Health for life

Testing for hidden early lung cancer

Remember this article on screening for lung cancer? 

More than 54,000 former and current tobacco users who looked like they were free of cancer were randomly assigned to a yearly cheapo chest x-ray vs. a yearly pricey low-radiation-dose CAT scan. Over 5 to 7 years of follow-up, the CAT scan was better at picking up early lung cancer (119 cases) which translated into a small but statistically significant survival advantage of 62 lives saved per 100,000 patient years.

Does this mean that Medicare, Medicaid and all commercial insurers should "cover" a baseline and yearly follow-up screening CAT scan for tobacco smokers at risk for lung cancer?  According to actuary Bruce Pyenson and colleagues writing in the latest issue of Health Affairs, the answer may be yes.

The Disease Management Care Blog thinks the answer may still be no. 

Is it being a heartless curmudgeon?  Read on and decide for yourself.......

In the Health Affairs article, the authors assumed current and former tobacco smokers comprise about 30% of persons aged 50-64 years.  They further assumed that about 50% of persons at risk would agree to the CAT screening exam.  Based on prior studies, they estimated that 21% of the baseline scans and 7% of the follow-up yearly scans would require additional testing and figured lung cancers would be present in 0.6% and 0.2% of the baseline and follow-up scans. They used a fee rate of $247 per screening for both the scan and included the cost of a counseling session on smoking cessation.  

Spread over a population, the cost of the screening would amount to 76 cents per member per month (PMPM). On a nationwide basis, there would be 130,000 additional lung cancer survivors.  The cost per life-year saved in 2012 dollars would range between $11,708 and $26,016.  To put things in perspective, it costs more per life-year saved to use current screening approaches to cervical cancer with pap smears (more than $50,000), colon cancer with colonoscopies ($18,000 to $29,000) and mammography ($31,000 to $51,000).

Much of the high costs of these other cancer screening procedures are the result of more persons being eligible for the testing.  In the Health Affairs study, the only persons getting the scan are smokers who are at high risk.

What did the DMCB learn?

One important lesson in this study is that cancer screening is not free.  Its too easy to assume that the early detection provided by mammography, colonoscopies and pap smears pays for itself.  Thats simply not true.  What is true is that cancer screening is good value, but itll still cost you for each life saved.

The second lesson is that good value still represents incremental cost.  As a result, the 76 cents PMPM is in addition to the money already being spent by health insurers.  While the extra pennies doesnt seem like a lot of money, the health insurance dollar is comprised of coverage of similarly priced goods and services, and all those pennies are continuing to add up.  The DMCB thinks were getting to the point where the U.S. would need to ask what coverage of which service should be cut to pay for lung cancer screening.

Both of these issues make it unlikely that insurers will willingly include coverage of screening CAT scans in their health insurer benefit.  They can also argue that it would be highly unusual to decide to cover a new screening procedure based on a single study that hasnt even been reviewed yet by the U.S. Preventive Health Services Task Force.

Last but not least, the DMCB is willing to bet that there wont be much consumer demand for coverage by insurers because of bias against the victims of tobacco-associated illnesses as well as the argument that smokers should self-pay based on the comparative cost of a years worth of cigarettes.

It remains to be seen if, under their ability to define a minimum insurance benefit as part of the Affordable Care Act, the Feds will require lung cancer screening.

Stay tuned!

Image from Wikipedia

There are several reasons to attend the Oct 21 Patient Centered Primary Care Collaboratives 5th Annual Summit.

Youll see the good work that the PCPCC is doing as the leading national organization advocating on behalf of the Patient Centered Medical Home (PCMH).

Along with an auditorium-full of like-minded learners, youll benefit from an agenda that is packed with clinicians from the real world of medical practice who have developed successful medical homes. 

Youll get to meet others who share your interest in an innovative and rapidly evolving approach to primary care.   

Youll be in Washington DC at the height of beautiful fall weather. 

And, last but not least, youll get your own copy of the PCPCC Report, Care value, community connections: Care coordination in the medical home.  According to this newswire press release, the report "includes the insights of thought leaders" on the theories and tactics behind the definition, role and function of care coordination.

The immodest Disease Management Care Blog couldnt have put it better itself, especially because its the author of the first second chapter.

One of the Disease Management Care Blogs local hospitals has jumped into a lawsuit against Medicare. 

According to this article, the dreaded 2003 Medicare Modernization Acts RAC audits have gummed up Part B as well as Part A payments.  Thats important because Part B includes physician services, which outside of hospital-physician alliances like Accountable Care Organizations, is typically completely separate. Hitting A as well as B not only represents a potential double hit to hospitals bottom lines.

Could that give hospitals a reason to think again about hiring physicians?

Even if the DMCB is wrong about the scope of the lawsuit, the articles paragraph on this hospitals costs in dealing with the RAC audits are eye opening: 6 staff members and additional hundreds of thousands of dollars to cover medical record requests, consultants and appeals.  If other hospitals are being forced to follow suit, the cost to the health care system is considerable.

And those are Medicare administrative costs. These are borne not by the feds, but by hospitals, which must comply with thousands of pages of complex rules and regulations.  While its mathematically true that Medicare has "low administrative costs," thats because the Agencys principal means of enforcement are cudgels like RAC audits with clawbacks with interest, penalties and other sanctions. 

While there is no shortage of hospital bad behavior, DMCB suspects most hospitals are honest and, despite that, have had no choice: add additional administrative expenses that are ultimately passed through to the patient and the nations fisc.

Here at Cheap Healthy Good, we usually reserve Wednesdays for long, academic posts in which the conclusions inevitably boil down to “eat more vegetables” and/or “do what’s best for you.” (The internet: where non-answers are the best answers.)

Today, we figured we’d try something a little different: a quiz. It’s designed to determine whether you should start, continue, or stop reading this blog. In a way, it’s kind of like asking, “How good are you at applying all this stuff?” or "Kale is awesome, right?"

So, using a pencil and a piece of paper, record your answers as you go along (or, you know, just remember them). At the end of the post, evaluate yourself using the provided key.

Have fun and good luck.

1. You have five dollars to feed yourself for two days. You buy:

• A) Bananas, carrots, sweet potatoes, beans, peanut butter, bread, and a dozen eggs. What? You had coupons.
• B) Two boxes of pasta, a jar of decent sauce, and a bag of salad. Breakfast is gonna be weird, but you’ll get by.
• C) Five junior cheeseburgers off the $1 menu. Then, you load up on ketchup and salt when your cashier is distracted by the senior bus tour.
• D) The latest issue of Maxim. Hopefully, it will keep you so distracted you won’t need to eat.

 2. It’s Friday night after work. In your fridge are two eggs, half a jar of salsa, and a hunk of bread. What’s your reaction?

• A) Time for Shaksouka! With herbs from my victory garden, of course.
• B) Scrambled eggs with salsa and toast. Not too shabby, sports fans.
• C) “Hello, is this Kam Sing? … Yes, I’d like a pint of Pork Chow Fun … yes, a pint … of Pork Chow Fun … Pork Chow Fun … a pint … one pint … Pork Chow Fun … No. Pork Chow Fun … one pint … Pork Cho- … Fried Rice is fine. Thanks.”
• D) What’s an “egg”?

3. Your favorite food publication is:

• A) Saveur. So beautiful. So erudite. You want to make crazy tantric Sting love to it.
• B) Cook’s Illustrated. So practical. So methodical. You want to spoon and make it a mix tape.
• C) Every Day with Rachael Ray. So colorful. So fun. You want to give it a friendly high five and a girly, non-boob-touching hug.
• D) Highlights Magazine. So Gallant. So Goofus. You want to learn math and simple decision-making skills from it.

4. Your favorite food is:

• A) Tout plat favorisée par des paysans français. Ils sont les meilleurs, cest exact?
• B) Turkey Chili. It’s delicious, surprisingly filling, and uses all the odds and ends lying around your rigerator.
• C) Kraft Macaroni and Cheese. If you use skim milk and halve the butter, it’s not so bad. Plus, it comes in Shrek shapes! I can eat that damn cat!
• D) Cigarettes. Mmm … tabacco-y.

5. Given five bucks and a choice of chocolate bar, you’d buy:

• A) Theo. It’s free trade organic cage free humanely raised Omega-3 other words.
• B) Lindt’s. Delicious, a little upscale. A real treat.
• C) Hershey’s. IT’S ALL YOU KNOW.
• D) A 40 of malt liquor with an M&M accidentally dropped in the bottle.

6. Your favorite Food Network show is:

• A) Baoot Contessa. You would kidnap Ina Garten and keep her in your basement if you were sure it wouldn’t upset Jeffrey.
• B) Everday Italian. Giada knows what she’s doing. Also? Claw hand.
• C) Quick Fix Meals. You don’t necessarily like it, but it’s tough to break from Robin Millers uncomfortably intense stare.
• D) Down Home with the Neelys. HAHAHAHAHAHA, PAT, AH LUUUUUUUV YOU BABY, AND NOW WE’RE GONNA MAKE SOME ITALIAN BARBECUE, RIGHT BABY? IT’S REGULAR BARBECUE, BUT WITH A BASIL LEAF. HAHAHA, BABY? (*Pat shoots self in face*)

7. Your definition of healthy food is:

• A) Organic, whole foods bought from local vendors and/or free trade organizations, prepared simply with a little oil. Julienned if possible, just because you like the word.
• B) Anything that will eventually decompose.
• C) Diet Coke and Weight Watchers Amaretto Cheesecake Yogurt.
• D) Moonshine without too much dirt.

8. The biggest problem with the American food system is:

• A) Not enough fennel.
• B) Too many chemicals. Useless government regulations and regulators. Unchecked corporations. Food deserts. False nutritional claims. Marketing junk to kids. … Wow, this is depressing.
• C) Um … well, Hot Pockets are kind of gross.
• D) Not enough heroin.

9. Quick! Make up a haiku about food!

• A) Pastured, grass-fed cattle / Mooing gently on the plain / Tomorrow’s sirloin.
• B) Though I loathe salad / I know it must be consumed / For good aorta.
• C) Long Island Iced Tea / has iced tea in it so it / has to be good, right?
• D) Beans. Beans. They make you / smart. The more you eat. The more / you … uh … umm … like art.

10. Your favorite food book is:

• A) Anything by Michael Pollan. In fact? Yesterday, you snuck into his office at UC Berkeley, stole his diary, and were startled to discover it reads exactly like the script for Taxi Driver.
• B) Kitchen Confidential. It inspired you to quit your job, start washing dishes for Babbo, and buy a Ramones box set.
• C) Cloudy With a Chance of Meatballs. They’re meatballs! But they’re also rain! From the sky! Yay!
• D) Me no read book. Me eat book. Book good. Book have fiber. Book make butt feel good.

KEY

If you answered mostly A, you should start your own food and frugality blog. Your favorite activities include calculating unit costs and taking landscape photographs of the Whole Foods bulk section. Your coupon organizational skills would put Encyclopedia Britannica to shame. It’s entirely possible you spent your formative years hidden in a cupboard in America’s Test Kitchen. You are most likely a chef, a mother of ten working off a $13/week budget, or Christopher Kimball.

If you answered mostly B, you should continue reading Cheap Healthy Good. While you enjoy a fulfilling life packed with engaging activities, you occasionally spend an hour contemplating the financial and flavor advantages of cremini over button mushrooms. Your worst enemies are jarred garlic, bottled water, and late-era Paula Deen (though you would still like to visit her at Christmas). You have used your food savings to pay your mortgage. You are most likely a single person in an urban area, a married person in a rural or suburban area, Johnny Depp, or my friend M.

If you answered mostly C, you should start reading Cheap Healthy Good. When it comes to feeding yourself, you have the best of intentions, but they’re often usurped by insatiable cravings for Lunchables. In a mental smackdown between convenience and frugality/health, the former leaves the latter naked and bleeding in a sewer grate. You are most likely a college intern, somebody on Glee, or my brother.

If you answered mostly D, you are obviously in the wrong place. It’s entirely possible you were searching for Cheap Healthy Dudes or Keep Wealthy Moods or something similar. You are most likely a poor speller, a third grader, or a tad unsavory.

Thats it, sweet readers. Thanks for playing, and stick around for Wheel of Fortune!

~~~

If you enjoyed this post, you might also dig:

• 2 Oatmeal Recipes: 1 Sweet, 1 Savory (Plus, a Quiz!)
• Brunch Clafouti: The Pop Quiz
• The SATs of Cranberry Zinger Muffins

(Photo from DK Presents.)

This past weekend, I paid $0.50 for a baggie of cardamom that was selling for $10.49 the next block over. The big difference between the two stores? The $0.50 folks ran an ethnic market. The $10.49 folks ran an upscale grocery store.

Six years ago, I lived in a neighborhood with two major supermarkets, both of which sold produce for above-average prices. Located 15 blocks south was a Korean-owned fruit and vegetable stand. The tomatoes, oranges, and garlic there went for half the cost of the local Key Food.

Earlier this year, a few friends needed 70 goodie bags for a promotional party. They cost about $0.34 a piece at the big-box supply store on 14th St. in Manhattan. Chinese food containers, which looked better and held more candy, went for $0.25 at Pearl River Mart in Chinatown.

It’s taken me a few years, but after Saturday’s cardamom adventure, I think I finally learned the moral of these stories: when in food-purchasing doubt, go ethnic. Whether you’re shopping for spices, produce, or supplies, those independent, family-run marts are fantastic alternatives to mega-stores. The prices are usually competitive (if not significantly lower), and the diversity of options, unbeatable. But it doesn’t end there. (Oh no – it doesn’t.) There are a bazillion other reasons why Kim’s Seafood beats out Food Lion any day of the week.

Shopping at ethic markets…

Encourages experimentation. Diversifying your diet is hard, especially when you’re locked into losing weight. If you’re looking to lift yourself from the meat-and-two-veg rut, ethnic markets are the place to be. Imagine aisle upon aisle stacked with soba noodles, yuca, and saag paneer. Even if you don’t know what any of those things are – trust me, they rule. And the store they came from can introduce your palate to all kinds of crazy flavors you didn’t even know existed.

Promotes diversity. Hey man, our families were all immigrants somewhere along the line. And according the Census Bureau, 40% of the U.S. population will be of ethnic origin by 2010. So, think of the ethnic market as a fabulous opportunity to introduce yourself to a new culture, but also, to meld that culture harmoniously into your own. While you’re perusing the shelves, take the time to speak to the proprietor or other customers. Odds are, everybody will learn something.

Reconnects you to your own culture. Are you a lapsed Swede? A part-German who’s completely ignorant of her background? A quarter-Brit with no discernible knowledge of her family’s cuisine? I am. Checking out ethnic markets gives me a good idea of what my grandparents and great-grandparents ate when they were still strolling the streets of Dublin. (Hint: potatoes.)

Helps small businesses. According to the Washington Post, family-owned ethnic grocers are losing ground as big-box supermarkets hone in on Asian, Hispanic, and African foods. Quite a few shops are even shutting their doors, and the operators’ expertise is being lost along with their leases. By buying from the ethnic market, you’re ensuring the preservation of your area, supporting a local family, and keeping that culinary knowledge alive in your community.

Ensures prepared foods are more authentic. Have you ever had sushi from CostCo? It’s excruciatingly bad. So is eggplant parmesan from Pathmark, and a burrito from Waldbaums. Oftentimes, ethnic markets will have a glass display case full of prepared foods. Try ‘em. See if you like ‘em. If you do, take some home, or try to prepare light versions on your own.

Is oh-so-hip. Eating well and frugally hasn’t always been synonymous with coolness, but it’s getting there, with lots of help from ethnic markets. According to almost every single craze-tracking source out there (magazines, websites, journals, etc.) ethnic food is consistently one of the fastest-growing trends in home cooking. (Cooking Light in particular is a big fan of meal diversification.) Buy a Ming Tsai cookbook, pick up a wok, and get with the times, man.

Makes for creative and creative gifts. Oftentimes, ethnic markets are chock-frigging-full of gorgeous tableware and cooking equipment, not to mention shelf after shelf of exotic mixes, spices, and specialty foods. And? It’s mostly pretty inexpensive. Next time you’re searching for a truly unique, out-there gift, grab a cart and go.

Can be a great bonding experience. Ethnic markets aren’t just grocery stores – they’re opportunities to spend quality time with loved ones. Teaching your kid about daikon? Learning from Grandma about what she ate in the olden days? Group-shopping for a Sunday dinner? Head for your local Indian grocer, which is a museum, a school, a library, and a food store wrapped all in one.

And last but not least (since it’s worth mentioning again), shopping at ethnic markets …

SAVES CASH. Ay-chi-wa-wa, yes. Though this might not extend to all markets/foods, you can conserve massive amounts of cash buying produce, spices, and certain ethnic specialties at the Korean place down the block, rather than the Megamart uptown. Cardamom! $0.50! Not kidding! Go!

If you’re interested in reading more about the glory of ethnic markets, these two faboo resources can help get you started:

• Wise Bread’s Tannaz Sassooni tells you what market sells which food. (Hint: Israeli = hummus!)
• After Hours’ Kathy Biehl lists a few great online ethnic markets.
  

This autumn, why not get out of the gym and try something new? Exploring the beauty of life around your city. Or try a class that youve always considered but never dared participate in. You can do a variety of excellent low-impact workouts, and yet still get in great shape. Now that bikini season is over, youll be under less pressure to get in "prime condition." Its time to have some fun with your workouts, and take it easy on your joints too!


1. Fusion Classes

Have you ever tried to do dance and Yoga at the same time? Or cardio Pilates? Fusion classes are all the rage, and theyre a fun way to get in shape in a new and unique way. This workout involves two or more different styles of exercise, and combines them in a way that youd never have dreamed of before. Youd be amazed at the crazy combinations people can dream up when theyre trying to come up with new exercise programs--which may be surprisingly fun!

2. Paddleboarding

This is somewhat of a cross between surfing and kayaking, and youll find that its a great workout for your upper body. Stand-up paddleboarding is done using a paddle to propel your board out onto the water. Those on the West Coast will no doubt have heard of this style of boarding, and youll find that theres even crazy combinations like Paddleboard Yoga. What a fun way to get in shape before it gets too cold to swim!

3. Aqua Aerobics

Most people think of Aqua Aerobics as being for senior citizens only, but there are many hardcore water aerobics classes for the younger generation. Imagine trying to run in place while knee deep in water, or trying to do inverted push-ups while half submerged. Its a pretty intense form of exercise/cardio, and yet the water makes it very easy for your joints. These classes tend to be low-impact workouts that get you breathing hard!

4. Swimming

Theres nothing quite like a good swim to take the edge off the late summer/early autumn heat--particularly in the south of the country (Arizona, New Mexico, Texas, Florida, etc.). Swimming is very low impact--easy on the joints--but its amazing for both your cardio endurance and for your upper body muscles. As long as youre actually swimming and not just splashing around, you can get in amazing shape. The best part: you can swim in a heated indoor pool even throughout the chilly winter.

5. Canoeing or Kayaking

Kayaking and canoeing both involve very little stress placed on your knee and ankle joints, and its pretty easy on your arm and shoulder joints as well. It will work those upper body muscles like nothing else can, and youll find that youre in much better shape after just a few weeks of hard rowing.

6. Inline Skating

Inline skating is a bit hard on your feet and ankles, but its actually quite good for those with tender knees and arms. Youll be amazed by how quickly you can tire out, and youll love the feeling of speeding down the street on those slick inline wheels. Whether you train on the streets or at a track, its a good way to take the pressure off your upper body.

7. Walking/Hiking

If you want the ultimate low impact workout, let Mother Nature be your trainer! Taking a walk/hike out into the forest or mountains near your home will allow you to see the beauty of the autumn wilderness, while easily walking away those calories. A daily walk in the park can help you to prepare for those weekend-long hiking and camping trips youll plan with your family. Its a low-impact exercise that involves a whole lot of fresh air--it doesnt get better than this.
_http://www.fitday.com/fitness-articles/fitness/7-fun-low-impact-workouts-you-should-try-this-autumn.html

UC San Francisco-led study finds consuming olive oil and nuts may improve survival

Men with prostate cancer may significantly improve their survival chances with a simple change in their diet, a new study led by UC San Francisco has found.

By substituting healthy vegetable fats – such as olive and canola oils, nuts, seeds and avocados – for animal fats and carbohydrates, men with the disease had a markedly lower risk of developing lethal prostate cancer and dying from other causes, according to the study.

The research, involving nearly 4,600 men with non-metastatic prostate cancer, could help with the development of dietary guidelines for men with the disease. While prostate cancer affects millions of men around the world, little is known about the relationship between patients diets following their diagnosis and progression of the disease.

The study will be published online on Monday, June 10, 2013, in JAMA Internal Medicine.

"Consumption of healthy oils and nuts increases plasma antioxidants and reduces insulin and inflammation, which may deter prostate cancer progression," said lead author Erin L. Richman, ScD, a post-doctoral scholar in the UCSF Department of Epidemiology and Biostatistics.

"The beneficial effects of unsaturated fats and harmful effects of saturated and trans fats on cardiovascular health are well known," Richman said. "Now our research has shown additional potential benefits of consuming unsaturated fats among men with prostate cancer."

Nearly 2.5 million men in the United States currently live with prostate cancer and another quarter-million men are expected to be diagnosed this year. One in six men in the U.S. will be diagnosed with the disease during their lifetime.

In recent years, evidence has indicated that diet might be an important way for men with prostate cancer to take an active role in determining their disease outcome and overall health. Research on advanced prostate cancer has suggested that fat intake may be relevant to disease progression, but this is the first study to examine fat consumption post-diagnosis in relation to risk of lethal prostate cancer and overall survival.

The new paper analyzed intake of saturated, monounsaturated, polyunsaturated and trans fats as well as fats from animal and vegetable sources.

The data were derived from the Health Professionals Follow-up Study, which began in 1986 and is sponsored by the Harvard School of Public Health and is funded by the National Cancer Institute.

The fat intake study involved 4,577 men who had been diagnosed with non-metastatic prostate cancer between 1986 and 2010. During the study timeframe, 1,064 men died, primarily from cardiovascular disease (31 percent), prostate cancer (21 percent) and other cancers (nearly 21 percent).

The authors uncovered a striking benefit: Men who replaced 10 percent of their total daily calories from carbohydrates with healthy vegetable fats had a 29 percent lower risk of developing lethal prostate cancer and a 26 percent lower risk of dying from all causes.

Adding a single serving of oil-based dressing a day (one tablespoon) was associated with a 29 percent lower risk of lethal prostate cancer and a 13 percent lower risk of death, the authors found. And adding one serving of nuts a day (one ounce) was associated with an 18 percent lower risk of lethal prostate cancer and an 11 percent lower risk of death.

The study adjusted for factors such as age, types of medical treatment, body mass index, smoking, exercise and other dietary factors, elevated blood pressure, cholesterol at the time of prostate cancer diagnosis and other health conditions. The researchers say further research is needed on the potential benefits of healthy fats among prostate cancer patients.

"Overall, our findings support counseling men with prostate cancer to follow a heart-healthy diet in which carbohydrate calories are replaced with unsaturated oils and nuts to reduce the risk of all-cause mortality," said Erin Richman, the first author.

The Disease Management Care Blog really likes Twitter. Its scrolling 140-character tableau of news nuggets fit perfectly on the DMCBs hand held device, lap top and home personal computer.  Its easy to glance at between tasks and the advertising is blessedly minimal. The DMCB controls the content by following and unfollowing other Twitter accounts with a simple click or a touch.

But why, physician-skeptics may ask, is Twitter any better than traditional web browsing, email, list-servs and handheld apps?  Your DMCB thought about that and is pleased to offer its Top Twelve reasons why every doc should include Twitter in their informatics medical bag.

1. Lit Headlines: The major medical journals use Twitter to efficiently describe their latest content with links. For example.

2. Fame: Traditional print authors are publishing more and more about less and less. Getting peers to follow your original and insightful tweets is the new route to attaining status as an expert.  The DMCB has more than 500 daily followers vs. how many actually read the average peer-reviewed article?

3. News Junkies: Some of your like-minded peers are freely aggregating and retweeting relevant headlines with links for your perusing efficiency. They can be indefatigable.

4. Kool-Aid Immunity: Did you know your Chief, Chair, VP, lead administrator or Dean wants to control all your communication?  Twitter is an easy way to step out of the information bubble and monitor contrary news about that EHR, medical device, performance standards, your institutions business partners, the competition and more. For example.

5. Efficiency: Twitter trains you to be both brainy and brief. If you cant fit it into 140 characters or less, youre wasting your readers time.

6. Messaging: The "@" allows you to interact with established and potential colleagues outside of your institutions email system. Thanks to this function, DMCB has met some wonderful colleagues.

7. Medical Conference Tweets: View formal and informal updates and insights about that conference youre attending from not only the meeting organizers but other attendees.

8. Community: Like-minded colleagues are not only clustering in listservs but in Twitter.

9. Room for Diversions: Efficiency makes it guilt-free to include non-medical content.

10. Speed: Its astonishing how quickly Twitter users spot and link just-released reports that take days to appear on the web and weeks to appear on print.

11. Searches: Yes, traditional literature searches and Google have their advantages, but the "#" function can find links to information resources that you might otherwise miss.

12. The Disease Management Care Blog is on Twitter.