First Autistic Presidential Appointee Speaks Out About Wanting More Technology Efforts to Help Those Afflicted with Autism

We always hear about the resistance to change and here’s one person calling for more technology for autism.  Certainly he still backs research but is also calling for technology to kick in a bit and help out with speech challenges and augmentation to give patients a better quality of life.  One large community opened their headquarters in Los Angeles earlier this year to help those with autism. 

Wellspring Opens Corporate Headquarters in Los Angeles – Autism Treatments and Services

This is a nice interview from Wired and speaks about how some thought he was not up to do the job, but when you think about someone representing autism on the Council for Disabilities it makes sense to me.  This is first hand experience that nobody wants, but none other can talk better about it.  He speaks out on some items, like using an IPad that is not approved by Medicaid as having an impact and the ability to help those with autism.  We have some old programs around and I have posted about them a couple of times about antiquated technology this is approved and is more expensive than what we have today out there, and on top of that it’s more expensive.  Mr. Ne”eman wants to bring this to light and get up to the 21st century and have some of the more modern devices and software available. 

Last year Kaiser Permanente received a grant from the NIH to study autism; $402,527 to extend an investigation of biologic markers for autism which was part of a huge grant program that totaled over $54 Million.  BD

Kaiser Permanente Receives $54 Million in Grants from NIH– Genomics, Cancer Research and More Using Patient Electronic Medical Records

In December, he was nominated by President Obama to the National Council on Disability (NCD), a panel that advises the President and Congress on ways of reforming health care, schools, support services and employment policy to make society more equitable for people with all forms of disability.

In truth, Ne’eman was facilitating a different kind of coming-of-age ceremony. Beckoning a group of teenagers to walk through a gateway symbolizing their transition into adult life, he said, “I welcome you as members of the autistic community.” The setting was an annual gathering called Autreat, organized by an autistic self-help group called Autism Network International.

Ne’eman: If we put one-tenth of the money currently spent on looking for causes and cures into developing technologies that enable autistic people with speech challenges to communicate more easily — so-called augmentative and alternative communication [AAC] — we’d have a vast improvement in the quality of life for autistic people and their family members.

We’ve already seen some very promising tools for AAC and other assistive technologies start proliferating on the iPad and the iPhone. But Medicaid won’t pay for such dual-use devices, despite the fact that having an AAC app running on an iPad may be much cheaper and more functional than carrying around a dedicated AAC device. That should change, because AAC devices are currently too expensive and often not versatile enough to be used in a diverse set of circumstances.

As a society, our approach to autism is still primarily “How do we make autistic people behave more normally? How do we get them to increase eye contact and make small talk while suppressing hand-flapping and other stims?” The inventor of a well-known form of behavioral intervention for autism, Dr. Ivar Lovaas, who passed away recently, said that his goal was to make autistic kids indistinguishable from their peers. That goal has more to do with increasing the comfort of non-autistic people than with what autistic people really need

Exclusive: First Autistic Presidential Appointee Speaks Out | Wired Science | Wired.com

Technorati Tags: Ari Ne’eman,Council on Disabilities,autism. technology,Heatlh IT,augmentation,AAC,Medicaid,Ipad,White House,disabilities,Kaiser Permanente

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White House Makes Official Introduction of the “Blue Button”–Microsoft Demonstrates HealthVault Integration And Sharing

If you check in here once in a while you know there’s quite a bit about personal health records and HealthVault.  I’m sure the video may be uploaded to YouTube soon so in the meantime I took a few screenshots of the highlights.  First off by using the Blue Button the information goes to HealthVault and secondly shown here is the Surgeon General’s My Family Health Record to where the information from HealthVault is uploaded so it shows how the data can be moved with HealthVault being the vehicle. 

A sample of some of the popular applications that work with HealthVault are shown in the next image.  Of course there are many and one is not going to use every application or you might working all day with your information  <grin> but rather you can choose what is useful and has value for your.  The demo family uses an example of a soldier who has returned from overseas service and the family getting all their health records together.  Of course there’s always a link at the Medical Quack to find HealthVault under the right hand side under resources.  Also, you can do a search or look at the PHR section and there’s many more additional posts.

VA Can Now Use the “Blue Button” to Download Their Data from Their PHR (Personal Health Record)

One of the most useful applications which I also have a link on the Medical Quack for is Trialx, which uses HealthVault to find a specific clinical trial you could be qualified for.  TrialX has done a few things with their site and the widget on the blog here allows you to do a quick look up for a clinical trial without a HealthVault account but after you see the results it’s easy to see why having a PHR makes it easier as there’s more data to match and the searches are refined. 

The VA had the first shot at giving this a try through the month of September.  You can read more at the Blue Button Initiative at the CMS Website. 

Also on the Medical Quack there’s always a ink to Healthcare.Gov where you can find information on health insurance and more.  The link below tells the story on how the site came into being and in a rather short time frame too.  BD

The Story Behind The Building of Healthcare. Gov - 90 Day Creation, Help From Twitter and the Silicon Valley Made It Possible

The Obama administration's White House Office of Science and Technology Policy has formerly unveiled a Web tool that will enable seniors and veterans to download their PHRs (personal health records) to a PC or storage device and maintain control over information sharing with health care providers, according to a White House blog post.

At a meeting of health care industry executives, venture capitalists, corporate executives, and government officials on Oct. 7 in San Francisco called DC to VC: Investing in Healthcare IT Summit, Aneesh Chopra, the U.S. CTO and associate director for technology in the White House Office of Science and Technology Policy, discussed the Blue Button tool. President Obama first introduced the Blue Button in August.

White House Rolls Out Health Record Download Tool - Health Care IT from eWeek

Technorati Tags: Blue Button,HealthVault,healthcare,technology,Health IT,EHR,PHR,data,software,personal health records,consumers,digital consumer IT literacy,Microsoft,Surgeon General,White House

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Whoops One More Detail With Covering Dependents Up To Age 26- If You Are Retired This May Not Be Possible-The Exemption Algorithm Says

Well at least it is working for the employed is the bright side here, but gee how much more difficult are those algorithmic formulas going to get?  Single Payer is looking better all the time.  I said a while back that we could end up with a public or private plan by default and if this continues with mass confusion on how to interpret those algorithms and keep up with the algorithms that you need for preventive care and be able to find a family practice doctor to see you…well…just like anything else in life an alternative plan of an unknown is looking better than the crappy “known” we have now.  I truly just don’t think that having insurers on the stock exchange is healthy as it brings too many elements into healthcare and exaggerates them beyond what needs to occur and we get distracted with only looking at money and don’t perhaps improve in care as we all want to see. 

Must be one heck of an algorithmic cost processing score as big companies are jumping on to this and many are finding this to be a big disappointment.  In some instances as things stand now, the only way to get dependent coverage is through a private policy, not through many employers.

It is getting harder to stuff our needs and desires into these data tables to cross our fingers and see if we qualify.  In doing this blog there seems to be a new snag announced almost every day and with the rate at which we work and handle data, this is getting to be very time consuming.  BD

Glenn Franco was excited to hear that the new health-care law requires insurance plans to offer coverage for dependents up to age 26. But when he recently called his health-plan administrator to ask about enrolling his 24-year-old daughter, Michelle, he was told she wouldn't be eligible for the new law taking effect on Sept. 23.

The reason? He is retired.

Many large employers are telling retirees the same thing. They include Alcatel-Lucent and Verizon Communications Inc., as well as state and federal government plans and those for military families and unions.

Thanks to a little-noticed clause in a 1996 law, retiree-only health plans are exempt from the Patient Protection and Affordable Care Act that went into effect last month.

That means the rule requiring health plans to extend dependent coverage to age 26, regardless of financial dependency, student status, employment or marital status, doesn't apply to millions of retirees' health benefits.

Thanks to a little-noticed clause in a 1996 law, retiree-only health plans are exempt from the Patient Protection and Affordable Care Act that went into effect last month.

Health Overhaul Overlooks Retirees - WSJ.com

Technorati Tags: health insurance,healthcare reform,dependent coverage,retirement,health plans,affordable care act

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Lipitor Stinks–Recall of Musty Odor Smelling Bottles– Too Close The Chemically Treated Pallets–Need 2D Barcodes-Pharmacists Would Have Welcomed the Opportunity to Scan With Cell Phones to Locate the Affected Items

Johnson and Johnson had the same problem and here we go again, look up those lost numbers and see if the pharmacies have any in house. Scanning with a cell phone with 2D bar codes once again would be a lot nicer and convenient.  I just hinted this week at someone from Pfizer to take at using bar codes, we would love it on consumer products too.  In this case the pharmacists would have loved it.  Read this next link for more information.

Microsoft Tag Bar Codes–Who’s Been Scanning the Medical Quack–The Bing Heat Map Tells All And Could Help Find Stolen or Expired Drugs and Devices With This Methodology

Here’s a clip from a prior post and check out that heat map Pfizer as once each bottle was scanned you would have intelligence too as far as knowing where the bottles are, think about it.  Use the image Bar Code Campaign to find out more.  I think I’m up to around 30 posts now on this topic.

“Ok remember a while back where I said stolen drugs could be located with Tags, well here we have a suggestion or an idea, a heat map from Bing.  The products could be tagged by “lot” number and/or products.  Obviously on a large scale we are looking at one grand “cloud” operation here.  Device and drug companies could have their own maps and of course with a synchronized FDA data base and perhaps one at the DEA some of those stolen articles could be found when someone goes to scan a product?  In case you have missed some of this click on the “bar code campaign” image and see a summary of what ideas I have been cooking up to even include the White House using them.  The link is always at the top of the blog for reference any time.

So I decided to look and see if anyone has been scanning my tags and I mapped them.  You need to have over 20 scans to show up and I was impressed I have over the number needed which means folks have been scanning the tags on this blog!  The purple dots are the cell phone scans. “

FDA Plans Recall Data Base – Nice Still Need Tags on the Products So We Can Find Them Immediately

Shoot even our neighbors in Canada would have loved to scan and find these bottles too with their cell phone I might guess.  BD 

A recall for Lipitor has been issued by Pfizer, Inc. for 191,000 bottles of the cholesterol drug due to reports of a musty odor, which may have been caused by some bottles being stored on pesticide-treated pallets. 

The Lipitor recall was announced this week in an FDA enforcement report, affecting seven lots of the drug sold in the United States and Canada, as well as three lots that were sold to a Canadian generic drug supplier. All were packaged in bottles from a third-party supplier.

The recall came after the drug maker began to receive reports from consumers about an odor from the Lipitor bottles. At least one illness has been reported in connection to the odor, but Pfizer claims that the illness was unrelated.

Lipitor Recall Issued for 191K Bottles Due to Musty Odor - AboutLawsuits.com

Technorati Tags: Pfizer,Lipitor,pharmacies,recalls,ordor,FDA,bar coding,MicrosoftTags,technology

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Lack of Consumer Health IT Literacy Is Beginning to Show - Candidate for The Senate Received Benefits From Medicaid And Now States The Program Is Unconstitutional?

I address this topic here all the time with leaders needing more consumer digital literacy and the same applies for those running for office and I try to stay middle of the road with this blog, but this one just blew me away.  The “non participants” in digital literacy today just don’t get it.  I think there are some folks that need a class in economics 101 to go along with some consumer digital literacy. 

He also wants to privatize public programs too, like Medicaid, and again this is just mind boggling to hear statements as such made as people go back and look at information and data, as we have the internet today that allows us to do so, but it appear some folks have not come to terms with this yet, again, the non participants in technology today.  This person is scary as well as potentially illiterate. 

We have reached the days to where you better as a politician get yourself an “algo man” and find out if what you say is systematically possible and secondary how it would project and fall into place – this is called business intelligence, what the participants in technology use today, big time at Wall Street for sure at they have all the money.  Here’s one more tale of illiteracy when it comes to general consumer digital awareness and use that was on MSNBC with names and images.

The Properties of an Adobe pdf Document -Rachel Maddow Rips the GOP on Lack of General Consumer IT Knowledge And Exposes the Input and Authors of the Content–Lobbyists

I feel this is why all the folks that do have algo men are sending money to the direction of these candidates as they are pliable and don’t appear to have enough common sense and can be easily controlled out of digital ignorance, distraction and with using the actions of drama kings and queens to get action. 

Health Insurers Sending Big Dollars to the GOP–The Folks Who Largely Lack General Consumer Digital Literacy And Health IT Literacy As Relates to the Power of Algorithmic Formulas

Some of those folks could do well to read this book:

“Proofiness–The Dark Side of Mathematical Deception”–Created by Those Algorithms–New Book Coming Out Soon

Joe Miller, the Republican nominee in Alaska's tight Senate race, admitted Thursday that his family received federally subsidized healthcare benefits through programs he considers unconstitutional.

Miller, a father of eight who's running on a platform of fiscal conservatism, said his family received health benefits through Medicaid and Denali Care, Alaska's Children's Health Insurance Program (CHIP), which is funded primarily with federal dollars, the Anchorage Daily News reported Thursday.

Healthcare Friday: Tea Party candidate benefited from 'unconstitutional' Medicaid program - The Hill's Healthwatch

Technorati Tags: healthcare reform,Pledge to America,GOP,politics,non participants,Medicare,algorithms fraud,digital literay,Health IT,Congress,participants

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Consumer Watchdog Urges White House To Reject Waivers for “Junk” Health Insurance Plans and Require Public Postings Of The Terms For Those Who Have Received Waivers

Making the terms pubic is really not a bad idea and something I think could be made publicly easily in this day of transparency.  The other matter addressed in this article is about an insurer who is a known problem and is asking for a waiver so it appears now we are down to who can get one and who can’t, and probably who will file a lawsuit if they are denied and feel discriminated against.  That seems to be the way this stuff works. 

When you read below about the people who bought an additional rider for chemo therapy and still had mountains of bills that it would not cover, did we make any progress here?  I know this is one case but if it’s your case, it matters. 

There’s lot of insurance available out there but we have only one life. 

In looking back I wonder if we would have had all this trouble and bureaucratic mess if we had the “public” plan that we all wanted in place?  It does you stop and think as there might have been a little more balance and given the government an opportunity to build some Health IT infrastructure of their own at the same time. 

Healthcare Reform Getting Pretty Ugly as Nobody Seems To Be Able to Find a “Pool” Large Enough to Spread the Expense–Single Payer by Default An Option When The Fighting is Done?

I understand the process of spreading the expense on insurance and the need to cut costs but hopefully we are cutting where care doesn’t suffer but in healthcare it has been a history of pretty much cutting where they can without a lot of notice and much of which operates in the background until it gets big one day.  We had health insurance companies make record profits this year and during the recession when people were losing jobs and it doesn’t set well with consumers. 

These 2 posts below kind of tell you what we are dealing with when it comes to health insurance companies and why they look so ill in the public eye, arrogance and greed and yet want to be seen as the good guys all the time?

UnitedHealth Shareholders Say We Don’t Care What Executives Earn and What Is Spent on Lobbying – Go For It

UnitedHealth To Pay Out Higher and More Frequent Dividends to Share Holders, No Caps on Earnings for Executives or What Is Spent on Lobbying Says the Board

You end up with this pseudo relationship that is sick in concept and yet we are stuck with it as the only political game in town without a real single pay plan.  The “junk” folks with today’s data methodologies too can hide in the background for a long time and whittle away at dollars until something big happens and someone dies or makes the evening news.  BD

WASHINGTON, Oct. 8 /PRNewswire-USNewswire/ -- Consumer Watchdog called on President Obama to reject waivers requested by junk health insurance plans, including one that left Dana Christensen with $450,000 in medical debt, that would allow them to evade minimum benefit requirements under the federal health reform law.

The New York Times reported yesterday that HealthMarkets, which sells insurance through MEGA Life and Health, is among the companies seeking waivers to continue selling limited-benefit policies under the federal health reform law.

Dana Christensen was left with $450,000 in medical bills when her husband Doug died of bone cancer and their MEGA policy did not cover his treatment. The Christensens had even purchased a special rider for chemotherapy, but it paid only $1,000 a day while chemotherapy cost up to $18,000 a day. On his deathbed, Doug asked Dana to divorce him so she would not be responsible for the bills. She refused. Read the Christensens' story: http://www.consumerwatchdog.org/patients/articles/?storyId=13540.

Consumer Watchdog called on the Department of Health and Human Services to require employers and insurance companies that it has already granted waivers to make public the terms of their limited-benefit policies and the data showing health insurance premiums will increase without the exemption.

Employers argue that limited-benefit policies are better than no insurance, but because employees don't understand how bad the insurance is, they may receive tens of thousands of dollars in medical bills before realizing they're not covered, said Consumer Watchdog. Temporary exemptions on an employer-by-employer basis may be called for, but no insurance plan should get a blank check to evade the law, said the group.

Consumer Watchdog Urges White House to Reject Bid by Notorious Junk Insurance Company to... -- WASHINGTON, Oct. 8 /PRNewswire-USNewswire/ --

Technorati Tags: HealthMarkets,HHS,consumer watchdog,healthcare reform,junk insurance,MEGA life,cancer,medica debt,fraud,legal suits

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Health Insurers Rolling Out Programs To Doctors and Hospitals to Help Keep the Cost Down With Even Additional Focus on Admissions

We all know about the new Medicare rules and guidelines too but I had to somewhat chuckle a little when I read the line below from the Aetna executive who basically had dreams of eliminating the need all together for hospitalization and that goal might be a little too over-zealous because that won’t happen any time.  Actually folks making statements as such kind of scare me a bit as I wonder where their sense of reality lies beyond statistics.

"The best discount and the best way to lower costs...is to obviate the need for the hospitalization all together," said Aetna's chief medical officer, Dr. Lonny Reisman. "We're insinuating ourselves more and more in the actual care of the patient."

These are tough times as hospitals on the other hand look at how many admissions they have and get paid for in order to keep the doors open when it comes to covering the fixed costs.  The AMA is kind enough to remind us too of the 65,000 folks in California that will be getting their average increase of just under 19% this month on Aetna premiums.  In New York Aetna was fined $850,000 to settle charges including incomplete disclosures, so more algorithms to question.

We all know there is money to be saved with prevention but it’s not 100% as people are born with diseases and afflictions that prevention might help with treatment processes but it won’t eradicate the problem.  This whole issue since some of the new laws have taken effect is getting interesting as we have Wellpoint trying to convince employers to grandfather their agreements, so not much will change.

WellPoint Puts More Algorithms Online So You Can Go Fix Yourself and Understand What a Grandfather Is

Further more I look at things at the link below to where the insurers have such an overhead of red tap (much they created internally) that they jump on this bandwagon to get subsidies for retirees too young for Medicare.  In other words we will let the feds take care of this money issue before they get you entirely at 65 if you decide to retire and want health insurance. 

HHS Gives Approval for More Companies and Unions to Participate in Federal Program to Support Early Retiree Health Insurance–Aetna and Cigna Signed To Fund Their Retirees

I guess HHS was backed into a corner here and couldn’t do much else, but if I were an employee of one of those 2 companies and was thinking about an early retirement, it certainly sends a message about how much I would valued, not much once a determination is made to retire, you’re history and don’t bug us about health insurance anymore.  Here’s one more example in addition to the article below.

Blue Cross, And Advocate Health in Illinois Sign Accountable Care Agreement

It will be interesting to see through all of the new programs and contracts if patient care and location comes into play too as that has been a real sticky point in the past with people having to travel great distances to see someone in network as we head a bit backwards to the HMO business models which were really not all that bad, but now with incentives going even further, time will tell how all this will play out.  BD

Health insurer Aetna Inc. (AET) is developing plans to pay a major San Diego medical group enhanced fees for providing extra services to keep patients healthier, and to share any resulting cost savings.

With a similar cost-saving goal, UnitedHealth Group Inc. (UNH) has started to base payments to its network providers partly on cost and quality measures, and Cigna Corp. (CI) guarantees corporate clients it will lower employee health risks.

Fueled by the weak economy, the health overhaul and anxious clients, insurers are taking steps to lower medical costs, including introducing new pay structures to encourage care that averts hospitalizations. They are also offering employers narrower, lower-cost provider networks, prodding enrollees to form healthier habits and pick less expensive doctors, and getting tougher in hospital price negotiations.

"The best discount and the best way to lower costs...is to obviate the need for the hospitalization all together," said Aetna's chief medical officer, Dr. Lonny Reisman. "We're insinuating ourselves more and more in the actual care of the patient."

UnitedHealth's commercial UnitedHealthcare business is testing the medical-home concept with some 50 practices in five states.

UnitedHealthcare Chief Medical Officer Dr. Sam Ho said the early signs are promising that the patients are getting more complete care by receiving more preventative services like diabetes and breast-cancer screening. Early results indicate people are staying healthier on an outpatient basis for longer, he said.

Health Insurers Adopt Programs To Cut Hospitalizations, Costs - WSJ.com

Technorati Tags: health insurance,Aetna Cigna,healthcare reform,United Healthcare,algoirthms,business intelligence

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House of Representatives Sends Letter to HHS Calling for the Elimination of Additional Cuts for Cancer Care

Normally I have not been too kind to Congress, mostly in attacking their areas of lacking health IT knowledge, but for a change this is something good that needs a hard look. Oncologists have already been hit and if the continued cuts occur during the next few year as scheduled, more patients will be going to the hospital for chemotherapy and some treatments may not be available at all.  I know one former oncologist who hung it up over this and went into family practice as he could no longer afford to pay in advance for the expensive drugs and then not even get full reimbursement from insurers and Medicare. 

On the other side of the coin, some pressure for chemotherapy drugs and other related treatments could certainly be explored too and we are seeing some of this with generic cancer medications in the last few years; however, cancer treatment is on the cutting edge and there’s not always time to wait for a generic as the patient may die in the interim.  If you read the notes in the article below, by 2013 Medicare will only be covering less than half the cost.

Cardiologists and Oncologists on the Brink with Healthcare Reform – Many State They Will Close Up Shop

One insurer, United has been pretty aggressive in this area with the letters and information they sent to oncologists last year advising them how many are “following the rules” and questioning their integrity as well as offering their analyzed data.

United HealthCare Sends Oncology Reports to Doctors – Assessing Cancer Treatment Rules Compiled by Ingenix

Under subsidiary actions United also may have some other interests with their recent purchase of a company in China called China Gate who’s business focus is to get wider distribution globally and in the US, of more Chinese drugs and devices and cancer would be right in there.  This, along with the letters sent to oncologists is under the United subsidiary of Ingenix, pay attention to what company subsidiaries are doing today as much of this activity is somewhat behind the scenes.  Also worth a mention here too are the jobs that are being lost in this area to other countries. 

UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally

In the future in order to keep cost down we could be seeing more Chinese cancer drugs being use in a hospital environment and in the last couple years this is a concern as the quality of some of their drugs has been a big issue here in the US and even in a poll in China itself, consumers trusted American drugs over the ones produced in their own country.  It makes one wonder if the US government will be looking at Chinese chemo drugs and follow this direction at some point?  That is just a question that comes to mind here. 

One last note there, this is why it is so important that we have philanthropy groups like stand up to to cancer to keep the drugs and cures rolling.  BD

WASHINGTON – Eighty-five members of the House have submitted a letter to federal officials calling on them to eliminate additional cuts to cancer care proposed in the 2011 physician fee schedule for Medicare and Medicaid reimbursement.

According to the Community Oncology Alliance, the letter is sponsored by Rep. Steve Israel (D-N.Y.) and was delivered Wednesday to Health and Human Services Secretary Kathleen Sebelius and Centers for Medicare & Medicaid Administrator Donald M. Berwick.

The CMS has scheduled reimbursement cuts for 2011, 2012 and 2013, at which time Medicare will cover less than half the cost of these cancer care services, according to the COA.

House to HHS: No more cuts to cancer care reimbursement | Healthcare Finance News

Technorati Tags: Cancer,Houe of Representatives,HHS,CMS,United Health Care,Insurance,China,budgets,doctors,chemotherapy,drugs,Medicare,researc and development

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Sanofi-Aventis Announces Dropping 1,700 Jobs–13% of Their US Workforce

The company is facing generic competition just like many of the other major pharmaceutical companies and also in the news they are attempting to purchase another biotech company, Genzyme.

Sanofi Proposal to Acquire Genzyme Rejected–Looking for Other Alternatives

Genzyme was probably not heard of by many until they had a real live virus in their systems and was the corner of corner of concern from the FDA as well with shutting down the plant twice while the vats were cleaned.   Genzyme is the sole manufacturer of a couple drugs used to treat rare genetic diseases. 

Virus hits Genzyme plant – Virus Infected Hamster Ovary Cells

We might guess that sales and marketing could be in the group here since pharma reps are steadily becoming a much smaller group anymore.  Plavix is one of the company’s best selling drugs, a name you may recognize.  BD 

French pharmaceutical giant Sanofi-Aventis has announced it will shed 1,700 jobs from its US workforce.

The move is part of a restructuring process that will allow the company to focus on drugs for diabetes, cancer and heart problems, it said.

The cuts represent 13% of the firm's total workforce of 13,000 in the US.

Like many major pharmaceuticals companies, Sanofi is facing increased competition from generic drug companies.

BBC News - Sanofi-Aventis to cut 1,700 jobs in the US

Hat Tip:  Pharmagossip

Technorati Tags: FDA,Virus,healthcare,pharma,drugs,contamination,Enzyme deficiencies,orphan drugs,Genzyme,biotech,Sanofi-Aventis,layoffs

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“eLEGS” Exoskeleton Robotic Rehabilitation Going Into Clinical Trials at Berkeley Soon–Restoration of Walking Functions For Those With Spinal Cord Injuries

This is a robot that one wears so people who have been paralyzed will have the potential to be able to walk again.  It has an on board computer and it easy for the patient to put on.  This is fascinating to watch and the video explains the design.

The body remembers with the muscles and is slated to sell for around $100k but I will be a while before one is available to take home.  Imagine someone who has not been able to walk for years and has been in a wheelchair.  This is one device to watch for sure as if you couple this with some of the new surgical techniques being developed today for spinal repair and with stem cells, there could be far less people in the future having to spend their days in wheelchairs.

Geron Gets FDA Approval To Resume Stem-Cell Study - Spinal Cord Injuries - Go UC Irvine!

If you have not seen the post above with the video with stem cells and spinal rehabilitation it’s worth the watch.  BD 

Amanda Boxtel, a wheelchair user, is about to stand up. A skiing accident 18 years ago partially severed her spinal cord leaving her paralyzed from the waist down. She slowly pushes herself out of the chair with crutches, teeters backward for a second, then leans forward – and takes a step. Soon she is walking around the warehouse in Berkeley, California, under her own direction.

Boxtel is wearing a new exoskeleton called eLEGS, which could soon help people with spinal injuries to walk with a natural gait. "Walking with eLEGs took some rewiring and relearning," says Boxtel, "but my body has the muscle memory. And I learned to walk really fast."

The suit consists of a backpack-mounted controller connected to robotic legs. It is driven by four motors, one for each hip and knee. The ankle joint is controlled with passive springs that keep the foot angled so that it can be placed on the ground, heel to toe, as the leg steps. Sensors in the legs relay position information to the control unit, which determines how to bend the joints and, in turn, walk. Onboard lithium-cobalt batteries allow the suit to be operated without a tether to a power source.

The company plans to begin clinical trials in early 2011, and estimates the cost on the market to be in line with that of a high-end wheelchair, around $100,000.

Exoskeleton helps the paralysed walk again - tech - 07 October 2010 - New Scientist

Technorati Tags: eLEGS,technology,robots,clinical trials,rehabilitation,walking machines,spinal cord,injuries,exoskeleton

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Microsoft Employee Health Benefit Plans to Change in 2013 Requiring Employee Contributions

This is a ways out and employees have plenty of time here to make changes and explore options.  The timing here is somewhat close to when major healthcare reform laws come into effect as this has been staged by the years to make transitions manageable. 
Perhaps now more employees will think about using HealthVault as I am sure many do and that’s the internal sell of course.  You would think all employees would be enrolled, but not since it is open to choice of participation, but for sure with upcoming changes with contributions it stands to be an incentive for those not on board yet. Hugo Ortega, a Microsoft MVP and Tablet PC fanatic was traveling through Redmond on his annual trip to Microsoft and while on campus there he stumbled upon the Health/Lifestyle room for employees and staff, (of course they would have one of these).    Sean Nolan (the Microsoft Healthcare Family Guy) also was very quick to let me know that all their machines are connected to HealthVault too. 

Take your Vital Signs at Microsoft – The Health/Lifestyle Room At Redmond

In the past there have also been some pilot programs in place with evaluating use and care within the healthcare benefit system inside Microsoft as well.  BD 

Microsoft held a "surprise town hall" meeting this morning to discuss the "evolution" of its U.S. employee benefits, requiring Blue Badges to contribute to their health-care plans starting in 2013.
After the meeting, which ended before 11 a.m., Microsoft sent the following statement:
We can confirm that Microsoft has begun to evolve its employee health care benefit. There will be no changes for the next two years, but in 2013, employees will contribute to their health care. A guiding principle in this evolution is that Microsoft will continue to offer market-leading health and wellness benefits that rank among the best in the country.

Microsoft employees must contribute to health care in 2013

Technorati Tags: Microsoft,health insurance,healthcare reform,HealthVault,PHR,technology,benefits

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Diet Drug Meridia From Abbott Labs Pulled–Patients Advised by FDA to Stop Taking Product And Slimming Beauty Over The Counter Product Advisory–Cardiovascular Disease Risks

This is a bit of a double whammy as the over the counter product was found to contain sibutramine, which is not a natural herbal product according to the FDA so doctors are asked to no longer prescribe Meridia and find another weight loss drug instead.  Sibutramine is also the active ingredient in Meridia. 

With the Slimming Beauty over the counter products, the FDA found that sibutramine was not listed in the contents, but lab reports did show the drug in the supplement.  This brings me back once again to my favorite topic of using a cell phone to find those recalls and the ability to identify any products that have new safety issues from the FDA.  The product Slimming Beauty is sold over the the internet and even if one had purchased online, we would be able to scan the bar code and find out the latest warnings on not to use due to the cardiovascular associated risks.  There are several natural herb companies that sell bitter orange and the one with the undisclosed ingredients is from Slimming Beauty. 

Microsoft Tags – Microsoft MSDN Posts Ideas from the Medical Quack About Use in Healthcare!

If you think this would be valuable, give me a vote on the poll as this stands to empower the consumer by all means and get the information out there timely.  BD

Abbott Laboratories has withdrawn its popular weight-loss drug Meridia because it increases the risk for heart attacks and strokes, the Food and Drug Administration announced Friday.

"Meridia's continued availability is not justified when you compare the very modest weight loss that people achieve on this drug to their risk of heart attack or stroke," said a statement from John Jenkins, director of the FDA's Office of New Drugs in the Center for Drug Evaluation and Research. "Physicians are advised to stop prescribing Meridia to their patients, and patients should stop taking this medication. Patients should talk to their health care provider about alternative weight loss and weight-loss maintenance programs."

Meridia, also known as sibutramine, was approved by the FDA in November 1997 for weight loss and maintenance of weight loss in obese people, as well as in certain overweight people with other risks for heart disease. The approval was based on studies that showed that the drug could help people lose at least five percent of their body weight compared with people who took a placebo and relied on diet and exercise alone, the FDA said.

The Checkup - Diet drug Meridia pulled over heart attack, stroke issues

Technorati Tags: Cardiovascular Health,FDA,Food Safety and Recalls,Obesity,Recalls,Women's Health,drug safety,Abbott Labs,Meridia,drugs,bar codes,tags,Slimming Beauty,weight loss

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Fujitsu Phone Announces Medical Data Cell Phone To Work with Electronic Medical Records-Secured Continua Certification

There are no visuals yet available but certification has been accomplished so standards and operation efficiency are met with Continua certification.  More information is to be released soon.  Recently announced Microsoft has also joined the collaboration efforts as a new member.  The link below has a bit of detail about how HealthVault connects with various devices too.

Microsoft Joins Continua Wireless Alliance and Issues New Guidelines for Certification For Interoperability

Who knows someday we may not even use a cell phone for calls anymore <grin>, couldn’t help that one.  The phone will connect with both devices and web based software and have the capabilities of securely sharing information.  Now after you have read this far, Japan gets first crack at it and it will be called the Docomo Prime phone.  The image included here is not the actual phone but rather images of the Fujitsu Prime Series phones.  BD

Fujitsu is beginning to preview a new type of phone that allows users to collect and share their own medical data. The prototype device, which uses Bluetooth technology to let people share their data, has already been certified by one major health care organization.

At the CEATEC (Combined Exhibition of Advanced Technologies) conference, which started Oct. 5 in Japan, Fujitsu unveiled the first prototype of this health care phone. The company also announced that the device has been certified by the Continua Health Alliance.

Once the medical data reaches the phone via Bluetooth, it can be sent to doctors and downloaded into EHR (electronic health record) applications on the handset.

Fujitsu said it will release more specific details of the phone when the commercial model arrives.

Fujitsu Phone Lets Users Collect, Share Health Care Records - Health Care IT from eWeek

Technorati Tags: healthcare management Systems,wellness,diabetes,drugs,compliance,Cener for Connected Health,Continua Health Alliance,algorithms,PHR,Fujitsu

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Power of MedApps Moves to the Cloud -FDA Approved Mobile Device That Collects from Many and Aggregates Health Data

Cloud Care is the name of the service and now to be able to have one device that connects and collects from other devices, it will no longer be necessary to have the information stored on a local PC.

FDA approves HealthPal – Bluetooth Device that Collects from Other Reporting Devices and Sends Information to PHR – HealthVault or Google Health

HealthPAL is the small, portable dedicated device that MedApps uses to collect data from connected glucose meters, blood pressure monitors, pulse oximeters and weight scales. The data is then sent over a secure server to an online portal like Microsoft’s HealthVault or Google Health for caregivers, physicians or the patient themselves to view.

SCOTTSDALE, Ariz., Oct. 5 /PRNewswire/ -- MedApps is pleased to announce its latest patent-pending innovation: The CloudCare™ Technology Platform.

CloudCare extends the power of the MedApps Remote Health Monitoring System by taking its core technology infrastructure to "the cloud". Cloud computing shifts the model away from the client-server standard, to web-based tools and applications that allow unprecedented flexibility and scalability.

Applying this platform to remote health monitoring technology will help eliminate many of the challenges that have prohibited wide-scale adoption. Firmware, drivers, and dynamic client profiles can all be kept in the cloud and managed remotely. CloudCare can enable a more patient centered healthcare delivery method by taking the focus off of the technology. Users, whether patients or care providers, are not required to have technical expertise to deploy, set-up and maintain equipment.

The CloudCare platform allows MedApps' HealthPAL to enter the ranks of consumer oriented services and devices with embedded cellular technology that are maintained through a cloud-based backend system, such as Amazon's Kindle, OnStar and the Apple iPad.

The Power of MedApps is Now in the Cloud -- SCOTTSDALE, Ariz., Oct. 5 /PRNewswire/ --

Technorati Tags: MedApps,wireless remote monitoring,HealthPal,HealthVault,Google Health,medical devices,healthcare,Health IT,Bluetooth,Cloud Computing,Personal Health Records

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Cardo Medical Orthopedic Medical Device Company In Beverly Hills Announces Layoffs–And Still Looking for Funding

Cardo markets FDA approved products to include  Total Hip System, Cervical Plate/Screw System, Spine Pedicle Screw/Rod System, Patello-femoral Arthroplasty, and Uni-Knee Arthroplasty.  Perhaps some investors will show interest again as their timing in going public was in September of 2008 and enough said there as well remember what happened in that month and year.

Their products from what is shown on the website is a smaller surgical device and procedure and less invasive.  Perhaps they might have a second life with the other big companies and their lawsuits that are ongoing with knee and hip replacements.  BD

From the website:

“Cardo Medical creates reconstructive orthopedic and spinal surgery products through advanced engineering. Cardo Medical's superior engineering talent closely collaborates with leading surgeons around the country to create products that reduce or eliminate joint pain and allow our patients to achieve more active lives. Cardo Medical's cutting edge products are designed to reduce operative time, enhance surgical technique, shorten hospital stays, reduce recovery time and improve outcomes”

LOS ANGELES, Oct 7, 2010 Cardo Medical, Inc. an orthopedic medical device company based in Beverly Hills, California, announced today that it terminated 15 of its 30 employees in varying functions and that its Chief Executive Officer, Andrew Brooks, M.D. and President and Chief Operating Officer, Michael Kvitnitsky have agreed to forego their salaries for the foreseeable future.

The Company undertook these actions to reduce its operating costs and preserve cash while it continues to seek alternative sources of capital or some other type of restructuring. Most recently, the Company had been seeking funding through a private placement, but was unsuccessful. While these actions are expected to result in substantial salary, fringe benefit and other cost savings going forward, the reduction in staff will result in a scaled-back level of operations and decreases in net sales going forward.

Cardo Medical, Inc. Announces Layoffs - MarketWatch

Technorati Tags: Cardio Medical,hip replacement,knee replacement,orthopedics,medical devices,healthcare,surgery,investments

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US Gov Office of Personnel Management To Create a Health Claims Data Base for Analytics and To Track Trends and Costs

This is a great move in this direction to have the government stick their toe in the water here and get some exposure and data for that matter.  It will be protected and in most cases anonymized to strip the personal data. 

The government will have their own numbers from claims with federal employees to look for their own methods and to reduce risk and improve outcomes as well as track drug and pharmacy pricing.  Also this will help with information needed when it is their turn to negotiate with health plans.  BD 

The Office of Personnel Management plans to create a health claims database from which it can analyze and track health trends and costs based on medical claims submitted by physicians and hospitals for federal employees and others covered by federal health plan options.

The health reform law called for the creation of the database, which OPM will start Nov. 15, the agency said in an announcement.

The information will come from healthcare providers in the Federal Employee Health Benefit Program and the National Pre-existing Condition Insurance Program, a plan started in August under the health reform law, which offers coverage for high risk pools of individuals.

http://www.govhealthit.com/newsitem.aspx?nid=74811

Technorati Tags: Office of Personnel Management,data,healthcare,analytics,claims,data bases,healthcare reform,US Government

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Healthcare CIO Survey Shows Large Concern Relative to Being Able to Fill Health IT Jobs–Proof That Technology Throws The “Creative Technologists” a New Left Curve Every Day

The CIOs o hospitals and medical centers do in fact have a lot of responsibility on their shoulders today. I mention technology as we see it today as that does have an impact as the best laid plans of yesterday may fall on their face tomorrow and they know this.  With being close at the the pulse of where everything has to take place, they are a very good indicator of what lies ahead.  These CIOs also have some very tech complicated issues they need to translate to layman’s terms as well to get funds, equipment, software and more and sometimes with a direction of Health IT changing maybe they only have a few hours to accomplish this. 

These departments today are pounded upon by others for the “right answers” and projections and sometimes others higher up in management cant’ comprehend why some of their opinions may change from week to week in staff meetings, which in essence shows they are out there doing their job if this occurs as it is what is today.  When taking a look at existing staff it might be fine today, but come tomorrow there’s something new added to the platter. 

We are way beyond IT and IS departments being able to create “magic” as they have done for a number of years and this does not reflect in any way on a lack of talent, it’s that left curve they deal with every day and every hour for that matter and I would also go so far as to say these folks have “brains that hurt”; and maybe that could be a good topic for a poll to see how many have “sore brains”.  These are the “creative technologists” that make it all happen.  You can read a prior post from earlier this year that explains this a bit more.

What is a Creative Technologist – Hybrid Executives - We Have a Big Shortage in Healthcare

“The job title itself is less important than being open to a hands-on and holistic view of technology as part of communication, as part of business, as part of the human experience, and therefore as part of culture.”

Without the creative technologist input, the rest can easily go downhill and CIOs are the creative technologists in our times today.  They sketch with technology, just like a visual creative can sketch with a pencil. In agencies with a more siloed approach, first, please rethink that – technology can’t live down the hall anymore; it’s part of everything that everyone in the company does

Thus I say today that every CIO is a “creative technologist” when you stop and think about it and their input should not be overlooked as there’s a lot of wisdom there if one listens.  BD

PHOENIX – In West Texas, where unemployment is at 2 percent, the popular chain Chili's had to close some of its restaurants because there were not enough employees to fill the jobs. Imagine what it's like for a healthcare system in that part of the country to recruit IT staff, says Gary L. Barnes, CIO of Medical Center Health System in Odessa, Texas.

Barnes served as moderator of a panel on IT staffing shortages Wednesday at the CHIME10 Fall CIO Forum in Phoenix. He was not alone in worrying about staff shortages. The four-member panel – from Maryland, New York, Massachusetts and Tennessee – shared similar concerns. To boot, a new CHIME survey released Wednesday revealed that 51 percent of CIOs across the country are worried they will have to put off planned implementation of electronic health record systems if they don't find the people to get the job done.

"We're running scared right now," Abel said.

Schade commiserated. "A small organization can't absorb turnovers," she said. "Once they have those openings, they have nowhere to go."

CIO survey forecasts IT staffing troubles ahead | Healthcare IT News

Technorati Tags: Health IT,technology,left curve,HITECH,CHIME,hospitals,medical centers,software,algoirthms,staffing,creative technologists

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Khosla, Sun Co-Founder–One More Entering Into the World of Philanthropy Challenging The Rich in India To Do More

When you stop and think about it, we have some similarities in thought here between what’s happening in the US and India and granted there are some very poor in India that really need just some basics and are still fighting polio, that part being unlike here in the US. Vinod Khosla was able to power the opportunities here in the US of years past and now is working to challenge others in India of wealth to collaborate.

He states in this article that the culture should change in India to get the rich involved with investing in programs that have an impact on poverty.  He states that charitable giving is at 10%, much less than what other countries experience, like here in the US where we stand at 75%, and that number in itself for us is worth paying attention too as it’s a lot larger than I even thought.  Just like here too he states that social enterprises cannot be relied up on to address poverty.  Desmond Tutu did some good work in this area years ago, and the comments in this article remind of that. 

Medical Tourism Booming In India But Yet How About Their Own Citizens Needing Medical Care and Education Where Philanthropy Is Helping Fill Some Of The Gaps?

His model here is using some forms of capitalism to help out and at least with making an effort here we can see if this may prove to be beneficial with at least a challenge to others in India to begin thinking in this direction.  We have those same ideas here in the US so perhaps this paradigm will spread worldwide.  BD

MUMBAI, India — Vinod Khosla, the billionaire venture capitalist and co-founder of Sun Microsystems, was already among the world’s richest men when he invested a few years ago in SKS Microfinance, a lender to poor women in India.

But the roaring success of SKS’s recent initial public stock offering in Mumbai has made him richer by about $117 million — money he says he plans to plow back into other ventures that aim to fight poverty while also trying to turn a profit.

And he says he wants to challenge other rich Indians to do more to help their country’s poor.

An Indian transplant to Silicon Valley, Mr. Khosla plans to start a venture capital fund to invest in companies that focus on the poor in India, Africa and elsewhere by providing services like health, energy and education.

By backing businesses that provide education loans or distribute solar panels in villages, he says, he wants to show that commercial entities can better help people in poverty than most nonprofit charitable organizations.

Besides Mr. Khosla, entrepreneurs like Pierre Omidyar, a co-founder of eBay, and Stephen M. Case, a co-founder of America Online, have started funds with similar aims.

Khosla, Sun Co-Founder, Uses Capitalism to Help Poor - NYTimes.com

Technorati Tags: India,philanthropy,Vinod Khosla,money,medical care,healthcare,wealth,technology

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Healthcare Reform Getting Pretty Ugly as Nobody Seems To Be Able to Find a “Pool” Large Enough to Spread the Expense–Single Payer by Default An Option When The Fighting is Done?

In writing and following the daily news as to what is taking place here in California and all over the US, it appears reform is getting to be much more complicated than anticipated with waivers and insurance carriers battling with what they want to allow and it’s once again all boiling down to money.  We live in very complicated times and when Medicare was created we didn’t live in the same world; however it has been the backbone for healthcare for seniors and we will all get there one day. 

Sure there are rising costs all over the place and I feel many do not embrace or acknowledge the fact that technology throws us a new left curve every day, the innovative times we have today is nothing like any of us have ever seen, and in full respect to all, anyone in public office is not going to have a solid plan but rather it’s more like do the best you can and keep on top of daily developments and changes so thus the GOP wanting to revoke some of the work that has been done is only a step backwards to the 70s mentality.  It won’t work as we have lawmakers still trying to create laws that relate to a time when things were much simpler.  It is time to stop the blame shifting that is going on and to try to collaborate as best we can.  It’s not Gumby and Pokie anymore.

Insurance in the basic concept is taking expenses and spreading it out over a large pool of individuals  so everyone can get care and we have evolved far from that concept with companies rolling on the stock market and adding pressures of dividends for investors and all of this gets in the way of the basic concept here.  Allowing insurers to go public was a mistake years ago but we can’t go back and blame but rather should look at what we did and go forward with some better solutions as there’s no great white hope hanging around the corner. A year ago I predicted that HHS and all their responsibilities were going to be a very heavy Health IT area, and thus so, those who recognize this and have some first hand experience in how to put the wheels in action were going to be needed as you can’t guess at this stuff anymore and the IT folks are no longer in a position to take political statements and create magic processes to make it work.  There’s a ton more code and processes out there that didn’t even exist 5 years ago.

Wendell Potter Tell All Book–Deadly Spin–One to Put On My List as “He Knows Algorithms and How they Create Profits”

Right now we are gambling with human lives out there and creating a system to where czars can control who gets care and who does not, which is against the principles of what we stand for in the US, and if you don’t think this is true, read the news every day, I do.  Perhaps the biggest error or issue here is not having a private option as we seem to be lacking a check and balance system here and granted devices and drugs are giving some relief but perhaps not enough so what is the value of some of the innovation we are seeing?  We have a lot of neat things going on with potential cures and treatments, but when you look closer where’s the true funding coming from for what we need today – philanthropy.  Nobody was addressing malaria until the Gates Foundation gave it a focus as the profit structures for companies to work on this were not there and yet it kills many every year. 

A single payer plan is not that simple either but could be done with planning as you have Medicare contractors owned by insurance subsidiaries.  Pay very close attention today to company subsidiary action as super business intelligence networks are being created with combining and mining data and with the “for profit” structure we have today, competition if fierce as to who can gobble up the best companies to yield the biggest and best profits.  The payers have the data and infrastructure and for a single payer plan to work, the government would need to have this data as well. 

We teeter on a level of disruption and distraction that keeps us from focusing on core issues and seem to thrive on the next OMG story that comes out and yes there’s interest in some these stories but it should not be to the point to where it demands focus that takes us away from what is at hand.  We have citizens that hate technology and then we have the opposite of geeks that jump on every stick of software and innovation that pops up without proven functionality but it looks good and does one small process for them.  Small personal interest groups in a one step software application kills us with the over all picture.  The public will generally let one know if it is a hit or not and somewhat set the pace, like the IPad for a simple example, great consumer response and in the masses. 

Coming back full circle we are at a cross road to where we need to decide how to let the government work for us or if we are more content to gamble on investments when it comes to care, which has been the stage set for a number of years.  After seeing flash crashes and worse, is this a good option?  I don’t feel good about it as there’s too much at stake and we live in a time of a lot of uncertainties and this creates a whole new lot that maybe doesn’t need to be there.  The world will be full of uncertainties and adding more seems to be a very futile decision right now when we do have the power to at least limit some of this and thus the GOP plan is not much more than a roll back to the 70s which will fail us and I think we all kind of can see that, but need to maybe admit and realize this without casting our fate to the wind, which is pretty much what it is. 

So by the time all the fighting is done over profiteering and those with technology have used their algorithmic formulas to create profits where they did not exist before we will in fact end up with very little and end up being a country in a constant state of chaos as tempers will rise and the lifestyles we have enjoyed for years will continue on a downward spiral. There’s no 2 ways about it, those with the mathematical formulas have been in a position to do some good things, but on the other hand it has been one of the biggest spoofs dumped on a society that is not up to the literacy levels in all areas to comprehend. 

“Proofiness–The Dark Side of Mathematical Deception”–Created by Those Algorithms–New Book Coming Out Soon

We all need to come together and quit fighting and work together as a country or the “Spoof for Profit” movement will continue as there’s a lot that goes on behind the scenes that most are not aware of and mathematical formulas run 24/7 and if you have not taken notice, see what you get on the web today with companies throwing more algorithms at you to guide you in one direction or the other and keep in mind there’s pretty much always big profits behind the mathematical spoofs you see today. 

Not everyone presents spoofs out there but the growing number is certainly beginning to outweigh those who are offering accurate information and collaboration that we need to dig our way out and thus in light of this ugly situation today a single payer plan established by the government might in fact end up being a partial solution to at least cool down the pressure cooker.  BD

The House Republican pledge unveiled two weeks ago would turn back the clock on health care progress. Rep. Pete Stark (D-CA), Chairman of the House Ways and Means Health Subcommittee, today criticized the Republican plan to allow insurers to discriminate against people with pre-existing conditions.

"The Republican pledge is a health insurers' bill of rights, rolling back important protections for people with pre-existing conditions," said Chairman Stark. "As with health insurance contracts, read the fine print when it comes to Republicans and their supposed assistance for people with pre-existing conditions. Limited protections only apply if a person maintains continuous health insurance coverage, and the Republicans continue to allow insurers to charge them more and limit their benefits."

Insurance News - Republicans Would Permit Insurers to Deny Coverage to People with Pre-Existing Conditions

Technorati Tags: health insurance,healthcare reform,algorithms,spoof,Spoof for Profit,formulas,ethics,Single payer system,profits,greed,dividends

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