Showing posts with label needs. Show all posts
Showing posts with label needs. Show all posts
Networked Empowerment of ePatients What the Population Health Management Community Needs to Know
Friday, May 2, 2014
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| Are you helping your e-patients? |
The Disease Management Care Blog got to hear a compelling conference keynote presentation by Dave deBronkart, a.k.a. "e-Patient Dave." Think of this as an ePost from the eDMCB about the eBusiness implications of ePatients.
By the way, a more suited moniker may be "Remarkable Dave." Hes survived Stage IV kidney cancer thanks to a an interleukin based treatment regime that he wouldnt have known about if it werent for his use of the internet. Thanks to his laptop and a remarkable degree of determination, he was able to network with similarly "empowered, engaged, equipped and enabled" cancer patients. Now a multi-year survivor, hes a go-to patient advocate for the Washington DC cognoscenti, is a co-founder of the Society for Participatory Medicine and a tireless advocate for acor.org.
While the DMCB could never capture the scope of e-Daves presentation in this blog, there were some insights that may be of use to the disease management and population health management service community:
The "Soup" of Information: As more medical information becomes available on-line, patients, families and friends will be "swimming" in social networks that will yield more insights about possible diagnosis and treatment options than an average physician could ever know about. This is not about reading on-line content. This is the two-way sharing of information in community networks of like-minded individuals who spend a lot of time and effort becoming experts. They ultimately produce value, not consume it.
Population Health Management (PHM) Implications: ePatients with chronic conditions are going to be unlikely to settle for the recommendations in your pre-fab care plans. Be prepared to accommodate new inputs that will complicate and enrich self-management. If a e-patient asks about an unknown treatment option out of "left field," the best answer may be "dont know, well find out more and get back to you."
Under the Garbage Theres Gold: When you consider that as many as 1 in 5 romances start with an on-line dating service that involves hundreds of options and many poor fits before couples find each other, it should be no surprise that much on-line medical information is likewise ill suited to an individual patients circumstances. Thats OK, because if patients keep digging, theyll find that key piece of information that they really need.
PHM Implications: An emerging value proposition: being a trusted advisor and catalyzing ePatient information networking and mining.
Wisdom of Crowds on Steroids: The best source of that information? Other patients who, unlike many of their physicians, have a lot of time and motivation to do "deep dives" in personally relevant research that would otherwise take years to enter mainstream clinical practice. Theyll also share their personal experiences with each other.
PHM Implications: Have you thought about not only helping your patients find an on-line community but hosting one?
Vaccine Airheads: Yes, there is a lot of potentially harmful information on the web but much of it is the fault of the medical community. The spurious link between vaccines and autism, for example, was the result of fraudulent research and faulty peer review. Compare the "death rate from Googling" to the "To Err Is Human" death rate of 98,000 per year, and you get the picture.
PHM Implications: As you accommodate an on-line community, expect some crazy points of view. Thats the price of doing business.
Jerks Google Also: If a hateful (maybe a less provocative term would be difficult) patient is using the internet to torpedo a doctor-patient relationship, chances are theyd torpedo the relationship without Googling. Use of the web is an innocent bystander.
Some other DMCB take aways:
There is ample research on shared decision making (plus a good article here) that shows that when patients get all the information they need, most not only choose wisely, they choose conservatively. While some may chose the "wrong" option, thats the price of patient empowerment. From a population-based level most of the curve shifts to the left. The good outweighs the bad.
Once again, we are witnessing the breakdown of "credentials" that separate knowledge-based professionals and self-trained amateurs. This is a disruptive innovation that represents an important threat to "cognitive" physicians.
Electronic health records that rely on a walled garden to try to capture patients will lose. Electronic health records that can accommodate the messy world of eDaves will survive. Electronic records that can enable it will win.
The ePatient movements benefits outweigh harms, is self-enforcing and impossible to regulate. That doesn mean that someone is going to try to do it.
One last closing insight from eDave: If you are reading this, think about what would happen if you developed a serious or life-threatening condition. You would start searching the internet.
You are already an ePatient.
Image from an HHS web site
Why Your Growing Child Needs to Eat More Fat
Wednesday, February 5, 2014
The low-fat craze of the 90s just wont die. I thought we were past low-fat at this point, yet every time I go to the grocery store Im still bombarded with the fat-free message. Its worse at Whole Foods, my place of employment. We even have a whole line of "healthy" fat-free salad dressings at our salad bar. And in my current school lunch rotation (part of the joyful road to becoming an RD), fat is being pulled from the menu like never before in favor of whole grains, vegetables, and skim milk. New York City schools have gone as far to ban butter (!?!?). For the average consumer, the message is loud and clear: fat is bad, mmmkay? Weve gotta eat more vegetables! Eat your broccoli, eat your salad! Throw out the butter and oil! Fats killing the kids!
But theres a problem with that. A big one. Of course vegetables are full of nutrients, but eating them without fat renders their fat-soluble vitamins (mainly vitamin A) useless. And you do NOT want that, especially if youre a little cherub in the 1st grade. Read on now, ya hear?
Eating fat allows you to absorb more nutrients out of your fruits and veggies.
I found this study via Chris Masterjohn; he mentioned it in passing in this article, but I feel that it deserves more attention. Its an extremely well-done study, and it proves conclusively that absorption of fat-soluble nutrients is dependent on the amount of fat in the meal.
The study, done in 2004, tested carotenoid absorption from a salad with varying levels of fat added (1). For the non-scientifically minded, carotenoids are vitamin A precursors; alpha-carotene, beta-carotene and lycopene were tested here. The researchers recruited 7 subjects, who each consumed 3 salads consisting of equivalent amounts of spinach, romaine lettuce, cherry tomatoes, and carrots with salad dressings containing 0, 6, or 28 g canola oil. The salads were consumed in random order separated by washout periods of at least 2 weeks, and the participants were instructed to avoid carotenoid-containing foods for 4 days preceding each test. Blood samples were collected hourly from 0 to 12 h post-meal.
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| Triangles = no fat, Open circles = 6 g fat, Closed circles = 28 g fat |
To quote the abstract of the study... "Essentially no absorption of carotenoids was observed when salads with fat-free salad dressing were consumed. A substantially greater absorption of carotenoids was observed when salads were consumed with full-fat than with reduced-fat salad dressing." Translation: no fat = no absorption. A little fat = a little absorption. A lot of fat = a lot of absorption. Doesnt get any simpler than that. We need fat for carotenoid absorption, no two ways about it.
The type of fat matters too. Another study examined the difference in carotenoid absorption in the presence of olive oil (monounsaturated fat) versus corn oil (polyunsaturated fat) (2). Absorption was shown to be much higher with olive oil in all cases, and this is likely to apply to other monounsaturated fats as well, like canola oil.
Why this matters: Its all about the kids.
But, you may say, these studies only apply to vitamin A precursors like beta-carotene... we get plenty of vitamin A in the diet so we dont need to worry about it. Not so fast. We consume enough vitamin A, yes. And nearly all of us absorb enough of it to prevent a deficiency. But does that mean we have enough to be optimal? Absolutely not. Especially for growing children, who need vitamin A for bone growth and facial development. Some evidence, like the work of Weston A. Price, shows that intake of vitamin A beyond just the minimum is needed for optimal skeletal development (3).
According to the authors of that first study, "Carotenoids are most commonly consumed in fruit and vegetables, and most populations depend on provitamin A carotenoids in these foods to meet vitamin A requirements." Since we know that the absorption of these vitamin A precursors is entirely dependent on the fat content of the meal, we can say that the presence or absence of fat in a childs diet may be the determining factor in their vitamin A status. In other words, your childs bone and facial development could be stunted due to a lack of fat in the diet. Every parent wants to do the best they can for their children right? Well, part of this would be liberalizing their fat intake.
The benefits of vitamin A.
The benefits of optimal bone development and facial structure are many-fold, but here are a few of them...
- Straight Teeth - Proper facial development will allow enough room for teeth to grow in and minimize the need for braces
- Injury Prevention - Giving your child a strong set of bones will lessen their chances of breaking one in the future
- Physical Attractiveness - Lets be real, people with fully developed faces and straight teeth are usually more attractive... and we all know there are perks to that (4)
Eating fat sounds like a no-brainer doesnt it? But this is a problem in todays fat-phobic society, with fat-free dressings and butterless school lunches. Parents want to do the right thing, but restricting fat is NOT the way to do it. We need a balanced diet with natural fats... natural fats like extra virgin olive oil, butter, coconut oil, and even some animal fat. A little fat does a body good. Let go of your fat phobia, please. Do it for the children.
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