Wednesday, April 4, 2007

clinical innovations - Ten Wild and Crazy Health Care Innovations

Part 1 – Clinical, 1 -4

I’m assuming this blog’s readers are familiar with Steve Martin, the comedian, who in 1978 issued an all time best selling album entitled “A Wild and Crazy Guy.” Martin’s signature image was an American Indian with an arrow sticking through his head.

Now I’m no Steve Martin, but I have Cherokee blood in my veins and a few piercing thoughts on health care innovations to share with you. As this blog’ readers and readers of my new book Innovation-Driven Health Care: 34 Key Concepts for Transformation (Jones and Bartlett, 2007, available from publisher 800-832-0034 or on might know, I have this “wild and crazy idea” that innovations will transform American health care.

I explained my idea this way in my book.

While the nation debates a single-payer versus a market-driven system, significant , underreported innovations are blossoming under the radar. Those innovations mostly bubble up from the marketplace, rather than filtering down from government. Whether by marketplace innovation or government action, Americans are seeking a system offering prompt access to affordable, compassionate, and effective care.

Here, for your consideration, are ten past and present “wild and crazy” innovations, operating outside of usual paradigms, i.e., representing “outside-the-box” thinking, that have changed how we think about health care. Some of these innovations are clinical. Others relate to policy and sociological perceptions.

1. Bacterial infections, not excess gastric acid, causes stomach ulcers. Since time immemorial, doctors have preached that stress, alcohol, caffeine, and fried foods, stimulates the body to produce more hydrochloric acid, which, in turn, erodes the gastric mucosa, causing ulcers and requiring bland diets to cure. Then in 1983, two Australian doctors – a pathologist and a gastroenterologist – observed heliobacter organisms in gastric biopsies. They postulated these organisms were the true cause of ulcers, not excessive acid. Initially the medical establishment deemed the idea absurd and radical, but its amazement found what the Australians said turned out to be true. So now we treat ulcers with antibiotics, and gastric surgery to remove ulcers rarely occurs. This is an example where experienced physicians, working outside the traditional research environment, made an observation revolutionizing the treatment of a common ailment. Their observation was to lead to a Nobel Prize for medicine.

2. High blood homocysteine levels, not high blood cholesterol, causes coronary artery disease. In 1968 Kilmer McCully, a Massachusetts General Hospital pathologist, found children with progeria, a disease of children characterized by advanced arteriosclerosis, sometimes caused strokes and heart attacks in the very young. These children had high homocysteine, an amino acid, levels in blood and urine. In a 1999 book, The Heart Revolution: The B Vitamin Breakthrough that Lowers Homocysteine, Cuts Your Risk of Heart Disease, and Protects Your Health, McCully claimed you could treat arteriosclerosis in adults by taking folic acid pills and eating B complex rich foods rather than taking statin drugs and other cholesterol lowering agents. Needless to say, his stance alarmed the research establishment, recipients of vast amounts of grant money invested in cholesterol research, and the pharmaceutical industry, especially Pfizer, who last year had $13 billion in revenues on Lipitor, a cholesterol lowering agent The controversy whether statins or taking folic acid to lower homocysteine levels is more effective in preventing arteriosclerosis remains controversial. More recently another hypothesis – that coronary thromboses are secondary to infection -- has fueled the controversy even further. The moral is: there’s always room for innovative thinking, even if it counters traditional beliefs.

3. An infection by a virus, human papillomavirus (HPV), which spreads through sexual contact, is responsible for most cases of cervical cancer. Previously it was thought trauma and chronic irritation from frequent sexual contact caused the cancer. The cervical cancer vaccine is the first vaccine ever developed to prevent a cancer – which strikes about 10,000 women each year in the US and 500,000 new cases each year worldwide. Cervical cancer kills about 40% of its victims, who are often young, in the U.S. and its treatment causes infertility.

4. Given proper clinical algorithms, almost all patients are capable of creating their own narrative clinical histories based on their chief complaint, gender, and age.

Let’s face it. Everyday at ATM machines, gas pumps, airline ticket counters, and grocery check out counters, consumers are punching in identity information and swiping cards. For most of the population, it is no great leap to punch in historical information of their current illness or reason for their visit to the doctor’s office, using a simple to use “yes” on “no” clinical algorithm based on their problem, gender, and age. This is converted into a narrative history which the doctors has in his/her hands when the patient enters the examining room. I call this sort on information “diagnostic support data at the doctor’s fingertips. In this wireless world, all sorts of variations off this theme are cropping up across the medical landscape. Some applications use Medicare claims data, others use pharmaceutical company data, still others claims data extracted and distilled from health plans, and finally some gather data from various departments of the hospital so the attending physician can know precisely what has happened elsewhere in the hospital.

1 comment:

Unknown said...

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