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Otis Brawley’s Book – How We Do Harm

Brawley book cover

Let me start by saying…DON’T read this book if you enjoy having your physician up on a pedestal.  It will change your perceptions and skepticism of the system.

DO read this book if you’re frustrated by our US health care system and wonder why we spend so much money without necessarily seeing differences in mortality and outcomes compared to other developed countries.

“Proponents of science as a foundation for health care have not come together to form a grassroots movement, and until this happens, all of us will have to live with a system built on pseudoscience, greed, myths, lies, fraud, and looking the other way.  Patients need to learn that more care is not better care, that doctors are not necessarily right, and that some doctors are not even truthful.”

(Quote from the book pg. 27)

Let me start with an abbreviated bio on Dr. Otis Brawley from the American Cancer Society’s website:

Otis W. Brawley, M.D., F.A.C.P., chief medical officer for the American Cancer Society, is responsible for promoting the goals of cancer prevention, early detection, and quality treatment through cancer research and education.

Dr. Brawley currently serves as professor of hematology, oncology, medicine and epidemiology at Emory University. From April of 2001 to November of 2007, he was medical director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital in Atlanta, and deputy director for cancer control at Winship Cancer Institute at Emory University. He has also previously served as a member of the Society’s Prostate Cancer Committee, co-chaired the U.S. Surgeon General’s Task Force on Cancer Health Disparities, and filled a variety of capacities at the National Cancer Institute (NCI), most recently serving as assistant director.

Dr. Brawley is a member of the Centers for Disease Control and Prevention Advisory Committee on Breast Cancer in Young Women. He was formerly a member of the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and Control Advisory Committee. He served as a member of the Food and Drug Administration Oncologic Drug Advisory Committee and chaired the National Institute of Health Consensus Panel on the Treatment of Sickle Cell Disease.

Dr. Brawley is a graduate of University of Chicago, Pritzker School of Medicine. He completed his internship at University Hospitals of Cleveland, Case-Western Reserve University, his residency at University Hospital of Cleveland, and his fellowship at the National Cancer Institute.

I would put this book on my must read list for anyone working in healthcare.  I have two other books there:

Here are some things I highlighted as I read the book:

  • People diagnosed with cancer who had no insurance or were insured through Medicaid were 1.6x more likely to die within 5 years than those with private insurance.
  • “No incident in American medicine should be dismissed as an aberration.  Failure is the system.”
  • “Our medical system fails to provide care when care is needed and fails to stop expensive, often unnecessary, and frequently harmful interventions even in situations when science proves these interventions are wrongheaded.”
  • He introduces the concept of the “wallet biopsy” as a term to describe the difference in care we get once it’s determined what type of insurance we have.
  • While he points out and is clearly an advocate for health discrepancies and the issues of the un- and under-insured, he also points out that “wealth in America is no protection from getting lousy care”.
  • He hits on a point that I agree with in medicine and everywhere else which is teaching people to say “I don’t know”.  He later says “If you truly respect the patients you treat, you will not obscure the line where your knowledge stops and your opinion begins.”
  • He makes a key comment “Can the health-care system make itself trustworthy, become accessible and driven by science?”  (This reminds me of another book on trust in the healthcare system.)
  • “In most cancers, the quality of the surgery is the most important factor in the ultimate outcome.”
  • He talks a lot about the motivation of physicians in determining treatment and how that can be misguided over time.  While some of this can be explained away with Defensive Medicine, he points out that many other times this is simply the business of healthcare with people making money off these treatments.  Or, as he also points out, sometimes it’s simply unwillingness to challenge the status quo of over-treating the patient.  [This is something that I’ve heard other oncologists who provide second opinions point out.]
  • I learned about “gomers” which stands for get out of my emergency room which are patients who come to the emergency room just to interact with someone without any real symptoms.  He also introduces several other terms apparently all derived from a book The House of God about an intership at Beth Israel Medical Center in the 70s.
  • He brings up an important issue that us as Americans and many physicians believe to be true which is that “death is a failure of medicine”.  I’ve talked with several physicians about this.  I believe it’s one of the things that contributes to the enormous amount of money we spend on people in their last 90-days of life.
  • He gives a great (but sad) story of the “moral hazard” scenario of a family trying to care for their parent in the last days of their life and all the “senseless acts of medical torture” that they put him through.  This is one of his classic examples of where the physician knows better but is actually instructed to do harm.
  • He talks about one of the physicians he was assigned to work with during a rotation.  I thought this summary of his rules was great:

“You don’t deviate from the science.  You don’t make it up as you are going along.  You have to have a reason to give the drugs you are giving.  You have to be able to quote literature that supports what you are doing.  You have to tell patients the truth.”

  • At one point, he says that he confirms a truth he learned as a kid which is scary – “Doctors try out things just to see whether they will work.”
  • He gives a brief nod to companies using business rules to safeguard patients through technology that requires physicians to document what they are doing and comparing those to guidelines.
  • He spends a lot of time on prevention and survivorship in terms of how people justify some of those numbers.  It’s worthy of an entire post, but the key point is that early diagnosis by itself simply increases the years of survivorship.  It doesn’t actually mean we did anything better.  He also points out that due to all the treatments we give patients some of them die of other issues rather than cancer that “improves” the cancer death statistics.
  • And, for all of my pharmacy friends, he doesn’t miss the opportunity to tell the Nexium story or to talk about Vioxx and what happened in both of those cases.
  • His stories are amazingly similar to some of the physicians that I worked with for the past two years.  He talks about the overuse of radiologic imaging.  He talks about the da Vinci robot.
  • He gives some unique insights into the politics of support groups and government funding which I’d never understood before.
  • A great quote he uses from Willet Whitmore when talking about PSA testing and prostate cancer was:

“When cure is possible, is it necessary, and when cure is necessary, is it possible?”

  • I also liked a quote he gave from another urologist which said:

“There is the kind of prostate cancer that can be cured, but does not need to be cured; there is the kind of prostate cancer that needs to be cured and cannot be.  We all hope there is a kind of prostate cancer that needs to be cured and can be cured.”

  • This leads up to his point that research shows that 1.3M American men were needlessly treated for localized prostate cancer from 1986-2005.  Wow!
  • He was very positive on the US Preventative Services Task Force (USPSTF) which I was glad to hear since that’s the group that several of my physician friends have used before for setting guidelines.

Hopefully, you get the point.  It’s a quick read with a good mix of studies, patient stories, and the history of cancer with a focus on both historical and current issues that face us in this time of transformation in health care.

Here’s a few more articles about Dr. Brawley and his book:

 

As a random point of interest, Dr. Brawley uses several references to teachers and his Jesuit education at The University of Detroit Jesuit High School and Academy in Detroit which is where I also went to school and had some of the same teachers.  Our school was featured a few years ago as the last Catholic college prep school still in the city.

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Should Providers Have Private Conversations With Your 12-Year Old?

There was an interesting story which came out of Michigan this past week from Christy Duffy about how her physician’s office was requiring all minors between the age of 12-17 to have a 5 minute private conversation with them (according to the law).  Of course, it appears that they made a mistake per her later post, but I think it serves to make several interesting points.

1. Don’t always assume that someone’s interpretation of the law is right if it doesn’t make sense.  Sometimes, you have to apply common sense and push back or ask questions.

2. There is a gray area between protecting the rights of our kids and protecting our rights.  While the intent of allowing our kids to have honest and open conversations is appropriate, there needs to be some involvement of the parents.

It’s an interesting topic for discussion.  Should our teenagers have access to providers on their own?  Yes.  If a teenager has a health issue, I think we’d all prefer that they talk to a professional rather than Dr. Google or their friends to find the answer.

Should a provider be able to force a private conversation with a minor?  Yes…if they have a legitimate concern about abuse, but I don’t see any other reason.

Should a teenager who’s covered by my insurance and lives in my house be able to block me from having access to their medical records?  Yes.  This is the law, but should providers be having private conversations to offer them this option?  I don’t think so.  I would like them to have those discussions with me and my child to say that here are their options.

Should a teenager have a private conversation with their provider about STDs, HIV, and birth control?  Yes, BUT I’d like to have the conversation at the right age with me in the room initially and then offer the private option.  I don’t think forcing that conversation on a 12-year old would make sense in a private setting.

Ultimately, this comes down to the issue of access to the medical records online.  What I heard was that this would also require the provider to get a cell phone and e-mail address for my kids.  Obviously, if they’re doing something confidentially with the doctor, that’s one thing, but as a matter of record, I disagree.  (I don’t even give out my kid’s Social Security numbers.)  I don’t want my kids to start getting e-mails, phone calls, and letters sent directly to them as early as 12-years old.  And, yes…I do try to shelter them a little.  We talk about all the issues, but in a way that my wife and I want them to learn, not according to some formula driven approach that’s mandated.  But, ultimately, I don’t think a 12-year old is mature enough to make all their own health decisions or to feel like they should.

Obviously, some part of this falls on the parent regardless to create an environment of open dialogue with their kids.  The kids have to feel comfortable talking with their parents which is important for health and many other challenges that our kids have to deal with.  And, unfortunately there’s always bad people in any profession so while sexual abuse by a physician or nurse is rare it’s not unheard of.  Ideally, I think you should have the choice of when to encourage a private conversation and never have it mandated (unless of course the provider suspects abuse).  Unfortunately, with a report of abuse being made every 10 seconds, we have a huge problem in our country.

Who Is The NetFlix Of Healthcare HR?

I was sent this deck a few weeks ago.  It’s been out there for a few years.  It’s the HR / Human Capital strategy for Netflix.  Netflix has been known for things like no vacation policy (i.e., take what you need).  This gives much more insight.

It’s not really an industry that I’m focused on, but I’d love to find a healthcare company with this approach to human capital.  That would be a company worth following and working with.

Diet Soda Versus Regular Soda – Ongoing Confusion

I view this as one more example of how the average consumer gets confused by all the information out there.

images

Should I focus on calories?

Should I focus on the ingredients?

Should I just drink water?  (of course)

Now, “new” research shows that the artificial sweeteners in the Diet drink can actually fool your body making it worse for you over time.  This isn’t completely new if you look at this blog from a few years ago.

But, we often wonder about why consumers don’t take responsibility for their actions and then get upset when more aggressive measures have to be taken.  (See the recent Penn State uproar.)

Consumers don’t know who or what to trust.

Should I drink alcohol?  Is it good for me in moderation?

How much exercise is needed?  New research shows that it can’t all be done at once.

Obese Scouts (And Leaders) Told To Stay Away

Did you catch the story the other day that kids and adults that had a BMI of over 40 were told they couldn’t come to the annual Boy Scout Jamboree? And those that had a BMI of between 32 and 39.9 had to submit documentation that they could attend.

What do you think about that?

If you look at the adult US statistics, this would represent about 30%+ of the population. (United HealthGroup report: “United States of Diabetes“)

This is one story where I’m sure there’s a lot that we’d want to know. In Time, they talk about the fact that they published the restrictions two years ago. This would have allowed people time to improve their BMI. But, jumping from 40 to 31 might be too big of a jump in two years for some people to do in a healthy way.

If I were developing this type of program for a company, I’d expect to answer these questions:

  • What did you do to support the scouts and leaders in losing weight? Did you give them a coach? A registered dietician?
  • Did you create a culture of health? What types of foods are at boy scout meetings?
  • Is there a reasonable alternative for the obese scouts to get a similar experience if clinically appropriate?

Obviously, this isn’t a work environment so the rules are different. On the one hand, congrats to them for being brave enough to take this topic on and try to encourage scouts and leaders to have a healthy weight. On the other hand, they need to make sure they do this in a way that doesn’t shame these people and need to make sure they support their weight loss.

But, don’t be fooled. The world is going to continue to move this way. Obesity is too big of a driver of healthcare costs and other presenteeism and absenteeism impacts.

Just look at Japan…(source)

Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.

Those exceeding government limits — 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks — and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months.

To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country’s Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.

Limiting Factor For Behavior Change is We Don’t Believe We Will Change

One of the biggest challenges in healthcare is getting people to change behavior or as Express Scripts would frame it – activating intent.  Since approximately 75% of healthcare costs are due to preventable conditions, it’s important that we can help people see the future value of change.  People often discount that future value of change based on the amount of effort required to get there.  They see the short-term pain not the long-term gain.

A new study puts an interesting perspective on this.  It shows that people can generally see the amount of change they’ve made in the past decade, but they fail to realize that change will continue for the next decade.  They appear to see themselves as stable at the current moment without significant change in the future.  I believe this is really important as we think about Motivational Interviewing techniques and communications for engaging consumers.

So, as you think about behavior change in healthcare for things like diabetes, you will likely continue to see more and more emphasis on behavior change and research in this area (see example from RWJF last year or Cigna whitepaper).

To learn more about this topic of behavior economics, you might look a few places:

And, here’s a good list of books to start with.

Saturday Evening Post On The Placebo Effect

Do you know what the Placebo Effect is?  There’s lot of information out there.  For example, here’s what WebMD says about it.  Here’s my definition of it.

In general, it’s when someone is told they are given a medication (or procedure) that will work but instead are given a sugar pill or otherwise “deceived” into believing they’ve gotten the prescribed treatment.  It is often used in clinical trials for drugs to establish the baseline of side effects.  The amazing part is that it shows the power of the mind to influence our healing ability.  

Below is a video that I’ve used a few times before.  It’s also been a concept I’ve built on in a few other posts – New To Therapy, Price And Placebo Effect, Guest Post on the Topic.

The amazing thing that captured my attention a few months ago is that this can work not only for medication but also for surgery.  (Maybe this is the key to saving money in the US healthcare system.)  This was tested in the case of knee surgery in a trial that was published several years ago.  This article also points out another trial on patients with Parkinson’s.  The reality appears to be that this is happening in trials but also in real life according to an article in American Medical News (see quote below).

Nearly half of physicians use placebos in clinical care, and only 4% tell their patients the truth about it, according to a survey of Chicago academic physicians that was published this month in the Journal of General Internal Medicine.

This begs all types of questions about who will respond to placebos and when or if it’s ok to use them with patients.

The Saturday Evening Post just published an article on this topic.  They touch on a few of the same studies I’ve looked at, but they also point out several new things that I put below – conditioned response and ritual.  They also share a video on the placebo effect.

Conditioned responses are a third way the placebo response works. In one elegant experiment demonstrating this phenomenon, scientists showed 40 volunteers two male faces on a computer screen for 0.1 second. When the volunteers looked at one face, they got a mild burn on their forearm; when they looked at the other, they got a more painful burn. The volunteers became as conditioned as Pavlov’s dogs. In the next round when they saw the high-pain face and felt a burn, they rated it as more painful than when they saw the low-pain face and felt a burn—even though the applied heat was identical the second time around.

The perception of pain, says Ted Kaptchuk of Harvard Medical School, who helped lead the 2012 study, depends on “what the nonconscious mind anticipates despite any conscious thoughts.”

The placebo effect doesn’t even depend on deception. It can kick in even when people are told they are receiving an inactive drug. For instance, in a 2010 study led by Harvard’s Kaptchuk, scientists recruited 80 people with irritable bowel syndrome, or IBS, and gave half no treatment and half what they were told were “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body, self-healing processes.” It was full disclosure. Even without the deception, the placebo-takers’ IBS symptoms improved over the course of three weeks. That response suggests another avenue for the placebo response: ritual.

The author (Sharon Begley) asks the key question which is how does this placebo effect play out in the 21st century.  With all this technology that we have and the physician shortage, is there a greater opportunity here?  Can we tap into this in a positive way?  She also points out how doctors are using other techniques such as relaxation therapy to address the power of the mind.

Court Decision Allows Pharma Reps To Discuss Off-Label Uses Of Prescriptions

I must admit that I’ve heard very little about this decision from the Federal Appeals Court for the Second Circuit of Manhattan that decided that discussing off-label uses for prescription drugs was an issue of free speech. This could change the way pharmaceutical manufacturers interact with physicians. It could change the job of the pharmaceutical rep. It could change how clinical trials are done. It could change how prescriptions are used. It could also lead to a whole new set of prior authorizations by companies that actually have to actively manage off-label usage as it becomes widespread.

On the other hand, I wonder if this door hadn’t already been opened. Have you looked at some of the peer-to-peer (P2P) healthcare websites out there or the disease based communities (e.g., PatientLikeMe or CureTogether)? Patients are already talking about what medications they are using to treat their diseases and their symptoms. Don’t you think those are leading to requests to the provider and discussions with them about off-label utilization?

And, I’m sure that Dr. Google has helped many patients identify other uses of medications. This process (to the best of my knowledge) is completely un-managed. It’s a popular enough topic that Consumer Reports talked about it earlier this year and even put together the following table on drugs commonly used off-label.

Specific drug, type of drug Examples of off-label use**
Aripiprazole (Abilify), antipsychotic Dementia, Alzheimer’s disease
Tiagabine (Gabitril), antiseizure Depression
Gabapentin (Neurontin), antiseizure Nerve pain caused by diabetes, migraines, hot flashes
Topiramate (Topamax), antiseizure, in combination with phenteramine for weight loss Bipolar disorder, depression, nerve pain, alcohol dependence, eating disorders
Risperidone (Risperdal), antipsychotic Alzheimer’s disease, dementia, eating disorders, post-traumatic stress disorder
Trazodone (Desyrel), antidepressant Insomnia, anxiety, bipolar disorder
Propranolol (Inderal), high blood pressure, heart disease Stage fright
Sildenafil (Viagra), erectile dysfunction To enhance sexual performance in people not diagnosed with erectile dysfunction, to improve sexual function in women taking certain antidepressants
Quetiapine (Seroquel), antipsychotic Dementia, Alzheimer’s disease, obsessive-compulsive disorder, anxiety, post-traumatic stress disorder
SSRI antidepressants such as paroxetine (Paxil) and sertraline (Zoloft) Premature ejaculation, hot flashes, tinnitus (ringing in the ears)
Prazosin (Minipress), high blood pressure Post-traumatic stress disorder
Amitriptyline (Elavil), antidepressant Fibromyalgia, migraines, eating disorders, pain after shingles infection
Bevacizumab (Avastin), certain types of cancer Wet age-related macular degeneration (eye disease)
Statins such as atorvastatin (Lipitor), simvastatin (Zocor), high cholesterol in adults, children with an inherited cholesterol condition Rheumatoid arthritis, to lower cholesterol in children who lack the inherited condition
Clonidine (Catapres), high blood pressure Smoking cessation, hot flashes, attention deficit/hyperactivity disorder (ADHD), Tourette’s syndrome, restless legs syndrome

* Not meant to be a comprehensive list. Many of the drugs listed here are also available as generics.

** Does not imply that use is clinically appropriate or inappropriate, or beneficial or not.

***To find out if a drug’s off-label use is supported by evidence, click on the medication name.

 

I would imagine that pharma is going to tip-toe through this open door not simply crash through it. They’re generally risk adverse so their discussions of off-label utilization will be fact-based (to limit exposure) even if (as we all know) statistics can lie. I would suspect (as I’ve seen on other blogs) that this will ultimately go to the Supreme Court before anyone really takes advantage of it.

I guess I’d also point to the issue that physicians have responsibility here. They prescribe off-label today. Here’s what the FDA says about this:

Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgement. If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain records of the product’s use and effects. Use of a marketed product in this manner when the intent is the “practice of medicine” does not require the submission of an Investigational New Drug Application (IND), Investigational Device Exemption (IDE) or review by an Institutional Review Board (IRB). However, the institution at which the product will be used may, under its own authority, require IRB review or other institutional oversight.

One way to begin to manage this would be to require the use of diagnosis codes (Dx) on all prescriptions. This would at least great a way of tracking how the medications are being used and allow for better technology oversight across the provider, payer, pharmacy, and PBM.

In the interim, Consumer Reports suggest consumers do the following:

  • When your doctor prescribes a drug, ask if it’s an approved use. If he or she doesn’t know, ask your pharmacist.
  • Check for yourself. Go to DailyMed (dailymed.nlm.nih.gov/) and search for the drug. Then click on the tab for “Indications & Usage” to see if your condition is listed.
  • If it’s an off-label use, ask your doctor if it’s supported by well-designed trials showing significant improvement for people with your condition.
  • Ask your doctor why he or she thinks the drug will work better than approved drugs for your illness.
  • Find out if your health insurer covers payment for the off-label use. Some may require evidence of effectiveness or failure with conventional treatments, especially if the drug is expensive.

AHRQ Questions are the Answer campaign

I often talk about the issue of communications in healthcare. That could be patient to patient, healthplan to patient, pharmacist to patient, or physician to patient (or many more).

Understanding health literacy and personal motivation are critical as are so many other factors. With that in mind, I was glad to see this new campaign from AHRQ.

(Here’s the text they sent me about it.)

“When patients become more actively involved in their own health, there’s a much stronger likelihood their health outcomes will be better.

That’s why “Questions are the Answer,” a new public education initiative from the U.S. Agency for Healthcare Research and Quality (AHRQ), encourages patients to have more effective two-way communication with their doctors and other clinicians.

“Questions are the Answer” features a website — http://www.ahrq.gov/questions — where you will find these free educational tools to use with your patients:

· A 7-minute video featuring real-life patients and clinicians who give firsthand accounts on the importance of asking questions and sharing information – this tool is ideal for a patient waiting room area and can be set to run on a continuous loop.
· A brochure, titled “Be More Involved in Your Health Care: Tips for Patients,” that offers helpful suggestions to follow before, during and after a medical visit.
· Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

Clinicians can request a free supply of these materials by calling AHRQ at 1-800-358-9295 or sending an email to AHRQpubs@ahrq.hhs.gov.”

All of this is good information, BUT:

  • Do physicians have time for this and are they prepared for these dialogues in plain language and with handouts and URLs they recommend?
  • Are patient’s prepared to slow their physicians down and make sure they explain everything?
  • Will this get measured at some point as a qualitative metric and correlated to outcomes?
  • Why Not Make “Low Fat” Normal And Label Others “Full Fat”

    One of the foods my kid loves comes in both normal and a low-fat version.  But, we’ve always bought the low-fat version.  One day, they were out so I bought the normal version.  I was surprised when he was upset.  Why did you buy me the full fat version he asked?

    It got me thinking.  Like “loss aversion” would reversing the positioning of products work?  There’s always talk about the “fat tax“.  Why not try making low-fat the standard and requiring labeling that points out what products are full of fat?

     

    Using Hypothetical Questions To Influence Decisions

    Most people don’t realize how questions can be persuasive, according to new research from the University of Alberta. Hypothetical questions usually start with the word “if,” meaning the information may or may not be true. Our brains process that information like the “if” isn’t even there, says study author Sarah Moore, Ph.D., a marketing professor at Alberta’s School of Business. “As a result, people accept the data you present at the beginning of a question as fact,” Moore says.

    This is from an article in Men’s Health.  It made me think about lots of ways that hypotheticals could be used to drive consumer behavior in healthcare:

    • If you were able to avoid having your kids home with the flu shot this year, would you take them to get a flu shot?
    • If you were able to save $50,000 in healthcare costs over your lifetime, would you make sure to take your medications everyday?
    • If you were able to spend more time with your family rather than waiting in line at the pharmacy, would you be more likely to use 90-day prescriptions?
    • If you didn’t have to take any sick days next year, would you go in for your annual physical exam?
    • If you decreased your likelihood of losing your foot to amputation due to diabetes, would you go get a foot exam every year?

    This fits well with a lot of the behavioral economics frameworks that companies are using today.

    Words Matter: Doodling – We Should Foster It

    As someone who was trained as an architect, I understand the value of sketches in the design process and have always “doodled” as I try to conceptualize what people are describing with words.  With that in mind, I really enjoyed this TED video and think it’s a good message for all of us in the communications field.

    Great Video! Placebo Effect Summarized In Video

    A great summary of lots of the placebo research.  A must watch.  (remember if you get this e-mailed to you that you might have to come to the website to see it.)

    Silverlink eBook: 13 Common Pitfalls In Consumer Health Engagement

    After working on consumer communications in healthcare for most of the  past decade, I realized that there were some common pitfalls that happen.  Many of them are pretty straightforward, but when rushed, they may get forgotten.  I worked with Dr. Jan Berger (our Chief Medical Officer) to identify a short list of them, and then the Silverlink marketing team pulled them together in a beautiful eBook

    Each of the pitfalls is set up with a quote and a great image:

    Then, there is a brief description to explain the pitfall on the page across from it:

    What are some of the pitfalls:

    • Not knowing how to declare success
    • Limiting design based on company constraints
    • Forgetting about health literacy
    • Not understanding the entire process
    • Thinking you represent the customer

    To get a copy of the entire eBook, you can register online.  [Alternatively, you can e-mail me at gvanantwerp at mac dot com.]

    “Disorder” Is A Dirty Word?

    In the spirit of my “words matter” theme, I found it interesting that the military has stopped using the term “posttraumatic stress disorder” and changed it to “posttraumatic stress” arguing that “disorder” ‘unnecessarily stigmatizes soldier’s natural response to the emotional and violent experience of battle’. 

    “I drop the d.  That word is a dirty word.”  General Peter Chiarelli, US Army (Time Magazine, 6/20/11)

    Words Matter: Have You Drugged Your Kid Today

    I think I’m going to start a series tagged to “words matter” where I call out some of the examples that I notice. The first one is the story about a teacher getting fired for her bumper sticker on her car. (Something I never thought would happen.) Her bumper sticker said “Have You Drugged Your Kid Today”.

    First off, I think people are entitled to their opinions.

    Second, I think we all would agree that there are certainly times when patients are given medications rather than ask to change.

    Whether kids are over-medicated today versus the past is hard to know. We are certainly more aware of conditions these days, but I think this is a hot topic. Just look at some of the articles on the topic.

    It’s not like the teacher was taking some massively controversial position. She wasn’t teaching the kids. She was simply expressing an opinion on a hotly debated topic in a quick sound bite which she put on her car in the form of a bumper sticker.


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