Princess Health and Build Your Own Yogurt Maker, Sous-vide Cooker, and All-purpose Fermenter for $40. Princessiccia

Princess Health and Build Your Own Yogurt Maker, Sous-vide Cooker, and All-purpose Fermenter for $40. Princessiccia

Gusty 06:00 Add Comment

I make a half gallon of yogurt, twice a month. I like making my own yogurt for many reasons, but it's a bit of a pain. Since I make large batches, I can't use a standard yogurt maker. I often get distracted and over-heat the milk, and the method I use to incubate the yogurt is wildly inefficient (my beloved Excalibur dehydrator). I also need a constant warm temperature for various other fermentation projects, and that's often difficult to achieve with the tools I have.

I finally found a better solution: a temperature controller that accurately regulates the temperature of a slow cooker by turning an outlet on or off. I simply set the temperature of the controller, place the temperature probe into the slow cooker, and plug the slow cooker into the temperature controller outlet. The slow cooker then stays at whatever temperature I want. Here's what the temperature controller looks like:

Once built, the temperature controller with or without the slow cooker can be used for a variety of other tasks (including regulating cooling devices). Here are some ideas that come to mind:

• Sous-vide cooker
• High-capacity yogurt maker
• Bread dough riser
• All-purpose thermophilic fermenter (e.g., for tempeh, natto, koji)
• Beer/cider/wine fermentation temperature controller
• Kegerator controller
• Freezer-to-fridge conversion
• Egg incubator
• Soil temperature controller for seed starting

Don't worry, I'm not turning into a food blogger. But this sous-vide-cooked
chicken I made with my DIY temperature controller was pretty tasty.
I used this recipe from NomNom Paleo.

You can build the whole thing for about $40, including the slow cooker.

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Princess Health and Rideout Hospital, California: CEO Pinocchio on quality of patient care during hospital computer crash. Princessiccia

Princess Health and Rideout Hospital, California: CEO Pinocchio on quality of patient care during hospital computer crash. Princessiccia

Appeal-Democrat healthcare IT crash healthcare IT risk Patient care has not been compromised Rideout Hospital Robert Chason

Gusty 13:41 Add Comment

EHRs and other clinical IT are touted as essential to improving safety, among many other benefits.

Yet when hospital systems crash, the common refrain by hospital executives to the press, when such stories are reported, is "...but quality of care was not compromised."  

In fact, I've made an indexing term for this refrain.  The following query link retrieves the posts so indexed, numbering almost 30 at present:  http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised

One hospital in California 40 minutes north of Sacramento had a crash and its CEO made exactly that claim.  However, a patient's husband disagreed, and called the CEO a liar.  Why?  His wife was affected by the crash in a very unsafe manner.

The Appeal-Democrat is a local news source for Sutter and Yuba counties, California, serving readers since 1860.  Emphases mine:

Letter: Re: Rideout Hospital computer problems

http://www.appeal-democrat.com/opinion/letter-re-rideout-computer-problems/article_4a408cc0-be47-11e4-9b7b-93c22da930d4.html 

Friday, February 27, 2015 

I am writing in regard to comments made by the CEO of Rideout Hospital regarding its recent computer crash. 

He said quality of care for patients had not been compromised during this incident. He is lying.

My spouse went to Rideout almost two weeks ago and had a Lexiscan of her heart when the computer system went down. The hospital doctor released her and assured her that if anything were wrong, the radiology department would spot it and she would inform us.

Here it is two weeks later and now they are saying because of the computer problem the entire test didn't get to her cardiologist until today. They think she may have had a minor heart attack and needs further cardiac intervention.

 Is this the new "open and improved" truths we are getting from this hospital? Rideout CEO Robert Chason misinformed us all. 

I am sure my spouse, who has fallen through the cracks during this inexcusable lapse in Rideout's technical policies, is not the only patient suffering similar situations. 

Shame on Chason for minimizing the effects of this catastrophe at our local hospital. 

Edward Ferreira 
Yuba City

Claims that hospital paralysis through health IT outages and malfunctions don't compromise patient care insult my intelligence.  Such claims insult the intelligence of patients and their families, too.  Outages and malfunctions nearly always compromise the quality and safety of care.
  
Patient safety is put at risk because hospitals are not making adequate efforts to keep these systems up 24x7. Many might say they can't afford it.  You don't put in life-critical information systems half-baked, however. Not in medicine, anyway.

Finally, the press, by accepting these Pinocchio-like statements from hospital administrations without severe challenge, only promote cavalier behavior of hospital executives.

Hospital executives:  EHRs are so absolutely essential to patient safety, we spend hundreds of millions of dollars on them. When they crash, however, patient care is never compromised.

-- SS

Princess Health and Turn, Turn, Turn - Another Health Care Revolving Door Update. Princessiccia

Princess Health and Turn, Turn, Turn - Another Health Care Revolving Door Update. Princessiccia

CDC CMS corporatism Covidien DHHS Medtronic Merck ONC revolving doors UnitedHealth

Gusty 10:46 Add Comment

It has been a while since our last revolving door update, so it's time to take another spin.


Summary of the Revolving Door Phenomenon

Before we get to some cases, though, let me summarize an important article on the revolving door that came out since.  This was published by U4, the "anti-corruption resource center" NGO based in lovely Bergen, Norway.  The title was "The Revolving Door Indicator: Estimating the distortionary power of the revolving door."  Although it's main point was to summarize a new measure the importance of the revolving door in a particular economic sector, it started with a very useful summary of the revolving door phenomenon.  It included a useful definition

According to Transparency International UK, the term 'revolving door' refers to 'the movement of   individuals between positions of public office and jobs in the private sector, in either direction.'

To expand,

The revolving door involves two distinct types of movement.  The first is from the public to the private sector, as regulators (ministers, cabinet secretaries, legislators, high-level officials, advisers) leave the public sector to enter the private sector they have regulated. The second is from the private to the public sector, as high-level executives of regulated companies enter the executive branch, the legislature, or key regulatory agencies.

It also included some idea of prevalence

The revolving door is particularly common in countries where explicit bribes cannot be paid safely, and thus regulators look forward to future employment with the regulated firms

We will discuss what the U4 report said about the implications of the revolving door after a quick review of the cases we have run across since May, 2014, involving the US government.  They will be listed in order of their appearance in the news.

Former National Coordinator for Health Information Technology and Colleague at ONC to Aledade (Company Supporting Accountable Care Organizations)

In June, 2014, various versions of this story appeared.  The Modern Healthcare version stated,

Dr. Farzad Mostashari, former head of the Office of the National Coordinator for Health Information Technology, is starting a new firm, Aledade, to help independent primary-care physicians form accountable care organizations. The startup has $4.5 million in seed funding from venture capital firm Venrock.

Independent practices looking to form ACOs have to expend money 'to hire the people, to get the agreements, to get the licenses, to do the legal work, to hire the executive director, and a medical director, practice transformation, the analytics software, the data warehousing, the EHR interfaces,' he said. 'All of that takes money,' often $1 million to $2 million.

Note that the current concept of the "accountable care organization" [ACO] includes heavy dependence on the electronic health records (EHRs) and other health information technology that Dr Mostashari had been so vigorously promoting as head of the ONC, so this transition seems to fit the revolving door rubric.

It also turns out that one of Dr Mostashari's former ONC colleagues was already at Aledade  

Mostashari will be joined by Mat Kendall, a former leader with the regional extension center program at ONC, who will be executive vice president

Former US Senators to Lobby for Medtronic and Covidien

In August, 2014, per Bloomberg,

Former U.S. Senators Trent Lott and John Breaux are part of a lobbying effort by companies that want to preserve the option of reducing their corporate taxes by moving their legal addresses overseas.

Nine U.S. companies that have sought cross-border mergers for tax reasons, are considering doing so or are targets of such deals have been pressuring lawmakers since April on legislation to stop the practice, federal disclosure reports show.

They include Medtronic Inc., the Minneapolis-based company that is seeking to acquire Dublin-based Covidien Plc. Medtronic paid Breaux-Lott Leadership Group $200,000 in June to block legislation from moving forward. Breaux, a Democrat, was once a member of the Senate Finance Committee. Lott, a Republican, is a former Senate majority leader.

Note that as Senator, Breaux had an important role in health policy, particularly the passage of the Affordable Care Act (ACA).

Former Assistant Secretary of Health and Human Services to Drinker Biddle & Reath (Lobbying Firm)

In August, 2014, per the Washington Post,

District Policy Group, the lobbying unit of law firm Drinker Biddle & Reath, is experimenting with a new model of using outside consultants to capture new business in the health-care field.

The group, which lobbies primarily on health-care policy, has taken the unusual step of forming an advisory board that includes external consultants. The outside advisers are not employees of the firm and instead receive a consultant�s fee, which means the firm does not have to pay their salary or benefits, but can still tout their services to clients.

The board was formed in July and is made up of four Drinker Biddle attorneys and two outside consultants, Tracy Sefl, a Democratic communications strategist, and Michael O�Grady, a health economics specialist and former Health and Human Services assistant secretary under President George W. Bush. Both Sefl and O�Grady have day jobs running their own consulting shops.

This seems to require no further comment.

Former Federal Trade Commissioner to Herbalife

In October, 2014, per the Hill,

Herbalife has hired a former federal regulator to run its compliance program as it deals with allegations of running a pyramid scheme.

Pamela Jones Harbour, who served at the Federal Trade Commission (FTC) from 2003 to 2010, has been named the company�s senior vice president of global member compliance and privacy, according to media reports.

The FTC opened a probe into Herbalife�s business practices earlier this year after lobbyists, interest groups and policymakers asked for a review.

Shortly after the FTC announced its investigation, the FBI began looking into how the direct-selling company recruits new distributors.

Herbalife is best known for its meal-replacement shakes and dietary supplement products. Harbour says she has been a Herbalife customer since 2004, according to Reuters, favoring the company�s Formula 1 shake mix.

Note that the FTC devotes considerable energy to health care issues, and Herbalife styles itself a "a global nutrition company" which makes "weight management" and "energy and fitness" products.

Director of US Centers for Disease Control and Prevention (CDC) to Merck as President of Merck Vaccines, then Executive Vice President for Strategic Communications, Global Public Policy and Population Health

In December, 2014, per a news release on BusinessWire,

Merck (NYSE:MRK), known as MSD outside the United States and Canada, today announced the appointment of Dr. Julie Gerberding, 59, as executive vice president for strategic communications, global public policy and population health, effective Dec. 15. In this newly created Executive Committee position, Gerberding, who most recently served as president of Merck Vaccines, will be responsible for Merck�s global public policy, corporate responsibility and communications functions, as well as the Merck Foundation and the Merck for Mothers program.

Note that

Prior to joining Merck, Gerberding served as director of the U.S. Centers for Disease Control and Prevention (CDC) from 2002-2009 and before that served as director of the Division of Healthcare Quality Promotion.

From UnitedHealth (Optum Subsidiary) Executive to Administrator of the Center for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services

In January, 2015, per the Business Journals,

Marilyn Tavenner's replacement at the Center for Medicare and Medicaid Services is a former executive at one of the contractors for the initially botched HealthCare.gov insurance exchange.

Andy Slavitt, former group executive vice president of United Health Group's Optum unit, joined CMS last June to help fix HealthCare.gov. Now he'll be acting administrator of CMS.

An Optum subsidiary, Quality Software Services Inc., was one of the original contractors for HealthCare.gov. QSSI developed the exchange's data services hub and a registration tool that allows users to create secure accounts.

Apparently nothing succeeds like failure.


Discussion

I apologize for the somewhat desultory way I have been summarizing health care revolving door cases.  My excuse is that such cases are almost never publicized as such.  Most of the stories above were found when looking for something else.  Despite its potential importance, the revolving door phenomenon gets little consistent coverage in the news media, and the particular issue of the revolving door affecting health care is particularly anechoic.  (If one searches for "'health care revolving door," one finds discussion of patients who are frequently re-admitted to the hospital.)  There is one website devoted to the revolving door affecting the US government, (OpenSecrets.org has a database here.)   However, it is not searchable by sector, and seems not to be complete (that is, for example, it fails to contain most of the cases I listed above). 

None of the cases above got more than minimal media coverage, yet they all involved people who at one time held high government positions, including US Senators, director of the Centers for Disease Control and Prevention (CDC), a Federal Trade Commission (FTC) commissioner, the director of Center for Medicare and Medicaid Services (CMS) within the US Department of Health and Human Services (DHHS), an Assistant Secretary of DHHS, and the National Coordinator for Healthcare Information Technology. So the anechoic effect persists regarding this issue.

Yet the revolving door is a significant issue.  As discussed in the U4 article, 

The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.

Also, the principal way the revolving door can benefit a company is...

The rent-seeking channel: The revolving door is used to capture public resources, through legal and illegal means, rather than to increase production or efficiency.  Transparency International UK (2011) and the OECD (2009) point out that the revolving door may lead to various schemes involving conflicts of interest, both during and after a regulator�s term in public office. This in turn generates undue bureaucratic and political power for firms using such schemes

Furthermore,

The revolving door is also related to lawful behaviours (Brezis 2013), termed 'legal corruption' by Kaufmann and Vicente (2011). This phrase refers to 'efforts by companies and individuals to shape law or policies to their advantage, often done quasi-legally, via campaign finance, lobbying or exchange of favors to politicians, regulators and other government officials. [�] In its more extreme form, legal corruption can lead to control of entire states, through the phenomenon dubbed �state capture,� and result in enormous losses for societies'

So,

Firms connected through the revolving door may therefore derive undue advantages by legally and illegally influencing the formulation, adoption, and implementation of laws, regulations, and public policies. For example, when firms are connected to (former) members of Parliament [or the legislature], they may influence the enactment of laws and regulations in their favour. When firms are connected to (former) ministers [or in the US, cabinet secretaries] and their advisers, they may influence the upstream formulation and implementation of policies and regulations in their favour. When firms are connected to (former) high-level officials, they may influence the downstream implementation of regulations in their favour.

Finally,

Empirical studies suggest that the revolving door gives firms political and bureaucratic power that enables them to divert state resources by biasing public procurement processes (Goldman, Rocholl, and So 2013; Cingano and Pinotti 2013), obtaining preferential access to public finance (Faccio, Masulis, and McConnell 2006; Boubakri et al. 2012), and unduly benefiting from tax exemption, arrears, and subsidies (Faccio 2010; Slinko, Yakovlev, and Zhuravskaya 2005; Johnson and Mitton 2003).

Therefore, firms politically connected through the revolving door tend to shape laws and regulations in their favour and to divert state resources to their own benefit. They are unlikely to gain a productivity advantage, and indeed may reduce productivity in the private and the public sectors. The literature on state capture and political influence (Hellman and Kaufmann 2004; Hellman, Jones, and Kaufmann 2003; Slinko, Yakovlev, and Zhuravskaya 2005) supports the thesis that such distortions result from the high concentration of political and bureaucratic power among a few powerful firms.

That all suggests that the revolving door in health care ought to get attention beyond posts in Health Care Renewal, but so far there has been precious little of that.  The continuing egregiousness of the revolving door in health care shows how health care leadership can play mutually beneficial games, regardless of the their effects on patients' and the public's health.  Once again, true health care reform would cut the ties between government and corporate leaders that have lead to government of, for and by corporate executives rather than the people at large

Princess Health and2015 Chilly Half.Princessiccia

Princess Health and2015 Chilly Half.Princessiccia

Gusty 14:08 Add Comment

With our big spring team races still on the horizon (TYS10K, Boston, Goodlife), we did not specifically target the 2015 Chilly Half.  Despite that, we had a good contingent of runners who tackled the half marathon and dropped some breakthrough performances along the way.

Here's how we did:

RESULTS

Results on our team rankings page

Aaron Mailman ran quite possibly his best race ever.  Just 1 week after his PB at the ReFridgee8er

8M, he managed an outstanding 1/2 marathon PB of 1:25:19, taking over a minute off of his time from last year.  This correlates to an 18:26 5K, Aaron's best performance ever since joining H+P! 

Holger was in next for the team with a very solid 1:28:25, placing in the top 10 in his very competitive AG.

Jessica was in next for the team with an outstanding result, breaking the 2-hour mark!

Cari had an awesome race- despite being sick along with facing a number of other challenges in the month of February, she still managed an outstanding time of 2:16 (a new PB by almost 30 minutes)!

Andrew and Heather Heij both had great races, running their first team race of 2015!

Princess Health and Did You Ever Notice?. Princessiccia

Princess Health and Did You Ever Notice?. Princessiccia

Gusty 12:32 Add Comment

To quote the late 60 Minutes curmudgeon Andy Rooney, "did you ever notice" how documentary movies--we could extend this to all sorts of documentation as Lancet does it far better than any American medical journals--on anechoic topics seem to come mostly from the Brits?

A telling new example: the just-released film The Widowmaker, found both here online and in a few E and W Coast theaters. (Real world locations given at above link. Seemingly, and sadly, no red states need apply.)

Widowmaker, boasting fine production values and an 'A' team of Gillian Anderson (fittingly of X-Files fame!) and the director of the Wikileaks films, puts a crack in the anechoic wall by pitting two expensive industry-led campaigns against one another: that in favor of CAC (calcium) scores and that in favor of DES (drug eluting stents) for coronary disease..

One comes away from this film with mixed feelings. There are fine moments of mirth, such as when standard EBM quasi-nihilistic talking-head Steve Nissen says "I don't like cost," whereupon the Texas state legislator and CAC true-believer Ren� Oliveira responds "he's an idiot." (The latter quoted in the recent, and acutely observed, NY Times review here.)

Um, boys, so many of you are heart patients--as indeed is your faithful blogger himself--but can we unpack this a bit?

OK, so should everybody in the world, or everybody with a family history, or everybody who ever smoked, get an expensive scan to stratify treatment? (See JACC's 2012 pro-versus-con assessment of this question here.)

I can't, and suspect no one totally can, answer this question. Though in 2015 I'm putting it again to some of my trusted colleagues and will add appropriate addenda in days to come via this posting and this blog.

What's interesting to me, though, is the way health subspecialty folks in the U.S. always try to over-ride common-sense approaches by appeals to (or at least, accession to) politicians who force the hand of industry. Or, perhaps, willingly and breathlessly allow their own hands to be forced by industry.

Health care experts increasingly become mere flotsam and jetsam on a sea of roiling industry-versus-industry waves. (In Texas, legislation was proposed to force payers to pay for CAC screening. And over-use of both stents and CAC scores have become huge sources of cost containment.woes.)

Increasingly, then, the problem in health care has become Spy versus Spy. Industry domination, about which my HCR fellow-bloggers have written eloquently in these pages, is so pervasive that us medical types are just collateral damange. Or, maybe a better metaphor, just injection devices for the profit motive. And media-docs, such as Richard Besser of ABC News, are happy to push the plunger just a little harder.

This film seems to favor the CAC score over the stent. Which probably has it backwards, but film-makers love conspiracies. Obviously, both technologies are over-utilized. (I say this as someone with one of the latter sitting inside his own LAD). Which is one of the many reasons why U.S. health care costs are the highest in the world while our coronary disease death rates are double those of, oh, say, Ecuador and Peru. Where, last time I checked, not so many people were getting scans to check their CAC scores.

To put it another way, the profit motive for devices and IT systems, and the over-arching technological imperatives are wonderful things. Lifestyle modification, not so much.

So who's the real idiot?

Princess Health andH+P at the 2015 Re-Fridgee-8er.Princessiccia

Princess Health andH+P at the 2015 Re-Fridgee-8er.Princessiccia

Gusty 19:03 Add Comment

One of the coldest Februaries in history?  Not a problem for H+P!  We had an outstanding 2015 team debut at the 2015 ReFridgee8er.  

There were a few major accomplishments at this race never before achieved by the team!  Here they are:

• This was the first time we have won both female and male races overall in the same weekend (Adam
  
  and Steph won the 8K, Sean and Andrea won the 8M).
• Steph set a NEW club record in the 8K (30:57) which was also a massive PB for her. 
• Adam Hortian was the first H+Per to ever break 26:00 in a team 8K, coming in only 6 seconds off his club record of 25:40.  
• The 8M team (Sean, Luke, Greg, Aaron, Dave, Nick) was the first to ever have 6 runners within the top 10 of any race.
• The 8M team has been calculated to be our 5th fastest team of all time according to our rankings system.

Now, here are the full results!

8K

• Adam Hortian won the race overall in an outstanding time of 25:46. 
• Steph came in 1st OA for females, 5th OA in a NEW CLUB RECORD of 30:57.
• Next in for the team was Jonathan Fugelsang with a massive new personal best of 34:32.  This brought him in 9th OA, and 2nd in his AG!
• Simon had a great race, but seems to be missing in the results- stay tuned!
• Paul was in next for the team in a time of 35:59, good enough to win his AG!
• Kristin Marks had a breakthrough race, running 38:44 and placing 2nd in her AG!

8M

• Coach Sean won in 45:36.
• Luke placed 3rd OA and won his AG in a new PB of 48:10!
• Coach Dyce came in 4th OA with a very solid time of 48:22.
• Nick Burt was in next for the team, finishing 6th OA and winning his AG in 50:08.
• Aaron Mailman was in 9th OA, 2nd in his AG, with a new PB of 50:39.
• Dave Rutherford was the 6th runner in for the team, the 6th runner to break the top 10, and won his AG with a great time of 51:36.
• Graham Dunn had a great return from injury, running 53:12, placing 3rd in his AG.
• Andrea was in next for the team with an outstanding team debut.  She place FIRST OA for females running 53:24.
• Emily was in next for the team.  She also had a breakthrough race, placing 2nd OA with a time of 54:49.
• Recovering from injury, Vicki came in treating this race as a tempo run.  She still managed a great result, placing 5th OA and breaking the 1 hour mark!
• Helen had a great race, taking a huge amount of time off of her personal best, and placing 2nd in her AG! 
• Don was battling a tough illness through this race, but still managed a great time of just over 1-hour.  
• Derek used the 8M as a training day- but still managed an impressive 1:04 and won his first AG medal with the team!
• Jessica had a great performance- she took 3 minutes off her
  
  PB and won her AG!

Up next for the team- the Toronto Yonge Street 10K AND the Boston Marathon!  #cantwontstop

Princess Health and Is Meat Unhealthy? Part IX. Princessiccia

Princess Health and Is Meat Unhealthy? Part IX. Princessiccia

Gusty 09:54 Add Comment

Welcome to the last post in the series. Time to summarize and wrap it up!

Respect

I respect each person's right to choose the diet they prefer. This includes vegetarians and vegans, particularly because most of them make daily sacrifices to try to make the world a better place for all of us. I'm an omnivore, but I sympathize with some of the philosophy and I often eat beans or lentils instead of meat*.

Our history with meat

Our ancestors have probably been eating some form of meat continuously for at least two hundred million years. However, the quantity has waxed and waned. The first mammals were probably largely carnivorous (insectivores). Yet our primate ancestors went through a 60-million-year arboreal phase, during which we probably ate fruit, leaves, seeds, insects, and perhaps a little bit of vertebrate meat. We only outgrew this phase in the last few million years, when we developed the tools and the brains to pursue prey more effectively.

During our 2.6 million-year stint as hominin hunter-gatherers, we ate an omnivorous diet, although we really have very little idea how much meat it contained (it probably varied by time and place). Historical and contemporary hunter-gatherer cultures are all omnivorous, and typically eat significant to substantial quantities of meat, suggesting that our ancestors may have done the same. Non-industrial agricultural populations eat as much meat as they can get, although they usually can't get as much as hunter-gatherers.

If there is such thing as a natural human diet, it is clearly omnivorous.

Meat, obesity, and chronic disease

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