Month: January 2014

The Art of Denim and It’s Not Levi’s

I have a jean crush on this Pointer Brand. (You MUST check out the videos of music at the factory). Pointer Brand is a TN company manufacturing American made seriously great jeans heavy duty etc. etc. Worth the visit to see what they have but the videos are precious. 

So Pointer Brand is highlighting something called American Original Blue Jeans – Raw White Oak® Cone Denim® Okay I give up, what is cone denim? I went to find out about Cone Denim. It turns out Cone Denim is a company that has been suppling denim since 1891. The find on this site are two videos. One is video it looks like its from the 40s? Very interesting and a candid look back to another America. The other is a hipster Brooklyn video of their products. Interesting as well. 

Sometimes when you step away from the usual sites and reading you find small gems. I forgot what’s like to just drift around the web discovering. 

Where Are You Going My Darling Young One?

Bryan Vartabedian, MD writing at 33 Charts examines “When Push Comes to Shove: The Slow Death of the Medical Blog-o-sphere” at Dr. Wes blog. Vartabedian post is “The Implosion of the Medical Blogosphere” and from his view there are more physicians on-line but they are residing in communities specific to their needs. He agrees with Wes that “their presence is less about doctorly togetherness and more about personal presentation.” Life is one HUGE stage. Further Vartabedian points to the new world of video and microblogging as well as the fact most are not creating but curating.

He closes with this which I agree with

So while the blogosphere of the early-mid 2000’s may be part of history, I don’t think public doctors are going away.  We just share, create and relate differently.

So can we move those new relationships to patient engagement? 

Malpractice Reform is Not a Cure to Our Healthcare Mess

I’m gobsmacked at how Aaron Carroll find, reads, and comments on as much as he does and how he takes a deep dive so succinctly. This is one example “Some sober thoughts on malpractice reform“. He read a manuscript in Health Affairs “Let’s Make A Deal: Trading Malpractice Reform For Health Reform“

In part he quotes the following

To obtain relief from malpractice liability, physicians may be willing to accept other policy changes that more directly improve access to care and reduce costs. For example, the American Medical Association might broker an agreement between health reform proponents and physicians to enact federal legislation that limits malpractice liability and simultaneously restructures fee-for-service payment, heightens transparency regarding the quality and cost of health care services, and expands practice privileges for other health professionals.

He further quotes from a key passage:

By contrast, decades of scholarship and empirical research suggest that malpractice liability acts only at the margin of health policy, where in relatively small ways it may both protect patients from negligent care and induce inefficient health care spending. (See the online Appendix for a more detailed summary of research on the malpractice system.) Physicians’ clinical decisions, on the other hand, are responsible for roughly two-thirds of total health spending. Physicians determine the quantity and quality of medical services and heavily influence the price paid for them. Research has revealed that far more of this spending is wasteful than can reasonably be attributed to liability pressure alone.

Check out Aaron Carroll, MD look at this topic, The Incidential Economist. He recommends reading the full article. It’s behind a pay wall and I am a cheap dude right now. But more importantly this is a new way to look at malpractice. A rather interesting and important step in this tort reform insanity. 

The Good Old Days of Marketing and Advertising: Re-Modeled for Big Data

The best marketer, strategist, advertising thinker online DigitalTonto offers up his take on where advertising and marketing need to go in todays big data love fest. His post “Why Most Marketers Will Fail In The Era Of Big Data“. Walks us through the heyday advertising Leo Burnett to big data.

Leo Burnett and Marlboro is a success story built on the back of guts and instinct. Those of us from the day know this story and even though it is for poison the reality is clear you can move from “worst to first”.

Greg reminds us of New Coke and what that ended up being. F L O P Yet it was tested with over 200,000 consumers who voted it a winner. (Reminds me of a brand manager who said he didn’t want us to use green on an ad because his wife didn’t like green.) Well the truth was no one wanted ‘real’ Coke taken away.

Lest we forget planners, those in the agency who would research the shit out of the consumer to enhance the creative product. They offered up the likes of ‘professional men’, ‘young aspires’, etc. As Greg shares planners suffered confirmation bias. So much for the human condition and data.

Today we are moving toward simulation marketing where data is analyzed by machines. It is the application of BIG data into marketing decisions to identify what to do, say, pitch, at various segments. Greg points out that we are no longer Leo Burnett’s but (a new word for me) growth hackers. But the following is where he sees this marketing world and us inhabiting it:

In fact, he points [Andrew McAfee] to research which shows that rather than trying to use data to inform our judgment, we would do much better by putting our energy into building better models, but taking their answers at face value.  Applying our own subjective judgment after the fact is much more likely to worsen results than it is to improve them.

I am not so sure that we have to do that, you know close our eyes fall back and trust someone will catch us. I am not a Luddite and I believe that we can take what the machines tell us and massage meaning and color and shading and messaging and strategy and a headline and a graphic from it. We need to work in parallel with the machines and the big data. To this point a good trusted and very smart friend had this response to Greg’s post:

So essentially no one has to actually think anymore, no one has to exercise judgment or insight or perception, they just have to be able to push the “start” button.  Hitchhiker’s Guide to the Galaxy: the answer is 42.  Perfect for today’s crop of spoiled, insolent, lazy-minded students.  The computer nerds win.  Civilization is totally, totally fracked.

Makes you glad we’re old and useless, rather than young and useless which is what we would be today, where the mantra is do not think, force not accommodate, and make war not love.

My take on this, my friend is right we can not surrender at least those of us who think and have experience. We can be Leo with the help of the machines. Perhaps even better but the issue is those to control the creative product in advertising and marketing are not creatives but that is whole long rant. 

Virtual Patient: Real Learning for Medical Students in Primary Care

Salminen, Zary, et. al submitted an original paper in JMIR “Virtual Patients (VP) in Primary Care: Developing a Reusable Model That Fosters Reflective Practice and Clinical Reasoning“. 

The authors were looking to create a virtual patient model for the primary care setting that would drive reflective practice and clinical reasoning. The virtual patient they sought to create included embedded process skills applicable to the primary care setting. 

Using virtual patients in medical education is not new. It has been used in all stages of a medical students learning to teach communication skills, patient focus, clinical reasoning, and reflective learning. What the authors note as lacking are reports on how to design and use VP within the primary care setting. 

The model the authors build they embedded ways to promote meaningful learning such as reflection, clinical reason, and in depth subject knowledge. This was accomplished with open-ended questions and free-text answers as well video clips. Students worked these cases independently without help from teachers it is self-directed and at their own pace. 

What struck me about this study is how they authors approached this. They built the VP around adult learning and not how can we cram as much knowledge as possible into a student and how do we do this around primary care. Using adult learning theory primarily Kolb and Schon’s reflection and change they found unsurprisingly students responded  positively and were able to apply new knowledge to their understanding of medicine. 

It would be interesting to see how a VP can be build around current epatients and their behavior as active learners and participants in their healthcare. Can a VP be used to demonstrate how to engage patients better and improve communications skills of those physicians well past medical school. 

Caregiving: Take a Tablet and E-Mail My Family

Jennifer Hicks a contributor at Forbes wrote a piece on simple tablet/technology for in home caregivers. It is called the Betty Care Tablet. This is a point-of-care system to help in home caregivers focus on patients and not paper work. Yup yup and more yup the world and in particular the US has a bolus of rapidly aging individuals with an estimated world population of 65+ to be 523 million in mid 2010.

Hicks shares the implementation of The Betty Care Tablet by Caring Senior Service. There goal is to reduce or eliminate abuse, neglect, and theft of the in-home care industry. This will be done at no cost.

The Betty Care Tablet designed for private duty home care agencies. The caregiver uses the tablet in the home setting for tasks such as scheduling, daily logs, and alerts with the office without paperwork. Families with internet access can log in from any mobil device for real-time updates.

Betty Care identifies the ability to easily update care plans based on need and goals. Changes are pushed to the tablet without delay all the while tracking real time activity feeds with weekly and monthly reports so the family is up to date.

On the Betty Care site they address the salient point of the idea, differentiation from other in-home caregiving organizations. Information can be collected, with notes and forms with checkboxes with easy to publish to the corporate portal.

I like the idea and would be interested in knowing levels of satisfaction from family members as well as if reports are sent to the PCP for chart update?

One other point to consider. Austin Frakt writing at The Incidental Economist stepped back to look at health insurance in America in an excellent piece “Stop rearranging deck chairs and focus on the engine room“. His primary point we need to examine healthcare delivery where 80 cents of each dollar ends up in the delivery system. Is Betty Care improving delivery? I think it is and I think this point to new business ideas across the spectrum of our healthcare system. 

Twenty Years Later We Wonder if Harm Was Done? Huh?

Bill Gardner writing on The Incidental Economist examines an article in the NY Times “A.D.H.D. Experts Re-evaluate Study’s Zeal for Drugs”. The study completed twenty years ago was named Multimodal Treatment of Attention Deficit Hyperactivity Disorder. It was free of pharmaceutical money, fully funded by NIMH and well controlled. It compared community care, high quality behavioral treatment, medication following evidence-based guideline, or behavioral treatment and medication. It ran for 14 months. But it became the single most important paper to support the pharmaceutical management of ADHD.

The conclusion of the researchers was:

Combined behavioral intervention and stimulant medication—multimodal treatment, the current criterion standard for ADHD interventions—yielded no significantly greater benefits than medication management for core ADHD symptoms; this parallels findings reported by others.

Today the authors of the MTA study question if their validation of medication-only may have harmed children in the long run. 

This study was not done in the 50’s and these researchers are well regarded leaders in the medical community. Could they have considered what they are seeing now. Or more likely, they are seeing the reality of their work played out over time as demonstrated in an investigative piece by the NY Times “The Selling of Attention Deficit Disorder“. What will be our collective 20/20 hindsight in 2033? Or perhaps with the Internet and more and more open access to data we are seeing a change. We are all getting collectively smarter and more attuned to our healthcare footprint.