HEALTHY ONLINE

Sometime during the last year of the second millennium, I wrote my last letter in response to the last letter I have ever received. It’s been email ever since. I don’t recall making a conscious decision to stop writing letters. It just happened. I cannot pinpoint the exact date when my work memos, agendas, proposals and various notes, disappeared from my desk as if swallowed whole by my laptop. They just did. I still have lots of papers lying around, but I recently noticed that I don’t have any pens. Now, I will let you in on a little secret. I can’t type. I have written tens of thousands of lines of code, thousands of emails, business plans, presentations, contracts, white papers and blogs, typing with one finger. I like it this way. I use everything Microsoft Office has to offer, but only ten percent of functionality, or maybe even less, and I use it all day long. I don’t know anybody that uses computers the way I do. There are times when I have to interact with proprietary software ...

Long ago and far away, at the conclusion of a worldwide armed conflict, the winning side was shaken to its moral core by the discovery that massive and cruel medical experimentation has been routinely conducted on human beings.  The perpetrators were brought to trial and the verdict included not just punishment for the guilty, but also a message for posterity intended to prevent future atrocities. It was a code of ethics, very brief and written in plain language, and it was named after the city where the trials were held. The Nuremberg Code eventually became the basis for U.S. federal laws governing research on human subjects and known today as the Common Rule . The first article of the Nuremberg Code is about consent: “The voluntary consent of the human subject is absolutely essential.  This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element o...

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Wanted: White knight (shiny amour optional) to save us from ourselves and the wretched lifestyles we choose. Your coffeemaker went dead on you this morning, and while lamenting your drowsiness at work, your friend Denise mentions that she just bought a new coffeemaker at Target and she absolutely loves it. You take your coffee the same way Denise does, black, strong, and all day long, so you decide to buy one for yourself. You are a busy professional and you don’t have time to go to Target, search for a good parking spot, walk to the store, walk around until you find the small appliances, pick it up, stand in line, walk back to the car, struggle to back out from the too narrow parking space, and drive home through congested intersections. It could easily take half an hour out of your already busy day. So you decide to buy it online in the evening. You get home, feed the kids, answer a couple of urgent emails from your boss, and after everybody goes to bed, you settle down to finish tho...

There is a new report out from the Congressional Budget Office (CBO) titled “ The Slow Recovery of the Labor Market ”, and as its title implies, it predicts a slow recovery from a labor perspective. Among other things, the CBO report is now making headlines in the political game of Obamacare because it forecasts a 2.5 million job reduction by 2024 due to the effects of the health care law. You should read the report itself (it’s not very long and it has lots of pictures), because it is practically impossible to find objective coverage of its contents in today’s media, which is full of ideology driven experts and completely devoid of old school reporters. I don’t know about you, but I for one am growing tired of the incessant drumroll crediting or blaming Obamacare for everything from the price of gas at the pump to the demise of penguins in Argentina, so let’s show some magnanimity and absolve Obamacare from, at least, the following 10 naturally occurring phenomena. Number 10: The CBO ...

Meaningful Use Stage 2 is now on the clock. Three years after the program began in 2011, and a year later than originally planned, the escalator has finally moved up one level. Surprisingly, the usually boisterous and highly hyped health information technology (HIT) media is largely silent on the subject. It’s almost like everybody gave up, or perhaps the entire Meaningful Use exercise is now assumed, and the buzz has shifted to sophisticated analytic apps, preferably mobile, that will utilize all the big data collected by EHRs to perform medical or fiscal miracles. Of course, the best engineered and the sleekest looking Ferrari cannot run without fuel, and since Meaningful Use participation is the fuel for all the cutting edge innovation floating around in the intelligent apps market, it may be useful to take a quick look at the Meaningful Use state of affairs for 2014. Let’s get some numbers laid out first, so we can have an informed discussion. According to CMS , back in 2011, the f...

I like reading Dr. Kevin Pho’s blog . I read, or at the very least scan, his diverse collection of essays every day. The posts themselves are mostly good, but I like reading the comments section more, and most of all I like the anonymous comments, because those are rare insights into how regular, everyday doctors think. I read Health Affairs and JAMA and NEJM and the New York Times to figure out what “thought leaders” say, and medical associations’ websites for “leadership” messaging. And guess what? The anonymous, and sometimes not so anonymous, opinions of the rank and file are diametrically opposed to official party lines. Of course, most doctors don’t read or comment on blogs, don’t speak at conferences and don’t write opinion pieces for mass media outlets. Over the years, I spoke with many members of the silent majority, not a representative sample by any means, but a good indicator that anonymous commenters are closer to being representative of popular opinion than their much mor...