return to Alcoholics Anonymous, and, when Brenner found out that he was a devout Christian, he urged him to return to church. He told Hendricks that he needed to cook his own food once in a while, so he could get back in the habit of doing it. The main thing he was up against was Hendricks’s hopelessness. He’d given up. “Can you imagine being in the hospital that long, what that does to you?” Brenner asked.

Dr. Brenner helped Frank by giving him resources and the relationships to change his lifestyle. Only about 10% of the solutions that got Frank back on track were medical, the rest were social situations that lead to lifestyle change. This is a significant paradigm shift. The companies that realize the future of health is about life and happiness rather than sickness, death, and medical solutions are the ones that will lead in the next decade. More importantly, the companies that can find a business model around social solutions for the neediest, most costly patients, are the ones who will not only make a killing, but change the face of healthcare in the world. image via Telegramme Studio

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Jay Parkinson — Thu, 25 Nov 2010 23:56:10 +0000

I'm often asked about new and interesting healthcare innovations happening here in the US. Honestly, it's very hard for me to come up with any. Here are the few that I think are interesting from the traditional sickness focused medical world:

ZocDoc: It's like OpenTable but for doctor appointments. Use it. I do.
Freelancers Insurance Company: They are clients of The Future Well so I'm biased. But they've created an insurance company designed for a life-long engagement with the 30% of the workforce that's deemed independent workers.
Hello Health: I'm a bit biased about this one as well.
Practice Fusion
One Medical Group
Current Health
Care Practice

All of these companies listed above are reinventing the delivery of healthcare by focusing on the consumer experience and their satisfaction. Beyond that, I'm not a big believer that the traditional medical care space is truly innovating on much of anything. Try and come up with one difference in your experience as a patient between going to the doctor today vs. going to the doctor when you were a kid. I believe that only a very, very small group of people want to track everyday health data. I don't see a new blockbuster drug around the corner that will significantly improve lives. New devices and procedures are being invented but nothing that groundbreaking. Most importantly, the way we study medical improvements is broken and there aren't any signs that this is improving. However, I'm fascinated by this cultural movement we're seeing toward health and social consciousness that will do more for health than pills and scalpels. I think more and more people are paying attention to what they eat, how much activity they get, and what kinds of neighborhoods to live in that will make them happy. Think about what didn't exist 15 years ago in a significant way:

Whole Foods
Fooducate and their iPhone App
Michael Pollan
Jamie Oliver
Food Inc and Supersize Me
RunKeeper
Nike Plus
Rapha
The Truth Campaign
Self-publishing: blogs for people with diabetes and other chronic diseases
Open Source Prosthetics
Dr. Google's 24/7 availability
Madonna Gyms or Equinox that make exercise entertaining and cool
Facebook and text messaging for organizing your social life and enhancing the health of your real life relationships
Bike sharing programs like bcycle
Relatively healthy fast food like Panera Bread, Le Pain Quotidien, and Pret-a-Manger
The Prius
Livestrong
etc..

The point is, very few of these innovations that affect your everyday health and life are coming from traditional healthcare. It's too bogged down in profiting off sickness, government regulations, bureaucracy, pilot projects, and expensive mandates to produce anything significant. If I were investing in health I wouldn't invest in sickness care, I'd invest in consumer-obsessed companies that are doing something for consumers to eat better, be more active, or live a healthier life. The most significant innovation in the past two decades has been a cultural health consciousness that's just getting started and it's coming from regular consumer companies realizing there's opportunity in brands that enable a healthier, happier life.

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Jay Parkinson — Mon, 09 Aug 2010 23:06:22 +0000

Susannah Fox at the Pew Internet & American Life Project recently posted a comment made on a blog about the internet and health:

Order Potassium Citrate Online Now, The remaining 95% of “patients” out there are not motivated to become informed, or invest the time/energy/money in using any of these tools. Potassium Citrate over the counter, These are the folks that know that fast food isn’t healthy, but are just too tired to choose differently, buy Potassium Citrate without prescription. Potassium Citrate trusted pharmacy, Some (emphasis on some) will do a standard Google search when they receive a new diagnosis at best. Yet these are the folks – often folks with multiple chronic (often preventable) health problems, buy Potassium Citrate online cod, Order Potassium Citrate online overnight delivery no prescription, many overweight, on multiple medications, order Potassium Citrate from mexican pharmacy, Buy generic Potassium Citrate, sometimes social problems – that have the real issue that needs fixing.

So we can all sit and perfect the tools for a few folks that never needed them anyway, buy Potassium Citrate online no prescription, Order Potassium Citrate no prescription, or we can recognize that the kinds of solutions required for healthcare in the US today have nothing to do with fancy IT, or prioritization on search engines, buy no prescription Potassium Citrate online, Buy Potassium Citrate without a prescription, and everything to do with low-tech, unsexy approaches toward grass-roots public health, order Potassium Citrate online c.o.d. Sorry to be the voice of reality guys.

We at The Future Well have been struggling with this concept for quite some time, Order Potassium Citrate Online Now. Where can i buy Potassium Citrate online, What effect will the internet have on our health in our daily lives. Will it have such a negligible effect that we don't even know it, buy Potassium Citrate from canada. Online buying Potassium Citrate hcl, Will it have a huge effect for a few very engaged people. What should we use the internet for in creating health solutions, buy Potassium Citrate from mexico.

Let's start with two facts:

Healthcare is local.

The internet has revolutionized the way we communicate and transact.

Order Potassium Citrate Online Now, Has the internet improved our physical activity. Purchase Potassium Citrate online, Has it made us eat better. Has it improved our social relationships so we're happier, purchase Potassium Citrate online no prescription. Rx free Potassium Citrate, Has it given us access to new information that helped us improve our health.

The answer is yes-- for a tiny fraction of us, where can i order Potassium Citrate without prescription. But something like walking 30 minutes a day decreases your risk of diabetes by 40%, Order Potassium Citrate Online Now. Buy cheap Potassium Citrate no rx, Will we sacrifice internet time to walk.

So how should we use the internet for health, buy Potassium Citrate online no prescription. Buy no prescription Potassium Citrate online, We say the same way we currently use the internet for everything else:

Let people make appointments with their local doctor online.

Let people communicate via email with their local doctors and other caregivers for questions and requests.

Let people learn from others with the same interests (either an interest in an illness or a wellness activity).

Provide accurate, not confusing, Potassium Citrate from canadian pharmacy, Buy cheap Potassium Citrate no rx, information about what the scientific community currently thinks is true.

Will the "digital natives" save us. They use the internet in totally new ways right?, Potassium Citrate price. Order Potassium Citrate Online Now, Probably not. Purchase Potassium Citrate online, This is what a recent article in Spiegel says:

Young people have now reached this turning point, online buy Potassium Citrate without a prescription. Japan, craiglist, ebay, overseas, paypal, The Internet is no longer something they are willing to waste time thinking about. It seems that the excitement about cyberspace was a phenomenon peculiar to their predecessors, where can i find Potassium Citrate online, Buy cheap Potassium Citrate, the technology-obsessed first generation of Web users.

For a brief transition period, buy Potassium Citrate without prescription, Buy Potassium Citrate from mexico, the Web seemed to be tremendously new and different, a kind of revolutionary power that could do and reshape everything. Young people don't feel that way, Order Potassium Citrate Online Now. They hardly even use the word "Internet," talking about "Google", "YouTube" and "Facebook" instead. And they certainly no longer understand it when older generations speak of "going online."

"The expression is meaningless," Tom says. Indeed the term is a relic of a time when the Internet was still something special, evoking a separate space distinct from our real life, an independent, secretive world that you entered and then exited again.

Tom and his friends just describe themselves as being "on" or "off," using the English terms. What they mean is: contactable or not.

Order Potassium Citrate Online Now, We're still humans with 200,000 years of ingrained behaviors that only changed to a sedentary lifestyle in the past 100 years or so. So we need real human to human interactions to encourage us to fight our modern conveniences, move, and eat food, mostly plants. This isn't sexy. It's low-tech. It's real relationships with family, friends, and local professionals trained in behavioral modification.

All of this, of course, needs to be packaged up in a sexy experience for people, Order Potassium Citrate Online Now. They need to feel comfortable surrounded by an aesthetic that makes them feel good.

So go local, embrace low-tech, maximize real relationships, and make it sexy. This will be the future of effective healthcare in a community. Our life expectancy has almost flatlined compared to the explosive growth in the last 100 years. We don't think anyone wants to live as a 90 year old for 40 years. If doctors want to be just as effective in the next 100 years as they were in the past 100, we'll have to focus on optimizing happiness and satisfaction with life in the healthiest years of our lives...and not simply prolonging life.

(photo by me of Grant and his wife Amanda in his backyard in London...taken with my iPhone).

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Taking care of this population with limited resources will be one of the biggest challenges. Innovative technology combined with new business models of paying for sustainable healthcare delivery for this population will provide some relief, but new processes of healthcare delivery must be invented for effectively keeping this population healthy, Order Frontier (Frontline) 22-44 lbs Online Now. A new kind of service and its associated processes must be designed from the ground up, where can i order Frontier (Frontline) 22-44 lbs without prescription. Buy Frontier (Frontline) 22-44 lbs without a prescription, Literally, every country struggles with the same outdated processes of healthcare delivery, buy Frontier (Frontline) 22-44 lbs from canada. Canada, mexico, india, If you ask anyone anywhere in the world, "What's the difference between going to the doctor today versus going to the doctor when you were a kid?" you get the same answer:

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David Cameron has been talking up his concept of "Big Society" and delivered a speech this week where he said:

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In accordance with the Big Society, purchase Human Growth Hormone online, Order Human Growth Hormone online c.o.d, last week, the UK's Health Secretary unleashed a major shakedown for the NHS releasing a white paper that promised three major upgrades for healthcare in the UK:

put patients at the heart of everything the NHS does;

focus on continuously improving those things that really matter to patients - the outcome of their healthcare; and

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This is essentially unleashing private enterprise in conjunction with primary care physician groups, instead of the NHS Primary Care Trust management, buy Human Growth Hormone from canada, Buy Human Growth Hormone no prescription, to support and coordinate the delivery of the highest quality, most cost-effective healthcare for people in the UK, where can i buy cheapest Human Growth Hormone online.

Immediately after the announcement, rumor has it there were many calls from health-related companies (like Health IT and health management) in the US trying to figure out what that means for the possibility of expansion into the UK, Order Human Growth Hormone Online Now. Buy Human Growth Hormone without prescription, This is what could happen if US Health IT and health management companies enter the newly-formed UK market:

Health IT companies will offer initial low cost solutions to physician groups in order to lock them into their higher cost, siloed, where can i order Human Growth Hormone without prescription, Online buying Human Growth Hormone hcl, proprietary technology that looks and functions like Windows 95. That is their business model, where can i buy Human Growth Hormone online. Buy Human Growth Hormone online no prescription, Beware.

Health management companies will offer to micro-manage healthcare for physician groups. Micro-management increases costs and leads to high dissatisfaction in both patients and doctors.

If the UK wants to do the right thing for the future of their healthcare, order Human Growth Hormone from mexican pharmacy, Canada, mexico, india, now is the perfect time to foster the development of an open-source, web-based health platform with APIs to power the future of healthcare, rx free Human Growth Hormone. Order Human Growth Hormone Online Now, This system would have, at minimum, the following standardized parameters:

an open-source, standards-based, exportable data format that allows structured data to freely flow between systems

a physician profile

a patient profile

a standardized physical location format (each address and each physical exam/procedure room)

a time slot (like CalDAV) for scheduling (imagine a person in London doing a web search for the nearest physician with availability in the next two hours with H1N1 vaccines in stock)

a focus on communication (think gMail), project management (think Basecamp), and efficient transmission of clinical data (think of a secure Facebook with open APIs that enable third parties to build applications (such as Farmville) on top of the platform)

a focus on gathering and learning from outcomes via today's kind of communication with patients (email, SMS, etc)

built in Customer Relationship Management (think Highrise or salesforce)

a robust patient interface that empowers patients with information and tools to help solve their acute problems or manage their chronic illnesses

Since patients will soon have the freedom to choose any doctor as their doctor, the physician groups and practices that truly deliver an elegant experience with excellent customer service will thrive, and those who don't will struggle to survive. Buy Human Growth Hormone online no prescription, We see a huge opportunity in building physician practices that choose a certain target market (think internet savvy, young urbanites) and deliver an experience that caters to their market's needs (think of a doctor's practice that looks and functions like an Apple Store for when your computer breaks), buy Human Growth Hormone online cod. Purchase Human Growth Hormone online, All of these practices should be networked together via the open-source platform described above.

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