Welcome to the September issue

By David Woods (david.woods@rxcomms.com)

Weblogs, or Blogs, have been around for about a decade. Generally viewed as quirky or even anarchic, they may now be gaining a new respectability and power … as evidenced by their influence in bringing about the defeat in US elections of pro-Iraq-war Democrat, Joe Lieberman.

Blogs are also playing a more mainstream and credible role in healthcare. There’s less of what The Economist calls some bloggers’ “vicious, shrill and sanctimonious” commentary. Indeed, Jerome Groopman, MD, in his popular recent book How Doctors Think, contends that many physicians are guided by stereotypes that may shut out possibilities that might contradict their preconceptions. His prescription: a heavy dose of heuristics – stimulating interest as a means of furthering investigation. It's a defence against uncertainty, he believes, that creates a culture of conformity and orthodoxy.

Dr. Alan Adler (pictured) agrees. He is among those who believe that physicians and other healthcare professionals should – in that hackneyed phrase – think outside the box. And one way of doing that, he says, is by tapping into the blogosphere, which is just one part of the broader social network that includes such interactive innovations as YouTube and FaceBook.

Adler, a general internist with a master’s degree in administration, is a senior medical director at Independence Blue Cross, a Philadelphia-based health insurer with more than 9000 employees and upwards of 3 million policy holders.

“What I like about blogs,” he says, “is that they give doctors and other healthcare workers an opportunity to hear unconventional wisdom and to interact with it.” Blogs provide the opportunity to interact with additional innovative and creative minds outside the usual work environment. Further, he believes, blogs provide two-way communication in which mainstream healthcare professionals can add to the knowledge of bloggers – thereby creating balance.

While those bloggers don't stand much of a chance in bringing radical change to a healthcare system that is complicated by agendas, special interests, and hierarchies, Adler believes that they can produce incremental change by forcing those in the mainstream to explore new or unusual tributaries.

At a time when healthcare is indeed becoming less hierarchical, blogs serve to speed up the move towards egalitarianism: patients armed with unconventional wisdom challenging the conventional variety. What will further help those patients sort the wheat from the chaff, says Dr. Adler, is a proposed Healthcare Blogger Code of Ethics.

In an article in Managed Care magazine (July 2007), Dr. Adler noted that “if you've only heard of blogs from the consumer press, you might think they consist entirely of blather about pop culture and outrageous fulminations from the political far left and far right. But the fact is, there are many serious, well-written blogs, and the major healthcare issues of the day are discussed on blogs more extensively than they are or could ever be discussed in academic articles.”

There are an estimated hundreds of healthcare blogs. Here is a list of some; and some of these will lead you to others you might want to look into:

• NHS Blog Doctor – www.nhsblogdoc.blogspot.com
• DB’s Medical Rants – www.medrants.com/index.php
• The Antidote: Counterspin for Healthcare – www.health-counterspin.blogspot.com
• Blogborygmi – www.blogborygmi.blogspot.com
• Trust me, I’m a Doctor – www.trustmemedblog.blogspot.com
• Health Affairs – www.healthaffairs.org/blog
• Pharmalot – www.pharmalot.com
• Healthcare Policy and Marketplace Review – http://healthpolicyandmarket.blogspot.com
• The Healthcare Blog – www.thehealthcareblog.com
• Medical Blog Network – http://trusted.md
• Master Blog – www.masterblogs.com
• Healthcare Blogger Code of Ethics – http://medbloggercode.com
  

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By David Woods (david.woods@rxcomms.com)

US News and World Report calls him a patient safety guru; Modern Healthcare has repeatedly named him among the top 100 most powerful people in American healthcare; his curriculum vitae runs to more than 70 pages, of which one whole page is devoted to his multiple honours and awards.

Dr. David Nash is chairman of the Department of Health Policy at Jefferson Medical College, an integral unit of Jefferson Medical College and of Thomas Jefferson University Hospital, which was founded in 1825. The Department employs 42 people from an eclectic range of disciplines including pharmacy, public health, medicine, nursing, and administration.

Funding for the Department's current range of 36 active projects comes from the pharmaceutical industry (40%); government (10%); and the remaining funding comes from a mix of both the private and public sectors. Among those projects are technology assessment; cost effective analyses;, diffusion of technology into medical practice; and policy pieces for differing audiences, including State government.

Specifically, the Department’s research team focuses on health services and outcomes projects in such areas as: clinical care quality measurement for hospital departments; productivity measurement associated with specific disease states; disease management outcomes measurement; senior health issues; and value-based healthcare purchasing for employers.

The Department produces numerous articles and research papers, as well as publishing four journals: American Journal of Medical quality; Disease Management; Biotechnology Healthcare; and Pharmacy and Therapeutics. David Nash serves as editor of all four.

There are several cutting edge policy issues currently attracting the Department’s interest. These include retail, in-store clinics; the US physician shortage, particularly in primary care; the growing issue of compliance with drug regimens; and the specifically US concerns over malpractice litigation, and the roughly 50 million Americans who are uninsured. So far as the issue of retail medicine is concerned, Nash is a strong proponent. What they offer, he says is access, convenience, and price transparency. In fact, he chairs something called the Take Care National Medical Advisory Board, a company in the retail medical business. (HOC will publish an article on these retail clinics in our October issue).

So far as the doctor shortage is concerned, Nash believes that while this is due to the usual suspects – overutilisation of services, an aging population and increasingly sophisticated technology – a more significant cause is what he calls the feminisation of medicine. More than half of the entering class of US medical schools are women … who tend to work fewer hours and have shorter careers.

The Department of Health Policy is appropriately involved in continuing education. It has a cadre of external Fellows and Senior Scholars, puts on a number of conferences each year, and operates ,jointly with Jefferson’s College of Graduate Studies, a Masters program in public health.

Having seen Dr Nash in action over several years, I can say that he also brings to his extraordinarily full professional life a talent for public speaking, and marketing … and for inspiring loyalty and enthusiasm among his staff.

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By Kevin Frick (kevin.frick@rxcomms.com)

As we provide and interpret pharmacoeconomic (PE) evaluation results for decision makers in different settings around the world, we should consider the standards being followed. And there are several of these: the ISPOR website http://www.ispor.org/PEguidelines/index.asp) presents a summary of international standards , grouping them into two broad categories: “PE guidelines” and “submission guidelines”. Even the labels for the two types of guidelines suggest that there is likely to be significant variation. PE guidelines largely reflect the best technical approach for conducting an economic evaluation without a specific objective. In contrast, submission guidelines deal with a very specific objective of pharmacoeconomic evaluation—submission for formulary consideration or other coverage-related decisions.

Those reading manuscripts in peer reviewed journals or conducting studies that are intended for publication need to familiarise themselves with how the recommendations vary and what this implies for how peer reviewed work translates into actual decision making. For those who hope for a single set of standards for pharmacoeconomic evaluation, it may be disheartening to know that PE guidelines vary significantly among different countries.

Even so, PE guidelines are more likely to recommend the societal perspective (as primary), have longer time horizons, and recommend QALYs as the preferred outcome measure. Thus, without some analysis from a perspective that is less general than the societal perspective and employing less time than the ‘lifetime’ or similar horizon allowing for all effects of an intervention, the information presented in peer reviewed manuscripts will not be easily used for formulary decisions. This ultimately means analysts must perform more work in order to use the information for decision making. Additionally, the variation in standards makes reviewing international manuscripts all the more challenging.

All this variation may leave us longing for a single standard. While the community of researchers interested in and users of pharmacoeconomic evaluation might consider the pros and cons of a single standard, this would not unambiguously improve outcomes for the populations that are affected by formulary decisions as some of the variation reflects different national interests, and may be warranted.

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“Why should the investigators confine themselves to one paper when they can slice up data into
two, three, five or more papers that will better serve their needs when they face promotion or
tenure committees? ‘Salami science’ does not always equal baloney, but such divided publication
is often an abuse of scientific publication.”
Edward J. Huth, MD (1923– ) – Former editor of the Annals of Internal Medicine

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The power of emotional intelligence

by Clare Gurton (clare.gurton@rxcomms.com)

When the Harvard Business Review published an article on emotional intelligence several years ago, it attracted a higher percentage of readers than any other article published in that periodical in the last 40 years – and the pace of growth continues. This year The First International Congress on Emotional Intelligence will be held in Spain [19–21 September] and the Sixth World Summit will be held in South Africa [10–12 September].

The increasing recognition of the power of emotional intelligence is global and illustrates its importance in business, where it’s said to help communication, self-direction, problem-solving, learning, creativity, and decision-making.

Emotional intelligence is the ability to identify, understand and appropriately use feelings. The term encompasses:

• Self-awareness – knowing your emotions, recognising feelings as they occur, and discriminating among them
• Mood management – handling feelings so that they're relevant to your current situation and you react appropriately
• Self-motivation – "gathering up" your feelings and directing yourself towards a goal, despite self-doubt, inertia, or impulsiveness
• Empathy – recognising feelings in others and tuning in to their verbal and nonverbal cues
• Managing relationships – handling interpersonal interaction, conflict resolution, and negotiations

Emotional Intelligence has proven a better predictor of future success than traditional methods like the GPA, IQ, and standardised test scores. There now is a considerable body of research suggesting that an individual’s ability to perceive, identify, and manage emotion provides the basis for the kinds of social and emotional competencies that are important for success in almost any job. Furthermore, as the pace of change increases and work makes ever greater demands on our cognitive, emotional, and physical resources, this particular set of abilities could become increasingly important. Hence the great interest in emotional Intelligence on the part of corporations, universities, and schools which has inspired research and curriculum development throughout these facilities.

Building one's own emotional intelligence can have a lifelong impact. In corporations, including emotional intelligence in training programs has helped employees cooperate better and become more motivated, thereby increasing productivity and profits.

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Healthcare Outcomes Communicator is designed to help you explain and enhance your role and value as healthcare economists and outcomes researchers. But we need input from you – the professionals working "in the trenches". So we encourage you to give us your feedback about how we're doing – to communicate with us so that we can better communicate with you.

Yours sincerely
David Woods and the Rx Communications team

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