Tami Flu

If employers have their say, your patients soon may become more interested in their health, turning to you for everything from stress management to healthy eating habits.

More than 83% of the nation's employers currently use health risk assessments to make employees aware of health risks as a way to encourage more prevention. A study released in July by Forrester Research Inc. showed signs that the assessments might have an effect on patient behavior, but the study's author says there's still a way to go before they have a measurable impact on health care costs.

The study, "What Consumers Do With Health Risk Assessments," found that 17% of employees who take the HRAs usually discuss the results with a physician and that 8% enroll in some type of structured wellness program designed to address a specific risk. The survey of 5,036 commercially insured people was conducted in October 2007.

Some experts say those percentages are good, given that more than two-thirds of the population is generally healthy. But study author Elizabeth Boehm, principal analyst in the Customer Experience for Healthcare & Life Sciences division of Forrester, said it could be better because "just about everyone has some behavior they could improve."

"The biggest issue is certainly the catastrophic health care costs, especially if you are large and self-insured," Boehm said. "But [employers] are also looking at issues such as productivity and absenteeism, and those are [affected] by fairly minor healthy behaviors like getting enough sleep or eating better."

[...]

Former UnitedHealth Group Chair and CEO William McGuire, MD, has agreed to forfeit another portion of the fortune he amassed during the 17 years he led the company, settling with investors in a lawsuit over alleged stock-option backdating.

Under the agreement, Dr. McGuire will pay $30 million to United investors in a class-action lawsuit led by a California pension fund and will surrender options to purchase 3.65 million shares of stock granted between 2003 and 2005. At mid-September's stock prices, those shares would be worth about $100 million. The case had been set for trial in September.

"In effect, this was an example of runaway executive compensation," said Peter Mixon, general counsel for the California Public Employees' Retirement System (CalPERS).

The CalPERS agreement is the third settlement involving the former CEO regarding alleged improper stock option backdating.

Backdating, the practice of retroactively assigning the grant date to a day the stock was at a low value, allows for automatic profit when options are sold at a higher price. It is not illegal, but investors are supposed to be informed when a company backdates stock options.

United already had agreed to pay $895 million to the same plaintiffs and is awaiting final approval of that deal by a federal judge. Former United General Counsel David Lubben also settled, paying $500,000 to plaintiffs.

Dr. McGuire did not admit wrongdoing; nor has he done so in any previous settlement. In a December 2007 settlement with the Securities and Exchange Commission, Dr. McGuire agreed to pay the SEC a $7 million fine, return $11 million in what the SEC called "ill-gotten gains," plus $1.7 million in interest, while also returning stock options and cash to United.

[...]

A pair of studies looking into the proposed merger of Highmark Inc. and Independence Blue Cross gave no clear answer to the question of whether the state's insurance deparment should approve the deal.

A report from LECG Inc., an Emeryville, Calif.-based company that offers expert testimony and analysis, said whether state law dictates that consolidation not be approved depends on how market share is defined. Another, by New York-based international financial consulting firm The Blackstone Group, was not conclusive as to whether the deal would fail to benefit policyholders and hurt network access. Blackstone said it had found no evidence that it would but noted that further data could change that conclusion.

The reports reflect the various definitions that regulators, experts, physicians and the plans themselves have offered in debating whether a Highmark-Independence merger should be approved. The Pennsylvania Dept. of Insurance commissioned the reports, released in early September, to help determine if it should approve the deal.

"In terms of the definition of what a market share is, the answer is going to be a combination of fact and interpretation of law," said Melissa Fox, a spokeswoman for state Insurance Commissioner Joel Ario. "Everything on the table will be considered."

The LECG report said that, assuming the two compete in a statewide market and using premiums as a measure of market control, the consolidated firm would have too large a market share as defined by the state statute that applies to mergers.

[...]

There are two papers out on science and medical blogging. The first is concerned with medical blogging, and I vaguely remember filling in the questionnaire some time ago. It is also reported on the blog of one of the authors, who also makes good use of lecture slides. There’s some interesting findings although the relatively small numbers, due to a response rate of 42% may make these results atypical. Ironically, given the media track record in science reporting, this is from a section entitled Journalistic Activities.

More than half of the responding medical bloggers have published a scientific paper (43/80, 54%), 35 (44%) bloggers have published a book or a chapter in a book, and 32 (41%) have published a newspaper article. Highly educated bloggers were more likely to have published a book or a chapter in a book (50% vs 14%, 21= 6.19, P= .01) and a scientific paper (62% vs 21%, 21= 7.57, P= .08) than those with lower levels of education. When it comes to best practices associated with journalism, the participants most frequently reported including links to original source of material and spending extra time verifying facts, while they rarely tried to obtain permission to post copyrighted material.

Female medical bloggers were found to get permission for posting copyrighted material more often than male bloggers (U= 386, n1= 25, n2= 44, P= .03). Bloggers who have published a scientific paper were more likely to quote directly other people or media than those who never published such a paper (U= 506.5, n1= 41, n2= 35, P= .016). Blog writers who were blogging under their real name were more inclined to include links to original sources than those writing under a pseudonym (U= 446.5, n1= 58, n2= 19, P= .01).

Kovic I, Lulic I, Brumini G
Examining the Medical Blogosphere: An Online Survey of Medical Bloggers
J Med Internet Res 2008;10(3):e28
http://www.jmir.org/2008/3/e28/

The second paper is about the role of blogs in academic science, and is effectively a call for institutions to engage with blogs as a new communication medium, although there are potential problems with the natural tendency of institutions wishing to control their public image, and the perhaps inhibitory consequences of blogging becoming part of a job, rather than a personal altruistic outpouring. I fully agree with this statement:

Scholarly journal articles are not intellectually accessible to most of the population, and are often behind an expensive pay-wall. Conversely, science blogs are freely accessible, interactive, and are generally written for a lay audience. Although only a small percentage of the 38% of 12- to 17-year-olds who read blogs may be reading science blogs, blogs clearly have the potential to reach an age group where excitement about a future career in science could be ignited. An excellent example of an educational, fun, and accessible science blog is The Panda’s Thumb, where evolutionary biologists tackle questions about evolution in easy-to-understand ways, and science teachers are an important part of their audience (http://www.pandasthumb.org/).

Batts SA, Anthis NJ, Smith TC (2008) Advancing Science through Conversations: Bridging the Gap between Blogs and the Academy. PLoS Biol 6(9): e240 doi:10.1371/journal.pbio.0060240

I happen to have a copy of The Ascent of Man by Jacob Bronowski, a book that tied in with the television series of the same name. Bronowski was quite keen on the television as medium for intellectual improvement, as this extract from the foreword of The Ascent of Man shows:

Discoveries are made by men, not merely by minds, so that they are alive and charged with individuality. If television is not used to make these thoughts concrete, it is wasted.

The unravelling of ideas is, in any case, an intimate and personal endeavour, and here we come to the common ground between television and the printed book. Unlike a lecture or a cinema show, television is not directed at crowds. It is addressed to two or three people in a room, as a conversation face to face - a one-sided conversation for the most part, as the book is, but homely and Socratic nevertheless. To me, absorbed in the philosophic undercurrents if knowledge, this is the most attractive gift of television, by which it may yet become as persuasive an intellectual force as the book.

Evidence suggests we are some way from this utopian hope for television:

As Charlie Booker says:

The first time you see the wall appearing and get a sense of how it works, I guarantee you’ll laugh out loud. Then it happens again. And again. And again. And then you realise there’s little or no varition: that’s all that happens, for the full half-hour. You’re watching celebrities being knocked into a pool, over and over, while the audience shrieks and applauds, and it all starts to resemble not just a dumb gameshow, but an almost nightmarishly dumb gameshow, the sort of gameshow you’d find in a dystopian science fiction film about an insane futuristic society. And you have to hold your head to quell the giddiness.

That’s how dumb it is.

In the end Booker gives the Hole in the Wall a get out of jail card. It’s for charity. It’s not the death of civilisation, but a bit of daft fun. The problem isn’t the dumb material, it’s the lack of intelligent material. When has television matched The Ascent of Man in the 35 years since it was broadcast? Perhaps, the only things to come close are David Attenborough’s series on nature. If the Ascent of Man was made now, an unlikely event, it would be hosted by an ex-python or a celebrity. Even when an “expert” is employed the results are usually dumbed down or seeking a shock factor. Radio 4, at its best, does a much better job than television when it comes to the intellect. Resources like TED on the internet provide far better material than you will ever see on television. Television is essentially a dumb media.