About this Video

Reporting AIDS is a recurring series that focuses on the people, policies and issues facing the global community. Shows appear twice a month with in-depth interviews conducted by host John Mikytuck.

Past episodes can be viewed here.

Documentary filmmaker Jay Corcoran captures the impact of AIDS on peoples lives. Corcoran’s three films; Life and Death on the A-List, Undetectable, and most recently, Rock Bottom, track the evolution of the AIDS epidemic since 1993. Corcoran’s films expose the struggles of people living with the disease and shine light on the underlying problems that continue to spread it. John Mikytuck talks with Jay Corcoran about AIDS on film.

• All patients are at risk for receiving poor health care, no matter where they live; why, where and from whom they seek care; or what their race, gender, or financial status is[1]
• Healthcare is increasingly more expensive and less accessible[2], with more than 46 million uninsured in the U.S. from every age group and at every income level, 8 out of 10 being in working families[3]
• There is a knowledge void - the healthcare community is drowning in oceans of information, yet doesn’t know the best ways to prevent health problems and treat them cost-effectively.[4]

In this next series of posts, I will offer an answer to this daunting question: What can be done to drive continuous improvements in care safety, quality and efficiency, which would enable people to remain healthy longer, manage chronic conditions more effectively, and receive the best possible healthcare delivered in the safest and most economical way?

My answer focuses on the creation, use and evolution of valid health knowledge. Why? Because, I contend, the quality of care would improve dramatically and costs would drop precipitously if everyone:

• Knew the best ways to prevent illness, to avoid complications of chronic diseases, and to treat health problems in the most effective and efficient manner
• Used this knowledge to promote wellness, self-management, and recovery
• Participated in evolving this knowledge to make it ever-more useful and effective.

So, what would it take to foster widespread knowledge creation, use and evolution in our healthcare system?

Well, since knowledge emerges from information,[5] it is essential that both consumers/patients and providers have access to useful health information, including patient health data, care outcomes, and evidence-based guidelines. Furthermore, the information must be presented in a way tailored to each persons needs and be made available whenever it’s needed. Unfortunately, this is much easier said than done for many reasons.

One daunting core problem involves exchanging patient data between disparate electronic record systems. After all, knowledge can’t grow and care can’t improve unless patients share their health information with their providers, providers share patient information with each other, and researchers have access to this information to develop evidence-based guidelines. And this must be done in a convenient and secure manner that protects patient privacy.

With cost estimates for developing a national health record system enabling patient data exchange being between $100-276 billion,[6] the question is, why must it be so expensive? Aren’t there any easy, inexpensive ways to do it? Let’s examine these questions.

One way to reduce health information exchange costs is by developing and using standards that promote interoperability between disparate health record systems.

Standards are models, principles, policies, or rules that provide an agreed-upon framework for doing and understanding things. When it comes to health information exchange and knowledge growth, at least two types of standards come into play: data and technology standards. These standards describe how health data are categorized and defined, how health outcomes and healthcare performance are measured, how healthcare knowledge is used, and how different software systems communicate with each other when exchanging data.

In my next post, I examine this double-edged sword of standards, pointing out their benefits and the thorny problems they create.

References:

[1] The First National Report Card on Quality of Health Care in America by RAND Corp (2006)

[2] Health Care Coverage in America: Understanding the Issues and Proposed Solutions by The Alliance for Health Reform (March 2007)

[3] The Current Situation - WellnessWiki

[4] The Knowledge Void - WellnessWiki

[5] DIKUW Blog

[6] Linking Providers Via Health Information Networks by The Alliance for Health Reform (2006) and
Dying for Data by R.N. Charette (2006)

Steve Beller, PhD

Talk Tank is a Women’s health forum that sparks conversations and dialogue between women and marketers. Women want to participate in a forum that includes other women, to hear their experiences, and to learn from them. Talk Tank provides the opportunity to do so.

Talk Tank is a town hall meeting with real women, getting their real, honest perspectives. It is also a participatory WebTV series that explores women’s health issues and encourages women to connect with each other and the guests.

This discussion is from the Talk Tank, a new WebTV series that explores Women’s health issues. To learn more about TalkTank, or to recommend a speaker for our event series or a future guest on the show, please visit the TalkTank web site.

Talk Tank is produced by KC Healthcare Communications and ScribeMedia.org.

KC Healthcare Communications is a marketing and public relations consultancy that helps companies create profitable relationships with the Chief Health Officer today (CHO) today: Women.

Women not only make 80% of the household health decisions, but they influence and advocate for our friends, the workplace, families and communities.

What do we know about women and health?

We’re a team of healthcare advertising, PR and marketing pros who know women, primarily because we ARE women. But, we also have over 50 years of combined healthcare PR, marketing and research experience with major pharmaceutical, advocacy and public health organizations.

KC Healthcare Communications can help brands to get “IN the Loop” and gain an inside edge — through conversations with health-engaged women, the media, and healthcare professionals, we will build your brand’s value.

Talk Tank brings 30 diverse women together to discuss a variety of health issues. Hosted by Kelley Connors and Wendy Borow-Johnson.

This discussion is from the Talk Tank, a new WebTV series that explores Women’s health issues. To learn more about TalkTank, or to recommend a speaker for our event series or a future guest on the show, please visit the TalkTank web site.

Talk Tank is produced by KC Healthcare Communications and ScribeMedia.org.

KC Healthcare Communications is a marketing and public relations consultancy that helps companies create profitable relationships with the Chief Health Officer today (CHO) today: Women.

Women not only make 80% of the household health decisions, but they influence and advocate for our friends, the workplace, families and communities.

What do we know about women and health?

We’re a team of healthcare advertising, PR and marketing pros who know women, primarily because we ARE women. But, we also have over 50 years of combined healthcare PR, marketing and research experience with major pharmaceutical, advocacy and public health organizations.

KC Healthcare Communications can help brands to get “IN the Loop” and gain an inside edge — through conversations with health-engaged women, the media, and healthcare professionals, we will build your brand’s value.

I recently was the Co-Chair of what has been described as a historic meeting at Yale University. This Conference of the Nation’s leading experts on eating, addictions, and obesity discussed the scope of the problem, the scientific literature, and prospects for the future. Clearly, overeating and obesity are major public health problems.

The Surgeon General has even said that these problems are the nation’s number one public health problem. Usually medical experts have focused on the effects of obesity such as the epidemic of type 2 diabetes, knee and joint replacements, cancer, high blood pressure, and gall stones.

Obesity is now a major problem in adolescents and adults and the major treatment, diet and exercise are not changing the epidemic or consequences.

It is like telling people to stop smoking. Sure we new that tobacco smoking caused cancer, heart disease, impotence and other problems. However, that knowledge and association between disease and smoking did little to help people to stop.

Usually, as physicians we think about de-stigmatizing mental or other illness. Oddly enough, stigma and stigmatizing smokers helped. Public policy law and protection of non-smokers helped. Just making it harder to buy cigarettes by removing vending machines and increasing the cost per pack helped. Public health measures were much more effective in reducing teen smoking and smoking rates than any number of medical treatments.

Even if you added all of the medical treatments together, public health approaches were more effective and reduced smoking, death, and disability. Experts at the Yale Conference debated whether addiction models might apply to some people with overeating, binge eating, and/or obesity.

Evidence from animals was presented and clearly sugar is self administered in rodents in a manner reminiscent of a drug of abuse. Withdrawal may even be demonstable to sugar in Princeton University’s Bart Hoebel, Ph.D. group studies. Basic science suggests a great deal of overlap between the messengers used in the brain to reinforce eating and those hijacked by drugs of abuse.

Drugs of abuse increase dopamine release and so does food. Anticipation of food and eating has similar effects. Great food that smells good, feels good, looks and tastes great is highly rewarding and much different than just having a cracker or even beef broth.

Broth is boring and Kobe beef quite unlike it in ability to change mood and behavior. In man, evidence of stirking similarities were reported for drugs of abuse and food in imaging studies using PET and fMRI.

Drugs of abuse and highly palatable food appear to compete in the brain for reinforcement sites so that drugs are more reinforcing during starvation and much less so after eating.

Drug addicts and alcoholics who stop using tobacco, alcohol, cocaine, or any other drug of abuse find that their appetite increases. Overeating and weight gain is so common after addiction treatment that preventative programs of diet, exercise, and counseling are commonplace in most of the Nation’s best drug and alcohol rehab programs. Go to any AA meeting and what you will hear is if you have drug craving, eat.

You also hear never get to hungry or you might relapse.

Clearly, in those prone to alcoholism or recovering from alcohol dependence or addictions, food may be much more drug-like than otherwise. Still, in all of us we can identify that we crave some foods and go to great lengths to get them.

Can someone really be addicted to food or a food addict when everyone eats and food, naturally, must be considered reinforcing lest the species fail to survive. Continued use, harmful use, use more than intended and other Substance Use Disorder criteria are commonly seen in food addicts.

They dream about food and plan meals and eating like an addict plans for drug use. Overeating to the point of physical, social, and occupational harm is common in food addicts. In a culture that can “hunt” or “fish” without expending energy at the market and has the world’s food types at its fingertips, boredom is a thing of the past.

Lets face it, our brains were unprepared by evolution for so much food, such great food, and the brain’s idea of saving for a rainy day makes obesity more likely now than ever.

Medical treatments are years away and bariatric surgery reserved for only those who are so obese that their body fat is going to be their cause of death without it. Prevention — and if that fails early intervention and diet and exercise — are the only current methods which we have available. They can work but they are less reinforcing than eating is.

So, we need group support. We need to go to Overeaters or Weight Watchers meetings or the Gym and get social support and reinforcement from our family, friends, and employers to make it and develop healthy eating and exercise balance and reverse the trend.

Science will help us understand what is happening and help by developing newer and more effective pharmacological treatments. However, fitness is preferable to even successful weight loss and a pill may work for the former but not with the later.

Fitness requires motivation, commitment, and sweat. That is the hard part but well worth the time. Invest in your health and your body and you can spend the dividends as you age.

Mark Gold is a professor and chief of Addiction Medicine at the McKnight Brain Institute

AIDS increasingly affects the young. Half of all people infected by HIV today will be under 25. Todd Murray, 26 and HIV positive, wanted to put a human face and voice to these tragic figures, so he founded Hope’s Voice. Young speakers from Hope’s Voice travel to high schools and colleges sharing their experience of contracting HIV so that others don’t have to.

“If someone had come to my high school from Hope’s Voice, I would have been much safer,” said Kevin, 23. Kevin found out he was HIV positive at 22, the day after he told his parents he was gay. “We had Abstinence Only programs in school and I didn’t know anything about condoms.” Kevin recently became a speaker for Hope’s Voice and thinks sharing his story is a better way of educating young people about HIV than hearing it from a doctor.

Abstinence Only programs are the latest effort by the federal government to stop AIDS among youth. These programs forego teaching condom skills and instead ask young people to abstain from sexual relations before marriage. Abstinence Only programs receive the bulk of federal HIV prevention funding for young people, though they have been repeatedly proven not to be effective.

Critics complain that Abstinence Only programs leave young adults more vulnerable to the diseases they are intended to prevent. When young adults inevitably have sex(over 80% of all teenagers that take a pledge of abstinence fail to maintain it), they don’t know how to use condoms. Abstinence Only programs were initiative by the Bush Administration and received strong support from conservative groups.

Medicine and wellness do not necessarily go hand-in-hand in today’s medical environment. Health care providers and patients are beginning to realize that medicine’s mechanistic approach to healing is far from ideal. The average length of the patient-doctor exchange hovers between four and eight minutes, enough time to write a prescription but not enough time for a comprehensive health analysis.

Working within the prevailing paradigm, health care providers tend to focus on ailments rather than overall health. Health is described in terms of disease, when it’s actually a continuum containing various gradations of both health and illness. Treatments emphasize fixing disease manifestations rather than addressing the deeper causes of disease.

This approach is of limited value, particularly for addressing the chronic illnesses that cause most deaths. Heart disease, for example, may take decades to unfold. With the right kind of intervention, the evolution of such ailments can be slowed, if not thwarted.

Integrating medicine and wellness may require significant changes to the health care system. Physicians need view health as a holistic phenomenon rather than a technical science. Patients must be committed to long term health solutions rather than quick fixes such as prescription drugs.

Advocates of medicine and wellness integration are hopeful that change will come. They are looking to creative insurance policies that make room for preventative medicine and seeking alternative medical settings where patients can receive care that integrates mind and body: medical spas, health club facilities, and alternative models for primary care offices.

This video is from Consumer Health World, May 2007. Register now for the December conference in Washington DC. You will be able to purchase the conference multimedia from the May 2007 conference shortly.

It’s obvious that consumers need valid, understandable information about the risks, benefits and costs of different treatment options. But often that’s not enough. Consumers also need the motivation, resources and skill to comply with chosen plans of care. In other words, they must be mentally, emotionally and physically able and willing to carry out their healthy living strategies, and do it effectively and efficiently.

Obtaining the needed information can be difficult because information found on different web sites, instructional pamphlets and expert opinions often offer conflicting, inadequate, irrelevant, unclear, and/or invalid information. Only 16% of online consumers searching for health information find what they were looking for. Although general search engines perform satisfactorily for generic searches, they may not do well for health queries. [1]

For example, much available information focuses only on conventional treatment options and ignores complementary and alternative medicine (CAM) interventions. Some information sources lack objectivity because they are influenced by advertisers sponsoring them. Some offer general information that is not adequately personalized for an individual’s particular situation. And it’s tough to find clear-cut information that lays out all reasonable options in terms of cost; risks (e.g., adverse side-effects, mortality rates, quality of life impairment, etc.); likely benefits; patient responsibilities; and so on. In addition, an individual’s personal preferences tend to be overlooked.

Another problem is that the mind-body connection is often ignored, even though up to 50% of all visits to a primary care physician are for conditions with affected by psychological factors, and the relationship between emotional stress and physical disease is well established.[2] So, if a person is diagnosed with a physical problem, related emotional/psychological issues are rarely addressed, and visa versa.

Furthermore, consumers can be overwhelmed by having to navigate through web sites with hundreds of links, or read search engine returns that can easily total in the tens of thousands to hundreds of thousands.

And one more thing, consumers often need to have conversations with subject matter experts-including knowledable peers and professionals-in order to have their questions answered and to receive hands-on guidance and encouragement. Sometime reading written materials, listening to tapes, or watching videos isn’t enough.

I suggest, therefore, that the best way to give consumers what they need is to implement a consumer-focused strategy with the following tactics-and do it in an easy, secure way that protects personal privacy:

• Perform comprehensive, lifetime health status and risk assessments that examine the “whole-person,” including psychological and biological factors, environmental influences, and personal preferences and abilities.
• Use the results of the assessment to provide personalized “information therapy” that gives a clear explanation of people’s existing conditions and risks, offers a risk-benefit analysis of both conventional and CAM treatment options, and gives instructions for adhering to healthy living strategies.
• Offer targeted, interactive, decision-support and problem-solving tools that assist people in making good choices and dealing with troubling issues likely to prevent treatment compliance, in order to replace stress, denial, depression, anxiety, etc. with effective coping skills and proactive behaviors.
• Focus on well-care (illness prevention, health optimization, recovery from health problems, and health self-maintenance).
• Connect people with vetted peers and professionals who share experiences and ideas, ask and answer questions, and give emotional support.
• Take the time to examine motivational issues and offer meaningful support and incentives.
• Offer alerts and reminders to increase awareness of what to do and when to do it.
• Make sure care is coordinated when multiple providers are involved (e.g., primary care and specialists).

We propose need, then, are collaborating networks of peers and professionals who use a next-generation Personal Health Application (PHA), which differs considerably from today’s personal health records (PHRs) and health information web sites.

Steve Beller, PhD

References:

[1] “Health Information Search Engines Emerge; Growing Consumer Demand for Health Information Increases Need for Better Quality, More Personalized Searches, Says Expert at 11th World Congress on Internet in Medicine.” Internet Wire (Oct 18, 2006).

[2] WellnessWiki

40,000 new cases of HIV are transmitted each year in the U.S., according to the Centers for Disease Control and Prevention (CDC). Over the last five years, public health officials have been challenged to reduce that amount by 50 percent.

To meet that goal, a new and unique strategy is redefining the idea of prevention.

Prevention with Positives is an HIV prevention program that targets those already infected with HIV.

“People realized that it takes a positive person to infect a negative one,” said Greg Cardona, Co-Director of Better World Advertising, a company specializing in social marketing campaigns. “Prevention with Positives provides support for people infected with HIV that are challenged by a variety of issues that could lead to bad decisions,” said Cardona.

One of the biggest issues still facing people that are HIV positive is stigma, according to Cardona. Twenty years into the AIDS epidemic, those infected by HIV face being ostracized by family and friends if they disclose their HIV status.

“Stigma keeps people from seeking medical care even though they know they are HIV infected,” said Cardona.

HIV Stops With Me, a Prevention with Positives social marketing campaign, was created by Cardona’s company in 2000. It uses the stories of HIV infected individuals to promote prevention messages and behavior change that address some of their issues.

Delano, one of the campaign’s models, has been used since 2006. A native of Haiti, Delano was in a committed relationship when he was diagnosed with HIV.

“I didn’t feel empowered to ask my partner his HIV status,” said Delano. “Getting HIV was a wake-up call.”

Cardona and Delano join us for an honest discussion of Prevention with Positives

After watching the show, please share your thoughts on this controversial prevention strategy. The comments section below the video should provide enough room.

Wendy Borow-Johnson, President of The Healthy Living Channel, sat down with Kathy Gruttadauria, show manager of the International Spa Show in New York to talk about some of the most important trends in the spa industry. The biggest trend is the interest in wellness and the medical spa field. Another trend in the market is a move torwards natural product lines. Consumers are educated about products and want to put natural ingredients on their bodies.

What trends are you seeing in the spa market? Leave a comment below.