Rx for Excellence Leaders in Quality Award

October 17, 2008 / Michael D. Miller MD / Miscellaneous, Quality of Care & Safety / No Comments

I often find it hard to tout my own accomplishments, so I’m happy to report that Dave Dykeman, a colleague and friend, nominated me for the Massachusetts Medical Law Report’s Rx for Excellence Leaders in Quality award. After what I’m told was careful consideration, I was selected as one of the people to receive this award – in part because of the success and substance of this blog.

I’m very honored to be included with the other distinguished awardees – including Atul Gawande, my old Congressional colleague. (You can see write ups of the awardees here.) And I hope that their decision is not only in recognition of our past achievements, but a vote of confidence for our accomplishments yet to come.…

The Granularity of Employer Provided Health Benefits

September 22, 2008 / Michael D. Miller MD / Economics & Financing, Health System Reform, Miscellaneous, Private-Employer Based Health Insurance / 2 Comments

After writing last week about Pitney Bowes’ experience in creating positive financial returns by providing quality health benefits for their employees, I attended a panel of alumni and faculty from the Yale School of Management that discussed the topic “Do Consumers Make Rational Healthcare Decisions?” (I’m told a video podcast will be available soon.) While their consensus on this question was no, their discussion and Q&A included employer provided health benefits.

Professor Fiona Scott Morton noted that the value employers get from providing health benefits depends upon their industry – specifically whether the company retains employees or has a high turn-over rate. …

Digesting Medical Progress

September 1, 2008 / Michael D. Miller MD / Health System Reform, Information & Communications, Innovation, Miscellaneous, Nutrition, Public Health, Therapeutic Substitution & Interchange / No Comments

One of the challenges for improving the healthcare system is creating a vision for what is achievable in a timeframe of months or years. The first step for creating such a realistic vision is to understand how progress has been made in the past.

A microcosm of such progress was described in a recent article in The Economist. This article describes advances in our understanding of stomach ailments – one of my favorite areas of biomedical progress because in the last several decades dramatic changes have occurred in our basic knowledge about this area, and so many people can relate to stomach problems.…

New Health Posting in Iraq

July 22, 2008 / Michael D. Miller MD / Delivery of Healthcare, Miscellaneous, Politics, Public Health / No Comments

I couldn’t resist witting something about this when I saw today’s press release from HHS which announced that Terry Cline, Ph.D., the administrator of HHS’ Substance Abuse and Mental Health Services Administration is leaving that post, and starting August 31st he will be the HHS Health Attaché and representative at the U.S. Embassy in Baghdad, Iraq.

On the serious side, I’m sure he will do good things to help improve the healthcare system in Iraq. But on the less serious side, someone (maybe Jon Stewart?), needs to ask how did this happen? How bad did he step on someone’s toes to get moved from Rockville, MD to Bagdad?…

Vacations – Poker – Diagnostic and Research Skills

July 21, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Innovation, Miscellaneous / No Comments

What’s the point of vacations? As a consultant that’s something I often ask myself since with the internet, cell phones, etc., it seems almost impossible to really “get away” and not be connected to work.

So what’s the value of vacations? I think I’ve found the answer at the poker table. As Ricky Ricardo used to tell Lucy, “Lemme splain!”

The point of vacations is to recharge by being in a different environment that presents a new context for viewing our normal “reality.” A great practitioner of this principle was Teddy Roosevelt. He would travel to the wildest and most dangerous parts of the world, and hunt the largest of animals.…

E-Prescribing – Good? E-Dispensing Bad!!

July 10, 2008 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Delivery of Healthcare, FDA, Information & Communications, Miscellaneous, Public Health, Quality of Care & Safety / 1 Comment

With two notable government actions in the last couple of weeks there has been significant movement towards increasing the use of e-prescribing.

DEA Proposed Rule
The Drug Enforcement Agency (DEA), proposed regulations on June 27th that would make it possible for controlled substances to be prescribed electronically. Interestingly, this was released right after a National Journal article on this topic.

The DEA’s proposed rule is very important, because while it is appropriate to place stronger safeguards on medicines that are likely to be abused (which is the criteria for being a DEA scheduled medicine), having controlled medicines prescribed by pen and paper while all other medicines are e-prescribed would be a logistical problem and obviate many of the potential benefits of e-prescribing. …

Pharma Industry’s US R&D Spending Breaks Milestone

July 7, 2008 / Michael D. Miller MD / Innovation, Miscellaneous, Politics / No Comments

According to my calculations, sometime this month research and development spending in the United States by pharmaceutical companies will pass the $100 million per day mark.

The $100 million/day figure assumes R&D spending seven days a week, and it doesn’t include R&D spending outside the US, or spending by smaller biotech, medical device, diagnostic, or health IT firms. By comparison, the National Institutes of Health spends about $79 million a day.

With all the reports about the slowdown in the industry’s output, higher barriers for FDA approval of new medicines, and the criticism of the industry and the FDA, I hope that the industry’s ongoing R&D investments do produce new medicines that are valuable to individual patients and society overall.…

The Face of Free Government Health Care

June 30, 2008 / Michael D. Miller MD / Economics & Financing, Medicaid, Miscellaneous, Politics, State-Level Healthcare Reform / No Comments

A couple of months ago I wrote about how one percent of adults in the US get free government health care. While the statistics in the February Pew study were very interesting (and somewhat shocking), I saw a report in a local Connecticut newspaper (The Day, June 26th) that put a face on these statistics.

The Day’s story was about Jihad Abdulshaheed, a 36-year-old man who had been incarcerated since November 2007. The judge was prepared to sentence to a one year sentence, and since he had already served at least 50% of his time, under the Department of Corrections guidelines for nonviolent prisoners he could have been released the next day.…

Nature v. Nurture – Smoking and Other Complex Problems

June 4, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Miscellaneous, Public Health / 3 Comments

A long-standing debate in the life sciences has been the role of nature versus nurture in determining individual characteristics. For example, how much of an individual’s height is determined by their genes and how much by their nutrition – both in childhood and prenatally?

In the last few decades advances in our understanding of genetics has shifted this dichotomy to describe it in terms of genetics versus environmental factors, and expanded our appreciation for the role nature/genetics play in causing all manner of human diseases. For example, it was discovered that genetically determined slow serotonin transporters in the brain can predispose individuals to developing depression.…

Level 4 Bio Lab at Boston University

February 1, 2008 / Michael D. Miller MD / Information & Communications, Innovation, Miscellaneous, Public Health / 1 Comment

Today’s Boston Globe had another report about the delayed opening of the Level 4 research lab at Boston University. Since it was first proposed and funded, this lab has raised controversy – primarily from those in the community who were concerned about the safety of research involving the most dangerous of organisms occurring in their urban neighborhood. While substantive process (and EPA) concerns have been raised during the building and certification of the lab, the problem really appears to have started from the beginning, with BU seeming to believe that all things biotech-science related are golden, and that their new lab would be welcomed into the neighborhood.…

1 2