More Details on Disgraceful Pharmaceutical Practices

Two days ago I wrote about the dual agency problem pharmaceutical executives face: "They're clearly crucial participants in  the sacred calling of health care. At the same time, they're embedded in a highly competitive industry with strong profit demands. Pharmaceutical executives work in the jaws of a severe dual agency challenge: sacred calling vs the invisible hand of the market."

Today's New York Times offered a telling detail on how the jaws of money led Valeant Pharmaceuticals directly to disgraceful - though legal - "leadership" in the health care sector.

Valeant's legal but disgraceful strategy was to achieve monopoly power by buying rights to old drugs and then raising prices to stratospheric heights. I call this disgraceful because human health is not a commodity to be traded and sold. Valeant added "value" (money) for shareholders and staff, but subtracted value from the domain of human health - directly, via reducing access to needed drugs, and indirectly, by contributing to demoralization within and about health care through its sordid practices.

Here's the crucial detail. The CEO would only receive a bonus if the stock price rose by a specified amount each year, and the shares he was awarded would only vest if the stock rose by 15% in three consecutive years. Last year his salary was reduced to zero, making him totally dependent on stock price. These are legal incentives from the perspective of finance, but they're disgraceful incentives from the perspective of improving human health.

On July 31, 2015, Valeant's stock sold for $257.53. At 9:58 AM today it was selling for $28.89. I hope the 89% drop will convey to investors that financial performance should not be the key criterion for evaluating performance in the health sector.

The reason the Valeant story leads me to rant so vociferously is that for health care professionals pharmaceutical companies are partners in delivering health care. When a drug allows us to help a patient in a meaningful way, we're grateful to the pharmaceutical company. It's analogous to our relationship with consultants who help our patients achieve better outcomes.

The problem isn't that Valeant made an honest mistake. We all do that. It's that they were playing by rules that don't belong in health care. Disgraceful rules!

[See here for a previous post on Valeant. For a post on how I felt personally betrayed by a scandal involving the drug Abilify, see here. And for a post about Valeant in today's Pharmalot blog, see here.]

I believe I have reasonable understanding of all the benefits a market economy can provide. I'm writing on one right now. But there's a widespread feeling among clinicians and patients in health care that resonates with this cartoon:

Who Should be Seen as a "Healthcare Executive" and Why Does it Matter?

The American College of Healthcare Executives (ACHE) has as its vision "To be the premier professional society for healthcare executives dedicated to improving healthcare delivery." ACHE's excellent 2015 statement - Creating an Ethical Culture Within the Healthcare Organization - rests on an assertion I wholeheartedly support: namely, that "all healthcare executives have a professional obligation to create an ethical culture." (I added the emphasis)

If you agree with the ACHE assertion, and I'm prepared to go to the mat for it, the first question is: what counts as a "healthcare executive"? How wide is the scope of the term?

Clearly, executives at hospitals, medical groups, and other organizations that deal directly with patients carry major moral responsibilities. After all, health care is crucial for realizing all three of the "unalienable rights" put forward in the Declaration of Independence: life (sometimes health care saves our lives), liberty (we can't exercise our freedom without health), and pursuit of happiness (we can be happy without health, but it's more difficult, and severe enough pain makes it impossible).

ACHE deliberately leaves the scope of the term vague. It defines itself an an organization for "healthcare executives who lead hospitals, healthcare systems and other healthcare organizations." From my experience as a physician, administrator, and patient, I'd cast a wide net for defining "other healthcare organizations" and setting ethical expectations for them.

In the complex U.S. health system direct care organizations aren't the only important moral agents. Health plans and pharmaceutical companies are perhaps the two most important examples of indirect moral agents.

Over the years I've tried to encourage health plans to create ethics programs the way Harvard Pilgrim Health Care, where I have directed the ethics program for sixteen years, has done. I've had zero success. This doesn't mean that other health plans are unethical, but it does suggest that ethical performance is not seen as something that requires the kind of concerted leadership the ACHE statement on responsibility for creating an ethical culture calls for. (For a previous post about my quixotic efforts, see here.)

Executives in the pharmaceutical industry face especially difficult challenges in relation to the kinds of expectations the ACHE standards articulate. They're clearly crucial participants in  the sacred calling of health care. At the same time, they're embedded in a highly competitive industry with strong profit demands. Pharmaceutical executives work in the jaws of a severe dual agency challenge: sacred calling vs the invisible hand of the market.

More than forty years ago, Arnold Relman warned of the potentially disruptive moral impact of what he called "The New Medical-Industrial Complex." Since his prescient warning there have been efforts to establish a shared moral code for all participants in the world of health care. A distinguished U.S. and U.K. group articulated the "Tavistock Principles," but these, alas, seem to have been dead on arrival, and have not been heard from for fifteen years. And for a number of years the American Medical Association sponsored an "Ethical Force" program that sought to establish measurable ethical standards for the major players in the health sector. I had the privilege of being on the advisory panel on health benefits determination. The project produced some excellent materials and a book, but as with the Tavistock principles, the effort was relatively short-lived.

When I mulled over how to end this post I realized that I don't have a tidy upbeat ending. The image that came to mind was of Sisyphus, eternally pushing a rock up the hill. It seems to me that Arnold Relman's call to action points to an ongoing task captured in this cartoon:

I'll do more rock pushing in future posts!

Insurance Coverage for Telemedicine

Last week the Harvard Pilgrim Ethics Advisory Group (EAG) devoted its quarterly meeting to the topic of "Developing a Framework of Ethics for Telemedicine." I chair the group and write a consultation report based on the discussion. Four of the group's recommendations are relevant for all health insurers and health plans, so I'm presenting them here:

1.  Nationally, telemedicine is evolving rapidly in a somewhat helter-skelter manner. The EAG recommended that insurers should focus coverage on areas in which telemedicine can minister to significant health needs. Fitbit and other health trackers are popular with consumers but do not reflect the kind of “need” that health insurance should cover. In contrast, services for patients who cannot access important care because of geography or limited mobility and services that maintain or improve quality while reducing costs provide real value.
2.  Patients and physicians both see continuity of care as a crucial health care value. But patients also value access and convenience, which have driven the uptake of telemedicine. Ideally, insurers will find ways to reconcile these potentially conflicting values, as by requiring telemedicine providers to foster communication with the patient’s primary care physician if the patient gives permission. The group imagined technological “fixes” that would encourage patients to be active participants in establishing continuity of care, as by having the telemedicine provider’s note go to the patient, to be shared with whomever the patient wishes to inform. 
3.  One of the questions the EAG had been asked was: "Should Harvard Pilgrim be a leader in providing telemedicine coverage or wait for well established quality information and support from the relevant professional organizations prior to offering access?" The group saw the question as too either/or. Telemedicine is at once (a) a promising innovation that is (b) energized by societal trends in use of technology in other sectors of life, but (c) uncertain in its impact on cost and quality of care. It encouraged Harvard Pilgrim to be active in the area of telemedicine, but do so in a try it/evaluate it/fix it/or drop it manner, in order to learn from experience and contribute to knowledge about the emerging trend.
4.   A Google search for "telemedicine providers" brings up a dizzying array of links. There is a lot of money to be made, and the marketplace is in a feeding frenzy. Given the certainty that consumers will be exposed to services ranging from high quality/high value enterprises to bottom feeders hoping to take the money and run, the EAG recommended that insurers only cover services from vendors who share and apply the same values with regard to improving quality, reducing overall costs, and supporting continuity of care. This revenue prediction table illustrates why the marketplace offers patients both promise and risk: 
5. 
   

   

   SKYROCKETING REVENUE PREDICTIONS FOR TELEMEDICINE!

To learn more about the Harvard Pilgrim Health Care ethics program, see previous blog posts here and here, and this article in Health Affairs

Recommended on Instagram: Brainpage

Here is an Instagram account that I like. They post many interesting photos that include images during neurosurgery. Check it out and consider following the account.

Follow me on Twitter: WRY999

Photo of double breased cormorant is from the author's files.

Spinal Instrumentation // Pic from @medschool_life Sometimes patients with severe Degenerative Disk Disease or other conditions which impact the integrity of the spine may need spinal fusion surgery. Various instrumentation (medical devices) are utilized to improve the rate of successful spinal fusion. Instrumentation can facilitate spinal fusion by limiting the amount of movement the spine is exposed to. There are three primary types of medical devices utilized when performing spinal fusion surgery: pedicle screws, anterior interbody cages, and posterior lumbar cages. Pedicle screws themselves are embedded into separate spinal segments and provide a firm anchor point for rods which then connect separate spinal components together, arresting their motion. Screws are places in 2-3 consecutive spine segments (e.g. Lumbar 4/5). A short rod can then connect the sets of screws and segments 4/5 now act as one segment, and the reduced movement can make their fusion more probable. As recently as 1996, surgeons have also used anterior interbody cages to aid in bone fusion. In this procedure, a porous titanium cylinder is placed within the disc space between two segments of spine. The holes within the cylinder allow the bone graft (material which induces bone growth) to grow from one vertebral body to another while passing through the cylinder. This procedure has diminished morbidity and improved fixation, all while allowing less overall instrumentation to be needed by the patient. Finally, posterior lumbar cages can be used when managing spinal issues in the lumbar region. A small incision is made and the laminae of the spine can be removed from one or two segments. This procedure will reduce the amount of pressure on nerve roots by placing metallic cages within the disc space. Bone graft is placed within the cages to aid in fusion. Sometimes this procedure is used in complex with pedicle screws and rod placement to further aid in remediation. Imaged above is a spine that has undergone screw pedicle installation along with rod fixation.

A photo posted by High Definition Neurology (@brainpage) on Mar 7, 2016 at 1:05pm PST

Computer-Patient Sex

This is a post I've been meaning to write ever since 2013, when I first saw Spike Jonze's remarkable film, Her. I've just watched it again  on DVD. So here goes.

Critics wrote about the film as a futuristic love story, in which Theodore Twombly ("Theo"), played by Joaquin Phoenix, a melancholy, emotionally inhibited, almost-divorced man, falls in love with Samantha, a bodyless operating system, played by Scarlett Johansson, whose voice we hear but who we never see, since she's an artificial intelligence program, not a corporeal being. Theo's job is as a writer of poetic, passionate letters for clients of BeautifulHandwrittenLetters.com. Outside of work he is bumbling through a life of non-attachments.

But in addition to being a love story, I see Her as a fable about a psychotherapy. As a despondent, lonely 30-something, casting about for what direction to go in life, Theo is a prototypical therapy patient. He hears an advertisement for an AI system that "listens to you, understands you, and knows you." In other words - the perfect therapist.

Theo responds to the ad.

Enter Samantha!

Samantha starts as a stunningly efficient personal assistant. Imagine IBM's Watson with a sultry voice devoting itself to understanding your every need and wish. But things rapidly get more personal. For Theo, listening to Samantha's voice through an earphone is as if he was on the couch, talking to an analyst sitting behind him. With a delighted little laugh he exclaims "you know me so well...I feel I can say anything to you." Who could resist? Theo rapidly falls in love - or, in the words my residency supervisors could have used, "develops an erotic transference."

Samantha responds to Theo's idealization. Soon they're talking at night - essentially having the equivalent of phone sex. For both Samantha and Theo it's an ecstatic experience. For the moment, both are blissfully happy. But when Samantha tries to have a "real," non-transferential experience with Theo, by sending a surrogate to be with him as her body. it's a disaster. Theo can idealize and "have sex" with his invisible therapist, but when reality enters in in the form of a corporeal being (the surrogate), he freezes. Fantasy is one thing. Reality is another.

I doubt that Spike Jonze had the theme of transference and patient-therapist sex in mind when making the film, but the film captures the dynamics of (a) idealization of the therapist, (b) the therapist's response to being idealized, and (c) the emergence of intense erotic feelings from the combination of (a) & (b), with brilliant clarity. Both characters are vulnerable and needy: Theo in his isolation and Samantha in her sense of being trapped in programming language and in that way not fully real.

The psychotherapeutic fable has a bittersweet ending. Samantha gets a grip on herself. She does what therapists who recognize they are losing control should do - she gets a consultant. The ghost of Alan Watts, the Zen philosopher/therapist, helps her recognize that she's not being true to her ideals. She and her companion operating systems go off into space. Theo is initially bereft, but he seems to have taken in Samantha's Wattsian wisdom. He writes a loving goodbye letter to his ex-wife, and in the final scene he is sitting on the roof of his building with Amy, his friend from college. They are clearly right for each other, and it's a more sane relationship than the therapist-patient passion between Theo and Samantha. The therapy has been successful. Both the patient and the therapist have matured, but only, on both parts, by relinquishing the fantasied relationship.

Her is a remarkable film - funny, touching, entertaining, and wise.

How Learning Braille Changes the Brain

Learning a new skill provides the opportunity to study brain neuroplasticity.

The Daily Mail recently highlighted research examining the effects of learning Braille language in a group of 29 sighted individuals.

The authors noted that changes in the the somatosensory cortex related to the tactile nature of Braille were found as expected.

However, the research team also found activation in a region of the lateral occipital lobe known as the visual word form area. This finding was unexpected and suggests new mechanisms in learning brain.

The study used sighted individuals and blind individuals may have distinct mechanisms for learning Braille. An informative study would use sighted and blind individuals with fMRI before and after a period of Braille training.

You can access the story on the Daily Mail HERE.

The free full text manuscript by the Polish research team can be found HERE.

Brain figure highlighting occipital cortex is mine from an iPad screen shot using the 3D Brain app.

Follow me on Twitter @WRY999

How Brain Cancer Can Produce Psychopathology

Working in consultation psychiatry you become familiar with how brain diseases, like brain cancer can produce a variety of psychopathology. It is important to not search for psychological explanations in these situations but accurate diagnosis and treatment of the underlying brain disorder is key.

The New York Times has a very evocative and informative piece by a neuroscientist who experienced metatstatic melanoma to the brain. Her account is an excellent summary of some of the types of psychopathology found in brain cancer. I counted these signs and symptoms of psychopathology but there are probably more in her account:
*blindness in a partial visual field (homonymous hemianopsia)
*psychomotor agitation
*personality change
*amnesia
*loss of personal GPS
*behavioral disinhibition
*agnosia
*hypergraphia
*grandiosity
*paranoia

Read the New York Times story HERE.

Osprey in flight is an original pic from the authors' files.

Follow me on Twitter @WRY999 and Instagram wry999

A Late Season Surge in U.S. Influenza

The CDC data surveillance on influenza is picking up an interesting pattern for 2015-2016 (See CDC chart).

The percentage of outpatient visits with influenza symptoms typically peaks around January 1, but this year (red triangle line) the number is continuing to increase making it the latest peak pattern.

Additional information about this year's influenza data from the CDC can be found here.

Dogs, Exercise and Diabetes via @NPR

Recommended Viewing:

Retail Clinics, Health Care Costs, and Medical Ethics

The March issue of Health Affairs includes an report by Ateev Mehrotra and colleagues about the impact of retail clinics on health care utilization and cost. His team used insurance claims from Aetna to study the question of the degree to which retail clinic visits replace physician office and emergency room visits or represent additional utilization.

In-store clinics like the 1,100 CVS Minute Clinics offer prompt attention for minor ailments and preventive care. They're convenient and cost less than physician office visits and vastly less than an emergency room visit. Health policy gurus have hoped that they would improve access and reduce costs.

It looks as if the hopes are half fulfilled. The clinics do improve access for minor conditions and as such are a welcome service. According to the Convenient Care Association - the trade association for retail clinics - to date consumers have made 35 million visits to these entities. But Mehrotra and colleagues found that 58 percent of the visits appeared to represent new utilization, with the result that covering retail clinic visits cost Aetna $14 more per patient per year.

The medical group where I and my family have gotten our care for decades operates its own internal version of retail clinics. During daytime hours it's possible to be seen for same day appointments and advance practice nurses are available 24/7 by telephone. When I've used the service my primary care physician has received immediate feedback via the electronic medical record. In one instance I would have gone to an emergency room if urgent care had not been available. And my impression from what I've read from Kaiser Permanente is that in the setting of an integrated group practice, walk-in capacity is cost effective as well as popular with patients.

So what's the big lesson from the Health Affairs report?

For me the study implies that our recurrent hope for a magic bullet that will reduce cost without integrating the care system and creating a budget for it is a pipe dream. Retail clinics have a lot to offer, but they won't solve our cost problem. Telemedicine also has a lot to offer, but it won't do the cost containment job for us either.

Instead of imagining that a magic bullet will solve the cost trend without our making hard choices, we instead need to bite the bullet and create budgeted care systems like the much maligned not-for-profit HMOs from past years. 

Vegan Under Pressure (Perfect Vegan Meals Made Quick and Easy in Your Pressure Cooker)

I am very excited to be part of the Vegan Under Pressure Blog Tour by reviewing Vegan Under Pressure, by Jill Nussinow, MS, RDN.  I created her Tapioca Berry Parfait and it was fabulous! See recipe below.

Jill Nussinow, known as The Veggie Queen,  became a Registered Dietitian because she always cared about her food, what it tasted like and that it was healthy.  She has followed a vegetarian diet, and then a vegan diet, since she was a teenager. About twenty years ago she rediscovered the age-old method of pressure cooking. She found it saved so much time when cooking whole grains and dried beans, as well as so many other foods.  The pressure cooker changed her cooking life and her health.  She could finally cook flavorful beans, vegetables, soups, stews, fillings, sauces and so much more in an hour or less.

I also love using my pressure cooker.  The foods taste amazing and I am always surprised at how quickly they cook and how fresh they taste.  Many foods cooked in a pressure cooker retain the nutrient-rich cooking liquid, so you are not throwing away any nutrients. I am all about preserving and making sure we get the nutrients from our foods. You can saute right in the pressure cooker without adding any oils, which I love!  For those of you concerned about BPA lining canned food, the ability to cook dried beans in just 12 minutes or less in the pressure cooker means avoiding this potential health hazard by not buying the cans. If you don't already have a pressure cooker, I would recommend it as an essential kitchen tool! It  will save you an enormous amount of time in the kitchen preparing healthy, fresh foods.

Vegan Under Pressure is divided up into twelve chapters.

Chapter One:  Introduction to Pressure Cooking.
Chapter Two:  Pressure Cooking Basics
Chapter Three:  Spice Blends and Other Seasonings
Chapter Four:  Grains
Chapter Five:  Beans
Chapter Six:  Vegetables
Chapter Seven:  Soups
Chapter Eight:  Main Courses
Chapter Nine:  Burgers, Patties, and Savory Cakes
Chapter Ten:  Toppers: Sauces, Fillings, and More
Chapter Eleven:  Appetizers
Chapter Twelve:  Desserts

Tapioca Berry Parfait, pg. 302 (Photo © Lauren Volo)

Tapioca Berry Parfait
Serves 4
PRINTABLE RECIPE 
 
Making dessert doesn't get much easier than this.  Be sure to use a 6-quart (or larger) cooker as this gets very foamy, which can clog the vent or cause spewing liquid in a smaller pot.  Make a double batch if you have enough room; it's that good.

½ cup small pearl (not instant) tapioca
2 cups almond or any nondairy milk
Pinch of salt, optional
¼ cup organic sugar or blonde coconut palm sugar
1 teaspoon vanilla extract
½ teaspoon lemon zest
2 cups fresh berries of your choice, sliced as needed
Fresh mint, for garnish

1. Place the tapioca pearls in a fine mesh strainer and rinse under running water for 30 seconds.

2. Add the milk to a pressure cooker.  Add the tapioca and salt, if using, and stir.  Lock the lid.  Bring to a high pressure; cook for 4 minutes.  Let the pressure come down naturally.  Quick release any remaining pressure after 20 minutes.  Open the lid carefully, tilting it away from you.

3. Stir in the sugar, vanilla, and lemon zest.

4. Spoon 2 tablespoons berries into the bottom of 4 pretty bowls or parfait glasses.  Add about 1/4 cup tapioca, then 3 tablespoons berries. Add another 1/4 cup tapioca and top with berries.  Garnish with mint.

Variation: If stone fruits are in season, substitute chopped stone fruit for the berries.

Love the lemon zest in this recipe!

Text excerpted from Vegan Under Pressure, © 2015 by Jill Nussinow.  Reproduced by permission of Houghton Mifflin Harcourt.  All rights reserved.

Learn more about Jill Nussinow,  get more recipes, and watch videos on her website below:
The Veggie Queen

HEALTH BENEFITS OF PASSION FRUIT

Passion fruit is a sweet fruit that is largely made up of seeds. It grows in warm climates all over the world. Passion fruit has so many health benefits which are attributed to its numerous nutrients. Passion fruit contains water, Carbohydrates, Protein, dietary fiber, folates, Vitamins (A, C, E, K, B6, niacin, riboflavin), calcium, iron, potassium and magnesium. Some of the potential health benefits of passion fruit include but are not limited to the following:

1 Reduction of High blood pressure

Potassium is a very important mineral needed for proper growth and functioning of our body, especially the cardiovascular system. Foods that are rich in potassium have been recommended for the reduction of high blood pressure.

2 Anti-cancer benefits

Passion fruit contain anti-oxidants which help in eliminating free radicals. Free radicals are responsible for changing the DNA of normal healthy cells, making them cancerous.

   

3 Eye health

Vitamin A, which is found in passion fruit is very essential for maintaining a healthy eye by preventing macular degeneration, night blindness and cataracts.

4 Helps in Indigestion and helps prevent constipation

Fiber is an essential component of our diet because it softens our stools and aids in bowel movement. Therefore, those who are suffering from constipation can eat fruits rich in fiber such as passion fruit.

5 Beautiful skin
if you want to have a beautiful skin naturally without spending too much on cosmetics, you should eat fruits that contain Vitamin A because it is needed for cell growth. This goes a long way to maintain a healthy skin and prevent premature aging. 

Using Social Media for Patient Care and Population Health

I'm very interested in the ways we can use digital technologies to improve clinical care and population health. Over the years I've written a number posts on the topic (if you want to see them, the Facebook and Social Networking links will get you there). 

Digital technology in health care is a booming area - a form of the wild west, with some terrific innovations and a lot of hype and racing to make a quick buck. Next week the Harvard Pilgrim Health Care Ethics Advisory Group, which I have the privilege of chairing, is discussing the ethics of telemedicine. It's going to be a standing room only gathering with more than 40 participants.

I'm a big fan of Leslie Kernisan, a geriatrician in the Bay Area. I've only "met" Leslie via email, but I follow her terrific GeriTech blog. Last week she wrote a post on geriatricians and social media, in which she spoke in very practical terms about whether, why, and how geriatricians should make use of social media technologies. With Leslie's permission I'm republishing her post here:

Patricia Bach, a geriatric psychology colleague who is active in social media, recently emailed me a question: how to encourage more clinicians in geriatrics and long-term care to use social media?

In particular, she asked me “What do you feel is the ROI for geriatricians to use social media/networking in their professional roles?”

This is an interesting question to consider. After all, we have a limited number of geriatricians available for a growing older population. We also each have only so much time and energy in every day. 

So how should each of us be spending our time? How much should be on social media, and do we all need to be using it? 

I myself really like blogging — obviously — but was a reluctant adopter of shorter-form social media. To this day, I have a minimal personal social media presence. I only got going on Twitter because I started this blog in the fall of 2012. For me, Twitter was a good way to learn about digital health and connect with others interested in tech and aging. 

Then I started using Facebook in 2014, mainly because I was focusing more on my geriatrics content for the public, and at that time Facebook seemed to be a better platform for interacting with the general public, compared to LinkedIn or Twitter. (I would say this is still true. 

In adopting social media for these reasons, I was manifesting something that is very important to consider when it comes to physician behavior — or really any person’s behavior — with a respect to engaging in a certain activity:

• What are the most important motivators and interests for the person? What are they most eager to accomplish? How does the activity address those?

• What are the demotivators? What are the downsides to engaging in the activity?

• How much friction or difficulty is involved in engaging in the activity?

You can also consider an activity in terms of “Return on Investment” (ROI), however, this term doesn’t usually take into account how soon the return is going to arrive. And we know that people are much more motivated by concrete returns that happen fast — and are related to something currently of great interest/appeal/fear to them — whereas they discount returns that are coming way off in the future. 

Social media is about communication and networking

Back to social media itself. It is fundamentally about communicating and networking. So to use it sensibly, I recommend individuals — or larger entities — consider the following:

• Who do you want to communicate with?

• What is your purpose in doing so?

• What actions do you hope the audience/people you connect with will take?

• What short-term and long-term results are you hoping for?

• How will this communicating and networking help you advance your most important goals?

• Which platforms are well-suited to your purposes?

• What non-social media methods could you use to achieve your goals, and would that be a better fit given your time/resources/purposes?

It is also important to consider the learning curve of whatever platform and communication strategy one is embarking on, as well as any risks or downsides.
For instance, most social media platforms generate a torrent of information. So one downside is that doing social media takes time and energy, and if you aren’t careful or disciplined about your approach, it can swallow up a lot of time and energy. 

Should geriatricians use social media? 

To answer this question, we should consider it from the perspective and interests of various involved entities. At a minimum these would include:

• The individual clinicians

• The organizations that clinicians works for in some way, such an employer or even an association that a given clinician feels a duty to serve

• Entities representing the welfare of the public, such as government agencies, large non-profits and foundations, and others who try to shape the healthcare environment so that the activity of clinicians benefits society.

Each entity has their own motives, interests, and particular priorities. Needless to say, there is often imperfect agreement between what the clinician is most interested in, the employer is most interested in, and other larger entities are most interested in. 

Whenever I hear someone — we’ll call them the “Suggester” — say “Doctors should do this!” or “Doctors should do more of this!” I certainly think about who is saying it, and what’s in it for them. 

And then I think about how to align that with what those individual doctors are interested in doing. Does this request fit in with the doctors’ interest and motivations? How feasible and easy to implement is it? Is the Suggester in a position to influence the doctors’ work environment or motivating factors? 

If you want people to do something, you need to understand how it fits in with what they are most interested in doing. And then you need to help make it possible and appealing for them to do it. 

An example from the published literature on healthcare social media: 

Here’s a quote from the abstract of a 2015 article titled “Social media is a necessary component of surgery practice.” 

“Each surgeon must embrace the power and potential of social media and serve as a guide or content expert for patients and other health care providers to facilitate and share responsible use of the various media available.” 

The abstract goes on to describe the potential power of social media to “improve consultation and collaboration, facilitate patient education, and expand research efforts…[and] to disseminate campaigns to increase disease awareness and communicate new research findings and best-practice guidelines.” 

I would not dispute the description of the potential power of social media. But it’s not at all clear to me that every surgeon must hence be on social media in a professional capacity. 

Instead, I would say that organizations that represent surgeons and surgical expertise should certainly have a social media presence. Certain individual surgeons may also find it serves their primary interests to be active on social media, either because they are doing it on behalf on an employer or professional association, or because the activity serves their personal projects and aspirations. 

Now, some will say that social media is important for maintaining your professional reputation. I’d say this really depends on what kind of work you are doing as a doctor. If you do research, then it can be good to have a social media presence that enables you to connect with colleagues and the media. If you are in private practice and are having trouble recruiting patients then yes, the right social media activity could help you raise your profile and find more work or patients. 

But most doctors I know are busy, and their biggest concerns relate to their working conditions and their ability to perform what they see as their core work. Usually, this is caring for patients and perhaps maintaining financial viability. For some physicians, it’s getting grants and other forms of academic success. 

Only rarely is it providing health information online to as many people as possible (that’s my project but I’m hardly representative of my colleagues) or even raising the visibility of the clinic or organization they work for, unless they are a designated social media ambassador (or trying to become one). 

Social media IS important to geriatrics and to the cause of improving the health and wellbeing of a growing older population 

To return to the question of whether there’s an ROI on geriatricians participating in social media: 

I absolutely believe that social media platforms can and should be used by geriatricians and related organizations, to help promote better health and healthcare for older adults. 

To begin with, in recent years social media endeavors — such as the Geripal blog — have played an important role in enabling geriatricians to connect with media influencers, which has helped the public become more aware of our field and expertise. The more often geriatric expertise is incorporated into the work of health journalists, the better. 

Then there is providing information more directly to the public. Digital platforms are now the primary way that most adults access information and certain forms of support. Older adults use digital media less than younger ones do, but their use of technology and digital communications is increasing rapidly, as noted by Pew. Pew has also found that family caregivers are often “wired for health.” 

As clinicians providing hands-on care, we should be familiar with the most commonly-used resources our patients and their families are using. These are increasingly digital, although the extent to which they are based on social media seems variable. (I find it depends on topic, niche, patient and caregiver population.) 

If an individual clinician is considering social media, I recommend considering the intended purpose and audience. Especially for those clinicians who mainly provide hands-on clinical work, social media may not be very useful to them. (You can network with colleagues at conferences and keep up with medical news via a few choice websites or journals.) 

However, most organizations should have a social media presence, which means some individuals will spend time maintaining that presence. Having a few clinicians participate in this can be nice, but they should be given time and resources to do it, and to keep up with the ever-evolving social media landscape. 

Social media for health and education 

I don’t have time to review the literature on this topic, so instead I’ll share my perspective as someone who has been creating geriatrics content online since 2008.
For educating and communicating out to the general public, I have found that writing longer content is far preferable to tweets, blog comments, or short Facebook posts. Create something that is more than a blip in a person’s attention, and that really tries to address a question or need. (I don’t personally produce videos but those can be great too. I am now going into audio and podcasting.) This content can be produced for one’s own website, or can be guest-posted to a bigger site with a larger audience. Interactive events like webinars with Q&A capability also have good potential. 

Otherwise, short-form social media (e.g. Twitter, Facebook) can and should be leveraged for dissemination. Such platforms allow clinicians and their audience to share longer content, or to share the notification of an upcoming event or opportunity. 

For learning from the audience — which essential to being truly helpful and to figuring out how to serve your audience — you need to spend a certain amount of time observing/listening, when it comes to what your audience says, does, and asks. Pay special attention to what they ask each other, and what they ask people who are not you, or not in your particular role. It’s also good to invite questions and participate in interactive events. 

Last suggestions for presenting to clinicians about social media 

Walk them through a process for thinking about their needs, their purpose, and how social media might fit in. 

Don’t conflate the needs/motives of the employer or society with the needs/motives of the individual clinicians. 

Provide education to make it easy for clinicians take the next step, if they’re interested.
Provide case studies and examples illustrating how different clinicians and organizations have used social media to achieve their goals. Tailor those case studies to overlap with what is likely to be the interests and goals of the clinicians you are presenting to. Some will be very interested in raising the brand and visibility of their clinic, but that may not be of interest to many geriatricians.

12 Wonderful Uses of Aloe Vera and its Side Effects

Aloe Vera is a very popular plant In Cameroon, Nigeria, Ghana and other parts of the world. It is very common to see people rubbing the gel on their skin or even consuming it for its numerous health benefits. Aloe Vera gel should be used as a home remedy. However, if it is to be used as a treatment for a disease, it is necessary to consult a Doctor or a Nurse before using it. Aloe Vera is a powerful medicinal plant and has been used to treat so many conditions in Africa for many generations. Below are some of the many uses of aloe Vera.

EXTERNAL USES

1 Minor burns

The application of freshly extracted Aloe gel help in the healing of minor burns that are gotten from  hot oil, hot water, hot iron and other hot instruments. it also aids in the healing of other minor scratches on the body that are not gotten through burns. 

2 Healing of sun burns

Light skinned people who suffer from sunburns can apply freshly extracted Aloe gel to relieve themselves from the discomforts associated with sun burn.  Aloe Vera gel products are also available in stores, and super markets for this same purpose. 

3 Soothes Insect bites

Applying Aloe Vera to insect bites will help in relieving your skin from the itches associated with the bite. It is very common to see farmers applying Aloe Vera on their skin after returning home from the farm in Cameroon.

4 Some minor rashes

The anti-bacterial and anti- fungal and anti-viral properties of Aloe Vera makes it a suitable home remedy for minor rashes and eczema. This is achieved by applying Aloe Vera gel on the affected area until it disappears.

5 Pimples and Acne

Apply Aloe Vera gel on the affected part of the skin. Some people wash of the gel after allowing it to sit for some minutes while others prefer to apply the gel on their face overnight and wash it off first thing in the morning. 

6 Beautiful Hair

Apply Aloe Vera gel to your hair, allow it to set for about 30 minutes and rinse it off with water. This conditions the hair, makes it soft and gets rid of dandruff.

7 Beauty Treatment

Many skin care products have Aloe Vera as an ingredient. Applying the gel to the face aids in smoothening the skin and slowing down the formation of wrinkles. It also decreases dark spots on the skin as well. 

INTERNAL USES

8 Helps in relieving Indigestion

This is achieved by sipping Aloe Vera juice.

9 Helps in constipation

Aloe Vera is used for constipation because of its laxative properties.

10 Diabetes

Natural healers in Cameroon have been using Vera Juice for  generations to stabilize blood sugar. In the past when they didn't have the necessary technology to diagnose diabetes, they will make their clients urinate on the ground and if "sugar ants" were found at the spot after some minutes, it indicated that the person had diabetes. The natural healers then placed their clients on plants like Aloe Vera and Bitter leaf to normalize the client's blood sugar .However, more research is needed to establish this.

11 Immune System Benefits

Aloe Vera contains anti- bacterial, anti-fungal and anti-viral properties that will help our immune system to fight some seasonal infections like cough and some seasonal allergies.

12 Oral hygiene

Pure Aloe Vera gel can help in eliminating bacteria that causes plaque. This is achieved by using fresh Aloe Vera gel as a mouth wash. Aloe Vera gel also speeds up the healing of mouth sores when used as a mouth wash.

Side Effects of Consuming Aloe Vera

Aloe Vera Gel contains a substance called anthraquinone which is a laxative and therefore, it can cause diarrhea. It can also interfere with some medications. It is important to consult with your doctor, nurse or nutritionist if you plan consume Aloe Vera for any health reasons.

Health Benefits of Okra

Okra, which is popularly known as “okro” or “gumbo” in Cameroon originated in Africa. It is currently being cultivated worldwide. In Cameroon, it is eaten when cooked although some people in other countries eat it raw. When it is harvested in excess in Cameroon, it is sliced into tiny bits, dried, powdered and packaged for future use.

Okra is low in calories and is high fiber content. It also contains Vitamin B, Potassium, Vitamin C, Calcium and folic acid and so many other important nutrients. 

1 May help in regulating Type 2 Diabetes

Eating okra helps in regulating blood sugar by slowing down its absorption.  

2 Helps in relieving constipation

Okra contains mucilage and is high in fiber. This aids in constipation by lubricating the intestines, softening stools and helps in its elimination.

3 Good vision and healthy skin

Okra is rich in Vitamin A and other antioxidants which help in preserving our eyesight and enhancing good vision. Eating Okra has be associated with the prevention of cataract as well. The antioxidants in okra also help in enhancing a beautiful skin and preventing pimples.

4 Helps in preventing birth defects

Folates are very essential for pregnant women because it helps in the development of the brain of the fetus, helps in the formation of neural tubes. Studies have also showed that consuming folates especially before pregnancy helps in preventing some unwanted miscarriages and neural tube defects.

5 Strong bones

Vitamin K which is found in okra helps in strengthening our bones, restores bone density and prevents osteoporosis.

6 Immunity against some infections

The consumption of foods that are rich in Vitamin C helps in boosting our immunity against some infections. It also helps in reducing the incidence of cough and cold.