A New Source for Flu Data-Google Flu Trends

November 17, 2008

Google.org recently launched a new source for flu data called Google Flu Trends.  Flu activity is estimated by the number of Internet  searches  for flu information.  This may correlate with the number of people  having flu like illness.  CDC and states now  collect data from outpatient visits for  flu like illness, laboratory reports of specimens testing positive for influenza, as well as reported outbreaks of influenza.

According to Google.org, they were able to estimate the 2007-2008 flu activity 1-2 weeks faster than CDC published reports.  Some states monitor daily influenza like illness activity through  syndromic surveillance which may be more timely than the published CDC reports.  Also some state health departments  are  looking at  data on over the counter medication sales.

Early warning allows state and local health officials to put into effect prevention and control activities as well as help people take appropriate precautions if flu is in their area.

The unique aspect of the Google flu surveillance is that it looks at the both the population that is seen by a clinician and those that are not seen by a clinician  for their symptoms.

Google.org adds to the growing sources of  innovative sources of health data such as ProMED-mail and Healthmap and I applaud their efforts. It will be interesting to follow this  data through the coming flu season and determine how it can be used to benefit health.


Prevention Platform – Obama-McCain Comparison of the Health Care Issues

October 4, 2008

The Kaiser Family Foundation has a new resource on its health08.org web site detailing Sen. John McCain’s and Sen. Barack Obama’s positions on key health care issues.  The side by side comparison focuses on issues not necessarily addressed in their health care reform proposals compiled from the candidates’ web sites, speeches and campaign debates.  These issues include:

  • Biomedical Research
  • Care Coordination and Prevention
  • Health Care Reform
  • Health Information and Technology
  • HIV/AIDS/Global Health
  • Long-Term Care
  • Medicaid and SCHIP
  • Medical Malpractice
  • Medicare
  • Mental Health Parity
  • Prescription Drugs
  • Racial and Ethnic Disparities
  • Transparency and Comparative Effectiveness
  • Veterans’ Health
  • Women’s Health

Under the heading of Prevention, Senator McCain

“believes individuals should do everything possible to prevent expensive, chronic diseases, and that parents have a moral obligation to educate their children on healthy lifestyles.”

I would like to know how he plans to accomplish these goals.  Other than advocating that businesses and insurance companies  promote the availability of smoking cessation programs and funding research on chronic illness prevention, he has little to say about how individuals and families can accomplish disease prevention.

Senator Obama, on the other hand, would require federally supported health plans to cover essential preventive services such as cancer screening and smoking cessation programs so individuals and families can have access to these services. He  would increase funding to expand community based preventive interventions. He  would work with schools to create more healthful environments for children with  school based health screening programs and clinical services as well as  increased support for physical education and educational programs for students.  His plan supports expanding and rewarding work site health promotion and prevention.  I see his plan as more than just  hoping that “individuals do everything possible to prevent chronic diseases”.

McCain Obama Health Care Plans

August 21, 2008

Jonathan Oberlander, Ph.D. has written an excellent review of the candidates plans for healthcare reform in the recent New England Journal of Medicine. The article includes a succinct comprehensive summary of both candidates’ key elements for health care reform. His main criticism of the McCain plan is

” its reliance on the individual insurance market.”

“In contrast to John McCain’s emphasis on markets and deregulation, Barack Obama’s reform plan relies on an employer mandate, new public and private insurance programs, and insurance market regulation.”

Health care reform will be an important issue in the coming election and this article is a must read.

Presidential Candidates’ Health Care Reform Proposals

June 11, 2008

Health care will be a top priority in the next presidential campaign. As the candidates consider affordable heath care for every American, I hope they do not lose sight of public health and the huge achievements that have improved the health and extended the life expectancy of persons in the United States.

According to Senator McCain in response to an set of ten questions posed by the AMA to the candidates about their health care reform proposals.

“The most important players in health care; however, are the patient and their health care provider-as everyone else merely plays a support role”

I would like to remind Senator McCain of the Ten Great Public Health Achievements in the U. S. -1900 to 1999 which include:

  • Vaccination
  • Motor-vehicle safety
  • Safer workplaces
  • Control of infectious diseases
  • Decline in deaths from coronary heart disease and stroke
  • Safer and healthier foods
  • Healthier mothers and babies
  • Family planning
  • Fluoridation of drinking water
  • Recognition of tobacco use as a health hazard

Public health is a major contributor to the health of Americans and not “merely a support role”. Public health at the federal, state, and local level plays a critical role in disease prevention and health promotion.

Drugs – Country of Origin and Safety

April 26, 2008

Are the pills you take as safe as the food you eat? I can peel my imported fruit but I must swallow my pills without washing or peeling.

There was an interesting article in the Wall Street Journal about the country of origin of pharmaceutical ingredients.

“Indeed, the FDA requires drug companies to disclose only the name and place of business of the manufacturer, packer or distributor of prescription medications. Active and inactive ingredients must be listed on the label, but not the raw materials or their origins, which are considered “commercial confidential.”

Since the FDA does not have the resources to inspect all overseas facilities that manufacture ingredients, it is up to the pharmaceutical companies to ensure good manufacturing practices. The recent contamination found in the blood thinner heparin supplied by China shows that this system does not always work.

According to a recent article in the New England Journal of Medicine (NEJM) Trying Times at the FDA – The Challenge of Ensuring the Safety of Imported Pharmaceuticals by Stuart O Schweitezer, Ph.D

“This sort of problem should theoretically have been prevented by the FDA, which inspects foreign factories producing drugs and chemical components that are intended for export to the United States. Investigations are continuing, but preliminary information shows that the FDA did not inspect the plant, though it had intended to do so. The FDA’s program for inspecting foreign drug manufacturers has been swamped by a rapid increase in overseas manufacturing of both finished drugs and chemical components. The FDA has a mandate to inspect producers of both drugs and chemicals used to manufacture drugs (active pharmaceutical ingredients, or APIs) in order to certify that plants meet the current Good Manufacturing Practice (GMP) standards. Data on the number of foreign drug and API manufacturers are difficult to obtain. The FDA uses two databases listing foreign plants that are subject to inspection. According to a 2007 report by the Government Accountability Office (GAO), one database lists approximately 3200 establishments, whereas the other lists 6800.3 Even if the smaller number is accurate, the agency inspects only approximately 7% of foreign establishments in a given year, meaning that it could take at least 13 years to inspect them all — once. The FDA cannot say how many foreign plants have never been inspected.”

The pharmaceutical industry is increasingly using foreign plants and ingredients. The burden on the FDA to ensure that the drugs we take are are safe and pure is daunting. So what is the solution to this problem?

In a recent NEJM article Allastair J.J.Wood M.D. has a very reasonable suggestion.

“We need to acknowledge that ensuring the safety and integrity of our food, drugs, cosmetics, and medical devices is primarily the responsibility of manufacturers, with the FDA providing a regulatory framework and oversight. It is also critical that legislators recognize their responsibility to provide the agency with funding that is adequate for it to perform its important functions.”

“No longer should manufacturers be able to imply that inadequate FDA inspection is an excuse for adulteration of their product during manufacture. We must stop allowing the game of “kick the FDA” to be risk-free to participants. The public’s health is at stake, and the time for adequate federal funding of the FDA is now.”

Cooperation in the Healthcare Industry

April 1, 2008

After being grounded in Atlanta during the recent safety inspection of Delta’s MD88 planes, I asked the ticket agent if she could book me on a different airline. She told me that Delta had no arrangement with competing airlines for such situations.

In my area all hospitals have signed a memorandum of understanding (MOU) to assist each other in a medical disaster. They all sit at the table and develop cooperative disaster plans. Despite the fact that there are several competing health organizations, they realize that no one wants their ” market share” during an emergency.

Perhaps the airline industry could learn a lesson from the health care industry.

Patients Rate Hospital Care

March 19, 2008

After my last post, Compare Your Hospital, I was asked about patient input on the care they received in a hospital. Several hospitals collect information on patient satisfaction but it was difficult to compare data since previously there was no standard questionnaire. The same organizations that developed Hospital Compare have also developed a hospital survey for measuring patients’ perspectives of hospital care. It is composed of twenty questions about aspects of the patients’ hospital experience such as:

  • communication with doctors
  • communication with nurses
  • responsiveness of hospital staff
  • cleanliness and quietness of hospital environment
  • pain management
  • communication about medicines
  • discharge information

In addition patients are asked to rate the hospital from 1-10 and if they would recommend the hospital to friends and family.

The survey should provide a meaningful comparison of hospitals from the patients’ perspective and public reporting should be an incentive for hospitals to improve.   Results of the survey should appear on the Hospital Compare website in March 2008.