Clash of the Memes: the Future Battlefield of Ideas

Dov Michaeli

Posted 10/23/11 on The Doctor Weighs In

In his book “The Selfish Gene” Richard Dawkins, the population geneticist, proposed the idea of a meme as a target of natural selection. What in the world is a meme?

Essentially everything stored in your brain is a meme. Remember the joke about the guy in the bar? You didn’t invent it –you heard it somewhere, stored it, and probably told it to a friend, helping to spread it. How many people ever heard of the German composer Richard Wagner? With the exception of readers of this blog –not very many. How many listened to his operas? Even fewer. How many listened to his opera Lohengrin? Fewer yet.

But everybody knows the music to “here comes the bride” which was taken from the Wedding March in Lohengrin.

Continue reading “Clash of the Memes: the Future Battlefield of Ideas”

Occupy Health Care!

Patricia Salber

Posted 10/17/11 on The Doctor Weighs In

The 99% are mad as hell and aren’t going to take it any longer.   They are sick and tired of Wall Street insiders getting richer and richer while the millions of Main Streeters keep on losing ground.

Today marks the one month anniversary of a movement that pundits initially thought had little chance of lasting.  Instead of fading away, the Occupy protests are metastasizing across the globe with demonstrations in London, Rome, Chicago, Tokyo and even in Paraguay…Paraguay, for God’s sake.   Some people are saying the Occupy movements are the “Arab Spring” of the West.  People, empowered by technology, are refusing to accept the status quo that protects the interests of a few.

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Comments on the Cleveland Clinic’s “Top Ten” Health Care Innovations

Dov Michaeli

Posted 10/08/11 on The Doctor Weighs In

Yesterday Pat Salber treated us to a list of truly great innovations compiled by the Cleveland Clinic. Let me say at the outset: each one of the innovations on the list is really a gee-whiz invention, and each promises to transform a specific field of medicine. But some of the inventions provoked some thoughts about our basic attitudes and beliefs.

Take the #1 innovation, catheter-based renal denervation for resistant high blood pressure. This is brilliant; resistant high blood pressure is just that –resistant to treatment. Disrupting the renal nerve seems to solve this vexing problem. So what’s my problem? Knowing the history of seemingly focused treatment “metastasizing” to totally inappropriate treatments, I am a bit cynical. How long will it be before surgeons see hypertension as a “profit center”? Stomach banding was designed for treating the morbidly obese. It is rapidly evolving as a painless way around the more demanding way of diet and exercise for weight reduction. Can renal denervation be far behind?

Continue reading “Comments on the Cleveland Clinic’s “Top Ten” Health Care Innovations”

Connecting the Dots Between Personal Fiscal Health and Personal Health

Jane Sarasohn-Kahn

First posted 9/5/11 on Health Populi

Home foreclosures negatively influence health in several dimensions: they cause stress on the lives of the home’s residents, including children, driving mental and physical illness; they impact neighbors who worry that home values will fall in their community; and, they can motivate unhealthy behaviors, such as drinking and foregoing medical treatment such as seeing the doctor and filling needed prescriptions for drugs treating chronic conditions.

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Patients and Clinicians: Fancy Yourself a Health Care Writer?

Brian’s Note: Neel Shah is a physician resident at Harvard and the Executive Director of Costs of Care, a not-for-profit devoted to highlighting more efficient ways to deliver care. CofC is running a writing contest for clinicians and patients – see below – with cash prizes and a board of judges comprised of health care luminaries. 

Looks like something fun to participate in. I’d urge you to give it a shot.

September 6, 2011


Spokesperson: Neel Shah, MD (Executive Director)


Phone: 617-841-8581


Neel Shah, MD

Costs of Care is officially launching its second annual healthcare essay contest today, with the goal of expanding the national discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs.

The contest will solicit stories from care providers and patients across the nation that illustrate everyday opportunities to curb unnecessary and even harmful health care spending on a grassroots level.

Costs of Care will award $4000 in prizes to top submissions. Two $1000 prizes will be reserved for patients, and two $1000 prizes will be reserved for care providers. Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care.

To help select the winning entries, Costs of Care has assembled an expert panel of judges:

  • Peter Orzsag, former Director of the White House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon General
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer research advocate
  • Dr. Alan Garber, health economist and Harvard University Provost

Anyone looking to learn more about the successful entries from last year’s contest can find our more at

All submissions will be due on November 15th, 2011. Finalists will be announced on December 15th, 2011 and the $1,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at during the 2012 calendar year, and will be made available to the media.

The contest is sponsored in part by through the generosity of Blue Cross Blue Shield of Massachusetts and Harvard Pilgrim Health Plan.

About Costs of Care

Costs of Care is a nonprofit organization that gives patients and healthcare workers the information they need to deflate medical bills, while expanding the national discourse on the role of care providers in responsible resource stewardship. Costs of Care was founded by a resident physician based at Harvard Medical School who noticed that even the best physicians sometimes overlook something critical—the bill.

Full contest details are available at

Please direct all contest-related inquiries to


What’s Going On At Parkland Memorial Hospital in Dallas?

Paul Levy

First posted 8/29/11 on Not Running a Hospital

series of stories at the Dallas Morning News raised some serious questions about the quality of care at Parkland Memorial Hospital.  I draw no judgments about those issues.  But what comes across in these stories is something equally interesting:  A hospital that has chosen to take a hard line, dare I say stonewall, with the local press on issues of community concern.  In an era of increasing transparency, this approach is an anachronism.

Those of us a certain generation remember Parkland Memorial as the site of President Kennedy’s trauma treatment and death in 1963, providing it an important symbol of high level care in our national consciousness.  But it is also a major teaching facility of the UT Southwestern Medical Center and is prominent in its own right for many reasons.

Continue reading “What’s Going On At Parkland Memorial Hospital in Dallas?”

Experience is not the Answer

Bradley Flansbaum

First posted 8/25/11 on The Hospitalist Leader

I assume, incorrectly perhaps, that mechanics have a basic knowledge of their craft such that routine auto repairs require little effort.  The tasks do not supersede the expected competency of the repairperson, and the customer can expect a car that operates at the time of pick up.  A small percentage of jobs may stretch that assumption, but that is okay by me.  Just like medicine, some mends are complicated. You need assistance from another mechanic or you refer the auto to a specialty garage.  No one is superman.

How does this relate to the practice of medicine?

I frequently notice pharmaceutical ads on Sunday AM television broadcasts, as well as newspaper articles that advertise a medical product, or report on a new device, surgery, or therapy—usually of the latest and greatest vintage.  As the data for these interventions is incomplete, or the costs unknown, the story concludes with a riposte conveying that the reader need not concern themselves with the alien facts—just “consult your health professional” and all will be well.

I also observe that politicians object to “meddling” when EBM-based policies from expert committees passively (or actively) affect the doctor-patient relationship, especially as it relates to decision-making and the counsel we provide.  Just watch the nightly news—sound bites abound.  This relationship is sacrosanct after all, and our advice is authoritative and 98.7% correct.  Who would question a physician after all?

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Bad Language: Words One Patient Won’t Use (And Hopes You Won’t Either)

Jesse Gruman

First posted 8/03/11 on Prepared Patient Forum

“There is a better way – structural reforms that empower patients with greater choices and increase the role of competition in the health-care marketplace.” Rep. Paul Ryan (R-WI)August 3, 2011

The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services.  But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service.  Two phrases commonly used to describe us convey meanings that mischaracterize our experiences and undervalue our needs: “empowered patient” and “health care consumer.”

As one who has done serious time as a patient and who spends serious time listening to talks and reading the literature that use these words to describe us, I ask you to reconsider their use.

Continue reading “Bad Language: Words One Patient Won’t Use (And Hopes You Won’t Either)”

The Long Term Effects of Our National Malaise

Dov Michaeli

First posted 7/28 on The Doctor Weighs In

Most of us are in a funk right now. We are involved with two wars which most of us don’t really believe in, we are slogging through the worst economic wreckage since the Great Depression, there is a pervasive sense that America is rapidly losing its optimism, its enthusiasm, its can-do attitude. It wouldn’t be a big stretch to conclude that we are losing our hope. On the individual level hopelessness is a hallmark of depression. Can our society suffer from the equivalent of depression? And what would the consequences be?

Research on environmental and cultural impact on societal behavior is hard to do. The main difficulty is to tease out causal connections from the incredibly rich fabric that affects society. For example, did religious institutions shape societal behavior, or did the latter provide fertile ground for the rise of religion? Or was it a two-way relationship, one affecting the other? All one can do is make observations, and observational studies are rarely conclusive.

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5 Myths About Smoking and Mental Illness

Pat Salber

First posted 7/27/11 on The Doctor Weighs In

Judith Prochaska has written a very interesting commentary about smoking and mental illness that appeared in the July 21, 2011 issue of the New England Journal of Medicine (NEJM).   The point of the article is that we in the health professions have failed to aggressively address smoking in people with mental illness.  She posits that it is because of five prevailing myths about smoking and mental illness.  She provides evidence to dispel those myths in every instance.

Myth #1:   Tobacco is a useful self-medication for people with mental illness

It shouldn’t be a surprise to learn that our friends in Big Tobacco have played a role in promulgating this myth by funding research and presentations supporting this hypothesis.  In fact, the industry has a long and rich historyof manipulating research to reach its goal of selling more and more cigarettes to more and more people.  One of industry’s main strategies was to create confusion to counter the increasing body of evidence about tobacco’s adverse health impact.  Just read this quote from a 1969 Brown and Williamson document:

“Doubt is our product since it is the best means of competing with the ‘body of fact’ that exists in the mind of the general public….”

Continue reading “5 Myths About Smoking and Mental Illness”

More Clinicians Understand That Patients Want To Communicate Online

Jane Sarasohn-Kahn

First posted 6/26/11 on Health Populi

As people take on more DIY approaches in their daily lives for travel planning, photo management, and investing, they’re looking for health care touchpoints to do the same — especially, their physicians. In 2011, more doctors are responding to this patient-driven demand, based on data published in the InformationWeek digital health care issue July 25, 2011, titled The Pain of Change.

Most patients would be willing to change physician practices if their doctors don’t offer online access to tools, based on a recent survey from Intuit which Health Populi covered in March 2011 here.

Continue reading “More Clinicians Understand That Patients Want To Communicate Online”

How Patients Disclose Medical Diagnoses Online

Jane Sarasohn-Kahn

First posted 7/22/11 on Health Populi

Once upon a time, being diagnosed with the “C” word, cancer, was information that kept people quiet and within the family. Today, social media platforms like Facebook, Twitter and blogs have increasingly become routine settings for discussions regarding the most personal of concerns” — like health care, according to an analysis titled, Seeking Social Solace: How Patients Use Social Media to Disclose Medical Diagnoses Online from Russell Herder, a Minneapolis-based marketing & PR agency.

Advocacy Groups Threaten Evidence-Based Guidelines

Josh Freeman

First posted on 7/13/11 on Medicine and Social Justice

Two recent “Commentaries” in the same issue of JAMA address different challenges to the implementation of evidence-based practice guidelines. One, “Direct-to-consumer cardiac screening and suspect risk evaluation,” addresses the challenges posed by the potential for profit that occurs when companies market screening tests directly to the consumer (DTC) that may not be indicated, may not be indicated for the people who it is marketing to, or may even be harmful to the recipients of such screening. This harm can be physical, as in untoward events, or in risks inherent in the further procedures for those who “screen positive” but turn out to have been “false positives.” The harm is also financial, for there is a cost to doing these tests – to the individual (sometimes) or to their insurer; in the latter case, whether that insurance is public (e.g., Medicare, Medicaid) or private, the cost is to all of us. And, of course, that cost is the reason for such marketing, as it is what translates into profit for the company selling the test.

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Health is Bliss

Jane Sarasohn-Kahn

First posted 7/14/11 on Health Populi

In the ever-morphing space between health, wellness and beauty is the latest online portal called The project was launched by Glam Media, which brings together women-focused brands and social media. Glam boasts a reach of 200 million across all of its online properties, and estimates that will realize an 11 million member community. Its target is “yogis, fitness enthusiasts and health conscious moms,” according to Glam’s website. Bliss Connect is the social networking component on the website for user-generated content.

[In a small-world, two-degrees of separation from my health care world, Glam was in fact inspired by Esther Dyson in 2002.]

With hyperlinks to “eat well,” “get fit,” “mind+spirit,” “head to toe,” and “sanctuary,” this website grabs onto the zeitgeist of Whole Health. Today’s features include “Exercise in Bed,” “Summer Snacks That Won’t Blow Your Calorie Budget,” and “Healthy Now, Healthy Later,” a four-step process to help you sustain good health habits — sponsored by One-A-Day vitamins.

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Advice on Social Media For Physicians

Kenneth Lin

Originally posted 7/6/11 on the American Family Physician Community Blog

The Mayo Clinic’s Center for Social Media recently posted a short video of prominent physician bloggers Bryan Vartabedian (a gastroenterologist), Wendy Sue Swanson (a pediatrician), and Katherine Chretien (an internist) giving advice to young physicians on the potential and perils of social media use.

The advice and additional resources these experts provide should be helpful to family physicians at all stages of training who are new to using social media tools. Dr. Chretien also writes an insightful commentary in the July 1st issue of AFP in response to the question, “Should I be ‘friends’ with my patients on social networking web sites?” (Short answer: no, but there are less ethically questionable ways to interact with one’s patients online.) As Dr. Chretien points out, the American Medical Association has recently published guidance on professionalism in the use of social media.

We encourage family physicians to explore the health care social media landscape through posts and comments on the AFP Community Blog and the journal’s Facebook and Twitter accounts, as well as by visiting our links to blogs written by and for family physicians.