Tuesday, February 28, 2012

For bringing medical care to the masses

Narayana Hrudayalaya is Walmart meets Mother Teresa.

The organization, a complex of health centers based in southern India (narayana hrudayalaya means "God’s compassionate home" in Sanskrit), offers low-cost, high-quality specialty care in a largely impoverished country of 1.2 billion people. By thinking differently about everything from the unusually high number of patients it treats to the millions for whom it provides insurance--and by thinking a lot like the world’s largest retailer--the hospital group is able to continually wring out costs. Narayana Hrudayalaya’s operations, for instance, include the world’s largest and most prolific cardiac hospital, where the average open-heart surgery runs less than $2,000, a third or less what it costs elsewhere in India and a fraction of what it costs in the U.S.
 "This hospital is for poor people, but we also treat some rich people. So we’re mentally geared for people who are shabbily dressed and have trouble paying. We don’t look at them as outsiders. We look at them as customers." Narayana Hrudayalaya’s flagship hospital has 3,000 beds, more than 20 times as many as the average American hospital. The company (mostly family owned, with JPMorgan among a handful of investors) negotiates for better prices and buys directly from manufacturers, cutting out distributors.
The company targets even routine inefficiencies. A beefed-up support staff handles the onerous paperwork for surgeons, freeing Shetty and his colleagues to perform more operations than a typical cardiac surgeon would, about a dozen a week.
 Patients who pay discounted rates are in effect compensated by those who pay full price or opt for extra perks. Typically, the latter group includes foreigners for whom a $7,000 heart operation, access to an experienced specialist, and a deluxe private room is a relative bargain. The balance of patients is, in fact, crucial. Every day, Narayana Hrudayalaya’s surgeons receive a P&L statement of the previous day that describes their operations and the various levels of reimbursement.
 Before becoming one of India’s best-known health-care entrepreneurs, Shetty was its best-known heart surgeon. He was interrupted in surgery one day during the 1990s by a request to make a house call. "I said, 'I don’t make home visits,' " Shetty says, "and the caller said, 'If you see this patient, the experience may transform your life.' " Which is exactly what happened. The request was from Mother Teresa. 

Why Doctors Die Differently

It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.
Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.
Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients' wishes, but when patients ask "What would you do?," we often avoid answering. We don't want to impose our views on the vulnerable.
The result is that more people receive futile "lifesaving" care, and fewer people die at home than did, say, 60 years ago.


A Diet Rich in Fish May Help the Aging Brain

Eating fish and other foods rich in omega-3 fatty acids could help people maintain healthy brains as they age, as well as protect their hearts, new research suggests.
In a study to be released Tuesday, participants with low levels of omega-3 fatty acids in their blood had slightly smaller brains and scored lower on memory and cognitive tests than people with higher blood levels of omega-3s.

At-Risk Patients Gain Attention of Health Insurers

One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors’ visits, trips to emergency rooms and prescription drugs.
And they are not always the end-of-lifers. They are people who suffer from chronic and increasingly common diseases like diabetes and high blood pressure.
Health insurers are likely to have little choice other than to monitor these cases more closely, said Daniel Malloy, an executive at IMS Health. Under the federal health care law, which is expected to go into effect in 2014 if it is not struck down by the Supreme Court, insurers will no longer be able to deny coverage to anyone with a potentially expensive medical condition or put limits on how much they will pay in medical bills.
And avoiding these patients altogether will no longer be an option. Insurance companies will be required to enroll millions of new customers without the ability to turn them away or charge them higher premiums if they are sick. They will prosper only if they are able to coordinate care and prevent patients from reaching that top 1 percent, Mr. Malloy said. “The insurance model is fundamentally changing,” he said.

No Extra Benefits Are Seen in Stents for Coronary Artery Disease

This review, published in The Archives of Internal Medicine, included only prospective randomized trials that compared P.C.I. and medical therapy with medical therapy alone. There were 7,229 patients in all, half randomized to P.C.I. and half to medicine alone. More than 70 percent of the surgical patients received stents, and the studies followed patients for an average of more than four years.
Death rates were 8.9 percent with P.C.I. and 9.1 percent with medical treatment. Rates for nonfatal heart attacks were 8.9 percent for those who got stents and 8.1 percent for those on medicine alone.

Monday, February 27, 2012

Can You Comparison-Shop for Surgery?

I have an early-onset type of cataract, and my vision has gotten so bad I’m ready for surgery. As a patient, I’m not too happy about being in this situation, but as a health-care-policy wonk, this seems like the perfect opportunity to test one of the central tenets of conservative health-care-reform plans: comparison shopping.

Elizabeth Taylor’s Killer Beauty

Elizabeth Taylor wasn’t one for understatement: she had eight marriages, won two Oscars and was a bold pioneer in AIDS activism. And let’s not forget those captivating violet eyes. Now, according to Slate’s Brow Beat blog, Taylor’s large, liquid eyes had the unusual benefit of a genetic mutation, one that left her with a double row of eyelashes.

Single molecule's electric charges seen in first image

Researchers have shown off the first images of the "charge distribution" in a single molecule, showing an intricate dance of electrons at tiny scales.

Sunday, February 26, 2012

Dessert…for Breakfast?

A new diet study claims that changing the time of day you eat dessert can help you lose weight.

...By the end of the initial 16-week period, both groups had lost a whopping 33 pounds per person on average, but at a 16-week follow-up, the researchers discovered something very surprising: The low-carb group had regained most of the weight they had lost (around 22 pounds, on average), while the dessert-at-breakfast eaters had continued to slim down to the tune of another 15 pounds. 

Ben & Jerry's launches 'Lin-Sanity' flavor, takes out fortune cookie ingredient

Vermont-based ice cream company Ben & Jerry’s has begun selling a limited-release new flavor at its Harvard Square shop in honor of basketball’s sudden sensation, Jeremy Lin, a Harvard University graduate who was an Ivy League star during his time with the Crimson, but left the Cambridge campus undrafted and largely unknown.

Saturday, February 25, 2012

The Evolution of a Point Guard

ORLANDO, Fla. — The most captivating strand of the Jeremy Linmystique is that he came from nowhere, emerging overnight to become a star, after being underestimated and overlooked, disregarded by college coaches, ignored in the N.B.A. draft and waived twice in two weeks.

The narrative is well-established, factual in its broadest strokes and altogether flawed, or at least woefully incomplete.
Jeremy Lin’s rise did not begin, as the world perceived it, with a 25-point explosion at Madison Square Garden on Feb. 4. It began with lonely 9 a.m. workouts in downtown Oakland in the fall of 2010; with shooting drills last summer on a backyard court in Burlingame, Calif.; and with muscle-building sessions at a Menlo Park fitness center.

Friday, February 24, 2012

Happiness and The Experiencing Self vs The Remembering Self

How 1-Minute Intervals Can Improve Your Health

While many of us wonder just how much exercise we really need in order to gain health and fitness, a group of scientists in Canada are turning that issue on its head and asking, how little exercise do we need?
The emerging and engaging answer appears to be, a lot less than most of us think — provided we’re willing to work a bit.

Aging of Eyes Is Blamed for Range of Health Woes

The aging eye filters out blue light, affecting circadian rhythm and health in older adults.

For decades, scientists have looked for explanations as to why certain conditions occur with age, among themmemory loss, slower reaction time, insomnia and even depression. They have scrupulously investigated such suspects as high cholesterolobesity, heart disease and an inactive lifestyle.
Now a fascinating body of research supports a largely unrecognized culprit: the aging of the eye.

Slow carb chemical may help heart

SEATTLE, Feb. 23 (UPI) -- Slow carbohydrates such as eggs, meat, legumes, lentils, broccoli and peas may affect a blood chemical linked to heart disease, U.S researchers said.

Tuesday, February 21, 2012

Diabetes May Begin in the Gut

Scientists studying mice have made a surprising discovery about the origin of diabetes. The disease may start in the intestines.

Wednesday, February 15, 2012

The Best Foods for Thought, Literally

We've long known that the Mediterranean diet is good for the heart. Now, it may be good for the brain as well.
A study published in this month's issue of the Archives of Neurology found that the diet might protect against blood-vessel damage in the brain, reducing the risks of stroke and memory loss.
It's the first study to specifically examine the effects of the diet centered around vegetables, fruits, fish, whole grains, nuts, olive oil and a moderate amount of alcohol, with limited consumption of red meat, sweets and refined grains like white bread or white rice—on the brain's small blood vessels.

In a Squeaky-Clean World, a Worm Might Help Fight Disease

Some bugs are good for our health, and a pig parasite called the whipworm appears to be one of them.
Whipworm eggs have been found in human studies to reduce symptoms in a host of diseases that affect the immune system. Researchers at several universities have shown promising results in small numbers of patients with multiple sclerosis, Crohn's disease and ulcerative colitis. Biotechnology companies are conducting large clinical trials of the treatment. Other studies targeting rheumatoid arthritis, autism and some allergies are expected to begin this year.
The introduction of the whipworm appears to spur the body to produce more of a different type of helpful immune cell—T2 helper cytokines—as a defense against the worms. This separate immune response appears to help counter the inflammatory response from diseases, say researchers

Dr. Summers and his colleagues demonstrated encouraging findings in two studies published in 2005. One examined 29 patients with Crohn's disease and found that after six months, 21 were considered remitted. (There wasn't a control group for comparison.) The other was study of 54 patients with ulcerative colitis. Patients who received TSO treatment improved significantly more than those who got placebo.
Another area of interest for TSO researchers is in multiple sclerosis, with two small studies published last year. One of these, published in the Multiple Sclerosis Journal, showed brain lesions decreased in four of five patients three months into treatment, and rebounded two months after it ended.
Some researchers say the therapy could hold promise for autism as well.

Monday, February 13, 2012

Anatomy of a Tear-Jerker

Why does Adele's 'Someone Like You' make everyone cry? Science has found the formula

What I found fascinating is that even at the Grammy's last night, when she sang this ang, it stood on its own as very powerful, without the need for visual hype, dancers etc...It was just Adele's voice with her excellent backing band that again creates moments of transcendence...


 What explains the magic of Adele's song? Though personal experience and culture play into individual reactions, researchers have found that certain features of music are consistently associated with producing strong emotions in listeners. Combined with heartfelt lyrics and a powerhouse voice, these structures can send reward signals to our brains that rival any other pleasure.


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