Christina Nesheva

GlaxoSmithKline plc

This conversation is closed.

What is the future of healthcare? How can it become health care vs sickness treatment? What role do technology and innovation play?

Healthcare costs are rising, the population is aging and medical needs are greater than ever. How can patients receive better quality care at an affordable price? How can we leverage technology to provide better and more affordable healthcare around the world?

  • Oct 19 2011: Technology is great, but I think the idea of caring for our health should also include consideration of what we're being told is food. Put obvious junk food aside for a moment, and just consider what we're being told about which foods are healthy. I have my beliefs about what we're being told, but there are lots of contradicting thoughts about what's healthy to eat and why, that it gets confusing. Modern medicine doesn't seem to be focusing much on this, to get to the bottom of all of it and promote what's truly healthy to take in as our nourishment and body's fuel. The government has taken the role of food approval, and alternate ideas are brushed off as fanatical. Are we eating what's truly proper food for the human body, or are we being told what's food based on politics, economics and government subsidies? Our bodies can't be healthy if we don't eat what they're meant to live on.
    • Oct 20 2011: Well said.

      The role of government is to do things that individual cannot do. Regulating markets, ensuring advertisements are truthful, ensuring food is food and food is healthy etc.

      The problem I see in western countries is the "hyper" faith in market economy. Frankly, free market works only when the participants are moral. When there are crooks and there are people feeding on gullibility of the vulnerable, government needs to step in to regulate. When you last saw an advertisement for a farmer market when nutrition are sold at cost. I bet you see much cheap calories ads from the fast food outlets.

      When an item is sold as food, it should be food. Who should enforce this? Self regulation does not work because there are always crooks everywhere. If government cannot step up to fulfill this, citizens may consider changing the government. :-)
  • Oct 17 2011: As a medical graduate who is trying to find a residency spot in U.S I found your topic very interesting to me. I'll tell you something I heard from Dr. Conrad Fischer the author of Routine Miracles. He was talking about the importance of preventive medicine and said : How many people got killed because of the terrorism? and How many people die everyday because of diabetes and coronary heart disease ?
    How much money spent on overseas wars compared to money spent on prevention of diabetes ?
    79 thousands die every year because of diabetes ? If this is was a military attack on U.S soil the country will unify overnight and say we got to solve that problem.
    • Oct 17 2011: Arafat,

      Well said. Sometimes we wonder how government can get the priority so wrong, or is it something else working against the better vision of those who really want to help?

      USA is a "free" society. But what is actually FREE? Free to misled people, to give false information, to advertise to sell products which are harmful. I watched a documentary "Killer at large" just last night. Surgeon General (2002-2006) Dr Richard Carmomna said something which is important. See http://www.youtube.com/watch?v=cPNw-kIPy8I

      Will our children live shorter than we are? Yes, very likely unless our focus on health care is to make healthcare professionals to focus on health, not just disease treatment. It is more than preventive medicine. I am taking a lot of pills to prevent my blood pressure to burst my veins. Is that preventive medicine. In a way yes, but in essence, healthcare professionals should help me exercise and reduce my waistline. I know, it is my fault that I do not exercise. But for a society to be healthy, the environment needs to support active lifestyle in a more engaging way.

      By the way, I have started exercising and I hope I can get rid of my medication in 1 year. Wish me luck.
  • Oct 19 2011: First we need to understand what health is. Health is when everything in the body is working the way it is supposed to. The health of any tissue and the health of any body part can only be as healthy as the care and support it receives. And by care and support I mean the quality of the nutrients provided through the blood, and the blood supply and regulation provided by the brain and nervous system.
    We need to understand that there is a built in intelligence that created the body from 2 cells, and that intelligence hasn't left the body. It is still there - running the show. Most people would agree that there is no process in the body that happens independently of the brain. If we truly understand this fact, we also must understand that any dysfunction (except acute injury, and a handful of congenital errors) is the result of aberrant function in the brain.
    Therefore healthcare isn't health care, but rather merely disease management, unless it addresses brain function. Perhaps the most revolutionary discovery and paradigm shift in the past decade is that the brain changes. Neuro-plasticity. The principle and fact that the brain physically changes size, shape, pathways, wiring and strength based on our environment and exposure in order to learn and adapt.
    It is possible to measure the function of the brain and define the parameters of normal or optimal. We can do this with posture, balance, muscle testing, reaction time, qEEG etc... If we can then render care and show improvement toward optimal, we have improved health, reduced the probability of disease, and slowed or reversed parameters of aging.
    This is the only way health care can go. We have to let the medical "disease care system" take care of emergencies which they do brilliantly, but stop giving people drugs to mask symptoms.
    Go to the source of the problem. Chiropractors have done that for over a hundred years.
    Neuro-science is just now catching up with the mechanisms why it works.
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    Oct 19 2011: The key components necessary to correct the problems with health care delivery within the United States include:
    1. Better adoption of evidenced based practices. We spend far to many dollars of unnecessary, ineffective and overpriced interventions when the clinical evidence contradicts these interventions.
    2. Expansion of patient empowerment. We need to invest much more time and resources into education of the public in the appropriate management of their health and their illnesses. This is where technology can play a vital role in developing targeted educational products that individuals can easily access and utilize. These educational interventions must be cognizant of literacy limitations and language barriers AND be free of profit driven bias.
    3. Development of a universal health delivery system for all United States Citizens. As a health care provider in the emergency room I see the economic and human costs of people not having access to care on a daily basis. We have an opportunity to look at other systems and develop the most effective and efficient. Unfortunately we are all aware of the barriers to this.
    4. Increased individual responsibility. We have become a nation of hypochondriacs. We believe that every complaint or symptom is a disease pathology and believe that the solution comes in the form of a pill. This is, in large measure, the result of out direct to consumer marketing. We must shift back to a system where individuals recognize their role in their health and accept the responsibility for adopting a healthy lifestyle.
    These are just a few of my observations as a health care provider. Change is not only necessary, but vital, if our strained healthcare system is to survive.
    • Oct 19 2011: Well said Edward!
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      Oct 19 2011: Edward, what you say resonates strongly with me, particularly the personal responsibilities and empowered patients.
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      Oct 20 2011: Quote: "We believe that every complaint or symptom is a disease pathology and believe that the solution comes in the form of a pill."

      That's what I see a lot of and never understood. My observation is even the opposite. Pills can make people sick.
      For instance, if there's a little problem like headache a pill can give release if one believe this but the chance the headache will come back increases while as the body or the person itself solves the problem the risk of getting a headache decreases.
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    Oct 19 2011: Healthcare needs product innovation but these product can only be successfully useful when process innovation will be there. To lower the healthcare cost weneed disruptive innovation in healthcare we need to change tradition healthcare process.
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    Oct 19 2011: I agree with most respondents; Education is the key to health care vs. sickness treatment.

    My problem with the US medical care debate is the automatic assumption that Health Insurance should be part of the solution. Insurance is traditionally purchased to protect yourself against something that you don't want to happen. It can't work, economically, when the general population uses insurance to pay for events that are certain to happen, or that you hope will happen.
    IE:
    1. Treatment of chronic illness. You know you need the treatment, so it will cost more overall to indirectly pay for it via Insurance.
    2. Health care. Again; you want to be healthy, so paying an insurance policy to pay for your efforts to remain healthy is more expensive than paying it yourself.
    3. Sickness treatment. This is the only aspect of Medical care that works as an insurable event. You don't want to get sick, so you don't want to use your health insurance policy for this. Therefore; this represents an economically insurable risk. But sickness treatment is only 1 of 3 broad categories within the Medical care arena that are economically insurable.
    These aren't the only problems with using insurance to pay for Medical care, but I hope they illustrate the problem. ?
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      Oct 19 2011: I wonder if at the moment Insurance is given such an important role because it offers the necessary effectiveness metrics for treatment. Metrics drive innovation, insurance companies and consortiums drive metrics. I'd be nowhere in my team's innovation without ICD-9, but coding today is done mostly for billing purposes, driven again by insurance companies. And this is just one example.

      Also we have to consider the economic value of stability. Paying more is not always bad. You don't just pay tfor treatment, you pay for the safety net that WHILE you're getting your treatment, chronic or not, any sudden hikes in costs or changes in standard of care, or acute incidents, and incedental trauma will not take unexpected $20,000 out of your pocket, derailing your entire financial life (thinking of average americans here).

      I'm not saying insurance today isn't flawed throughout. I am FAR FROM defending today's model, but it's not just something that you deprioritize or think of ways to get rid of. I think it's something which needs re-design, but should always be a part of the system when considering the holistic "health CARE", not just incedental medical treatments. And it should reward behaviors such as healthy diets, supplementation, and exercise or active lifestyle, which should become increasingly easy in the world of Big Data.
      • Oct 19 2011: You miight consider if science and evidence -based practice offers the necessary effectiveness metrics for treatment, not insurance companies.
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        Oct 20 2011: Insurance is not flawed, in my opinion. And insurance has it's place in health care.

        I'm suggesting we insure the 'insurable' portions of health care, and recognize that some health care costs are not 'insurable'. Here's an illustration:

        You insure a house against catastrophic damage (something that you hope will never happen), but you don't insure the house against regular maintenance, because that would bring an additional cost into the equation - the cost of the insurance company itself. Hiring an insurance company to pay for your yard work and house maintenance would be much more expensive that paying for it yourself, right? That is also true for routine medical visits and treatment of chronic illness.

        It's another matter entirely to say "I want a collective group to subsidize my chronic health issues and routine office visits". This is a valid concern for the poor, but this issue should be treated as another matter entirely.
        If someone wants/or needs that kind of financial help, it's less expensive in the long run to treat that as the separate issue that it truly is.

        Insurance is a very expensive way to pay for routine expenses, and that's a big reason health costs are increasing rapidly.
    • Oct 20 2011: Insurance is obviously part of the problem, so should be part of the solution. -in my humble opinion, Insurance companies act like gangsters: you have to purchase the policy for you to be protected, if not you will die. period!
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        Oct 23 2011: Like gangsters? Wow. I think you need to change insurance companies. Mine never came to my house and gave me an "offer I could not refuse".

        To me, I CHOSE to buy insurance to mitigate the risk. I could take the same amount of money and save it in the event of some catastrophe, but I make a CHOICE to buy insurance. And the neat thing is that I can CHOOSE a lower price by doing everything I can to stay healthy.

        However, now if the government REQUIRES me to buy insurance... well, then I suppose the government is now becoming a gangster, but that is a different story.
        • Oct 24 2011: seems that you had many alternatives to choose your health insurance. Can you tell us? and, YES, it is precisely that I had received: an "offer I could not refuse", again, gangsters or even worse -I did not realize they were making more profits by avoiding the costs of visiting me at home, as you pointed out.
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        Oct 24 2011: Edgar, yes. There are websites which list many alternatives. Do you really want me to advertise them here? Some are more expensive than others, but that is the free market. Why are you limited?

        You say they are making a "profit", but you are likely misusing terms. They bring in more money than they spend on YOU, but that is how they work. Somehow, they have to pay for the extra costs that occur. Many people get much more paid for them then they ever paid into insurance (which is the whole point of insurance). That money does not grow on trees. It comes from managing costs. If, in the end, the net of all revenue less all costs is positive, THEN they have a profit. To me, that is fine since that is what businesses strive to do(but not all do). Would you rather the insurance companies scrape by? Or, perhaps you prefer they lose money and go out of business?
        • Oct 24 2011: Let me ask you something. What if you decide not to buy a health insurance policy? Simple, you will not be able to solve even a regular health event by yourself, quickly the situation will get worse for you, and sooner or later you will be at high risk of death. So, back to the beginning of this conversation, you do not have a better choice Drew, you are forced to accept that "offer I could not refuse", imposed by the current health system through insurance companies, whatever that nice webpage you were close to advertise. It is buy or not to buy, if you do not buy then you will die! --- Sorry, I still find this modus operandi similar to the gangsters!
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        Oct 24 2011: Edgar, I am not sure what you expect. You say how important insurance companies are yet you don't want them. Which is it?

        As you point out, you DO have a choice not to go with insurance companies. Many people do and they are not dead. Yes, it is very risky (FYI: there are many things about life that are risky.) But without insurance companies, how else would you manage the risk?

        I think you real issue is with the cost of healthcare, not the cost of insurance. If your issue is with the cost of insurance, then please respond to the second part of my previous response.
        • Oct 24 2011: They are not dead yet, but will be soon if they are not cared. That's my point, the fact that one of two choices is equivalent to shorten lifetime or an early death [I can't imagine to whom I would give that kind of alternatives to elect]. That's absolutely unethical, and sadly nobody seems to notice! We have accepted that doing bussiness with the pain and suffering of people is a good thing. As in Stockholm syndrome, we have learnt to love our captors, sometimes to the point of defending them.
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        Oct 24 2011: Edgar, I am not sure what you expect. You say how important insurance companies are, yet you don't want them. Which is it?
        • Oct 25 2011: That's the easy part: I would like to have a system where everyone equally has the best possible health --- How to get to that system? would be possible if at least we were looking in that direction. --- I do not see insurance companies in any role in that world. I really do not hate insurance companies; I just simple believe that health should not be their business. Moreover, health of people should not be a business the way it is in these days. Let me explain, insurance companies base their income on an adverse events that are more common among the people every day, so that their businesses will eventually become unsustainable, simply because you cannot expect to increase premiums forever. And they know about it, so they are just taking advantage of such widespread pathological optimism, and continue to use a wonderful business tool they have what is increasing premiums at will, until the government decides to put a stop to these guys and take seriously this problem.
        • Oct 25 2011: Now, it is not a secret that health is related to economy in several ways. So. health-related areas of economy should also be matter of intervention. In general, you will have few healthy people generating the resources to maintain or recover a lot of unhealthy people; so, economy won't grow. On the other hand, economy in their hurry of growing is pushing people to consumerism; as result you have a money-driven society with all the harmful consequences that implies; or just a typical individual, eager for junk food and banal things, propelled by advertising, that is becoming more obese every day, illiterate, unsatisfied, irritable, and anxious, in other words, an army of unhealthy people that contributes nothing to society and economy. We have to do something smart about that, soon!
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    Oct 23 2011: In future technology driven by innovation (i.e. humane genome project) will track down diseases much earlier so tackling that will be rather cheaper and in that case it will be real healthcare then instead of current sickness care.
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      Oct 25 2011: Yes, but innovation costs money. It also comes from many efforts, mostly failures. Who should ultimately pay for that? I think its fair that the ultimate consumers of it pay for it. As such rising costs will continue to be a factor with healthcare.
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        Oct 25 2011: Cost of innovation always included cost of failure & money also always went out of the pocket of consumer in any industry. Healthcare industry is now striving to keep down the cost of innovation down looking in to different model , some of which seems to me to be counter productive even i.e. outsourcing R&D.

        Whenever someone talks about healthcare cost, immediately most of us talk about cost of medicine , but we need think of what % cost goes to medicine cost in to the total cost structure ?

        Even with a product of innovation once econmy of scale is there cost of products goes down.However here the point I focuesed is Human Genome project , which can offer us the ability to detect many diseases much earlier of it's outbreak so can take preventive measures.
        Usually preventive measure is cheaper.

        Please check the link below , which says how genome project cost can go down

        http://www.ted.com/talks/richard_resnick_welcome_to_the_genomic_revolution.html
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    Oct 23 2011: The issue in the US, in my opinion is not the concept of health insurance, which seem quite viable. You can insure yourself against a catastrophic and unforeseen/unavoidable event. The issue, as I see it, is that we as consumers have deferred our "health responsibility" to an industry whose job (as an industry, I am not referring to a doctor who has taken an oath) is to be profitable and to which this industry has exercised its right to partner with other industries like pharmaceutical. This is an unnatural relationship for an industry to bear and the result is that our medical system is clogged with patients who are not actually participating in their own recovery. What should be “diagnosis, advice, short term care and recovery” is instead “diagnosis, advice, prescribe, and long term care”.
    Using Medicare spending as a model, "the big four" illnesses by cost are Heart Disease, Diabetes, Stroke and Lung Disease. The total medicare spend on these four was nearly $500 Billion in 2007 compared to $10 Billion on Cancer. The issue is that ALL of these are lifestyle related and controllable diseases. These huge numbers however are clear evidence that we are not changing our lifestyle or controlling these diseases, we are opting for long term care.
    The answer to the growing health care crisis is for us as consumers to address what is making us sick, seek expert advice, take advantage of the most advance health care available on the planet for short term care and whenever possible, take responsibility to change whatever you need to recover.
    It is possible that the collapse of the current health care model will finally drive that change in our collective psyche.
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      Oct 25 2011: You make a good point. One respondant to another thread of this discussion felt that he had no choice about paying an insurance company. Yes, going with insurance is "safer" but its not the only choice. As you mention, it may take a collapse for some people to see the situation from a different perspective.
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    Oct 21 2011: Healthcare costs are not rising as much as many people think. A substantial proportion of the increase in cost relates to bureaucracy, not actual healthcare. One of the main uses of technology in healthcare is to reinforce bureaucratic overheads.

    An increase in professionalism and a reduction in bureaucracy would both reduce costs and improve health. The reason it would improve health is that it would provide people with timely and appropriate treatment, reducing the inevitable health decline which comes when an illness goes a long time without treatment.

    A side effect of this would be that a highly professional healthcare sector, without the deadweight of excessive bureaucracy, would have the time and the knowledge to keep up to date with developments and discuss the options openly with patients.
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      Oct 25 2011: Yes! Excellent point all around. It is bureaucracy in healthcare, like bureaucracy in government or business, which can have some of the biggest (negative) impacts in cost. Bureaucracy also diffuses individual responsibility so individuals have a less clear view of how their actions affect others.
  • Oct 20 2011: Must see about the future of health(care) : the most underutilized resource is the patient : Let patients help http://www.ted.com/talks/lang/eng/dave_debronkart_meet_e_patient_dave.html

    more video's to be seen on http://www.tedxmaastricht.nl/videos/ (where Daniel Krafy gave his great talk "there is an app for that"
    or join us on the second TEDxMaastricht "the future of health" April 2nd www.tedxmaastricht.com

    Lucien Engelen Founder and Curator TEDxMaastricht (@zorg20)
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    Oct 20 2011: Many of today's illnesses are due to lifestyle factors. We are in a position whereby we treat illness once it has set in, rather than encouraging wellness, so that illness doesn't set in. The only solution is preventative medicine, through dietary and lifestyle changes, that encourages optimum health and vitality. Of course, "the sickness industry" wouldn't make any money if that were the case, so many people are still trapped in the illusion that there is no other way. Virtually all of today's degenerative diseases are preventable. Technological solutions could involve wellness testing for prevention of sickness. Currently most medical technology is designed to find, diagnose and confirm sickness, rather than prevent it. In nutritional therapy clinical practice, tests can be run to look for minor imbalances in bodily systems and to treat those imbalances before they become clinical pathologies.
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    Oct 19 2011: There are many things wrong with how North American's view their health and the systems that delivery healthcare. To summarize, they fall into the following 6 categories:

    1. Citizens have to take responsibility for their personal health. When over 60% of all North Americans are now either overweight or obese bad health has reached epidemic levels. It’s going to bankrupt our country, or many people will die young with poor quality of life.

    2. We have to change the system from Illness care centric to health care. Currently we don’t have a “healthcare” system, as the only time you use the system is when you’re ill.

    3. Doctor’s compensation must be completely overhauled. Currently doctors are compensated on treatment, not outcomes. Your doctor is not incented to make you healthy, only treat your illness and the associated symptoms.

    4. The cure too many diseases is prevention. Charities that raise billions each year on the “cure” should be redirected to Prevention initiative. Also, Big Pharmaceutical organizations have to invest more in prevention and not treatment through pills. The result of the current model is our Doctors are simply drug pushers for the Big Drug Company Cartel.

    5. Government has stop subsidizing “Big Food” and the unhealthy products they market to us and our children that are known to cause long term degenerative diseases and start supporting the natural (organic if possible) foods that will have positive health outcomes.

    6. Understand that the lifestyle choices made today will impact the long-term health outcomes decades into the future and leverage “behavioral economic” techniques that incent people for the good choices they make today that have long-term positive health outcomes in the future.

    For more, go to www.nofinishlineblog.com
  • Oct 19 2011: I believe that healthcare issues can be corrected only if all parties involved are properly incentivised. In the US the employer generally pays the insurance premiums to the health insurance companies. The insurance companies pays the doctors and the hospitals. And they inturn are expected to provide service to the employee or the patient. Remember all parties want to improve their net returns. So the employee has less incentive to take care of his health because it costs him less to go to the doctor for any symptom of illness. This results in poor health and more visits to the doctor. The doctors or the medical establishmenst would like to increase their revenue. So they encourage multiple visits and also prescribes unnecessary tests and costly procedures and medicines. Also because of the malpractice issue they are more likely to play it safe by requirng MRi's and CTscans and other such tests to confirm diagnosis with high levels of accuracy. This increases the overall cost of treatment while increasing the profitability of the medical industry. The insurance companies then average the costs over their insurers and go back to employers for more premiums every year. The employers therefore have inherent incentive to reduce salaries and employment. Eventually it is the employee that is hurt in the long run.

    If everyone is brought under this umbrella insurance the insurance costs will explode or the quality of service will take a significant hit with no long term solution.

    So maybe
    1. Increase the deductible that the employee has to pay for healthcare while simultaneously requiring employers to transfer a certain said sum as healthcare allowance. This sum will accrue to the employee if he does not have to visit doctors as much. This will give hime an incentive to live healthier.
    2. Increase the level of education about health through nationwide campaigns.
    3. Maybe spend billions on nationwide get- fit programs instead of supporting defunct bankrupt institutions.
  • Oct 19 2011: Personal responsibility is, in my view, the key to health. Many people, myself included, take our health/ wellbeing for granted, until everyday life is interrupted by illness. I've learned through illness that maintaining my health is key to me enjoying and getting the best out of life. It's taken until my 40s for me to learn this lesson even though I'm a healthcare practitioner who has been studying & working in health care for 17 years.
    The challenge I see is communicating this effectively to people across the planet. People in societies with more money should have more resources to tackle this but ironically health concerns such as obesity tend to be higher in the developed, economically better off world.
    Technology is improving but talk of things like 3d printers coming up with ready made organs sounds like fantasy at present but may become reality- possibly at a huge cost. Healthy solutions need to be cost effective for individuals for them to be feasible for society otherwise there will always be a divide between the haves and have nots.
    Prevention agendas, in my experience, tend to focus on preventing particular illnesses, diseases or illness producing behaviours such as smoking which focusses the mind on these illnesses rather than wellness.
    There's a lack of focus on the paradox that is both the joy of health and the inevitability of death that can focus peoples awareness on their individual circumstances and responsibility... to themselves and their own futures.
    • Oct 20 2011: Harish,

      You have identified an important distinction which we need to make when talking about preventive medicine: prevention of particular illnesses vs general health or well being.

      The first type of prevention is for genetically biased illnesses of diseases and the second is for the general public. If someone's family members have been identified for a particular genetically related diseases, preventive measure should be taken for each and every members who may be affected.

      General public awareness of health and the benefit of being well should be communicated to the public and must not be overwhelmed by misinformation (in form of advertisement of bad food). To prevent the overwhelming of misinformation, corporations should be held responsible for the claims they make in any advertisement and held corporations to moral guidelines to the same standard we held moral guideline to persons. If anything, corporation's moral obligation should be set higher than personal because they have the resources to properly investigate the statements they are making is evidence-based. CEO or executive officers of corporation should be held responsible *personally* for *repeated* false statements.
    • Oct 20 2011: For you to take responsibility early before 40s, you would probably need more information when you are 6, so at the end the problem becomes more a shared responsibility with others: health policymakers maybe?!
  • Oct 19 2011: Here are my thoughts on improving health care. At the moment insurance companies are driving the clinical decision making in health care and causing the sky rocketing costs. First we need to hand the clinical decsion making back to the clinicians- doctors, nurses and therapists who are the experts, not some business man or administrative assistants who sit at desks and authorizes or denies treatment. Insurance companies need to reimburse for preventative and maintenance practices for the major diagnosis posing the greatest burden on health care- things like heart disease, adult onset diabetes, obesity, tobacco, alcohol and substance abuse. Individuals/patients, not doctors should be held accountable for continued unhealthy practices such as
    smoking and obesity.
    Public policies making it mandatory to BUY health Insurance from a private for-profit business to me is unethical and gives these insurance companies a license to price gauge, deny claims, and provide inadequate coverage as they wish. We should just provide them with masks and guns to rob the American people.
    A single party goverment PAYOR ( that does not mean the government provides the health care ) is the only way to arrive at a solution, as HUNDREDS of other countries have.
    And just another thought...if all our healthcare dollars are ending up in the hands of insurance companies with the salaries of healthcare workers continueing to be so low...THERE WILL NOT BE ANYONE TO TAKE CARE OF YOU..NO DOCTORS, NO NURSES, NO NURSES ASSISTANTS, NO REHAB THERAPISTS...because when us baby boomers retire...there isn't going to be anyone in their right mind who will work in this broken medical system!!!
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      Oct 19 2011: Actually, single largest contributor to high cost of health care are costs of clinical trials and regulatory approval process. Inefficient FDA is why costs are high, not nearly as much due to insurance firms.
      • Oct 19 2011: i would have to disagree.
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          Oct 19 2011: I am really interested in your view and your argument. What is your own experience with insurance and regulatory costs that makes you disagree? I help design clinical trials and see the junction of costs in patient and investigator burden, molecule development, investigator grants, marketing, etc etc etc... Many of these costs arise from regulations which add highly superficial utility to the end-product, but are very costly. Many regulatory authorities require ALL questions answered in submissions, even mundane ones, which can take months to answer at $1-10 MILLION per day in lost pharma revenues due to limited age of patents for that time, which drives drug costs up to compensate. New submission process, new trial models, new data organization, AND NEW REGULATION STRUCTURE would be a huge headway to lower costs, even if you're right about insurance costs, and I'm somehow just not seeing them to be as much of a contributor to the bottom line as Reg.
      • Oct 20 2011: I have 30 years experience in healthcare. I am first and foremost a compassionate clinician providing care to patients. I have also worked in discharge planning, utilization review, clinical research including clinical trials, marketing and and teaching. My experience with insurance companies , regulations and regulatory costs is so extensive I could not possibly present here the facts that support my opinion.
  • Oct 19 2011: The core of the issue in the United States is incentives. The vast majority of our providers are paid based on a Fee for Service reimbursement model. This model incentivizes the quantity of care. Hence, physicians are not paid to manage the health of their patients, but rather were paid to place orders and do procedures (the more they do the more they make). There are a few models that take a different approach. For instance, the Kaiser system gets fixed prepaid amount per patient and are responsible for delivering the care required for that patient. Given this capitation, they are incentivized to manage the longer term health of the patient.
    This model was tried more broadly in the 90s by the HMOs, and failed due to perceived decline in access, versus a fee for service system. Health Reform is trying once again through the ACO and Patient Centered Medical Home initiatives, where a Provider organization takes responsibility for the health of the community at a fixed rate per person (depending on their conditions). Time will tell if this is successful.
  • Oct 17 2011: The problem with the healthcare system in United States is simple. There is simply no prevention. Most efforts are focused on treatment more than prevention then again there's no money in wellness. The money is in keeping the population sick. Patients get on drugs like Lipitor or metformin and they never get off. This will have to change otherwise are going to create generation upon generation of sick people.
  • Oct 17 2011: Christina,

    Your opening questions addressed a very important point which is missing in the discussion. Healthcare - caring of people in order to keep them healthy VS sickness treatment - remedies when health does not do its job. OK, there are diseases which attack healthy people too, but the bulk of the general practice is remedies to bad habits and poor health. Obesity related illnesses are an example of poor choices made by people - and I think it is the responsibility of health professionals to help people keep health.

    This is just an early idea and there are many finer points to be considered to be qualified as a potential proposal. What if, just what if, doctors are paid on number of people they can keep healthy? Say a local doctor is paid a fixed sum to look after 1000 people in an area. If anyone is sick, the doctor has to treat the illness, no additional fee except in situation where the illness are preventable. But if all 1000 people are well and healthy, the doctor can have all his/her time doing "nothing" and yet still get paid.

    The focus on treating sickness instead of keeping people healthy has missed the most important point in HEALTH CARE. It is about HEALTH, not illness nor its treatment! Yes, there are unlucky situations that we may have illnesses or diseases which are unrelated to the state of health. but If we are healthy, our immune system should protect us from a large number of avoidable illness. Sickness treatment is the complementary part (a smaller part) of health care.
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      Oct 18 2011: Your thoughts around health care and not sickness treatment resonate strongly. We take health for granted (in most cases) and as a result we are focused on restoring health when we lose it rather than making sure that we do not lose our heatlh in the first place. We definitely need the sickness treatment but the question is how can we can raise the importance of prevention, how can prevention become one of the key objectives of the healthcare system and then how can we get all participants to be aligned in the achivement of that objectives.

      I think it is encouraging that more and more people are starting to think about prevention but more remains to be done.
      • Oct 18 2011: Christina,

        When we are healthy, we take it for granted. Many do not pay particular attention to maintaining health. When illness strikes, it suddenly comes into focus the importance of health. The current problem of chronic disease is EXACTLY because the impact on our lives is in the "future" and there are always more "urgent" priority at hand.

        The first thing that comes to mind is education. We need a public awareness that health is the most important asset anyone can have. Without health, there is no future.

        The "health education" must include all the importance of nutrition, adequate exercise and mental health. Obviously it is easy said than done.

        Money makes the world goes round. If there is money to be made in keeping people healthy, there will be people willing to find ways to earn that money. Look at the number of fitness companies, weight lost companies and the like. When the public understands health is an asset which needs maintaining, there will be people willing to pay for professional to help them keep healthy.

        Calories in the supermarket are cheap, nutrition is expensive. In the time of economic crisis, I'm afraid the situation will get worse before getting better.
      • Oct 19 2011: Most people focus on prevention by focusing on early detection. It is more important to actively develop a higher state of health. This is the definition of wellness.
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        Oct 20 2011: Well said Christina.

        There is a direct cause and effect regarding the alarming increase in cases of degenerative diseases directly attributed to lifestyle choices. The challenge is encouraging people to make healthy decisions today that have positive health outcomes many decades into the future.

        Generally, humans are short-sighted: why forgo the instant ecstasy of that second or third serving of chocolate cake, or the joy of unprotected sex, when the rewards of restraint are so distant? We can’t simply address the “demand” on our health care system without addressing the root cause of its “supply” issue.

        Rewarding people today for health choices that have future positive outcomes is how “Behavioral Economics” is being leveraged with success around the world.
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    Oct 16 2011: Christina...In Europe, specially in UK you have to think deeply in your own weeckness in health issues. Why? Let me explain you something about nature.....here in Mexico just in my state (Jalisco) we have more biodiversity than in all Europe, our plants and fruits are in the first place to be remedies for health care. Our full natural richness is a treasure that all countries want and came here to pick up plants to develop patents and transformed in pills and drugs. The health concept is very different in poor countries than in rich countries. And in that issue, we are a rich country.
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    Nov 2 2011: The current "sickness treatment" model is clinician oriented. The technology has great potential to engage patients to their health management.
    The mhealth technologies, smart homes, patient portals are not widely common yet. But they can support patients' decision making and help them monitor and record their daily livings.
  • Oct 27 2011: The future of healthcare is integrated care. In integrated care systems, there’s no ‘wrong door’ to care. If you visit your primary care doctor, she’ll assess your mood, your mental health, your alcohol and drug use. If you go to a mental health or addictions professional, he will take your blood pressure, discuss your weight and eating habits. Healthcare providers aren’t divided in integrated health systems, so they connect you with the help you need, and make sure each patient is receiving coordinated, quality care. Visit the SAMHSA-HRSA Center for Integrated Health Solutions for more information at www.integration.samhsa.gov.
  • Oct 25 2011: in most countries the medical system is bankrupting. in the usa the medicaid/medicare system is bankrupting the system.
    i would suggest that medical students who cannot pay for a medical school education be giving a free medical school education. instead of being burdened by student debt medical students upon inception of practice
    would not be burdened with medical school debt.
    participating medical students would be giving the option of a free medical education provided they are willing to provide a free percentage of medicare care for poor deemed eligible by government for a set period of time and set percentage of poor patients.
    patients must be deemed eligible poor by the federal government. the time of obligated service and percentage of patients set by federal government. the government would soon recover their initial outlay of providing a free medical school education to students 5 fold, plus because of
    the no billing proviso to medicare/medicaid . the federal government would recover much more than their initial financial outlay to students. students would not be burdened student loan obligations. this program would be for office visit only.
    we can take this program one step ahead with a little vision and insight.if the doctor would be willing to have the
    government pay their opening office costs the doctor would be obligated to provide free care according to their specialty for exp: lab tests, x-rays,
    cat/mri and other special precedures etc.time and obligation of of free service set by governments. the no billing proviso to medicare/medicaid would apply. the government would really save large amounts of money.
    in the long term the saving to governments could amount to trillions of dollars.
    from what i understand in the usa for every 1% medicare saves over a 1 year period
    over 15 years comes to a 1 trillion dollars saving?
    joseph p.martino
  • Oct 25 2011: What is the future of healthcare? It's not too hard to see. Exactly the way it's been going for decades.

    How do you "redesign" something such as the health industry, or health care that is basically a criminal activity? Doesn't the "average American" want to "get rid of" crime and crime syndicates? Even if, or especially if, they have the appearance of being legitimate? All white-collar crime likes to appear legit.
    Seven years ago the figures I found showed around 30 million Americans living in daily, acute pain, because they could not afford medical coverage and they could not afford medicine. Are they "average Americans" or is there something wrong with their morals? Today, the latest check I made showed the figure had risen to around 39 million Americans. I'm one of those.

    It's taken me awhile but I get it now. People really do like inequality. That is how business thrives and profits are made. None of it has a thing to do with health care that is humane. Health care is not about being humane or serving humanity. What they serve you is a plate for you to place your money on. How do you fix that? How many times have we learned or heard about "previous existing conditions"? How many times have we learned or heard about, "that condition is not covered in your policy?"
    How many times have we learned or heard or know about someone who is ill, unable to work, so they can't continue putting in the hours to keep their benefits alive?

    And as time goes by, less can afford coverage that covers, and more become ill and uncoverable. Also, those few who are able to do so, maintain a distant and unfeeling attitude towards those who are in pain and suffering. I will keep saying it until I die, which is very near now, and I might add, extremely painful.

    "Things don't, "get done because of money." Things "don't get done",.....because of money!"

    That is the future of health care. A healthy economy needs more ill, diseased and dying people. It doesn't need or want healthy ones.
  • Oct 23 2011: tnx for watching them, next April there will be 20+ more, great to see healthcare moving and shifting towards what we call participatory healthcare. great discussion here ! thank you for that, important.
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    Oct 23 2011: Why allways we are worried by the future if that thing doesn't exist?

    Why we dont doing something with the present.....? Our present time to be healthy.

    Why we dont learn from the past?
  • Oct 21 2011: I think Christina started by asking a question that didn't have much connection to politics in the health care department, so my opinion on that is that the role of technology and innovation would be to educate on prevention and result in better health, prevention is the key for me.
    Now, for the second part of it... healthcare.. oh my! the endless debates on the subject, so political, so exhausting! I just always wonder, why do we expect the government to take care of everything? We complicate things so much... let the government take care of those who can't take care of themselves (I am aware that there are many that simply don't want to do it and rather have the gov do it for them) and those of us who are lucky enough to have a job accept our responsibilities and keep paying for our health care, and yes, our taxes will take care of those who don't work and don't get their own care... so what? am I happy about it? No, I am not, but you can't force people to work, you can't force people to do anything they don't want to do, it is the way of life. It is endless, we can go on an on about why people don't work, how they abuse all established systems, where our tax money goes, etc... unless we are in some position of power there isn't much we can do... of course we can all be activists and push for what we believe, sure.. lets work on that.
  • Oct 21 2011: I am rather cynical about "health care" and medical technology, considering that many elderly people with medical insurance get extraordinary and expensive care at the end of their life to perhaps extend their life by three months for a charge to the insurance company of a large fraction of a million dollars! Hence, rather than being noble health care professionals, they are vultures.

    While quality of life is important ones freedom of choice is also important.
    Education is very important, for example, teaching healthy lifestyles cf. bad habits and risky habits like smoking tobacco, drinking alcohol, smokeless (spit) tobacco, injected illicit drugs, eating burnt meat from the BBQ grill, or getting sun burnt.
    Unfortunately, some Public Service Announcements and public school educational programs tend to be propaganda.
    Finally, the pharmaceutical cartel has an agenda, maximizing profit. Chronic illnesses are succored with palliatives. This cartel is necrophylic. It is hostile to dietary nutrients, vitamins, and herb supplements like garlic, ginger, Aloe Vera gel, oregano oil, manuka oil, manuka honey, cayenne pepper, (mega doses of intravenous) vitamin C, and the innovation of liposome encapsulation which delivers the nutrient or vitamin directly into the cell.
  • Oct 21 2011: The majority of health problems are became from lifestyle factors so I think that the key is prevention.Humanity is always looking for the ''magical'' pill or treatment.Protect and care ourselves should be one of the greatest social values.In case of a disease that could not be prevented possible solutions could be volunteering offer of services(education), charity , exchange of services or (products), payment in installments
  • Oct 20 2011: I can't comment on US health policy, but I know the UK needs to acknowledge that evidence based practices need to be implmented correctly to be effective. We have NICE guidence (recommending best practice) and these focus on promoting cost-effective, evidence-based practice. However, implementation is a key part of health services. The best evidence-based programme in the world will not work if you have the wrong dosage or if offered in the wrong setting. This is particularily true of mental health, where good implementation is too often sidelined in favour of cost-savings.
  • Oct 20 2011: In this debate, may I ask everyone to step back and ask the following question.

    Should health be a person's right in a modern society?

    If yes, then government has the responsibility to provide health care.

    If no, then it is up to individual to maintain health, and if bad luck strikes, we will just fold our hands and see how this person can cope.

    In our modern society (especially in developed countries), what is health care?
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      Oct 20 2011: no, health is not a right. neither healthcare is a right.

      no, even if something is a right, it does not mean that the government should provide it.

      no, if government does not provide healthcare, we still can finance it through private health insurance. we can have charity organizations. we can have crowd financing. there are infinite number of solutions.

      i don't understand the last question.
      • Oct 20 2011: Krisztián,

        I am sorry I did not make the contrast clear enough.

        Let say free speech. Is that a right or not? Many western countries have free speech as a right (USA constitution makes it a right), but this is not universal.

        Education - is that a right or not? Should every child get an education? Again, some countries provide education and to different levels. Some see education as a private matter to be determined by parents.

        I can see argument on both sides whether health should or should not be seen as a right for citizens of a particular countries. Of course, if health is not a right, that does not imply there are no other means of providing health care - as you have adequately made clear.

        If the social good of a healthy citizenship outweighs the burden on the government, then making health as a right makes sense. The eradication of small pots is a good example of collective action. Government is for collective actions which individual or corporations cannot or unwilling to do. If the social good of healthy citizenship is important (just as free speech is important for a democracy), why not makes it a citizen right?

        Of course the flip side of the argument is to ask if government is the best agent to provide health or should health be provided by free market. Which is economically more efficient?

        I guess the answer depends on one's the political view. As the population in developed countries are getting old and we generally have a smaller number of children, the burden of health care in the next 10 to 30 years is a big issue especially if the population is not healthy.
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          Oct 20 2011: free speech is a right, but it is tricky. the actual right is "not to be kept from saying whatever you want". speaking is an action, and nobody should be able to prevent you from doing that. neither by physical means nor by threats or fraud. this law does not imply anyone has to provide you the means of communicating your thoughts. it is your job to find the tools or forums you need.

          education is not an action of the subject. education is not a right. learning is an action, and thus learning is a right. nobody should be able to prevent you from learning. teaching is a right. nobody should be able to prevent you from teaching something. it is also a right not to learn. not learning is an action. forcing people into learning something is unethical.

          health is not an action, but a condition. healing is an action, but not an action of the subject. thus neither of them is a right. pursuing health is an action, and it is a right. nobody should be prevented from pursuing health. thus, the FDA for example is unethical.

          having food is not a right. it is not an action. being able to pursue food is an action, and is a right. producing and selling food is an action, and is a right. buying food, provided that there is a seller, is a right. thus tariffs, quotas and regulations are unethical.
      • Oct 20 2011: Thanks for the clarification. I have not thought about that.

        Thanks again.
      • Oct 20 2011: Krisztián,

        After thinking a little about this. I cannot agree with you.

        "speech" is noun - "free speech" is a qualified noun. A special kind of natural ability of human.

        "health" is a noun, but also a qualified noun (a well being living ). A special kind of living, again a natural ability of human.

        If "free speech" can be a right, there is no reason why "well being" is not a right. Just like we have the right to live in a safe environment. If there is thief, e.g., police (a government agent) has the responsibility to make right for us. Health is the right to live healthy. To live healthy is an action and it is a right.
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          Oct 20 2011: speaking is an action. one can decide whether speak or not, and what to speak.

          health is not an action, and being healthy is also not an action. it is not your decision whether you are healthy or not, and what illnesses you have.

          safe environment is also not a right. having a safe environment is not an action. you cannot decide if you want to be safe or not, and if not, how.
      • Oct 20 2011: I am still not convinced. But will leave this. Thanks anyway.
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      Oct 20 2011: Totally for profit grain based chemical agriculture and our bloated pharmaceutical health care paradigm are the problem. These have become core beliefs and created a population of media zombies blinded by fake science.

      A solution will never appear through the same illogic that brought us to this point of sickness, bankruptcy and delusion. Personal empowerment, real nutrition and an understanding of simple remedies will not be found in this ocean of ignorance.

      Embellishing a system built on a crooked foundation and faulty thinking will only deliver more of the same.
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    Oct 20 2011: Today healthcare needs New healthcare model like --- Mass collaboration or a participatory healthcare model:- In this model patient –lead the care. Now patient is less for acute and more for chronic disease which is generally arises due to lifestyle of the citizens. Patient are more concern about their healthcare, want every information about their healthcare, get second advice from internet or doctor or from same disease patients . Now current treatment is not sufficient for patient they need more care or ongoing support to live with their chronic condition. This model focuses on co-production and co-creation or patient engagement kind of healthcare. For example: Patientlikeme.com, Medmd.com, medical information on mobile.
    Now,new approach of healthcare are evolving like Co-design, Co-production and co-creation
    Co-design:- Co-design in healthcare means when patient, professional and community working together to design solution for healthcare but final solution is implementing by professionals.
    Co-production:- When patient and community are helping equally to improve healthcare system using their capacity. Here shifting of power and responsibility from professional to patient and community. For example: Merevalehouse of UK, it is a private residential home for people living with dementia where residents are encouraged to design and deliver services.
    Co-creation:- When patient or users are in center not only in design of service but also in production. Like mobile app for healthcare, various healthcare tools for healthcare, various healthcare tools to take care of self well being.
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    Oct 20 2011: Healthcare begins with personal responsibility and prevention.
    Truthful information is not forthcoming from the pharmaceutically oriented sick-care industry that dominates govt agencies and the corporate media. Disinformation on nutrition, toxins, radiations and emotional stress abounds while truly effective, inexpensive natural therapies have been discredited, suppressed and even outlawed. And so, personal responsibility is thwarted by illogical drug-care dependency. Ignorance allows and perpetuates this and other corporate monopolies. Would this for profit industry ever embrace an economical approach?
    We also place too much importance on high-tech solutions. In reality our technology is the problem! Modern chemical grain-based agriculture produces disease causing processed cereals, corn syrups, vegetable oils, CAFO meats/milks/eggs and GMOs while destroying the environment. Then side effect laden drugs are prescribed to counter this mis-nutrition. Sustainable progress is invariably killed in the crib. Simple cures for cancer, arthritis, atherosclerosis, etc. have been used by millions. These protocols are holistically aimed at total health restoration, not temporary relief of symptoms.
    Our collective belief structure ignores common sense self care and is programmed to disbelieve even truly scientific alternatives to the expensive "officially endorsed' system.
    Simple scientific principles offer informed prevention and effective reversal of disease. We as well as other life forms on Earth suffer acidic hypoxia, an electron energy shortage, oxidative stress. Oxidative stress is "unbelievably", but ultimately at the root of all modern disease. This at the hands of industrial pollution, bad foods, economic anxiety, media induced delusion and psychological terrorism,.
    The 99% must not fail to install intelligent management of this planet. For more information; www.forbiddenhealingforum.com.
  • Oct 19 2011: It's really not about the future as it is about the now. Some may not be here for the future. I'm scanning thru all the replies and some seem to have lost the plot completely.I work in healthcare since 1990 and have seen so many changes. But have seen even more changes in the foods we eat, the water we drink, and cars we drive. The Oreo I used to eat in 1978 is not the same Oreo I eat today... Just a hunch on that one.
    Ask yourself these questions about what is being done "now". It starts with you, me, and our family history.
    What is the relationship between you and your physician(s)? How many times a year do you see your primary physician? Do you only see them when you're sick, need a Rx, referral, or do you actually go in for a wellness check/exam each 1-2 yrs? Has your primary care physician seen you when your healthy and sick? If so, chances are you are getting better care than those who only see their physician when sick.
    Do you lie to your physician? Recently there was a woman who comes and wants a referral for a CT scan of her lungs, but tells her physicians and nurses that she doesn't smoke. Her family rats her out finally... Or how about how many drinks you really had in a week? You cant lie to your physician if you want the best care possible.
    How many times have you made an appointment with a physician and became a "no show". This is just bad karma my friends, bad karma all around. If you think you free'd up their time, you are absolutely wrong. You burned a whole days salary. There is no good care, no care at all for that matter if you don't show up to your scheduled appointment.
    Do you know your family medical history? Talk about patient empowerment! You must educate your provider with your family history. Cancer, Heart, birth defects, there's so many ways you can educate your physician to better treat you in sick or health. Not enough characters here to talk tech & need to get back to work anyway. See your doctor and build a relationship, start now.
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    Oct 19 2011: Sorry if I implied that it COMPLETELY doesn't happen. I meant to say that it doesn't happen enough. Paycheck is still king to many in this field, not service and compassion. Not for everyone, and I am grateful for that, but for many out there. Sorry if I was unclear.
    • Oct 20 2011: If you saw the pay checks of most healthcare workers you would be SHOCKED. I am talking about the healthcare workers who take care of your grandmother after a stroke, or your Dad after a surgery or your sister recovering from cancer. I am talking about nurses and nurses assistants and radiology techs and surgical assistants, and physical therapist and speech therapists. The biggest reward in those jobs is knowing that you were kind and helped the patient and family get through the day and ultimately improve the quality of their lives. Believe me the paycheck is not king. You are most likely thinking of the CEO s of healthcare companies or those working in the pharmaceutical industry which probably account for less than 1% of those working in healthcare.
  • Oct 19 2011: Drugs are made to produce money, not to heal, that's why they only treat symptoms. As long as this system is active the problems will stay. The knowledge already exists. No new technologies required. And I am not talking about first aid which is the only thing I would allow a "western doctor" to touch me.

    Crohn's Disease & PTSD & I am med free. I am not completly healthy yet but I am doing a lot better than all those med addicts believing in this "incureable" BS.

    The answer to the problems would be a resource based economy.
  • Oct 19 2011: I'm currently working as an EMT in Washington and one of my duties is to transport patients in an ambulance, who are incapable of sitting upright, to routine appointments such as dialysis, surgeries and check-ups etc. Usually this means patients with amputations, bone or muscle diseases, obese patients, elderly patients etc and as a result I spend a lot of time going in and out of nursing homes. I am saddened by the general lack of compassion for the patients. I also know that it is very difficult for the nurses, aids and therapists to spend a lot of "quality time" with each of the patients considering that often there are only one or two nurses for every 50+ patients. I would like to see more patient advocates and volunteers in the facilities to spend time socializing with patients and to make long term, live-in healthcare a more enjoyable or at least a less depressing experience. I think that good health"care" involves caring and compassion.
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      Oct 19 2011: I don't know if we will ever get to a world where compassionate people work in position where compassion is required the most. It is a sad reality we're not there today. But many things you described will rapidly change with modern technologies. Inexpensive exo-skeletons for disabled and elderly, which enable walking. New biologic treatments for weight control, labs/tests done by a portable device or a mobile phone even, where no appointment would be necessary, or routine visits for a chat with doctor, which can happen online, without having to be there. There's hope that most people will be less disabled by their "disabilities".
      • Oct 19 2011: Dear Sir,
        Come to my work for a day and you will see compassionate people who work in positions where compassion is most needed. Or follow Doctors without Borders, or go to a free medical clinic for the homeless, or any of the thousands of organizations that work for small pay or no pay to compensate for a broken medical/healthcare delivery system. Modern technologies ,which I use in my work everyday, are a mere adjunct to compassionate people who are also experts in there field.
      • Oct 20 2011: It is encouraging to see your comments. All of the issues of insurance, medications and prevention have little to do with the reality of the vulnerability of illness. At some point everyone will be ill, and will then be dependent on the health care providers. It is only then that the basic patient/care giver relationship comes into play. Each and every one of us will be counting on the care and compassion, empathy and respect to get us through every phase of recovery. Kindness costs no more than rudeness. Mutual respect and trust are the elements of the healing partnership. A health care model of patient and family centered care can actually reduce costs, speed healing and in the end, promote a better health standard.
    • Oct 20 2011: In terms of providing support, I try to categorize into two: those that require skills from high intensive training and those that require little skill.

      The first category obviously falls onto the shoulder of the providers and compassionate providers can give a much better experience for the patient and in turn will make the session much more enjoyable to the provider as well. When compassion is felt and appreciated, the patient will express the thanks in much more sincere way and we are tuned to acknowledge such appreciation. Compassion goes both ways.

      The second category - by properly labeling them and identify them can lessen the burden of the professional providers if and only if the society is willing to accept that some family members must be involved and the cost of a dedicated family member (the lost opportunity of making money for those needy families) should be somehow compensated through public support. The cost of family support outweighs the cost of professional support by factors and hence it is worthwhile for the whole society to consider a more "socialistic" solution to a crisis plagued by under funding.
  • Oct 19 2011: I believe that the future of health care is the shift from patient centred care to 'network centred care'. Personal support networks for individuals with health care needs in the community, particularly those with chronic care needs will benefit from professional, medical services working in tandem with a group of family members and close friends who all have a vested interest in the health of their loved one with illness or infirmity. This network requires careful coordination and the IT tool "Tyze" (www.tyze.com) is a private, secure way to do this. The NUKA system of care in Anchorage Alaska has radically changed the way that health care is delivered to a 'difficult to serve' population. For many of their chronic care patients who often called 911 and required visits to the Emergency room, the primary diagnosis was changed to that of isolation. Secondary diagnoses were the more clinical ones. This new system of health care delivery has had a huge positive influence on outcomes.
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    Oct 19 2011: Albert Ip, not so sure I would call you common.

    I agree we must be the change and act upon us first. Example is one of the most if not thee most effective ways to lead. When we lead this way, we have a positive impact on people around us and people we meet. We may be influencing CEO's and Chairman's without even noticing it.
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    Oct 19 2011: What if wellness activities were free, covered by medicare or whatever and treating sickness was expensive, rather than the other way around - it is expensive to eat healthy, exercise regularly, and engage in stress reducing activities.

    If society started to invest money in Wellness, shifting it from sickness treatment - we would have a start - maybe split the "heath" savings between more wellness activities and exploring a new energy source.

    That said we will also have a new resource PEOPLE - if people are healthier, longer could we they start doing some of the things people used to do, that we have machines doing now? Farming, Forestry, etc

    The shift starts with the mind - decide to live a healthier, longer life and decide what you will do to make a difference with your extra time.
  • Oct 19 2011: If a solution is found but is being locked up in someone's safe or behind patents, the solution cannot be used to help people, it is quite useless, is it not?

    Knowing is the first step. After we find a solution, the task begins.
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    Oct 19 2011: Christina today I wake up with some flu....here in Guadalajara begins the cold air. I prefer some infussion from "ABANGO", is a mixture of seven herbs, and I feel better with no pills or strange drugs. This technology cames from centuries ago and we are plenty of abango and many others remedies for everything. And I say everything includes cancer or diabetes or gangren....for example to purify the blood the better is a teaspoon of dry rattlesnake in the soup. So we keep our health with nature in our side. Of course we have also a lot of pills and drugs from labs but.....
  • Oct 19 2011: Heath Care, lets look at the bigger picture.
    Just over 200 years ago, our population on earth was about 1.5 billion people.
    Then the Industrial Revolution began, and with it technology that gave doctors the tools to cure all kinds of diseases.
    Our population this year is to surpass 7 billion, talk about "Health Care and Sickness Treatment."
    Not in the history of man kind has there been such an increase in such a short time.
    Right now we are on the "Threshold" of our Natural Resources consumption at the current population rate.
    If we found a cure for cancer and AIDS today, tomorrow we would have to have a new energy source.
    We have to reach a balance between the two.
    • Oct 19 2011: The bigger picture is pretty ugly.

      With that many people, human has become a pest of this planet. We dig things up from deep down, pollute the air, pollute the water, change the earth surface, destroy forests and eco-system. Soon, nature will get rid of us (or we get rid of ourselves), yet lives on Earth will go on and our marks on this planet will be wiped clean.

      If human wants to prevent that happening too soon, we need to restore the balance with nature, clean up the environment, reduce the damage to the eco-system, gradually reduce our population and let our own system (human body as an ecosystem) works with the larger eco-system.

      :-)
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        Oct 19 2011: We need more knowledge, that's all.
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          Oct 19 2011: Gerald, what if we stop neglecting the knowledge that we already have?
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        Oct 19 2011: True, Juan, but still; we don't have enough knowledge. We need fusion, for instance. We need to be making anything out of hydrogen, and why not food. So many things ahead of us. Killing people is a poor solution to overgrowth, and it's short term, anyway. We need more knowledge. And we'll do just fine.

        For one thing, 7 billion humans is way too much as it is. Only knowledge allows for this to happen.
        More people, more knowledge needed, that's all.
      • Oct 20 2011: innovation is a desperate way to try to fix what we did wrong in the past to Mother Nature!
        • Oct 20 2011: Innovation alone is not enough. I have seen "dark hands" from special interests tapping on the shoulders of law makers and cracking up their propaganda machinery to misinform the general public both here in Australia and elsewhere in the world.
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      Oct 19 2011: Dan,
      It wasn't exactly the way you tell it.
      There was one big factor that did increase the population enormously.
      It wasn't the doctors but it was hygiene.

      As I found out when searching for my ancestry the situation at the start of the nineteenth century was that most children died. Mothers got on average 10 to 20 children and 3 to 5 children became parents themselves. Halfway that century hygiene was introduced on all levels and suddenly most children stayed alive. This caused much poverty because society couldn’t cope with that much people. Those who could emigrated abroad, most to the US.

      Later, on a smaller scale, the same happened with the introduction of penicillin and vaccination programs.
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    Oct 18 2011: Christina, innovation and technology will continue to play an important role, however what I would like to see first is a shift of focus from medical and pharmaceutical companies.

    I know I'm a dreamer but I truly believe that if they focus on saving lives over profit there will be a mayor change. Debunk vitamins myths, strengthen nutrition training in medical curriculum, endorsing a healthy diet with a decent amount of exercise to a greater extent than just recommending it, I truly believe we can do better in that regard.

    Definitely more affordable if this happens.
    • Oct 19 2011: Juan,

      I almost agree with all you say.

      "saving lives over profit" - it depends on what do you mean by "saving". We all die. There is yet no way to prevent us from eventual dying (well I watched TED talks that there are people working to extend our lives to escape mortality - but that's for another time.) If we want to shift pharmaceutical companies focus from profit, that is not possible. The existence of the companies IS to make profit, anything else is secondary. Current western laws also treat company (a legal entity) differently from people (also a legal entity). If a person has committed a murder, that person will be "put away" (in prison, e.g.) When companies kill in millions (e.g. selling a product which will kill a person), the companies do not share the same responsibility of a person. That's insane.

      Human exists to reproduce. Companies exist to make profit.

      With that givens and in order to change, we must make companies behave "morally" like we require persons to behave "morally". If a company is selling products which are detrimental to health, we should, at the minimum, require the company a full disclosure of the impact on health, AND the company should bear the cost of remedy to the damage made. This is particularly important for products which we consume as "food".
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        Oct 19 2011: Albert thanks for your input, I agree we die. Also agree that companies should be accountable to a greater extent for their actions as they are today.

        An example of what I meant would be when a company sells medicine to other countries after being banned in their own country for containing a virus or bacteria. They chose profit over life.

        I'm aware that no ordinary man would choose to shift their companies to be more concerned about actually curing diseases rather than making symptoms go away for a while, this will obviously have a major impact in business, however I do believe there are extraordinary humans that are willing to do this, and these humans will also overcome the business challenge.

        And as many things we a re working on today it will probably take time.
        • Oct 19 2011: Hi Juan,

          Good to see the kind of optimism you have on fellow human. Yes, when there is no conflict of interest, we are basically good. It is only the heroic and the great are willing to give up one's interest for the good of the bigger self.

          When one's success is measured by money or power, I'm afraid an external agent (such as a law) will be needed to "guide" companies into more morally responsible behaviours. After all, companies are made up by people. If the founders of the companies are less interested in profit and willing to do some social good, it is possible. Many non-profit companies are set up just to do that.

          Back to the question at hand, many pharmaceutical companies are too profit oriented and only develop drugs where there are markets. It is up to the common people to educate ourselves in order to live a healthy life.
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    Oct 17 2011: In my view there's a lot of misconception about health and sickness.

    To be healthy is natural.
    To be sick is for the most part due to stress.
    The way our society operates and on top of that all stories about what people could make sick are making them sick.

    Believing is a force that can work for our wellbeing when used in order to acquire trust and security, it can work to our disadvantage when it is used to make us panic or to create fear.
    The medical discussion within science as in communication with common people through the media is partly responsible for many to become sick. This also has a lot to do with pharmaceutical companies that need to sell their drugs, maybe it would benefit all as they weren't commercial anymore but in public domain.

    The force of believe isn't understood well enough within science and it would make a big change as it was.
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      Oct 17 2011: "To be sick is for the most part due to stress."

      do you have any evidence supporting that statement?
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        Oct 17 2011: Evidence could be found anywhere in life but also concluded from many studies in the past.

        To explain the idea behind that statement I can quote my answer to another question:
        http://www.ted.com/conversations/5577/what_is_the_difference_between_4.html?c=316780

        "If there are feelings there are also emotions for as far as I know. In Emotions the body expresses any feeling. It is moved and communicates this with the group by emotions.
        One can either control them or suppress them or let them be as they are.
        If the energy that is mobilized by any emotion is suppressed it will react on the body instead as it should on the cause of the initial feeling. To let this energy go inward provokes stress and either if the stress builds up one can blow out of his/her mind or become ill.
        Stress puts the body in the active mode to react efficient on danger or other things that need to be solved. Metabolism is shut off to use all energy for the task. (One second late and the lion grabs you.) After the task is accomplished one should relax and everything is fine again. But if there's stress building up by suppressing emotions there can be no relaxation. So because metabolism doesn't function properly and breathing becomes out of order, the body isn't fed as it should and becomes ill.
        So you better express your emotions directly as they appear but keep your mind with it to avoid any damage to other people."
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          Oct 17 2011: it is a very nice theory, but i was asking for some hard data backing that claim up. some sort of clinical study or other statistical analysis.

          for one, some time ago i read about a study that refuted the link between "positive thinking" and cancer survival. it seems that, contrary to the popular belief, positive thinking, optimism, "energy" and such things have no effect on 3 year or 5 year cancer survival as long as the patient follows doctors' orders and does not skip treatments. it might not be the final answer on the issue, but nevertheless one piece of the big picture. this is the kind of information i'm looking for.

          personally, i believe that the effects of stress are far less important than we used to think.
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        Oct 17 2011: I think that for most cancer patients it is a bit late to change patterns of thought overnight that has formed over many years.

        The evidence for myself is overwhelming. It can be found anywhere in nature.
        For many years I kept tropical fish and especially Cichlids.
        If circumstances are good, water quality, community pressure, space, places for shelter and breeding, they flourish. Colors are increasing with the day, they grow larger, are vital, active, self-confident.
        If stresses occur they get stressed, bad water, too little space, too few hidings, too much competition, etc., they get bleak, their resistance fall dramatically, they isolate themselves and then they're suddenly dead.

        This you can try out a thousand times with the same results over and over, and with people that can put in intelligence to change some aspects for the better or that are treated by health workers it can last a while but in the end it isn’t different.
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          Oct 17 2011: i appreciate your opinion, but i have to point out that we call such things "anecdotal evidence". it is very easy to formulate incorrect assumptions based on such "evidence". among others, nonrepresentative sampling and confirmation bias heavily distort facts, even with the best intentions.

          granted, there are some cases of some sicknesses that are caused by stress, and this fact is actually observed in controlled studies. but it is far away from sicknesses being mostly caused by stress. we don't have any hard data supporting that. of course, it does not mean that you can not have such a belief.
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          Oct 17 2011: I'm an Immunologist and a supporter of using the scientific method for problem solving but I want to share a story of mine because this conversation is going in a bit of a circle.

          When I was in my final year of a BSc I had to use up an elective on a non-science course. I love science and didn't want to learn about anything else so I took the closest thing I could find: Medical Anthropology (the study of how human culture affects health and dissease). Now, my guard was up on the very first class as I got into a debate with the instructor over whether poor social conditions could cause dissease. I was adament that he was wrong and MICROBES cause dissease!

          Surprisingly though, over the course of the semester I came to realize that we had fundamentally different definitions of "health". Western cultures tend to think of things like infections when we think of sickness: something that can be treated, measured, and analysed with statistics. However the "feeling" of being sick is a person's interpretation of what is happening to their body and that can ONLY be described by anecdotal evidence. In addition, some cultures have different criteria for illnesses: for example childbirth which is a natural process might not be considered within the medical realm at all, whereas feeling angry which is abnormal may be treated as a severe illness.

          Western medicine is particularly bad at preventative medicine and treating mental illness so while we need to be rigorous about testing medical practices and coming up with logical solutions, I think it helps to think outside the box and take things like stress into consideration too.
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        Oct 17 2011: A little Google helps to understand the mechanism better as I explained.

        http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=92975996&m=92975979

        It would prevent a lot of medical care if more people start to understand this.
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          Oct 17 2011: 1. we don't need to understand it any more. it is quite clear what you are saying. i don't want to understand it better. i want proof of it.

          2. your statement was not that some sicknesses are caused to some degree by stress. you said much more than that. you have said that *most* sicknesses are caused by stress. and i'm still waiting for any *reliable* sources to back it up.

          i think we've talked too much about that already. theres no point in repeating the same stuff all over again. next time i will respond if you show me a scientific research that supports the claim that most sicknesses are caused by stress. until further notice, i will treat that as common misconception.
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        Oct 18 2011: @Letitia Falk
        Letitia, I can't understand why it's so hard to see that if the cells of our body are deprived of nutrients that they start to malfunction. It must be self-evident.
        As it is about emotions like being angry or feeling powerless and many more, they all provoke stress as I described above and as cells can't flourish the body gets sick.
        In our society there are so much factors for stress that it is almost a miracle that so many people are relative healthy. We are really a tough kind of species.

        In Germany I see medics look that way ever more and with growing interest. And as with the fishes, if people have their relations right, if they have living and breathing space, if their minds are trusting and without fears, if they aren’t exposed to pollutions and toxins of all kinds, they thrive and won’t get sick.

        Sickness is a natural mean to restore equilibrium in the living system. Nature works rather indiscriminating. Every sick person wants to get better and fights the system but what we need to be concerned with is our social, psychological and physical environment. In this traditional healers do a better job than modern medical science.
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          Oct 18 2011: you refused letitia's helping hand, and went even further stating that stress directly affects cell level functions.

          the notion that most sicknesses are caused by stress seems to be unfounded to me. the idea that stress would directly disturb cell functioning is just outright ridiculous.
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          Oct 18 2011: What stress does is trigger the body to focus on short term priorities. Stress disturbs digestion, growth and your immune system.
          It does that through the secretion of glucocorticoids. High levels of glucocorticoids in your blood is a barometer of your stress level.
          In the wild, a stressful period is short, and not unhealthy. In our society, chronic stress does damage to us. Ulcers are typically stress related.
          This is not pseudo science. This is endocrinology.
          I've read a book about it. Hope I explained it ok.
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          Oct 18 2011: Let me explain more about it. When you're running for your life, your body secretes hormones that direct sugar towards the muscles, that inhib sperm creating or egg making, that inhib digestion, body developpement and the immune system.
          When you're safe, glucocorticoids go back to normal, and your body works normally.
          However, if you're worried at your office, and in a situation where you're stressed for a long period of time, the high level of hormones disturbs your natural long term functions over a long period.

          Stress is not pseudo scientific. Toxins, pollution, bla bla. Stress is a secretion of hormone in response to a peculiar stimulus, supposed to help the organism in emergencies.
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        Oct 18 2011: For the proof you need, they're working on it.
        So you need a little patience.

        http://health.universityofcalifornia.edu/2011/01/03/science-of-stress/
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      Oct 18 2011: QUOTE by FRANS : To be healthy is natural.

      Really? And why is that?
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        Oct 18 2011: To be healthy is unnatural, would that make sense?
        If it wasn't natural to be healthy wouldn't we be extinct a long time ago?

        The body is tuned and fine-tuned over our ancestral lineage from the first appearance of life on earth.
        Illness is part of it. It is a way to keep us healthy and eliminate failures and to keep the ecosystem balanced. That we swapped our natural environment for our own created society gives a lot of unbalance that can teach us to adjust this environment to meet our needs.
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          Oct 18 2011: Okay so we're having an ethical debate now? Surely because sickness is "natural" doesn't mean that we should stop trying to alieviate human suffering?

          To say that there is no cause of sickness except our social system is insane: there are dissease causing organisms and genetic causes of dissease that would still plague us even in a utopian social system where everyone was happy and stress-free. Likewise it is also insane to say that stress has no effect on health when it not only decreases the "feeling" of health and well-being but has been shown to decrease immunity among other affects.

          Obviously both natural and self-created factors contribute to our heath. Lets use our various backgrounds to tackle this problem in multiple ways instead of fighting over what the root cause is?
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          Oct 18 2011: Illness does not benefit us. It's just other organisms trying to screw with ours. We either defend ourselves successfully or die. There is no such thing as an echosystem. Everything is out there to wipe you out. Nature is war, there is no Garden of Eden balance.
          "Ilness is a way to keep us healthy"; what nonsense! If it wasn't for goddamn germs, we would have tremendous available energy to spend on something less useless.
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          Oct 18 2011: Actually our ability to fight off dissease would be severly compromised without "germs". Our skin and mucous membranes are covered with commensal "friendly" bacteria that outcompete dissease-causing germs by taking up all of the space avialable. This is why doctors often suggest taking "pro-biotics" or eating yogert while on a course of anibiotics: to restore the good bacteria that normally line your digestive tract.

          Over the course of evolution, we have developed a mutually beneficial relationship with some other species which can be kept in balence: not everything is out to get us :)
    • Oct 19 2011: Frans,

      Life is about eating and be eaten. Living organisms are a large web of inter-dependence. Some living organisms have symbiotic relationship with us, some wants to take advantage of us (may be in a way to kill us). As you have correctly pointed out, nature is indiscriminate between human and other organisms.

      I have read somewhere that there are more foreign cells (ie those that do not share our own DNA) in our body than our own cells. We are a system by itself. When our system is "balanced", we are healthy.

      Stress is obviously part of the balance. If you force me to put in order of importance, air is most important, without it we will die in minutes. Water come next. Food (as in energy) would be the third. When these three essentials are met, we are in a position to discuss the "other" essentials - nutrition, quality of air and water, mental state of mind, level of exercises, immunization and the rest. In general maintaining a "balance" is what makes us healthy.

      For developed countries like USA and Australia (I'm Australian), obesity is the result of poor quality of food. May I repeat, calories are cheap and nutrition is not. A large portion of our society are eating too much meat, too little vegetables and fruits. One way to help a population to be more healthy may be to promote the nutrition-dense diet. I think (just a guess) a lot of weight loss companies are missing the market. The focus should not be on calories, but on nutrition. :-)
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    Oct 16 2011: Get rid of intellectual property altogether. That will drastically reduce the cost of drugs and new technology.

    Research is a collective enterprise - scientists will still research new drugs and technology, as they did long before the concept of intellectual property. Furthermore, researchers are in it for the knowledge, the benefit to humanity, and possibly the glory, not primarily for the patents/money.

    Big pharma and idiot conservative economists will vehemently deny this, but that's to be expected.

    There is also a large shortage of doctors, at least in the US...despite the fact that we have high unemployment and an educational system that can re-create all videos, textbooks, interactive tutorials, etc. at zero marginal cost (AKA the Internet.)

    We could kill two birds with one stone (lowering medical costs, decreasing unemployment) by creating a cheaper, more flexible licensing system for medical personnel:
    http://www.ted.com/conversations/1650/in_2011_is_it_possible_to_mak.html
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    Oct 15 2011: I can't really comment on the state of healthcare in England but we are definitely struggling to find a solution here in the US. It is obviously a multifaceted problem involving policy makers, private medical device/drug industries, clinicians and the patients!

    Policy Makers: Thanks to innovation in medicine/technology, most people now die of chronic diseases as they age. This is very different from acute care and requires an long-term doctor to patient relationship. This is just not possible with myriad of private insurance companies. Moreover, our insurance provider is ultimately determined by our employers. So, without sounding too socialistic, there is a need for a centralized healthcare system so that patient information can be easily accessed by the primary care physicians REGARDLESS of where the patient is.

    Drug Companies: Instead of focusing on developmental research ( to extend patent period), drug companies should worry less about profit and invest more in diversifying their target diseases. For instance, developing a drug to treat a small population of patients might not be profitable but it is certainly necessary (government should also subsidize these research).

    Clinicians: Patients from an area with more specialists per capita are more likely to be subjected to invasive and expensive procedures. There has been an overwhelming push to churn out primary care physicians but without success simply because it is not profitable. Bach and Kocher have proposed an interesting solution that would effectively make medical school free for primary care physicians and specialists would still have to pay for training.

    Patients: An an age when information is readily available, patients have an responsibly to monitor their own well being and conditions. From a cultural perspective, there is a need to promote a healthier lifestyle.

    technology: promote more transparency between patient and their information/physicians. (i'm out of characters)
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      Oct 15 2011: A lot of changes are being proposed and debated here in the UK. As in most countries, the healthcare system is inefficient.

      It will be interesting to hear more from you about what role you see technology playing in healthcare particularly mobile. as a whole, the industry is very conservative (for the right reasons).
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        Oct 15 2011: Well, wireless technology is slowly being incorporated into the healthcare environment. From what I've seen, wireless patient monitoring is on the rise (e.g. philips intellivue system). Of course, there are tons of physiological monitoring apps available for our smart phones but it hasn't gain too much momentum due to privacy and standardization concerns.

        Regardless, I think mobile healthcare communication is inevitable and eventually, patients will be able to communicate about their chest pain or suspicious lesion with their physicians over their phones.

        One topic that I'm particularly interested in is wireless monitoring of not only patients but various other parameters within any healthcare environment from patient traffic to equipment locations, infection risk level all with respect to time, location and responsible personnel. This will be an interesting way to measure general hospital quality.

        If you don't mind, can I ask why you're interested? I see that you're working for GSK which is predominantly a drug company? Are there plans to incorporate wireless technologies into our pills?
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          Oct 16 2011: This is very interesting. My thoughts are along the same lines. It is also quite fascinating to see the whole explosion of research and activities in the area of incorporating technologies into healthcare.

          I work for GSK but this conversation and question is because of personal interest and represents my own views.
  • Comment deleted

    • Oct 17 2011: Ed,

      Medicine, no matter how you like to call it, should be evidence-based. If something works repeatedly under similar condition, it is medicine and it will not be "alternate" medicine. For those which do no show any effect or better than placebo, these alternate "medicine" should be excluded. Just a disclaimer, I am born Chinese and many Chinese medicine is just placebo, but there are many which are actually evidence-based. The task for those interested is to sort out the good ones from the useless.
      • Comment deleted

        • Oct 17 2011: Ed,

          re: change "should" to "must - we have an agreement. :-)

          But I do not understand why reference to "consciousness", especially "checking their level of consciousness". Are you saying "treatment" has consciousness?

          My reference to "evidence-based" is a reflection of many voodoo, mystic, no evidence supported magic spells being promoted as treatment - which is feeding on people's gullibility at time of weakness. I think that's immoral!