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Microbiome Update

Microbiome update

20210318

Credit: https://www.nytimes.com/2021/03/18/well/eat/microbiome-aging.html?action=click&algo=bandit-all-surfaces-decay-decay-02&block=trending_recirc&fellback=false&imp_id=986584686&impression_id=0cc53dd8-8b11-11eb-87e0-b362713e87cd&index=8&pgtype=Article&region=footer&req_id=227739339&surface=most-popular-story&variant=2_bandit-all-surfaces-decay-decay-02

By Anahad O’Connor

The secret to successful aging may lie in part in your gut, according to a new report. The study found that it may be possible to predict your likelihood of living a long and healthy life by analyzing the trillions of bacteria, viruses and fungi that inhabit your intestinal tract.

The new research, published in the journal Nature Metabolism, found that as people get older, the composition of this complex community of microbes, collectively known as the gut microbiome, tends to change. And the greater the change, the better, it appears.

In healthy people, the kinds of microbes that dominate the gut in early adulthood make up a smaller and smaller proportion of the microbiome over the ensuing decades, while the percentage of other, less prevalent species rises. But in people who are less healthy, the study found, the opposite occurs: The composition of their microbiomes remains relatively static and they tend to die earlier.

The new findings suggest that a gut microbiome that continually transforms as you get older is a sign of healthy aging, said a co-author of the study, Sean Gibbons, a microbiome specialist and assistant professor at the Institute for Systems Biology in Seattle, a nonprofit biomedical research.

“A lot of aging research is obsessed with returning people to a younger state or turning back the clock,” he said. “But here the conclusion is very different. Maybe a microbiome that’s healthy for a 20-year-old is not at all healthy for an 80-year-old. It seems that it’s good to have a changing microbiome when you’re old. It means that the bugs that are in your system are adjusting appropriately to an aging body.”

The researchers could not be certain whether changes in the gut microbiome helped to drive healthy aging or vice versa. But they did see signs that what happens in people’s guts may directly improve their health. They found, for example, that people whose microbiomes shifted toward a unique profile as they aged also had higher levels of health-promoting compounds in their blood, including compounds produced by gut microbes that fight chronic disease.

Scientists have suspected for some time that the microbiome plays a role in aging. Studies have found, for example, that people 65 and older who are relatively lean and physically active have a higher abundance of certain microbes in their guts compared to seniors who are less fit and healthy. People who develop early signs of frailty also have less microbial diversity in their guts. By studying the microbiomes of people of all ages, scientists have found patterns that extend across the entire life span. The microbiome undergoes rapid changes as it develops in the first three years of life. Then it remains relatively stable for decades, before gradually undergoing changes in its makeup as people reach midlife, which accelerates into old age in those who are healthy but slows or remains static in people who are less healthy.

Although no two microbiomes are identical, people on average share about 30 percent of their gut bacterial species. A few species that are particularly common and abundant make up a “core” set of gut microbes in all of us, along with smaller amounts of a wide variety of other species that are found in different combinations in every person.

To get a better understanding of what happens in the gut as people age, Dr. Gibbons and his colleagues, including Dr. Tomasz Wilmanski, the lead author of the new study, looked at data on over 9,000 adults who had their microbiomes sequenced. They ranged in age from 18 to 101.

About 900 of these people were seniors who underwent regular checkups at medical clinics to assess their health. Dr. Gibbons and his colleagues found that in midlife, starting at around age 40, people started to show distinct changes in their microbiomes. The strains that were most dominant in their guts tended to decline, while other, less common strains became more prevalent, causing their microbiomes to diverge and look more and more different from others in the population.

“What we found is that over the different decades of life, individuals drift apart — their microbiomes become more and more unique from one another,” said Dr. Gibbons.

People who had the most changes in their microbial compositions tended to have better health and longer life spans. They had higher vitamin D levels and lower levels of LDL cholesterol and triglycerides, a type of fat in the blood. They needed fewer medications, and they had better physical health, with faster walking speeds and greater mobility.

The researchers found that these “unique” individuals also had higher levels of several metabolites in their blood that are produced by gut microbes, including indoles, which have been shown to reduce inflammation and maintain the integrity of the barrier that lines and protects the gut. In some studies, scientists have found that giving indoles to mice and other animals helps them stay youthful, allowing them to be more physically active, mobile and resistant to sickness, injuries and other stresses in old age. Another one of the metabolites identified in the new study was phenylacetylglutamine. It is not clear exactly what this compound does. But some experts believe it promotes longevity because research has shown that centenarians in northern Italy tend to have very high levels of it.

Dr. Wilmanski found that people whose gut microbiomes did not undergo much change as they got older were in poorer health. They had higher cholesterol and triglycerides and lower levels of vitamin D. They were less active and could not walk as fast. They used more medications, and they were nearly twice as likely to die during the study period.

The researchers speculated that some gut bugs that might be innocuous or perhaps even beneficial in early adulthood could turn harmful in old age. The study found, for example, that in healthy people who saw the most dramatic shifts in their microbiome compositions there was a steep decline in the prevalence of bacteria called Bacteroides, which are more common in developed countries where people eat a lot of processed foods full of fat, sugar and salt, and less prevalent in developing countries where people tend to eat a higher-fiber diet. When fiber is not available, Dr. Gibbons said, Bacteroides like to “munch on mucus,” including the protective mucus layer that lines the gut.

“Maybe that’s good when you’re 20 or 30 and producing a lot of mucus in your gut,” he said. “But as we get older, our mucus layer thins, and maybe we may need to suppress these bugs.”

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If those microbes chew through the barrier that keeps them safely in the gut, it is possible they could trigger an immune system response.

“When that happens, the immune system goes nuts,” Dr. Gibbons said. “Having that mucus layer is like having a barrier that maintains a détente that allows us to live happily with our gut microbes, and if that goes away it starts a war” and could set off chronic inflammation. Increasingly, chronic inflammation is thought to underlie a wide range of age-related ailments, from heart disease and diabetes to cancer and arthritis.

One way to prevent these microbes from destroying the lining of the gut is to give them something else to snack on, such as fiber from nutritious whole foods like beans, nuts and seeds and fruits and vegetables.

Other studies have shown that diet can have a substantial impact on the composition of the microbiome. While the new research did not look closely at the impact of different foods on changes in the microbiome as we age, Dr. Gibbons said he hopes to examine that in a future study.

“It may be possible to preserve the aging mucus layer in the gut by increasing the amount of fiber in the diet,” Dr. Gibbons said. “Or we might identify other ways to reduce Bacteroides abundance or increase indole production through diet. These are not-too-distant future interventions that we hope to test.”

In the meantime, he said, his advice for people is to try to stay physically active, which can have a beneficial effect on the gut microbiome, and eat more fiber and fish and fewer highly processed foods.

“I have started eating a lot more fiber since I began studying the microbiome,” he said. “Whole foods like fresh fruits and veggies have all the complex carbohydrates that our microbes like to eat. So, when you’re feeding yourself, think about your microbes too.”

Anahad O’Connor is a staff reporter covering health, science, nutrition and other topics. He is also a bestselling author of consumer health books such as “Never Shower in a Thunderstorm” and “The 10 Things You Need to Eat.” 

Arivale busts: a scientific wellness darling

Arivale – the end of a promising “scientific wellness” company

Anyone who cares about well-being, particularly that subset of well-being that many labeled as the “scientific wellness” movement, should note a decade-ender: the failure of Arivale. 

They burned through $50 million. They sold 5,000 customers over their lifetime. The customers were paying $99 per month on LABS tracking and health coaching that was tailored to the person’s genomes and other critical lab work. 

Their conclusion: customers would not pay for what it cost to serve them. In the future? Maybe. But not now. 

=======ARTICLE ON ARIVALE FOLLOWS=======

CREDIT: https://www.geekwire.com/2019/scientific-wellness-startup-arivale-closes-abruptly-tragic-end-vision-transform-personal-health/

Scientific wellness startup Arivale closes abruptly in ‘tragic’ end to vision to transform personal health

BY TODD BISHOP & TAYLOR SOPER on April 24, 2019

Arivale, the genetic testing and personal health coaching startup co-founded by genomics pioneer Leroy “Lee” Hood, shut down unexpectedly Wednesday — bringing an abrupt end to its ambitions to transform the lives of Americans through a new field that Hood dubbed “scientific wellness.”

All of the Seattle-based company’s approximately 120 employees were let go as of noon today, Arivale CEO Clayton Lewis confirmed in an interview. Arivale raised more than $50 million over its lifetime. The company offered ongoing wellness and nutritional coaching tailored to the results of each person’s genetic, blood and microbiome tests.

FOLLOW-UP: Why Arivale failed: Inside the surprise closure of an ambitious ‘scientific wellness’ startup

The decision was a surprise to many Arivale employees and customers. In a message to Arivale customers this afternoon, the company attributed the decision to “the simple fact that the cost of providing the service exceeds what our customers can pay for it.”

The message added, “We believe the costs of collecting the genetic, blood and microbiome assays that form the foundation of the program will eventually decline to a point where the program can be delivered to consumers cost-effectively. However, we are unable to continue to operate at a loss until that time arrives.”

Lewis told GeekWire that the high cost of acquiring customers also played a role in the decision.

“What is tragic on so many levels is that we were not successful in going out and convincing consumers that you could optimize your wellness and avoid disease with a little bit data and some changes in your lifestyle — that there’s not a market for that product that I believe in passionately,” Lewis said. “And that’s what we were trying to do.”

About 5,000 people took part in the Arivale program over the lifetime of the company, and Lewis said he is “incredibly proud” of the results. The program launched at a cost of $3,500 per year, but the price had dropped to the point where most customers were paying $99 per month for the flagship Arivale program, Lewis said.

The larger personal wellness industry includes heavyweights such as 23andMe, a genetic testing startup valued at more than $1 billion, and smaller players including EverlyWell, which raised a $50 million round last week, and Viome, the Seattle-area microbiome company led by Naveen Jain that just announced a new $25 million funding round from investors including Salesforce CEO Marc Benioff.

Global Wellness Institute estimates that the preventative and personalized medicine and public health industry is worth $575 billion.

Some of Arivale’s underlying work will continue at the Institute for Systems Biology (ISB), the not-for-profit biomedical research organization co-founded by Hood, where the ideas that led to Arivale were originally developed. ISB is now part of Providence St. Joseph Health, where Hood is chief science officer. Clayton said ISB is expected to hire some of the employees let go by Arivale as part of its closure. He declined to disclose details of the severance offered to employees, but said the same package was provided to all executives and employees.

Investors in Arivale included Arch Venture Partners, Polaris, and Maveron, where Lewis worked full-time before joining Arivale as co-founder and CEO.

Its scientific advisory board included George Church, a professor at Harvard and MIT; James Heath, president of Institute of Systems Biology; and Ed Lazowska, computer science professor at the University of Washington.

“Lee Hood sees the future with unmatched clarity,” said Lazowska, an early participant in the Arivale program. “A clear view, however, does not always imply a short path. Scientific wellness, as pioneered by Arivale, will be a foundation of 21st century medicine. But not right now. Right now, the cost of providing the service (the tests, the coaching) exceeds what people are willing to pay. Those costs will fall in time, and Arivale’s model and Arivale’s discoveries will see another day.”

Lewis said he has come to believe that Arivale was about a decade too early.

Arivale’s executive team included Sean Bell, chief operating officer; Jennifer Lovejoy, chief translational science officer; Mia Nease, head of healthcare and life sciences partnerships; Andrew Magis, director of research; Ashley Wells, chief product officer; and others.

Hood, who led the Caltech team that pioneered the automated DNA sequencer, said in a 2015 interview with GeekWire that Arivale was “the opening shot in a whole new industry called scientific wellness, and it really stands a chance of being the Google or Microsoft of this whole arena.”

GeekWire chief business officer Daniel Rossi was a longtime paying customer of the program, and we chronicled his early experience with Arivale in series of articles in 2017. “Arivale was crucial to my health journey,” Rossi said. “From them I learned not only the genetic hand I was dealt but also the best ways to maximize my health and well-being. I am most thankful for the weekly calls with my coaches who encouraged me every step of the way. I’ll miss this program. It was terrific.”

Here’s the text of the message sent to Arivale customers earlier today, a version of which was also posted to the Arivale website.

To Our Customers,

We are very sorry to inform you that, effective immediately, Arivale can no longer provide our program to you and our other customers. This letter explains why we are ending the consumer program and answers the questions you are likely to have about the process.

Our decision to terminate the program today comes despite the fact that customer engagement and satisfaction with the program is high and the clinical health markers of many customers have improved significantly. Our decision to cease operations is attributable to the simple fact that the cost of providing the program exceeds what our customers can pay for it. We believe the costs of collecting the genetic, blood and microbiome assays that form the foundation of the program will eventually decline to a point where the program can be delivered to consumers cost-effectively. Regrettably, we are unable to continue to operate at a loss until that time arrives; in other words, we have concluded that it is simply too early for a direct-to-consumer scientific wellness offering to be viable.

We founded Arivale with the vision of making personalized, data-driven, preventive coaching a new wellness paradigm in the United States. Since its launch in 2015, the results of the Arivale program have been remarkable. To cite but one example, our scientific paper describing the improvements seen in multiple health markers in ~2500 participants was recently accepted for publication in the journal Scientific Reports.

While our direct-to-consumer model isn’t yet sustainable, we know that the Arivale program improved the lives of our customers and showed great scientific merit. We are proud of everyone at Arivale for their dedication and devotion to our mission and grateful to you and all of our other customers for joining us on this journey. Together, our efforts have launched a new paradigm—scientific or quantitative wellness—which, we are confident will become a major component of 21st century medicine.

================== END ARTICLE==============

Written by: Todd Bishop is GeekWire’s co-founder and editor, a longtime technology journalist who covers subjects including cloud tech, e-commerce, virtual reality, devices, apps and tech giants such as Amazon.com, Apple, Microsoft and Google. Follow him @toddbishop, email todd@geekwire.com, or call (206) 294-6255.

Charisma

CREDIT: www.nytimes.com/2019/08/15/smarter-living/what-makes-people-charismatic-and-how-you-can-be-too

What Makes People Charismatic

Ask people to name someone they find charming and the answers are often predictable. There’s James Bond, the fictional spy with a penchant for shaken martinis. Maybe they’ll mention Oprah Winfrey, Bill Clinton or a historical figure, like the Rev. Dr. Martin Luther King Jr. or Mahatma Gandhi. Now ask the same people to describe, in just a few seconds, what makes these charmers so likable.

It’s here, in defining what exactly charisma is, that most hit a wall. Instinctually, we know that we’re drawn to certain people more than others. Quantifying why we like them is an entirely different exercise.

The ancient Greeks described charisma as a “gift of grace,” an apt descriptor if you believe likability is a God-given trait that comes naturally to some but not others. The truth is that charisma is a learned behavior, a skill to be developed in much the same way that we learned to walk or practice vocabulary when studying a new language. Other desirable traits, like wealth or appearance, are undoubtedly linked to likability, but being born without either doesn’t preclude you from being charismatic.

Quantifying charisma

For all the work put into quantifying charisma — and it’s been studied by experts through the ages, including Plato and those we talked to for this piece — there are still a lot of unknowns. There are, however, two undisputed truths.

The first is that we are almost supernaturally drawn to some people, particularly those we like. Though this is not always the case; we can just as easily be drawn in by a charismatic villain.

The second truth is that we are terrible at putting a finger on what it is that makes these people so captivating. Beyond surface-level observations — a nice smile, or the ability to tell a good story — few of us can quantify, in an instant, what makes charismatic people so magnetic.

Perhaps it’s evolutionary. As a species, innate instinctual feelings lead to things we often describe as gut feelings. These feelings are actually a subconscious response to dozens, or possibly hundreds, of verbal and nonverbal cues that we unknowingly process in every interaction with others. It’s a necessary skill, one that allows all mammals to gauge the intention of others by taking continuous inventory of things like body language, speech pacing and subtle movements that may allude to a threat.

John Antonakis, a professor of organizational behavior at the University of Lausanne in Switzerland, notes that charisma, at its most basic, is merely information signaling. “Basically put, charisma is all about signaling information in a symbolic, emotional and value-based manner,” he said. “Thus, charisma signaling is all about using verbal — what you say — and nonverbal techniques.”

For comparison’s sake, what Dr. Antonakis described is essentially a simpler version of the fight-or-flight response. Instead of fighting or fleeing, however, we’re making constant micro-decisions about whether the person demanding our attention is deserving of it. 

The three pillars of charisma, and how to practice each

Olivia Fox Cabane, a charisma coach and the author of the book “The Charisma Myth,” says we can boil charismatic behavior down to three pillars.

The first pillar: PRESENCE

The first pillar, presence, involves residing in the moment. When you find your attention slipping while speaking to someone, refocus by centering yourself. Pay attention to the sounds in the environment, your breath and the subtle sensations in your body — the tingles that start in your toes and radiate throughout your frame.

The second pillar: POWER

Power, the second pillar, involves breaking down self-imposed barriers rather than achieving higher status. It’s about lifting the stigma that comes with the success you’ve already earned. Impostor syndrome, as it’s known, is the prevalent fear that you’re not worthy of the position you’re in. The higher up the ladder you climb, the more prevalent the feeling becomes.

The key to this pillar is to remove self-doubt, assuring yourself that you belong and that your skills and passions are valuable and interesting to others. It’s easier said than done.

The third pillar: WARMTH

The third pillar, warmth, is a little harder to fake. This one requires you to radiate a certain kind of vibe that signals kindness and acceptance. It’s the sort of feeling you might get from a close relative or a dear friend. It’s tricky, considering those who excel here are people who invoke this feeling in others, even when they’ve just met.

To master this pillar, Ms. Cabane suggests imagining a person you feel great warmth and affection for, and then focusing on what you enjoy most about your shared interactions. You can do this before interactions, or in shorter spurts while listening to someone else speak. This, she says, can change body chemistry in seconds, making even the most introverted among us exude the type of warmth linked to high-charisma people.

Scratching the surface

All of our experts agreed that charisma isn’t a one-size-fits-all descriptor; it’s more of a hierarchy. Some people exude charm through warmth and generosity, while others are likable in a sort of evolutionary sense — the alpha types who radiate confidence and success.

Going back to the three pillars, the most charismatic people you know on a personal level have generally achieved a high level of success in only one, or perhaps two, of these traits. A rare few, though, show a mastery of all three.

Dr. King, for example, displayed signs of mastery in each of these pillars, leading to the rare classification that Ms. Cabane calls “visionary charisma.”

If that’s the top of the hierarchy, the next three examples would reside somewhere in the middle.

Steve Jobs, the co-founder of Apple, exhibited mastery in power and achieved high marks for presence. However, according to his daughter Lisa Brennan-Jobs, in her 2018 memoir “Small Fry,” he lacked warmth. Tesla’s chief executive, Elon Musk, also arguably lacks warmth. He’s a classic introvert who makes up for his lack of people skills with mastery in presence and above-average levels of power.

Mr. Jobs, according to Ms. Cabane, is best classified as having “authority charisma,” while Mr. Musk has “focus charisma.”

Then there are those like Emilia Clarke, who starred on HBO’s “Game of Thrones.” Clarke’s exuberance earns her high marks in “kindness charisma,” a classification for those who excel at the warmth pillar, while maintaining a high presence but low power.

This is just scratching the surface, of course. But the important takeaway here is that charisma isn’t a singular thing. Instead, it’s often best to think of it in the same way you would consider intelligence. Earning high marks in math and science is a signal of intelligence, but so is mastery in art or music. Trying to compare one intelligent person to another just leads to more confusion.The same can be said for charisma.

Charisma training: Low-hanging-fruit edition

If you’re looking for a good starting point to be more likable, Dr. Antonakis suggests storytelling. The most charismatic people in a room, he says, are those who speak metaphorically, providing substance to a conversation through exemplary use of anecdotes and comparisons. They aren’t recounting events but paraphrasing action while using facial gestures, energetic body language and vocal inflections to frame key points. They’re experts at using moral conviction and reflections of group sentiment, as well as employing questions, even rhetorical ones, that keep people engaged. In short, they just tell a good story.

In fact, a theme emerged while speaking to experts on charisma, one that becomes instantly recognizable to anyone who has taken a public-speaking course or sat in on a Toastmasters meeting: The most charismatic people are often the most effective public speakers.

Charisma goes beyond being a refined and engaging speaker, however. Charismatic people are well liked not just because they can tell a good story, but also because of how they make others feel. Aside from being humorous and engaging, charismatic people are able to block out distractions, leaving those who interact with them feeling as if time had stopped and they were all that mattered. They make people feel better about themselves, which leads them to return for future interactions, or to extend existing ones, if only to savor such moments.

The quickest way to be more likable is to get out and practice being more likable. It starts at home, by removing your own self-doubt and focusing instead on being an active participant in conversations and interactions with others.

From there, it requires little more than saying yes to more social invitations, joining a public speaking class (or a local group like Toastmasters) and continuing to look for ways to show off your strengths while leveling up your weaknesses. Each interaction offers a chance to practice, to study and to employ new strategies.

Much like learning any other skill, sometimes it will go well and often it won’t, especially at first. But if you think of charisma as a skill tree, each practice session is merely a way to brush up on the many ways to climb it.

Bryan Clark is a journalist from San Diego who lives at the intersection between technology and culture. 

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Digital Immortality

In this week’s Sunday NYT Magazine, a discussion was recorded about the future of technology. One of my favorite writers, Sid Mukerjee, discussed chronic disease. In that discussion, he touched on a notion of immortality that I have been pondering for some time.

Here is what he said, and after is what I say in response.

MUKHERJEE: “In terms of longevity, the diseases that are most likely to kill us are neurological diseases and heart disease and cancer. In some other countries, there is tuberculosis and malaria and other infectious diseases, but here it’s the chronic diseases that dominate. There are three ways to think about these chronic diseases. One is the disease-specific way. So, you attack Alzheimer’s as Alzheimer’s; you attack cancer as cancer. The second one is that you forget about the disease-specific manners of attacking diseases and you attack longevity or aging reversal in general. You change diet, change genes, change whatever else — we might call them “trans factors,” which would simply override the “cis factors” that existed for individual diseases. And the third option is some combination of that and some digital form of immortality, which is that you record yourself forever, that you clone yourself and somehow pass along that recording. Which is to say that the body is just a repository of memories, images, times. And as a repository, there’s nothing special about it. The body per se, the mortal coil, is just a coil.

This is the first time I have heard a major thinker put immortality into this context. And yet – its so obvious to do so!

For example:

– wouldn’t it be fair to say that every autobiography ever written would be a sincere attempt by the writer to achieve some form of immortality?

– in like manner, isn’t the task of the biographer, in part, to immortalize their subject?

– more broadly, how do societies around the world remember their ancestors? Their memories are their attempts to allow ancestors to live forever!

This point is nicely illustrated by the Irish culture. In my work on the History of Ireland, the centrality of “oral tradition” was crystal clear. I came continually across how the Irish told stories to revere their ancestors. The Irish would distill their ancestors into a wide variety of stories that helped the present generation understand the past.

So, by extrapolation from this point (which is obvious), can this be asked: “Can I be immortalized digitally?

Digital storage costs have plummeted. Methods of organizing and tagging video and audio recordings are now commonplace. Search engines are commonplace. Pattern recognition combined with search is exploding.

So what will prevent me in the future from immortalizing myself digitally? What prevents me from storing who I am, what I did, what I learned, where I have been, what I have experienced, who I knew, who my ancestors were, who my children and grandchildren were, etc etc?

Perhaps the answer is: nothing. Nothing prevents me from being digitally immortal.

Climate Change Language

We Need A Better Language for Climate Change – that Acts as a Call to Action

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Below is as essay that makes the case for a new six-box classification system for global climate change – two columns and three rows. The core idea here is to move climate change out of a subject for the editorial page and into a subject for daily new – much like how storms, earthquakes and epidemics are covered. We want a language that serves as a “call-to-action”.

The news would inform the world about climate-change related occurrences that have impacts that are “major”, “disaster”, or “global disaster”, and that are either “incidents” (one-time) or “recurring”.

I worked this out with Karen . I am the scribe. Obviously, this is DRAFT 1.

=============================
Climate Change Language

CREDIT: Karen Flanders-Reid
CREDIT: https://www.nytimes.com/2018/08/08/opinion/environment/california-wildfires-trump-zinke-climate-change.html

Karen and I read today’s NYT article about California wildfires, and found ourselves musing – is the language of climate change right? Why is a “wildfire” just an isolated incident? Why isn’t it part of a larger wildfire classification system (“BREAKING NEWS: THE CALIFORNIA WILDFIRE HAS JUST BEEN RECLASSIFIED AS CATEGORY V.”?

We went on to ask: if climate change is the critical issue of our day, why Why isn’t the wildfire in California an climate change incident – part of a larger climate change classification system?

Why do the NYT editorial writers have to scream – everything is related to climate change!!!! After all, news breaks when a Hurricane is re-classified: “BREAKING NEWS: THE TROPICAL STORM OVER CUBA HAS JUST BEEN RE-CLASSIFIED BY THE WEATHER SERVICE AS A HURRICANE.”

Why doesn’t climate change have its own global classification system? How do we move from the editorial opinion desk to the news desk? How do we move from “The science is being ignored.” To “BREAKING NEWS: THE WILDFIRES IN CALIFORNIA HAVE JUST BEEN RECLASSIFIED BY THE WEATHER SERVICE FROM A CLIMATE-RELATED INCIDENT (CRI) TO A CLIMATE-RELATED DISASTER (CRD).”

EXAMPLES OF POWERFUL GLOBAL CLASSIFICATION SYSTEMS

To identify a powerful classification system, and the new language it implies, it first would be useful to identify the other global classification systems that exist – especially those with imply a call to action.

There are at least four:

Storms; Classified by the World Meteorological Organization (WMO), using the Saffir–Simpson scale:

Tropical Depression
Tropical Storm
Hurricane/Cyclone Categories 1-5

Source: https://en.wikipedia.org/wiki/Maximum_sustained_wind

Earthquakes: Classified by the US Geological Service, using the Richter Scale:
Moderate (above 8)
Strong (7-7.9)
Major (6-6.9)
Great (5-5.9)

Infectious Disease; Classified by the global centers for disease control, the classes are:

Outbreak (more incident than expected)
Epidemic (spreads rapidly to many people)
Pandemic (spreads rapidly to many people globally)

Source: https://www.webmd.com/cold-and-flu/what-are-epidemics-pandemics-outbreaks#1

A NEW GLOBAL CLASSIFICATION SYSTEM FOR CLIMATE CHANGE

To Begin

We recommend s simple structure, with easily understood terms, that evolves over time:

Starts with a few terms, and adds terms over time.
Begins classifying major occurrences only, and evolves to classify most occurrences.
Begins classifying evidence-based occurrences only (where science is conclusive that the occurrence is climate-change-related) and evolves as science becomes increasingly conclusive.

Initial Terms

“Occurrence” – a natural phenomena that occurs somewhere

“Climate-Change-Related” (CR) – a shorthand for saying that the preponderance of science indicates that a given occurrence is a contributor to or the result of climate change.

“Incident” (I) – an episodic occurrence (with a beginning, middle, and end)
“Recurring” (R) – an on-going occurrence (no end in sight)

“Major” (M) – an occurrence with sufficient size to merit being classified.
“Disaster” (D) – an occurrence, with major impacts
“Global Disaster” (G) – an occurrence with major global impacts

Initial Classification System:

Climate-related Occurrences shall be identified.

Once identified, they shall be classified in one of six classes:

Either “incidents” or “recurring”.
Either “major”, “disaster”, or “global disaster”

“Climate-Change-Related Event” (CRE) – any occurrence that is deemed to be a contributor to climate-change.

“Climate-Change-Related Outcome” (CRO) – any occurrence that is deemed to be the result of to climate-change.

All major climate-change-related occurrences would be classified as follows:

CR Incident (CRE-I): An episodic event, with a beginning, a middle, and an end.
CR Disaster (CRE-D): An episodic event, with global impacts

The Weather Service would be tasked with implementation, and aligning with the World Meteorological Organization (WMO) and other agencies around the world.

SmartWatch Technology Reliably Detects Afib

The quantified self movement strikes again!

CREDIT: Cleveland Clinic Article on Detection of Afib via SmartWatch

Smartwatch Technology Reliably Detects Afib Prior to Cardioversion
Study suggests a role for KardiaBand when paired with physician review

A newly FDA-approved smartwatch accessory can record heart rhythm and successfully differentiate atrial fibrillation (AF) from normal sinus rhythm (SR) through an automated algorithm, according to a Cleveland Clinic investigation. The study, which will be presented March 11 at the American College of Cardiology’s 67th Scientific Session, also showed that the accuracy of interpretation gets even better when the accessory is supported by physician review.
The findings suggest that the wearable technology, known as KardiaBand™, can help screen patients before presentation for elective cardioversion to avoid unnecessary procedures, among other potential uses.
KardiaBand, which consists of a software app for an Apple Watch® and a sensor band that replaces one of the watch’s straps, provides a 30-second recording of an ECG rhythm strip when the wearer places a thumb on the sensor band. The app contains an algorithm for automated detection of AF.
“Our objective was to determine how accurately KardiaBand and its algorithm can differentiate AF from sinus rhythm compared with physician-interpreted 12-lead ECGs,” says senior author Khaldoun Tarakji, MD, MPH, a Cleveland Clinic electrophysiologist. In November 2017, the device became the first smartwatch healthcare accessory to be approved by the FDA, “but we wanted to test it ourselves to determine how well it would perform in clinical practice,” Dr. Tarakji explains.
Study essentials
To that end, he and Cleveland Clinic colleagues prospectively enrolled 100 consecutive patients (mean age, 68 ± 11 years) with chronic AF who were scheduled to undergo cardioversion. Upon presenting for the cardioversion procedure, all patients were given a KardiaBand-equipped smartwatch and trained in its use, after which they underwent traditional ECG assessment and a 30-second KardiaBand recording. If cardioversion was still indicated, they underwent ECG and KardiaBand testing after the procedure. KardiaBand recordings were then compared with the physician-reviewed ECGs and also reviewed by two blinded electrophysiologists, with these readings compared to ECG interpretations.
Eight patients did not undergo cardioversion because they presented in SR; these patients were excluded. Among the remaining patients, a total of 169 pairs of ECG and KardiaBand recordings were available for comparison (each patient had two before and two after cardioversion).
Key findings
• Of the 169 pre-cardioversion KardiaBand recordings, 57 fell out as “unclassified,” meaning that the KardiaBand algorithm did not draw a conclusion of either AF or SR.
• Among the remaining 112 pairs of recordings, the reviewing electrophysiologists determined that the KardiaBand algorithm correctly detected AF with 93 percent sensitivity and 84 percent specificity compared with ECG.
• When the blinded reviewers bypassed the automated algorithm and interpreted each patient’s KardiaBand strips against his or her ECG, sensitivity rose to 99 percent and specificity was 83 percent. Further, in the 57 unclassified cases, the reviewers were able to use the strips to correctly diagnose AF versus SR with 100 percent sensitivity and 80 percent specificity.
“This study shows that KardiaBand provides excellent sensitivity and good specificity in identifying AF,” says Dr. Tarakji. “The numbers improve further with physician overview of these recordings, indicating that even unclassified KardiaBand strip recordings could be of value to reading physicians.”
Smart devices demand smart use
KardiaBand carries the benefit of enabling patients to record their rhythm at any time, as opposed to only when they are wearing a Holter monitor or at a physician’s office. “We can catch intermittent episodes when they happen, and we’re not limited to a specific duration of monitoring time,” Dr. Tarakji says. He adds that wearable devices like this can also reduce time spent responding to false alarms if a recording taken at the same time shows normal rhythm.
Yet many questions remain about how KardiaBand and similar products may ultimately be used in practice. Dr. Tarakji cites a few examples:
• Which patients are best suited to this technology? For many patients dealing with AF, KardiaBand can provide reassurance when they need it. But for others, having constant access to their ECG data may lead them to check their rhythm obsessively, raising anxiety. “In general, however, patients value the instant feedback they get,” Dr. Tarakji observes.
• Do physicians have the IT infrastructure in place to make these devices part of their practice? Wearable devices can mean a flood of event reports to clinicians’ email boxes. At Cleveland Clinic, information from patients’ KardiaBands bypasses the email system and feeds into a cloud-computing platform that physicians can access anytime.
• How should clinicians respond to short episodes, particularly in asymptomatic patients? “We currently have a gap in our clinical knowledge about whether brief, random episodes that are asymptomatic warrant anticoagulation or not,” Dr. Tarakji explains, adding that ongoing studies are trying to address this important question.
“Future studies will focus on how we can use these smart devices intelligently to make sure they’re improving quality of care rather than just producing noise for physicians,” he observes.
A parallel goal, he says, is to ensure that the devices provide value by making care delivery more efficient. Noting that patients currently need to pay for KardiaBand out of pocket, Dr. Tarakji says that “developing a richer body of research evidence is the best way we can demonstrate cost-effectiveness to healthcare payers.”
Tech like this can’t be ignored
Indeed, KardiaBand could prove cost-effective by allowing patients who are in SR to avoid needless trips for elective procedures, such as in the case of the eight patients in the study who were found to be in SR when they presented for cardioversion and did not require the procedure. Other potential uses of KardiaBand for the longitudinal management of AF patients could well prove cost-effective too.
Regardless of how quickly such cost-effectiveness evidence may come, Dr. Tarakji says clinicians cannot be passive in the face of technologies like KardiaBand. “Patients will come to us with new products, and we can’t turn away,” he observes. “We need to test these products and find ways of responding to the information they deliver in a way that improves patient outcomes, all while remaining mindful of both patient and physician satisfaction.”
The researchers report that KardiaBand’s manufacturer, AliveCor, provided smartwatches for the study but was not involved in the study’s design, implementation, data analysis or interpretation.

Well-Being – Real Time Revisited

NOTE: This post revisits a post titled “Well-Being Real Time”. The original post was May, 2014, and can be found at: http://johncreid.com/2014/05/well-being-real-time/.

Well-Being – Real Time Revisited

Well-being is arguably the central mega-trend of the 21st century. As we look to the future, we have an obligation to “unpack” this dense concept, and find its essential component parts.

We describe these components here as “ACE” – ACT, CARE, and EAT. The wish we have for ourselves and for others is to be well. “Be Well” is our salutation and our call to actions.

How far out are we looking?

The future is now. ACE is here – together with real time measuring and monitoring. ACE is our pathway to greater and greater levels of personal well-being.

ACE measuring and monitoring will be supported by all elements of the quantified self movement. FitBit, Apple Watch, and so many other new monitoring devices will allow us to to bring personal well-being into a real-time modality.

ACE represents three pillars, each deceptively simple:

A – ACT: ACT is short for activity. The call to action is “stay active”. Well-being activity has physical activity at its center, but the pillar also embraces social activity, and activities of the mind. Staying active is a critical element of being well.
C – CARE: CARE is short for well-being care. The call to action is “care for yourself” and “care for others.”Well-being care of course has health care at its center, but there is so much more. e.g. genomics, massage, essential oils, acupuncture, etc. “Caring for myself” and “Caring for others” are elements of this pillar. “Preventive care” regular check-ups, colonoscopies after age 50, mammograms, pre-natal care for expecting mothers, etc.
E – EAT: EAT is short for eating and drinking. The call to action is “Eat well.” Well-being eating is the exploration of how what we eat and drink contributes to our well-being.

As simple as these pillars appear, each is complex: deep enough for a life-time of focus. Each represents bodies of research, skills, capabilities, and areas of professional endeavor. All together, these pillars represent pathway that each of us will follow as we attain greater and greater levels of personal well-being.

Discussion:

ACT

A – ACT (walking, running, calories burned etc)

Staying active is a critical element of being well. Well-being activity has physical activity at its center: sports, walking, lifting, climbing, yoga, and all of the other activities that light up a FitBit. The pillar also embraces activity of other kinds, e.g. social activity, and activities of the mind.

CARE

Well-being care is all about promoting health. Of course, it has health care at its center, but there is so much more. e.g. mental health, addictive behaviors, massage, genomics, essential oils, acupuncture, etc.

“Caring for myself” and “Caring for others” are elements of this pillar. “Preventive care”, eldercare and aging, palliative care are included, but so are regular check-ups, colonoscopies after age 50, mammograms, pre-natal care for expecting mothers, etc.

The ability to routinely monitor vital signs at home or at the office will be a part of this pillar. Lab work – including saliva, blood, and stool samples, will be more real time, more regular and less expensive. These trends will be one of the keys to progress in the care pillar. On the innovation side of this pillar will be many technologies, but breakthroughs in genomics will certainly be high on the list. Telemedicine is another innovation that will alter access to well-being care.

Predictive modeling will be more relevant than never. Am I headed for pre-diabetes? If so, what evidence shows me a path to avoid that condition?

CARE-MMEDS (what MEDS I take, what compliance I have, etc)

CARE-RResting Metabolic Rate (calories burned at rest)

CARE-VVITALS (pulse, BP, etc)

CARE-LLABS (blood testing, etc)

CARE-SSleep (duration, deep sleep, etc)

EAT

EAT is short for eating and drinking. The call to action is “Eat well.”

Well-being eating is the exploration of how what we eat and drink contributes to our well-being. Naturally, there is a social element, where eating and drinking together makes the experience more fulfilling. There is a physiological element, having to do with ingestion, osmosis, calories, glucose and glycogen, enzymes, etc. There is a psychological element, related to the feelings of satiety, or hunger, or thirst, and their related cravings. There is a sensory element, where sweet and sour contrasts, aromas, and their related metaphorical associations, play a part.

Eating delicious food and drink with friends is certainly a component. But achieving a balanced diet, with moderation as a central tenant,

On the one hand, this pillar is ancient. For thousands of years, elders have taught daughters and sons how to cook well. and cooking techniques have evolved

On the other hand, this pillar is ripe for innovation. The new breakthrough science related to the micro-biome is a part.

EATS (what I eat and drink, especially calories)

Implications

Monitoring all components of ACE (MEDS, Activity, Resting Metabolism,VITALS, EATS, LABS, Sleep) is now going to accelerate at an exponential rate.

There will be three settings where ACE monitoring will accelerate:

Employees in Workplaces: Employers will offer employees routine monitoring as part of employee benefits and/or health insurance.
Residents in Communities: Communities will offer residents routine monitoring as one of their amenities. Wellbeing facilities and programs will become as important as golf courses and swimming pools. Look for HOA’s,Condo and Coop associations, and subdivision developers to increasingly view MARVELS as critical to “place-making”.
Clients of service-providers: Hotels, spas, assisted-living centers, nursing homes, and many others will increasingly offer MARVELS monitoring as one of their base services.

The Privacy Imperative will be the critical success factor for all of these pushes into the future. It is foundational.

Without it, there will be no progress.

With it, personalized, real-time care will flourish. Each individual will be able to opt-in to his care-coaching community (and to opt-out whenever they choose), and get the extraordinary benefits that such a community can provide.

Want to talk to your well-being coach? FaceTime them, and they – with your permission – will help you sort out what’s going on with you.

Feel like you might need a check-in with a doctor? Send them an email – with your ACE history embedded in it, or get them on the phone or FaceTime, and see if they need you to come in.

The future is now.

BEWELL Centers will be everywhere. Look for:

DWELL CENTERS (part of BEWELL Centers) – for community ACE measuring and monitoring support. Target population is neighbors in the community.

Employee BEWELL CENTERS (part of BEWELL Centers) – for employees in workplaces ACE measuring and monitoring support. Target population is employees in the workplace.

CLIENT BEWELL CENTERS (Part of BEWELL Centers – for service-providers ACE measuring and monitoring support.Target population is clients of the service provider.
(Walgreens and CVS are already moving aggressively in this direction>

References:
The Privacy Imperative
LABS revolution
LABS By Disease
Quantified Self Movement

Amazon, BH, JPMorgan

With 1.2 million employees, Amazon, Berkshire Hathaway, and JP Morgan have decided to venture together into health care for their employees.

Following in the grand tradition of Henry Ford, who set up Henry Ford Hospital in Detroit, these three giants are stepping in too.

They have no illusions about how difficult it will be. But with premiums rising 19% per year, its clear that Congress is doing nothing, and someone has to do something.

“Planning for the new company is being led by Marvelle Sullivan Berchtold, a JPMorgan managing director who was previously head of the Swiss drugmaker Novartis’s mergers and acquisitions strategy; Mr. Combs; and Beth Galetti, a senior vice president at Amazon.”

The article points out that there are others working on this.

“Robert Andrews, chief executive of the Healthcare Transformation Alliance, a group of 46 companies, including Coca-Cola and American Express, that have banded together to lower health care costs.”

“Walmart contracted with groups like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need organ transplants and heart and spine care.”

“Caterpillar, the construction equipment manufacturer, sets its own rules for drug coverage, which it has said saves it millions of dollars per year, even though it still uses a pharmacy benefit manager to process its claims.”

Suzanne Delbanco, the executive director for the Catalyst for Payment Reform, a nonprofit group that mainly represents employers”

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CREDIT: https://www.nytimes.com/2018/01/30/technology/amazon-berkshire-hathaway-jpmorgan-health-care.html?smid=nytcore-ipad-share&smprod=nytcore-ipad

TECHNOLOGY
Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care

By NICK WINGFIELD, KATIE THOMAS and REED ABELSON
JAN. 30, 2018
SEATTLE — Three corporate behemoths — Amazon, Berkshire Hathaway and JPMorgan Chase — announced on Tuesday that they would form an independent health care company for their employees in the United States.

The alliance was a sign of just how frustrated American businesses are with the state of the nation’s health care system and the rapidly spiraling cost of medical treatment. It also caused further turmoil in an industry reeling from attempts by new players to attack a notoriously inefficient, intractable web of doctors, hospitals, insurers and pharmaceutical companies.
It was unclear how extensively the three partners would overhaul their employees’ existing health coverage — whether they would simply help workers find a local doctor, steer employees to online medical advice or use their muscle to negotiate lower prices for drugs and procedures. While the alliance will apply only to their employees, these corporations are so closely watched that whatever successes they have could become models for other businesses.

Major employers, from Walmart to Caterpillar, have tried for years to tackle the high costs and complexity of health care, and have grown increasingly frustrated as Congress has deadlocked over the issue, leaving many of the thorniest issues to private industry. About 151 million Americans get their health insurance from an employer.
(Why will health care be so difficult for these companies to untangle? Analysis from The Upshot.)
But Tuesday’s announcement landed like a thunderclap — sending stocks for insurers and other major health companies tumbling. Shares of health care companies like UnitedHealth Group and Anthem plunged on Tuesday, dragging down the broader stock market.

That weakness reflects the strength of the new entrants. The partnership brings together Amazon, the online retail giant known for disrupting major industries; Berkshire Hathaway, the holding company led by the billionaire investor Warren E. Buffett; and JPMorgan Chase, the largest bank in the United States by assets.

They are moving into an industry where the lines between traditionally distinct areas, such as pharmacies, insurers and providers, are increasingly blurry. CVS Health’s deal last month to buy the health insurer Aetna for about $69 billion is just one example of the changes underway. Separately, Amazon’s potential entry into the pharmacy business continues to rattle major drug companies and distributors.
(Here’s a look at how the even the threat of Amazon’s entry into an industry can rattle stocks.)

The companies said the initiative, which is in its early stages, would be “free from profit-making incentives and constraints,” but did not specify whether that meant they would create a nonprofit organization. The tax implications were also unclear because so few details were released.
Jamie Dimon, the chief executive of JPMorgan Chase, said in a statement that the effort could eventually be expanded to benefit all Americans.

“The health care system is complex, and we enter into this challenge open-eyed about the degree of difficulty,” Jeff Bezos, Amazon’s founder and chief executive, said in a statement. “Hard as it might be, reducing health care’s burden on the economy while improving outcomes for employees and their families would be worth the effort.”

The announcement touched off a wave of speculation about what the new company might do, especially given Amazon’s extensive reach into the daily lives of Americans — from where they buy their paper towels to what they watch on television. It follows speculation that the company, which recently purchased the grocery chain Whole Foods, might use its stores as locations for pharmacies or clinics.
(We asked health care experts to imagine what the three corporations might do.)

“It could be big,” Ed Kaplan, who negotiates health coverage on behalf of large employers as the national health practice leader for the Segal Group, said of the announcement. “Those are three big players, and I think if they get into health care insurance or the health care coverage space, they are going to make a big impact.”

TAKING ON ‘THE HUNGRY TAPEWORM’
A look at the three companies that announced a joint health care initiative on Tuesday.

Total employees: 1.2 million 
Amazon: 540,000 
Berkshire Hathaway: 367,000
JPMorgan Chase: 252,000.
Individual strengths 
Amazon: logistics and technology
Berkshire Hathaway: insurance
JPMorgan Chase: finance.

Jeff Bezos of Amazon:
“The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty.”
Warren E. Buffett of Berkshire Hathaway:
“The ballooning costs of healthcare act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable.”
Jamie Dimon of JPMorgan Chase:
“The three of our companies have extraordinary resources, and our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans.”

But others were less sure, noting that the three companies — which, combined, employ more than one million people — might still hold little sway over the largest insurers and pharmacy benefit managers, who oversee the benefits of tens of millions of Americans.

“This is not news in terms of jumbo employers being frustrated with what they can get through the traditional system,” said Sam Glick of the management consulting firm Oliver Wyman in San Francisco. He played down the notion that the three partners would have more success getting lower prices from hospitals and doctors. “The idea that they could have any sort of negotiation leverage with unit cost is a pretty far stretch.”

Even the three companies don’t seem to be sure of how to shake up health care. People briefed on the plan, who asked for anonymity because the discussions were private, said the executives decided to announce the initiative while still a concept in part so they can begin hiring staff for the new company.

Three people familiar with the partnership said it took shape as Mr. Bezos, Mr. Buffett, and Mr. Dimon, who are friends, discussed the challenges of providing insurance to their employees. They decided their combined access to data about how consumers make choices, along with an understanding of the intricacies of health insurance, would inevitably lead to some kind of new efficiency — whatever it might turn out to be.

“The ballooning costs of health care act as a hungry tapeworm on the American economy,” Mr. Buffett said in the statement. “Our group does not come to this problem with answers. But we also do not accept it as inevitable.”

Over the past several months, the three had met formally — along with Todd Combs, an investment officer at Berkshire Hathaway who is also on JPMorgan’s board — to discuss the idea, according to a person familiar with Mr. Buffett’s thinking.

The three chief executives saw one another at the Alfalfa Club dinner in Washington on Saturday, but by then each had already had dozens of conversations with the small in-house teams they had assembled. The plan was set.

Mr. Buffett’s motivation stems in part from conversations he has had with two people close to him who have been diagnosed with multiple sclerosis, according to the person. Mr. Buffett, the person said, believes the condition of the country’s health care system is a root cause of economic inequality, with wealthier people enjoying better, longer lives because they can afford good coverage As Mr. Buffett himself has aged — he is 87 — the contrast between his moneyed friends and others has grown starker, the person said.

The companies said they would initially focus on using technology to simplify care, but did not elaborate on how they intended to do that or bring down costs. One of the people briefed on the alliance said the new company wouldn’t replace existing health insurers or hospitals.

Planning for the new company is being led by Marvelle Sullivan Berchtold, a JPMorgan managing director who was previously head of the Swiss drugmaker Novartis’s mergers and acquisitions strategy; Mr. Combs; and Beth Galetti, a senior vice president at Amazon.

One potential avenue for the partnership might be an online health care dashboard that connects employees with the closest and best doctor specializing in whatever ailment they select from a drop-down menu. Perhaps the companies would strike deals to offer employee discounts with service providers like medical testing facilities.

“Each of those companies has extensive experience using transformative technology in their own businesses,” said John Sculley, the former chief executive of Apple who is now chairman of a health care start-up, RxAdvance. “I think it’s a great counterweight to what government leadership hasn’t done, which is to focus on how do we make this health care system sustainable.”

How Amazon Rattles Other Companies
The e-commerce giant’s actions – some big, like buying Whole Foods Markets; some smaller, like Amazon meal kits – have led to stock sell-offs for a wide range of businesses.

Erik Gordon, a professor at the University of Michigan’s Ross School of Business, predicted that the companies would attempt to modernize the cumbersome process of doctor appointments by making it more like booking a restaurant reservation on OpenTable, while eliminating the need to regularly fill out paper forms on clipboards.

“I think they will bring the customer-facing, patient-facing thing into your smartphone,” he said.

Amazon has long been mentioned by health care analysts and industry executives as a potential new player in the sector. While the company has remained quiet about its plans, some analysts noted that companies often use their own employees as a testing ground for future initiatives.

The entry of Amazon and its partners adds to the upheaval in an industry where much is changing, from government programs after the overhaul of the tax law to the uncertain future of the Affordable Care Act. All the while, medical costs have persistently been on the rise.

Nationwide, average premiums for family coverage for employees rose to $18,764 last year, an increase of 19 percent since 2012, according to the Kaiser Family Foundation. Workers are increasingly paying a greater share of those costs — they now pay 30 percent of the premium, in addition to high deductibles and growing co-payments.
“Our members’ balance sheets speak for themselves — health care is a growing cost at a time when other costs are either not rising or falling,” said Robert Andrews, chief executive of the Healthcare Transformation Alliance, a group of 46 companies, including Coca-Cola and American Express, that have banded together to lower health care costs.

Other major employers have also sought more direct control over their employees’ health care. Walmart contracted with groups like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need organ transplants and heart and spine care. Caterpillar, the construction equipment manufacturer, sets its own rules for drug coverage, which it has said saves it millions of dollars per year, even though it still uses a pharmacy benefit manager to process its claims.

Suzanne Delbanco, the executive director for the Catalyst for Payment Reform, a nonprofit group that mainly represents employers, said controlling rising prices is especially hard in markets where a local hospital or medical group dominates. While some have tried to tackle the issue in different ways, like sending employees with heart conditions to a specific group, “it’s piecemeal,” she said.

She added, “There are so many opportunities to do this better.”

The issue is not solely a 21st-century concern: In 1915, Henry Ford became increasingly worried about the quality of health care available to his growing work force in Detroit, so he opened the Henry Ford Hospital. It is still in existence today.

Nick Wingfield reported from Seattle, Katie Thomas from Chicago and Reed Abelson from San Francisco. Michael J. de la Merced contributed reporting from London, and Emily Flitter from New York.

A version of this article appears in print on January 31, 2018, on Page A1 of the New York edition with the headline: 3 Giants Form Health Alliance, Rocking Insurers. Order Reprints| Today’s Paper|Subscribe

Prevention Revisited

The essay below is an argument for the quality of life benefits of prevention. But its conclusions about whether prevention saves money? Those conclusions are depressing.

But I want to consider it. If prevention doesn’t save money, this goes against every intuition I have ever had on the subject.

The source of this essay is worth considering. If you look below, Dr. Aaron just published a book arguing that bad foods are not so bad – in moderation. This is a conclusion I happen to agree with. I agree with “all things in moderation”.
 
For example, a primary conclusion is that insuring people makes them more, rather than less, likely to use the emergency room. But this conclusion is about insurance, not prevention, and speaks to people’s need for convenient access to health care.

Or a second example used: anti-smoking. The essay’s conclusion is outrageous: it says that society will pay more because people who stop smoking will live longer! So, if society wishes to reduce costs, a mass euthanasia program, at, say, age 67, will really do the trick!
 
I publish but do not endorse…..

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CREDIT: Essay in the New York Times

THE NEW HEALTH CARE

The essay below is depressing. But I want to consider it. If prevention doesn’t save money, this goes against every intuition I have ever had on the subject.

I definitely don’t trust the source of this essay, or its conclusions.

For example, a primary conclusion is that insuring people makes them more, rather than less, likely to use the emergency room. But this conclusion is about insurance, not prevention, and speaks to people’s need for convenient access to health care.

Or a second example used: anti-smoking. The essay’s conclusion is outrageous: it says that society will pay more because people who stop smoking will live longer! So, if society wishes to reduce costs, a mass euthanasia program, at, say, age 67, will really do the trick!

I publish but do not in any way endorse…..

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CREDIT: New York Times Essay

THE NEW HEALTH CARE

Preventive Care Saves Money Sorry, It’s Too Good to Be True

Contrary to conventional wisdom, it tends to cost money, but it improves quality of life at a very reasonable price.

By Aaron E. Carroll
Jan. 29, 2018

The idea that spending more on preventive care will reduce overall health care spending is widely believed and often promoted as a reason to support reform. It’s thought that too many people with chronic illnesses wait until they are truly ill before seeking care, often in emergency rooms, where it costs more. It should follow then that treating diseases earlier, or screening for them before they become more serious, would wind up saving money in the long run.
Unfortunately, almost none of this is true.

Let’s begin with emergency rooms, which many people believed would get less use after passage of the Affordable Care Act. The opposite occurred. It’s not just the A.C.A. The Oregon Medicaid Health Insurance experiment, which randomly chose some uninsured people to get Medicaid before the A.C.A. went into effect, also found that insurance led to increased use of emergency medicine. Massachusetts saw the same effect after it introduced a program to increase the number of insured residents.

Emergency room care is not free, after all. People didn’t always choose it because they couldn’t afford to go to a doctor’s office. They often went there because it was more convenient. When we decreased the cost for people to use that care, many used it more.
Wellness programs, based on the idea that we can save money on health care by giving people incentives to be healthy, don’t actually work this way. As my colleague Austin Frakt and I have found from reviewing the research in detail, these programs don’t decrease costs — at least not without being discriminatory.

Accountable care organizations rely on the premise that improving outpatient and preventive care, perhaps with improved management and coordination of services for those with chronic conditions, will save money. But a recent study in Health Affairs showed that care coordination and management initiatives in the outpatient setting haven’t been drivers of savings in the Medicare Shared Savings Program.

There’s little reason to believe that even more preventive care in general is going to save a fortune. A study published in Health Affairs in 2010 looked at 20 proven preventive services, all of them recommended by the United States Preventive Services Task Force. These included immunizations, counseling, and screening for disease. Researchers modeled what would happen if up to 90 percent of these services were used, which is much higher than we currently see.

They found that this probably would have saved about $3.7 billion in 2006. That might sound like a lot, until you realize that this was about 0.2 percent of personal health care spending that year. It’s a pittance — and that was with almost complete compliance with recommendations.

One reason for this is that all prevention is not the same. The task force doesn’t model costs in its calculations; it models effectiveness and a preponderance of benefits and harms. When something works, and its positive effects outweigh its adverse ones, a recommendation is made.

This doesn’t mean it saves money.

In 2009, as part of the Robert Wood Johnson Foundation’s Synthesis Project, Sarah Goodell, Joshua Cohen and Peter Neumann exhaustively explored the evidence. They examined more than 500 peer-reviewed studies that looked at primary (stopping something from happening in the first place) or secondary (stopping something from getting worse) prevention. Of all the interventions they looked at, only two were truly cost-saving: childhood immunizations (a no-brainer) and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were cost-effective, meaning that they cost less than $50,000 to $100,000 per quality adjusted life-year gained.

But all of these analyses looked within the health care system only. If we really want to know whether prevention saves money, maybe we should take a wider perspective. Does spending on prevention save the country money over all?

A recent report from the Congressional Budget Office in the New England Journal of Medicine suggests the answer is no. The budget office modeled how a policy to reduce smoking through higher cigarette taxes might affect federal spending. It found that such a tax would cause many people to quit smoking — the desired result. In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked.
But in the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit — even with the increased revenue from taxing cigarettes.

But money doesn’t have to be saved to make something worthwhile. Prevention improves outcomes. It makes people healthier. It improves quality of life. It often does so for a very reasonable price.
There are many good arguments for increasing our focus on prevention. Almost all have to do with improving quality, though, not reducing spending. We would do well to admit that and move forward.
Sometimes good things cost money.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. He is the author of The Bad Food Bible: How and Why to Eat Sinfully.

====================APPENDIX================

CREDIT: https://www.npr.org/sections/thesalt/2017/11/19/564879018/the-bad-food-bible-says-your-eating-might-not-be-so-sinful-after-all

The Bad Food Bible
How and Why to Eat Sinfully
by Aaron, M.D. Carroll and Nina Teicholz
Hardcover, 272 pages

There are some surprises in your book, like milk isn’t as nutritious as some might think?

This is one of those where, if you just look at nature, we’re the only animal that consumes milk outside of the infant period. Now there’s no need for it. Part of that is politics, and the fact that the United States got involved in promoting dairy and the whole dairy industry. But there’s really no good evidence outside of the childhood period that milk is necessary. One of the things that I tried to state in the book, and this is true of all beverages with calories, you should treat them like you treat alcohol. I mean, what else are you going to do with a good chocolate chip cookie? Of course you need a glass of milk with that. That’s like dessert — it’s something you should have because you want it, not because you need it.

Raw eggs often get a bad reputation, particularly when it comes to cookie dough. How bad are they, really?

The raw egg is another one where of course there is a risk. But you have to weigh that against joy again. The truth of the matter is that if you committed to eating raw eggs in cookie dough once a week every week for the rest of your life, you’d almost never come into contact with salmonella. If you did, you’d almost never get sick. If you got sick, you’d almost never notice. Even if you noticed, it would almost never result in something serious. The chance of you actually getting seriously ill is infinitesimal. … The joy of doing those kinds of things with your kids or enjoying the process of baking is much more satisfying and will lead to greater increases in quality of life than the infinitesimal risk that you’re hurting your health in some way.
So, it sounds like there’s a lot of misinformation surrounding what food is bad for us. What’s your eating advice then?

So I think you know, in general, one thing you can do is limit your heavily processed food as much as possible. Nature intended you to get the appley goodness from an apple, not from apple juice. But the more we can do to smile, to cook for ourselves, to know where our food is coming from, to be mindful of it, the better. But we shouldn’t be so panicked and fearful and constantly believing that if we don’t do what we’ve heard from the latest expert, that we’re going to get sick and die. That is just not true.

Of course, we are staring down the barrel of Thanksgiving, which for many of us can be a moment that produces a lot of anxiety, especially food anxiety nowadays. It just feels like it’s all so fraught. I’m evil if I eat meat. I’m bad if I like Diet Coke. Food is loaded.
It’s also really important, it’s one day a year! Your health and your eating habits are not established by one day a year. It’s perfectly fine to enjoy yourself and to live! You need to weigh — in all your health decisions — the benefits and the harms. And too often we only focus on the latter. And included in benefits are joy, and quality of life and happiness. There are times when it’s a perfectly rational decision to allow yourself to be happy and to enjoy yourself. I’m not sort of giving a license for people to eat whatever they want, anytime they want. Yes, the Diet Coke, the pie, these are all processed foods. So you should think about how much you’re eating them in relation to everything else. But on the other hand, a piece of pie on Thanksgiving is not going to erase everything else you’ve done the rest of the year. Thanksgiving is easily my favorite holiday and it’s not just because of the food, but also because of the meal and the fact that you get to enjoy it with family and friends.

I’ve got to ask you, what are you having for Thanksgiving?

As much as I can cram into my body on that day. But, I love turkey, really well-done turkey. I love mashed potatoes, and stuffing and gravy, and I think pie is the greatest dessert that exists, so I’m sure I’ll be having too much of that as well.

Producer Adelina Lancianese contributed to this report.