Monday, April 30, 2007
Sunday, April 29, 2007
Ethics and Global Health
What can I say? This is definitely a very heated subject.
Dr. Shahi said in his lecture, "We have the power to change species. We have the power to alter genetic make-up of individuals and organisms. We have the power to destroy ourselves. Should we be trusted with such power?"
I think we should. These powers have potential to bring life altering improvements. Call me optimistic if you want, but I do have faith that we are all good to most extent, especially if we will feel the impact.
A code of conduct definitely provides guidance in making responsible decisions. Though there are some that take a code of conduct lightly, there are the majority that take it to heart and for those, it definitely steers actions in the right direction.
Dr. Shahi said in his lecture, "We have the power to change species. We have the power to alter genetic make-up of individuals and organisms. We have the power to destroy ourselves. Should we be trusted with such power?"
I think we should. These powers have potential to bring life altering improvements. Call me optimistic if you want, but I do have faith that we are all good to most extent, especially if we will feel the impact.
A code of conduct definitely provides guidance in making responsible decisions. Though there are some that take a code of conduct lightly, there are the majority that take it to heart and for those, it definitely steers actions in the right direction.
Saturday, April 7, 2007
The Changing Role of the Private Sector in the Global Health Arena
I think the key to improving global health is increase involvement of the private sector. The private sector has so much to offer. The private sector should definitely contribute to global health but whether we can call "mandatory 10% profit donation" a donation or philanthropic is an issue.
How do we get the private sector to want to get involved? Can we just have a mandate requiring the private sector to "donate" 10% of its profits? Is it really a donation if we mandate it? I do not believe so. We can't just require 10% profit donation and award the private sector for being philanthropic. Philanthropic means "organized to provide humanitarian or charitable assistance" or benevolent. I believe philanthropic should only be awarded to those who actually volunteer assistance.
I think the Bill and Melinda Gates Foundation sets a valuable example for others to follow. The Gates Foundation definitely have raised the bar in private involvement. Whether we expect other companies to do as much is another issue. I feel the private sector should contribute as much as they are able to. I feel any assistance is great and will definitely set the trend towards private involvement in global health as a norm.
I feel I am more of an Visionary Entrepreneur. I definitely feel that if an entrepreneur can develop something that is beneficial and impacts global health, then it is okay for that entrepreneur to gain financially. We would all hope that the financial gains would then be cycled back into the global health arena, but I feel we shouldn't push it. The entrepreneur already developed something that impacts global health positively; why isn't that entrepreneur able to earn a living out of it? I feel with any relationship there is a give and a take. We as public health professionals would love for the entrepreneur to give give give and for us to take take take, but we have to understanding a healthy relationship is one where both partners win. The entrepreneur should have the ability to gain financially (take) while developing something that impacts global health positively (give).
I definitely agree that it is possible to be both a business entrepreneur and a social entrepreneur.
How do we get the private sector to want to get involved? Can we just have a mandate requiring the private sector to "donate" 10% of its profits? Is it really a donation if we mandate it? I do not believe so. We can't just require 10% profit donation and award the private sector for being philanthropic. Philanthropic means "organized to provide humanitarian or charitable assistance" or benevolent. I believe philanthropic should only be awarded to those who actually volunteer assistance.
I think the Bill and Melinda Gates Foundation sets a valuable example for others to follow. The Gates Foundation definitely have raised the bar in private involvement. Whether we expect other companies to do as much is another issue. I feel the private sector should contribute as much as they are able to. I feel any assistance is great and will definitely set the trend towards private involvement in global health as a norm.
I feel I am more of an Visionary Entrepreneur. I definitely feel that if an entrepreneur can develop something that is beneficial and impacts global health, then it is okay for that entrepreneur to gain financially. We would all hope that the financial gains would then be cycled back into the global health arena, but I feel we shouldn't push it. The entrepreneur already developed something that impacts global health positively; why isn't that entrepreneur able to earn a living out of it? I feel with any relationship there is a give and a take. We as public health professionals would love for the entrepreneur to give give give and for us to take take take, but we have to understanding a healthy relationship is one where both partners win. The entrepreneur should have the ability to gain financially (take) while developing something that impacts global health positively (give).
I definitely agree that it is possible to be both a business entrepreneur and a social entrepreneur.
Wednesday, April 4, 2007
Health Financing and Health Outcomes
This week was a little scary for me. Thank god its over. I just had the last presentation of my MPH career. :o)
The link is to the first article I was going to do my individual oral presentation on, but did not because I felt it was not "global" enough.
"An Innovative Proposal for the Health Care Financing System of the United States"
https://blackboard.usc.edu/courses/1/20071_pm_565_41128/uploads/_398412_1/1093.pdf
The main points are:
The authors propose a "Federal Health Insurance Reserve System (FHIRS) to reduce ingrained errors and enhance the positive aspects of both the market and the government systems."
Problems with our health financing system that requires solutions:
1. The uninsured and underinsured.
2. Politically and litigiously mandated benefits.
3. Unequal tax treatment for health financing.
4. Lack of individual choice of plans and providers.
5. Perverse financial incentives for the insurance industry.
6. Underfunded and confused Medicaid programs
7. The Ponzi-type Medicare scam of cross-generational financing.
8. Insufficient national clinical trails and lack of constraint of unnecessary malpractice suits.
9. Unfair competition by hospitals charging their own patients different amounts for identical services and pharmaceutical companies charging individuals and small organizations more than large organizations, increasing the number of uninsured.
10. Excessive costs threaten the national economy, access to quality medical services, and federal and state budgets partly because of the lack of economic incentives to limit health care expenditures.
11. Lack of a national program to coordinate, analyze, and recommend optimizing medical are and controlling costs.
The authors propose that "Congress create individual tax incentives, mandate universal catastrophic coverage, and charter an independent FHIRS protected from direct political, commercial, and legal pressures to establish regulatory controls and productive incentives for a competitive market-based system."
This FHIRS would be charged to "encourage efficient use of health care dollars for the public good, increase freedom of individual choice coupled with acceptance of individual responsibility, ameliorate inflation, and stimulate innovative and fair competition."
The article goes on to explain how the FHIRS proposal would ameliorate the problems with our health financing system.
The most interesting solution is for the problem of lack of a national program to coordinate, analyze, and recommend optimizing medical care and controlling costs. As we know the United States is ranked really low in how our health system performs and ranked the highest in how much our health system costs. The authors seem to believe that because FHIRS will be an apolitical agency free from commercial pressures, it would be in an ideal posotion to lead and encourage efforts to carefuly assess the overall effets of both new and traditional medical modalities. FHIRS computers will collect insurer's data, hospital outcome data, and longitudinal data on chronic conditions and costs. These data would be shared with various private and government reserach institutions, academia, and organized medicine while assuring patient confidentiality. Whether it is possible to have an apolitical agency is one thing but how to sustain its apolitical character is another.
The authors end with "America does respond to crisis so we anticipate that by calling attention to some of the underlying causes crippling the medical care system, articles such as this will increase awareness that reasonable reform is possible. There may be a FHIRS in our future!" What do you guys think? This article was written in 2003. Where are we now? Financing is such a hot topic in elections now. Where will the future of our health care financing be? FHIRS or another new creative acronym?
The link is to the first article I was going to do my individual oral presentation on, but did not because I felt it was not "global" enough.
"An Innovative Proposal for the Health Care Financing System of the United States"
https://blackboard.usc.edu/courses/1/20071_pm_565_41128/uploads/_398412_1/1093.pdf
The main points are:
The authors propose a "Federal Health Insurance Reserve System (FHIRS) to reduce ingrained errors and enhance the positive aspects of both the market and the government systems."
Problems with our health financing system that requires solutions:
1. The uninsured and underinsured.
2. Politically and litigiously mandated benefits.
3. Unequal tax treatment for health financing.
4. Lack of individual choice of plans and providers.
5. Perverse financial incentives for the insurance industry.
6. Underfunded and confused Medicaid programs
7. The Ponzi-type Medicare scam of cross-generational financing.
8. Insufficient national clinical trails and lack of constraint of unnecessary malpractice suits.
9. Unfair competition by hospitals charging their own patients different amounts for identical services and pharmaceutical companies charging individuals and small organizations more than large organizations, increasing the number of uninsured.
10. Excessive costs threaten the national economy, access to quality medical services, and federal and state budgets partly because of the lack of economic incentives to limit health care expenditures.
11. Lack of a national program to coordinate, analyze, and recommend optimizing medical are and controlling costs.
The authors propose that "Congress create individual tax incentives, mandate universal catastrophic coverage, and charter an independent FHIRS protected from direct political, commercial, and legal pressures to establish regulatory controls and productive incentives for a competitive market-based system."
This FHIRS would be charged to "encourage efficient use of health care dollars for the public good, increase freedom of individual choice coupled with acceptance of individual responsibility, ameliorate inflation, and stimulate innovative and fair competition."
The article goes on to explain how the FHIRS proposal would ameliorate the problems with our health financing system.
The most interesting solution is for the problem of lack of a national program to coordinate, analyze, and recommend optimizing medical care and controlling costs. As we know the United States is ranked really low in how our health system performs and ranked the highest in how much our health system costs. The authors seem to believe that because FHIRS will be an apolitical agency free from commercial pressures, it would be in an ideal posotion to lead and encourage efforts to carefuly assess the overall effets of both new and traditional medical modalities. FHIRS computers will collect insurer's data, hospital outcome data, and longitudinal data on chronic conditions and costs. These data would be shared with various private and government reserach institutions, academia, and organized medicine while assuring patient confidentiality. Whether it is possible to have an apolitical agency is one thing but how to sustain its apolitical character is another.
The authors end with "America does respond to crisis so we anticipate that by calling attention to some of the underlying causes crippling the medical care system, articles such as this will increase awareness that reasonable reform is possible. There may be a FHIRS in our future!" What do you guys think? This article was written in 2003. Where are we now? Financing is such a hot topic in elections now. Where will the future of our health care financing be? FHIRS or another new creative acronym?
Tuesday, April 3, 2007
Monitoring, Surveillance and Rapid Response Capabilities
In regards to the monitoring of global health, the 4 points to consider in the article Jen posted are definitely relevant.
1. Improving the technology and methods for population health measurement
I feel that as technology advances, we are able to shift how we measure the health of populations. We will be able to do it easily and quickly and provide reliable information. As technology advances, we will have no choice but to update our system of measurement. With every new method comes initial criticism, but as more and more people see the reliability in the new technology or method, the information will be accepted.
2. Strengthening national capaicty & motivating governments to collect and analyze useful health data
National capacity is definitely important in collecting and analyzing health data. We can have all the technology in the world and the most advanced method of measurement, if the nation is unable to utilize the new technology or method, health data will not be collected or analyzed correctly. Governments are definitely key stakeholders. Whether we like it or not, everything on this planet is political. It will be the biggest uphill battle anyone can face if there is no political backing in the idea.
3. Establishing global norms and standards for what are the core health related measurements & how to measure them
I feel this is an idealistic point. It seems easy to sit everyone down and establish global norms and standards for what are the core health related measurements and how to measure them, but the hard part is getting everyone to sit down at the same table. If we are unable to get everyone to participate and agree to meet, how are we able to establish global norms? Again governments and heads of organizations need to realize how pressing this issue is before collaboration is able to begin.
4. Reporting to the globe valid, reliable, & comparable assessments of inputs, service delivery & achievements for health
This is definitely key. Once people see valid, reliable, and comparable assessments of inputs, service delivery and achievements for health, people are more likely to jump on the wagon and adopt the new idea. This is like what we talked about the other class, we have the innovators or technology enthusiasts, early adopters or visionaries, early majority pragmatists, late majority conservatives, and laggards or skeptics. We have to cross "The Chasm" of monitoring health globally before we are able to monitor health globally.
Implementation of a "gold standard" is definitely the key. We will not be able to cross "The Chasm" of monitoring health globally until we are able to provide reliable information to prove to the early majority pragmatists, late majority conservatives, and laggards or skeptics.
I do see where the skeptism of the WHO comes from and do agree to some degree. Whether people side with WHO or against WHO should not matter. A strong new health monitoring organization is definitely a necessity. This new organization will not only make those skeptical of WHO feel at ease but also gain the support of those who side with WHO because of the strong leadership and sole role of monitoring.
I don't know about everyone else, but I would be lost if I was not able to fly. I love traveling and the thought of having to drive everywhere, let alone places where driving is impossible to get to, is scary. I, like most people in this century, like to have things fast; I like fast internet, eating fast, getting to places fast, and experiencing the fast life. Even though it is a pain to travel on planes, I feel we will finally get back to a happy medium where most if not everyone feels at ease in flying again. Til that day comes, I am going to continue to fly and travel the world or wherever the plane can take me. :o)
1. Improving the technology and methods for population health measurement
I feel that as technology advances, we are able to shift how we measure the health of populations. We will be able to do it easily and quickly and provide reliable information. As technology advances, we will have no choice but to update our system of measurement. With every new method comes initial criticism, but as more and more people see the reliability in the new technology or method, the information will be accepted.
2. Strengthening national capaicty & motivating governments to collect and analyze useful health data
National capacity is definitely important in collecting and analyzing health data. We can have all the technology in the world and the most advanced method of measurement, if the nation is unable to utilize the new technology or method, health data will not be collected or analyzed correctly. Governments are definitely key stakeholders. Whether we like it or not, everything on this planet is political. It will be the biggest uphill battle anyone can face if there is no political backing in the idea.
3. Establishing global norms and standards for what are the core health related measurements & how to measure them
I feel this is an idealistic point. It seems easy to sit everyone down and establish global norms and standards for what are the core health related measurements and how to measure them, but the hard part is getting everyone to sit down at the same table. If we are unable to get everyone to participate and agree to meet, how are we able to establish global norms? Again governments and heads of organizations need to realize how pressing this issue is before collaboration is able to begin.
4. Reporting to the globe valid, reliable, & comparable assessments of inputs, service delivery & achievements for health
This is definitely key. Once people see valid, reliable, and comparable assessments of inputs, service delivery and achievements for health, people are more likely to jump on the wagon and adopt the new idea. This is like what we talked about the other class, we have the innovators or technology enthusiasts, early adopters or visionaries, early majority pragmatists, late majority conservatives, and laggards or skeptics. We have to cross "The Chasm" of monitoring health globally before we are able to monitor health globally.
Implementation of a "gold standard" is definitely the key. We will not be able to cross "The Chasm" of monitoring health globally until we are able to provide reliable information to prove to the early majority pragmatists, late majority conservatives, and laggards or skeptics.
I do see where the skeptism of the WHO comes from and do agree to some degree. Whether people side with WHO or against WHO should not matter. A strong new health monitoring organization is definitely a necessity. This new organization will not only make those skeptical of WHO feel at ease but also gain the support of those who side with WHO because of the strong leadership and sole role of monitoring.
I don't know about everyone else, but I would be lost if I was not able to fly. I love traveling and the thought of having to drive everywhere, let alone places where driving is impossible to get to, is scary. I, like most people in this century, like to have things fast; I like fast internet, eating fast, getting to places fast, and experiencing the fast life. Even though it is a pain to travel on planes, I feel we will finally get back to a happy medium where most if not everyone feels at ease in flying again. Til that day comes, I am going to continue to fly and travel the world or wherever the plane can take me. :o)
Monday, April 2, 2007
Technology Innovation and Global Health 2: Infocomm and Medical Devices
I definitely believe in Telemedicine. I think it would be great to be able to email or message my doctor in the privacy of wherever I may be and whenever I want to. I do agree with how Singapore runs telemedicine in that, teleconsultations are only available to those that have already had a face to face physical examination by the doctor and the doctor is clear with the patients condition.
I am extremely interested in the Non-Occlusive BP Monitoring watch. I know it would be helpful to my mother. I also think Thermography is interesting and certainly have tried to convince my cousin to try it out.
Technologies seem to amaze me time and time again. The cost-effectiveness analysis of these new biotechnologies need to be widespread and broad instead of narrow and segmented.
I am a big fan of Health Information Technology. We had computerized health records in Boston when I worked at Boston Medical Center. I can't begin to say how convenient it was. Anytime you logged into the patients charts a big flashing warning will pop up showing the medications the patients were allergic to. This computerized health records system was shared over affiliated hospitals around Boston which made moving around and seeing numerous doctors in various places easy and fast (no need to request records to be sent).
I find it interesting that the HIT Leadership Panel consisted of business leaders. In Japan, it is the big car companies that purchase health insurance for their workers under the companies own "insurance company". It is interesting to see that the HIT Leadership Panel is capitalizing on this idea by inviting CEOs from FedEx, Target, GM, Pepsico, Wells Fargo, International Paper, Proctor and Gamble, Johnson Controls, and WalMart.
I am from Taiwan and I have seen the various problems with the Smart Cards happening in person. I do agree that I have frequently heard more complaints from hospitals rather than praise. I feel that the Smart Cards will be a great supplement and can facilitate the transfer of our current paper system to the Health Information Technology, linked computerized health records.
I do feel that this is a better system than the magnetic strip because as we all know magnetic strips can end up losing its ability to be read. Yes it will cost lots of resources to adopt this system and the funding for this adoption could be difficult to find, but I think in the long run this is a better system. Because I am from Taiwan, I would feel comfortable carrying around a card with all my personal information on it. I believe the only way to prevent misuse would be to make the Smart Cards password protected like ATM cards and a PIN would have to be pushed on the reader for the hospitals to access the information. This would prevent information to be misused if the card was lost or stolen.
I am extremely interested in the Non-Occlusive BP Monitoring watch. I know it would be helpful to my mother. I also think Thermography is interesting and certainly have tried to convince my cousin to try it out.
Technologies seem to amaze me time and time again. The cost-effectiveness analysis of these new biotechnologies need to be widespread and broad instead of narrow and segmented.
I am a big fan of Health Information Technology. We had computerized health records in Boston when I worked at Boston Medical Center. I can't begin to say how convenient it was. Anytime you logged into the patients charts a big flashing warning will pop up showing the medications the patients were allergic to. This computerized health records system was shared over affiliated hospitals around Boston which made moving around and seeing numerous doctors in various places easy and fast (no need to request records to be sent).
I find it interesting that the HIT Leadership Panel consisted of business leaders. In Japan, it is the big car companies that purchase health insurance for their workers under the companies own "insurance company". It is interesting to see that the HIT Leadership Panel is capitalizing on this idea by inviting CEOs from FedEx, Target, GM, Pepsico, Wells Fargo, International Paper, Proctor and Gamble, Johnson Controls, and WalMart.
I am from Taiwan and I have seen the various problems with the Smart Cards happening in person. I do agree that I have frequently heard more complaints from hospitals rather than praise. I feel that the Smart Cards will be a great supplement and can facilitate the transfer of our current paper system to the Health Information Technology, linked computerized health records.
I do feel that this is a better system than the magnetic strip because as we all know magnetic strips can end up losing its ability to be read. Yes it will cost lots of resources to adopt this system and the funding for this adoption could be difficult to find, but I think in the long run this is a better system. Because I am from Taiwan, I would feel comfortable carrying around a card with all my personal information on it. I believe the only way to prevent misuse would be to make the Smart Cards password protected like ATM cards and a PIN would have to be pushed on the reader for the hospitals to access the information. This would prevent information to be misused if the card was lost or stolen.
Wednesday, March 21, 2007
Technology Innovation and Global Health 1: Biomedical Sciences
I think Alan Kay said it best, "The best way to predict the future is to invent it."
In regards to the "Top Ten Biotechnologies for Improving Health in Developing Countries," I agree with the top 3, especially in regards to recombinant technology for vaccine development and technology for more efficient drug/vaccine delivery.
This article definitely promotes prevention and health and proves that biotechnology can be made affordable. I do agree with Kat on the fact that the article focused too much on the top three. This article definitely is key to encouraging the development of technologies for improving health in developing countries.
I thought Farah's article, "Genomics and Global Health: Solutions in Development," was so interesting!
Bioremediation is so clever! I am surprised it is not more common. Yes it is slow, does require specific environmental conditions, and not yet viable for complex chemicals, but why should that hold us back from using it as a supplement to the usual toxic waste removals that we traditionally use now and help alleviate global warming? The bacteria, yeast, and fungi are cheap and not harmful to the environment.
Genetically modified crops is definitely another great biotechnology that should be used more often. It definitely helps micronutrient malnutrition in various countries and assures sustainability. The main opponent is definitely those who favor organic foods. Yes genetically modified crops are not natural, but they are definitely helping out nature and providing people in developing countries with nutrients they would otherwise have no access to.
What still confuses me is combinatorial chemistry. It seems like a great tool and could be useful, but how common will it really be? How universal will it be? Is it really applicable? It definitely is interesting and seems promising.
I strongly believe that public-private partnerships are the only way that biotechnologies will spread quickly and become universal. The private will have the funds and expertise while the public has the influence for implementation.
In response to Farah's question, "When great drugs are already out there not being disseminated properly, should we be putting billions of dollars into R&D for new drugs?" I think we should keep putting some money in R&D for new drugs but take some of the budget and put it in R&D for disseminating great current drugs. It is sad that there are so many great drugs let alone 1 that are proven to be extremely effective and beneficial for all that are not being utilized due to the poor methods of dissemination.
This ties into the diffusion of innovations. It is sad to see that lots of great idea do not cross "The chasm" This definitely proves that the way you market your innovation is how the innovation will diffuse into the public and become mainstream. With changing technologies and shifting from the old to the new, I think compatibility is the most important. The innovation needs to be able to coexist with technologies and social patterns already in place in order for ease of adoption and changing the opinions of critics (late majority and laggards).
In regards to the "Top Ten Biotechnologies for Improving Health in Developing Countries," I agree with the top 3, especially in regards to recombinant technology for vaccine development and technology for more efficient drug/vaccine delivery.
This article definitely promotes prevention and health and proves that biotechnology can be made affordable. I do agree with Kat on the fact that the article focused too much on the top three. This article definitely is key to encouraging the development of technologies for improving health in developing countries.
I thought Farah's article, "Genomics and Global Health: Solutions in Development," was so interesting!
Bioremediation is so clever! I am surprised it is not more common. Yes it is slow, does require specific environmental conditions, and not yet viable for complex chemicals, but why should that hold us back from using it as a supplement to the usual toxic waste removals that we traditionally use now and help alleviate global warming? The bacteria, yeast, and fungi are cheap and not harmful to the environment.
Genetically modified crops is definitely another great biotechnology that should be used more often. It definitely helps micronutrient malnutrition in various countries and assures sustainability. The main opponent is definitely those who favor organic foods. Yes genetically modified crops are not natural, but they are definitely helping out nature and providing people in developing countries with nutrients they would otherwise have no access to.
What still confuses me is combinatorial chemistry. It seems like a great tool and could be useful, but how common will it really be? How universal will it be? Is it really applicable? It definitely is interesting and seems promising.
I strongly believe that public-private partnerships are the only way that biotechnologies will spread quickly and become universal. The private will have the funds and expertise while the public has the influence for implementation.
In response to Farah's question, "When great drugs are already out there not being disseminated properly, should we be putting billions of dollars into R&D for new drugs?" I think we should keep putting some money in R&D for new drugs but take some of the budget and put it in R&D for disseminating great current drugs. It is sad that there are so many great drugs let alone 1 that are proven to be extremely effective and beneficial for all that are not being utilized due to the poor methods of dissemination.
This ties into the diffusion of innovations. It is sad to see that lots of great idea do not cross "The chasm" This definitely proves that the way you market your innovation is how the innovation will diffuse into the public and become mainstream. With changing technologies and shifting from the old to the new, I think compatibility is the most important. The innovation needs to be able to coexist with technologies and social patterns already in place in order for ease of adoption and changing the opinions of critics (late majority and laggards).
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