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Express Scripts, Mylan, and the EpiPen

According to CNBC’s article, Mylan can lower EpiPen price today, Express Scripts says, Express Scripts’ Chief Medical Officer, Dr. Steve Miller told CNBC, “"If she [Mylan CEO Heather Bresch] wants to lower the price [of the EpiPen] she can lower the price today…We'd pass the savings that we take from the marketplace back to our plans." That is fine, as far as it goes, however, if Express Scripts really wants to help reign in pharmaceutical prices, they could give consumers more say in their medications.

As an example, I take valsartan to control my hypertension. Every three months, I receive a new supply from Express Scripts. Express Scripts puts on the label who manufactures it. In my case, the aalsartan comes from Mylan. Given the behavior of the current CEO of Mylan, I would prefer that none of my medications come from Mylan. Drugs.com lists a dozen generic manufacturers of V]valsartan.

Likewise, I take fenofibrate for high cholesterol. Like with the valsartan, Express Scripts has sent me fenofibrate manufactured by Mylan. I can’t find the list of other manufactures of fenofibrate, but I’m guessing there are choices there as well.

If Express Scripts would start shipping me medications not manufactured by Mylan, it would be a great start. If lots of patients started requesting the medication not be provided by Mylan, if at all possible, it would help return Adam Smith’s invisible hand to the pharmaceutical marketplace and prevent predatory pricing from companies like Mylan.

AI, Health Care, Genomics, Fitness Apps, Mobile Apps, Social Media and Beyond

It was probably in the 1970s that I first read Richard Brautigan’s poem, All Watched Over By Machines Of Loving Grace. I grew up working with computers; I like to speak of myself as a digital aborigine, yet it seems like now, we may be moving closer to Brautigan’s poem.

This isn’t without its concerns. One recent article had the headline, Our tech future: the rich own the robots while the poor have 'job mortgages'.

This reminded some of my friends online of Fritz Lang’s Metroplois

In a futuristic city sharply divided between the working class and the city planners, the son of the city's mastermind falls in love with a working class prophet who predicts the coming of a savior to mediate their differences.

Yet I’m not so sure the future is quite as bleak.

I work at a health center that focuses on underserved populations. It probably isn’t a typical health center of this time because we are very interested in how we can use technology to improve health outcomes for everyone. This has led me to keep an eye on a bunch of developments, and here, I’ll do a little bit of my own sci-fi futurist writing.

Recently there has been a lot of interest in Google Deepmind’s Go match against Lee Se-dol. Yet it is important to remember there are other AI’s. IBM’s Watson comes to mind. Of course, so does Wintermute and Neuromancer, but that’s a whole different blog post.

Watson is interesting to me for a couple reasons. Watson has been doing a lot of interesting stuff in health care. (See some of the episodes of Conversations on Health Care for more on this.) Watson is now branching out into Social Media.

Some interesting work in the nexus of health care and social media includes Linking social media and medical record data: a study of adults presenting to an academic, urban emergency department

So, what might Watson, looking at health care and social media be like? Artefact has its ideas, described in What iPhone-Based Health Care Could Look Like In 10 Years. They talk a little bit about fitness monitoring apps connected with sites like PatientsLikeMe or 23andMe, but the article doesn’t talk about artificial intelligence.

Meanwhile, North Face is adding IBM Watson to its shopping app. So, imagine an AI connected to social networks, genomic data, fitness data, marketing information, and anything else it can get to, all with a proactive, Siri like interface…

“Good morning, Aldon. It looks like it should be a nice day today, and you didn’t get much exercise yesterday. You should really try to take a walk down Main St at lunch time today. You don’t have anything in your calendar conflicting with that, and there are several Ingress portals you can capture…Before you get to work, I want to make sure you’re aware of these articles about the health center, opioid addiction, and telemedicine… Later in the day, if it doesn’t get too crazy, you should get in touch with your old friend Bill. He seems to be having a rough time right now… You should read his Facebook posts and reply or give him a call.”

“Thanks, Watson. Can you post something uplifting on his Facebook posts for me? “

“No problem, Aldon. By the way, I don’t want to nag, but it is really time to have your vision checked again. Do you want me to check your calendar and set up an appointment for you?”

“Yes please.”

With that, I get up and make my oatmeal.

The Digital Church

In a recent online discussion, someone mentioned to me the idea that Christianity goes through a five hundred year trend of re-evaluation and remodeling. I was asked if I thought we might be at one of those once in every five-hundred year events. I’ve often wondered how close we are to another American Great Awakening. The Great Awakenings happen much more frequently.

It is interesting that this has come up in an online discussion, something that didn’t exist during the reformation or the early Great Awakenings. Many of my media oriented friends often talk about the Gutenberg Press as bringing about great changes in terms of education, politics, and religion. Is the Internet bringing about a similar change?

Much of my political involvement has been focused around online activities. The communities I belong to are often around common interests shared online and not around common geography. Yet our church structure is still seems to be primarily oriented around common geography. At the same time, people are looking at how to get Christianity out of the church building and more into the community. How does this relate to the church community being online?

The stuff we post online is much more permanent and searchable that the comments we make face to face or write in letters. If you know where to look, you can find stuff I posted online back in 1982. Recently, a friend died of cancer. I had met him through an online group back in the 90s, and people in the group are still connected online. They are sharing memories and pointing to photos that were shared back in the 90s.

In two different online religious groups, people have asked that personal information either not be shared, or shared with the smallest amount of personal information necessary.

Now I get some of the desire for privacy. When I started considering more deeply what God is calling me to last spring, I was hesitant to talk publicly about it. Part of it was that it seemed God was calling me to a much more intimate relationship, and we are often restrained in talking about intimacy, especially when there is uncertainty about the relationship and vulnerability. Yet at the same time, as we become more sure of the relationship, we proclaim it boldly. I think of my friends posting life events on Facebook, a new relationship, the engagement ring, the marriage, the birth of a child. As I write this, I think of the song we sang in youth group years ago, “I’ll shout it from the mountain top, I want the world to know, the Lord of Love has come to me, I want to pass it on.”

I think of some of the meditations I’ve been reading recently, about our experience of God’s Incarnation, God’s love, God’s presence, happens in the simple parts of life, like appreciating the sunrise on the daily commute, or the kind words of a coworker at the office. How do we experience the presence of God online?

Likewise, I get the idea of telling one’s own story, and not someone else’s story. Yet when we think of our self as part of a community, part of the body of Christ, the line between my story and our story blurs.

When I get into discussions about acceptable behavior online, I often go back to Mark Prensky’s article Digital Natives, Digital Immigrants. He was writing in the context of education, but I like to think of it more broadly. In the context of this post, I have to wonder what a church of Digital Natives looks like.

Are the people who are more hesitant to share online digital immigrants? Are they the older folks regularly attending churches as opposed to the millennials who have by and large abandoned church? What might a church of the twenty first century, organized around online interests instead of geographical proximity look like?

I’m also interested in how all of this relates to addressing stigmas, confessing sin, and several other topics. I hope to be exploring some of these ideas in more detail over the coming months.

This is

Recently, I attended the OMMA conference about videos at Internet Week. One of the best talks was by Gary Osifchin of Mondelez, the parent company of Honey Maid graham crackers. He spoke about their “wholesome” campaign. He spoke about how people see graham crackers as wholesome, but that people often associate “wholesome” with “old-fashioned” or “boring”. In order to stand out in this world of constant advertising and marketing everywhere, you need to present a strong point of view.

He suggested that to make “wholesome” relevant and exciting against this background, you need to look at cultural truths, for example, the changing face of American families. It is a risky strategy, because there will always be people who rebel against changes in cultural truths, but I believe that Honey Maid’s “Wholesome” campaign was very successful and helped to get people to look at how the world is changing.

He spoke about how he hoped other brands would follow suit and how the wholesome campaign is not just a single set of ads, but is a ten year campaign. On twitter, they are using the hashtag “#ThisIsWholesome”. It made me stop and think about how this could be done for other brands.

“This is…” I work at a health center serving vulnerable populations. What would a campaign about “This is health” look like? Would it talk about programs we do to help people eat healthier food? Get more exercise? Read more? Become more involved in their community? All of that fits into broader discussions about health, including social determinants of health and health equity.

What about my run for State Representative? Can we change “This is politics” into something positive? Can we talk about caring for the vulnerable amongst us, instead of how so much politics of today seems to be about grabbing what you can for yourself at the expense of everyone else around you? Instead of politics, should we talk about governance, citizenship, responsibility, or some related idea? After all, it seems like the cultural truths are currently stacked up against any positive image of politics.

As I think about the phrase, “This is…”, various phrases come to mind. “This is… American Idol”. “This is Spinal Tap”, “This is water”, “This is my body, which is given for you”.

What do we want to declare as cultural truths? What do we hope such declarations will bring about?

Health Equity and the 2014 CT Legislative Session

Last year, as a member of the Connecticut Health Foundation’s Health Leadership Fellows Program the group I was part of mapped out plans for bring Health Impact Assessments into Connecticut policy decisions, especially the state legislative process.

A key component of this plan was to improve the way health advocates work together during the legislative session. We set up a Google Group, CT Health Equity Bills to discuss this. As we enter another legislative session, members are encouraged to discuss upcoming bills and opportunities to testify.

I must admit, prior to becoming a CT Health Foundation fellow, I would often be asked to support various bills, and I rarely thought about these bills in terms of the impact they would have on health equity, and I suspect that many legislators don’t think about bills in terms of health equity the way I believe they should.

The Connecticut Health Foundation has published a blog post, Things We’ll Be Looking Out For During the 2014 Legislative Session. While it doesn’t address specific bills, it provides an important framework for this year’s session. I have been speaking with other organizations and hope to share thoughts about their agendas as well.

Meanwhile, I’m already getting messages from activists to support different bills. One of the first bills I received a message about was S.B. No. 23 AN ACT CONCERNING BENEFIT CORPORATIONS AND ENCOURAGING SOCIAL ENTERPRISE.. Friends have pointed me to a Change.org petition uring the senate to take up SB 23 this year.

it is early in the session and I don’t know what SB 23 is going to look like by the end of the session, but I strongly support the goal. Yet I hadn’t been thinking of this bill in terms of health equity. My gut feeling is that it won’t harm efforts for health equity and has the potential to benefit health equity efforts, but beyond that, I haven’t really thought it out much.

Then, at dinner last night, I got into a fascinating discussion with a friend from Yale’s Global Health Initiative. She was at a conference where people were talking about using a social impact exchange as a means of encouraging social entrepreneurship and investment in Haiti to deal with the issues of cholera.

While I do expect the passage of SB 23 to lead quickly to the issue of Social Impact Bonds, or the establishing of a social impact exchange, and a resulting improvement in efforts to address health equity in the state, it does seem like a step in the right direction.

Another bill I was contacted about was S.B. No. 120 AN ACT CONCERNING DYSLEXIA AND SPECIAL EDUCATION.. “To include dyslexia detection, recognition and intervention education as part of the professional development program for teachers and to amend the state IEP form to include dyslexia.”

With sponsors ranging from Sen. Bye to Rep. Cafero, this seems like a pretty straight forward broadly supported bill. Yet even with a bill like this, it is important to think about how it relates to health equity. Are there disparities in the diagnosis and treatment of dyslexia in Connecticut? How are they tracked? How will they be tracked and corrected?

A final bill for this blog post: H.B. No. 5144 AN ACT CONCERNING ACCESS TO BIRTH CERTIFICATES AND PARENTAL HEALTH INFORMATION FOR ADOPTED PERSONS., “To provide adult adopted persons, twenty-one years of age or older, access to their biological parents' health information and information in the person's original birth certificate or record.”

A friend contacted me about this bill. She was adopted as a child and does not have access to information about her biological parents. While it is easy to think of this in terms idle curiosity that an adopted child might have about their history, there are important health issues to consider. Are there biological family history information that could help the adopted child better deal with their own health? Again, I don’t know much about the health equity aspects of this. Are there disparities in access to birth and health information by adopted children along racial or ethnic lines? Would this bill help address such disparities?

Over the coming days, I expect I will hear more about these and other bills. I hope you’ll join me in thinking about the impact these bills would have on health equity in our state.

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