In honor of Ash Wednesday –the day after Fat Tuesday and the beginning of Lent—I thought I might share the spirit of a recent report published by the Consumers Union of the United States.  Why?  Because if you believe the statistics, about one third of you who are reading this post made a health related resolution last evening and believe it or not, most of you are far more likely to keep that resolution than the similar or same one you made this past New Year’s Eve.

So consider this post a public service:

If you’ve vowed to quit drinking –at least through Lent—be aware that there is a high probability you will feel much better as a result. But be warned: Quitting drinking will most likely result in an unexplained weight loss and a general surge in your personal productivity. And if you’re taking any prescribed medications, you may find that they actually work.

If you chased your last shot of tequila last evening with a cigarette or four, five, etc., and you woke up this morning fully resolved to never again smoke, good for you. Not only will food taste better to you, but you will taste better –if that’s important. It may even have an impact on your partner’s libido. The residual benefits seem endless, but they could be startling to your system. Bottom line: If you’ve successfully quit smoking, you might want to let your doctor know, especially if it was last night.

In both cases, and all kidding aside, don’t keep these and the other following “secrets” from your doctor:

You’ve lost your job or you’ve started a new one: The stress related to job loss or starting a new job is relevant. And if you’ve lost your job, a consumer reports survey indicated that a whopping 28% of us stop filling our prescriptions and taking our medication. Your doctor needs to know.

You’re forgetting things: Forgetting things is not necessarily a sign of some scary disease –like Alzheimer’s. It may be something far more treatable. And it may help speed and/or confirm the diagnosis of something else that’s been bothering you.

You’re seeing someone new or you’ve just left your significant other: You don’t have to be having an affair to qualify. Maybe you were seeing another doctor for what you believed was an unrelated problem. Maybe it was a specialist or you came back from a vacation with a”bug” and took heavy doses of an antibiotic based on the experience of your travel friends. Or you pulled a muscle in your back and “borrowed” some pain killers? Tell your doctor –even if it’s just an affair.

You’ve lost your sex drive: If it’s not your partner’s choice, and you’re not taking certain psychiatric drugs, including anti-depressants or blood pressure medication, or pain killers –or even if you are—you need to have a candid discussion with your physician about it. Regardless of your partner’s claims to the contrary, you are right, not having a sex drive is a matter of concern.

OK. I had a little fun with this post this morning, but I hope the points are well taken. Many of us “gear up” to see our physicians and not only rehearse what we’re going to say, but how we’re going to say it.While there’s nothing wrong with being prepared, I suppose the point being made here is to prepare yourself to be totally candid with your physician –and to not exclude from those discussions the personal things that are going on in your life –the good, the bad and the ugly.

From what I keep hearing, it’s been a rough couple of years for 99% of us, especially your doctor, so he/she should understand and you’ll get a better result.

Happy Day After Fat Tuesday!

—Tom Finn

Banner Health reports savings of $41.5M in one year?  That’s not only an impressive number, but it says a lot a good things about Banner’s executive culture, starting with how secure, supported and nicely aligned the cross functional teams responsible for this performance must have been.

I’ve been reporting savings based on competitive bid results for the better part of 25 years and more often than not, internal politics generally prevents the execution of any program substantial enough to produce a result of this magnitude –especially in healthcare. So when reading through this announcement, it wasn’t just the savings number that grabbed my attention, but the fact that a) the savings were not the result of a competitive bid and b) over a third of that number was achieved through data driven efforts to standardize and eliminate variance. Now that is newsworthy.

Banner is a Premier Alliance member, so they jointly made the following press announcement just a few hours ago. Here are some excerpts:

CHARLOTTE, N.C.–(BUSINESS WIRE)– Banner Health saved $41.5 million in one year partnering with the Premier healthcare alliance to reduce supply chain costs, eliminate clinical variations and improve the overall quality of care delivery.

As a Premier owner, the health system continuously works on wide-ranging initiatives to reduce expenses associated with supplies and other consumables while improving care quality. Employees from both organizations work to negotiate supply contracts, standardize utilization and improve quality.

Banner’s achievements last year include savings of:

• $1.6 million in reducing use of adhesion barrier products in cesarean sections, with no ill effect on patients or babies;
• $3 million by addressing utilization variances in the OR;
• More than $9 million in standardized supply contracts in pharmacy, cardiology and the cath lab; and
• An estimated $600,000 by linking their affiliates to Premier’s continuum of care contracts.

“Generating this level of supply chain savings is not possible by either Banner or Premier alone. It is definitely the result of a terrific team effort between dedicated employees of both organizations,” said Banner’s Vice President of Supply Chain Management Doug Bowen.

Banner has developed an impressive process to evaluate resource use and standardize care practices, particularly in high-volume populations. With clinical consensus groups led by physicians and nursing leaders, clinical practice guidelines are adopted across the health system.

Dr. John Hensing, Banner’s executive vice president and chief medical officer, said, “I cannot overstate the value of the Premier solutions, people, processes and data. They are supporting our ongoing commitment to learn how to leverage innovative technologies, implement innovative techniques and adopt standardized care models across our health system. It’s all about how we can best deliver the safest and most effective clinical outcomes across the organization and do it rapidly and consistently.”

Banner is the recipient of 2012 Richard A. Norling Premier Alliance Excellence Award for its leadership and collaboration with the alliance to provide high-quality, efficient care. Banner also participates in a number of Premier initiatives to improve care, such as collaborating with more than 290 hospitals in QUEST® and nearly 80 health systems in PACT™ (Partnership for Care Transformation).

Banner also accesses and integrates its clinical and supply chain data to identify quality improvement, and savings and waste reducing opportunities using Premier performance improvement solutions, including:

• SpendAdvisor® MySpend™, which analyzes supply spend to compare it with like organizations and find savings opportunities;
• QualityAdvisor™, which integrates patient-level quality, safety and financial data to help hospitals make better decisions in care delivery for reductions in harm, mortality and readmissions, and improved resource utilization;
• SafetySurveillor®, an automated surveillance application that helps prevent healthcare-associated infections and optimize antibiotic use; and
• OperationsAdvisor®, which monitors labor productivity through assessments and comparative data that measure performance against peers and national benchmarks.

__________

For many years, GPOs took it on the chin and deservedly so, based on most accounts.  “Man can not live on admin fees alone.” That was the lesson –the voice of the providers–  and those GPOs who took that message to heart and evolved to deliver more than just a contract portfolio have flourished.

Premier’s decision to tackle variance by aggregating the data of its members, analyzing and playing back those data in ways optimized to drive change (i.e. drive standardization/eliminate variance) was an excellent decision when they made it and one that is just starting to scratch the surface of the promise it holds.

—Tom Finn

How do you like that for a headline?

Apple is always in the news these days.  Despite its iconic status and $100 billion in cash –or because of it– the company is a favored target of the most sensationalized forms of media criticism. For example, recent stories in the NY Times, Forbes and Wired have put a bright spotlight on Apples’ supply relationship with Foxconn, its largest Chinese manufacturing partner. Why? Because it has been reported that Foxconn has a “suicide problem” within its employment ranks. Not to diminish the alleged problem, but the coverage has been so grinding and unrelenting that you would think Upton Sinclair or Ayn Rand were behind it.

Mattel had to deal with a $100 million recall of toys that were tainted with lead paint; Nike endured a fairly thorough expose’ of child labor abuses at several of its third world factories and Wal-Mart has been cited so many times for supporting “sweat shops” across its various apparel lines that recent examples of similar abuse are barely newsworthy anymore. In all of those cases, someone stepped up and “accepted full responsibility” (a meaningless gesture except to members of the media) and the headlines stopped.

But Apple isn’t falling on its sword because it doesn’t believe it is responsible –and neither does Foxconn. These partners have clear concern for the problem and are doing everything they can to address it, but they won’t concede that their operating policies and procedures are causal –and those of us who know anything about suicide should agree with them. Do we really presume to view the Chinese factory worker through this pathetic lens?

So how would you handle a situation where your partner’s employees are killing themselves “in lemming-like fashion,” and are carrying out their plans at work?  Yes, at a plant in Shenzhen, China (about a two hour drive north of Hong Kong) and over a three year period, several workers (17 is the reported number) have actually committed suicide by jumping off the Foxconn factory roof. And even worse, their action has inspired dozens of copycats who are threatening to kill themselves en masse, no less.

• The problem: Factory workers committing suicide.  Apple’s and Foxconn’s corrective action: The installation of catch nets, cancellation of certain insurance programs that compensated worker’s families for injuries suffered on the job (perceived as a possible inducement by  some workers to kill themselves), ergonomic specialists and interior decorators (to change living and working environs in ways that supposedly mitigate suicidal thoughts), suicide prevention experts, mental health counseling, a willingness on the part of management to move workers to other factories closer to their home provinces and yes, back pay for uncompensated overtime abuses and a fix to a less than stellar pay raise policy.

Can you imagine the PR assignment? You’re providing a factory tour to reporters and obliged to acknowledge “jumper nets.”  Something like:  “Yes the ‘jumper nets’ are hard to ignore but check out our new employee gift shop.”

The part of me that wants to write about the plight of underpaid and displaced workers in developing countries just can’t get past the sensationalized coverage various media outlets have given this “story,” despite the existence of such well known and mitigating circumstances.  For starters, Apple is easily one of the most socially and environmentally conscious companies on the planet.

And not to confuse the current coverage of “suicide workers” with the facts, but:

• Students at US colleges kill themselves at a higher rate (more than 13X) than the calculated suicide rate of workers employed by Foxconn (the company employs more than 1 million workers). By the way, that rate of suicide in American colleges is several times the national suicide average among sufferers of depression and bi-polar disorders. Why isn’t that story front page?

• According to the World Health Organization (WHO), the nominal suicide rate across China is almost 25X the rate at Foxconn, but apparently, no one at the New York Times or Wired bothered to check that out either.

While most of the business world reluctantly accedes to the underlying tenets of sustainability, especially those related to social responsibility, Apple and Foxconn are relative beacons. Nevertheless, to avert the same kinds of criticisms suffered by Bush and Obama after other well publicized natural disasters, Apple’s CEO, Tim Cook and Foxconn’s CEO, Terry Gou, are being hugely high profile in the corrective actions they’re taking. There is a lesson here. You don’t have to be responsible for a problem to justify your role in helping with a solution.

And the fact that many believe the NY Times ran the original sensationalized story (full of anonymous sources) as payback to Apple for allowing its competitor, The Wall Street Journal, to continue to scoop it on Apple technology announcements is old news.  No one doubts that played a role. However, Apple quickly rushed to get the ABC network involved in publicizing its damage control because it was also too easy (Disney and Apple enjoy a number of linkages, including the fact that the Jobs family is the largest shareholder in Disney and Disney owns ABC). I wish Apple had chosen another media outlet because it appears that Apple opened itself to the very kind of criticism it should have been smart enough to avoid.

For those of us who marvel at Apple’s mastery of supply chain, is the instructive point here a recognition that when everyone in your supply chain is playing it as close to the edge as they do, the risks become unmanageable? Sorry for the unfortunate pun, but are we really willing to connect the dots between people who threaten to kill themselves and a recent pay raise given to these same workers –or is the problem and solution just a little bit more complicated?

Chinese society is cycling through an extraordinary transition. To suggest that foreign companies operating in China need to be shining examples in terms of their  social responsibility is an understatement. But to chastise those who are, in fact, willing to set good examples, and exploit old imagery of industrial age factory conditions, in support of some other agenda, is not helpful. It sets us back.

—Tom Finn

Everyone knows the basic formula for losing weight: eat less, exercise more. It’s the decision to do it that actually counts. How many of you start diets on Monday morning? How many of you say you’ll take the time to get in shape once the big work project is over, or after the kids go to college, or the litany of other excuses we employ because it’s just hard to get out there and pound the pavement for 3 miles? Moral being, there IS no good time. You just have to do it.

The quote in the title of this article comes from Oregon Democrat senior senator Ron Wyden, who actually had the nerve to work with a Republican before the election on creating a proposal to reform and strengthen Medicare. The WSJ posits that this bipartisan move has the potential to be “big, thoughtful, promising.” Democrats? Well, they’re not so pleased.

Wyden’s voting record is nothing if not progressive. Yet “he’s spent most of his 16 Senate years working from the backbench, with Republicans, on big problems—with some 150 bipartisan bills to date.” A big believer in the fact that “big issues require bipartisan buy-in,” Wyden is seen as somewhat of a “wonk” or “workhorse.” What I want to know is, party alliance aside: why are his efforts being seen as a bad thing? Anyone anywhere can tell you that Medicare needs radical reform — so why not get started now?

“Mr. Wyden has been stressing to colleagues that this joint proposal is different from Mr. Ryan’s initial reform—which Democrats attacked—and offers plenty to reassure his party. It preserves the option for seniors to stay in government-run Medicare, makes Mr. Ryan’s “premium support” plan more generous, even adds a catastrophic benefit. Mr. Wyden notes there’d have been no plan had not Mr. Ryan agreed to “traditional Medicare remaining a permanent part of the program,” a fact, he says, that rebuts any notion of it “withering on the vine.”

The real problem, he acknowledges, is ideological opposition to any private-sector involvement—a position that frustrates the senator, since it is already reality. More than 40% of Oregon seniors already use private coverage, through Medicare Advantage or Medigap.

“This is a disconnected conversation,” he pronounces. The Wyden-Ryan bill is simply acknowledgment that any serious entitlement reform must encompass choice and markets.

Now I don’t “go political” very often (strange, you’d think, for a political science major) but I have to praise Wyden for rising above partisan lines and attacking the actual issues, recognizing the fact that if anybody’s going to do anything beyond blowing hot air, you have to just dig in. He even recognizes his actions as rare, saying, “you have to lead by example.”

Lesson being? Get out there and lace up your running shoes. Get your butt to Zumba class. Trade your pastry for protein. And don’t wait until Monday morning to do it — because frankly, despite Wyden and Ryan’s best efforts, who knows what Medicare will look like in the ten years you could have spent taking care of yourself?

- Sheena Moore

Beep… Beep… Beep…  
GHX finds way to track implanted devices
Global Healthcare Exchange, maker of online software that manages supply chains for the health care industry, has bought technology allowing it to track surgically implanted devices. Louisville-based GHX acquired the Beep N Track software from Implanet, a French maker of prosthetics. Financial terms of the deal weren’t disclosed…

Congrats, India!
India Healthcare Industry Witnessing Remarkable Growth
Noida, UP — (SBWIRE) — 02/15/2012 — India is one of the world’s rapidly emerging healthcare markets. In the past few years, the country’s healthcare industry, including the market for hospital services, has witnessed a remarkable growth on back of increasing investment in infrastructure development. According to a new research report by RNCOS, mobile surgical center is emerging as a new concept in the country’s healthcare industry that bridges the demand and supply gap by providing better services. With the rising income levels and increasing coverage, per head healthcare spending in India is estimated to reach over US$ 120 by 2014…

This is frightening…
Latest Drug Shortage Threatens Children With Leukemia
It’s a new kind of brinksmanship for U.S. doctors: caring for patients with life-threatening diseases when the supply of critical drugs threatens to disappear. The latest crisis concerns the old standby cancer drug methotrexate. For six decades, it has made the difference between rapid death and lifelong cure for thousands of children with acute lymphoblastic leukemia, or ALL, and a type of bone cancer called osteogenic sarcoma…

Take care of your bodies, folks.
3 predictors of future memory loss: do you have any of them?
If your doctor had a crystal ball that could predict whether you’d become senile in old age, would you want to know? Perhaps, if you could actually do something to prevent it. A growing body of research indicates that certain lifestyle factors may be associated with an increased or decreased risk of developing dementia due to Alzheimer’s disease or strokes…

From Spend Matters
Monitoring Rising Oil Markets: Transportation, Energy, Plastics, Chemicals and Beyond (Part 1)
For most consumers, the oil markets have the greatest impact at one proverbial place: the pump (at least as they perceive it). But rising prices and general volatility have far greater impacts that cascade across the supply chain, impacting transportation costs (and surcharges), plastics and chemicals, general energy cost and much more. Over on Spend Matters’ sister site, MetalMiner, Stuart Burns recently took it upon himself to to examine what’s on the oil horizon, starting with the fact that oil (at least oil as traded in Europe) is at a six month high (roughly $118 a barrel at the time he wrote the article). He suggests that, “the spot price has been rising on concerns over where the showdown with Iran is leading.”

From Spend Matters UK/Europe
GovMark looks at the market for agency staff in local government
GovMark are an interesting small firm that we came across recently via their MD, Ian Makgill, who is an occasional and perceptive commentator here. They’re an offshoot of Ticon, Makgill’s research firm, and GovMark is focused on researching public sector markets in order to provide information of value to suppliers of goods and services into the public sector. Surely there’s loads of that around already, you might say? And don’t firms do that themselves?

After two years of research, including video taping how it’s currently done in the OR and 800 interviews with manufacturers, administrators, physicians, nurses and supply chain professionals, GHX announced a bold and strategic move yesterday. As Derek Smith, the company’s EVP of Marketing & Product Management said to me, “we will do for Physician Preference Items (PPI) what we did for medical surgical instruments.” What’s he’s talking about is delivering an infrastructure-level PPI supply chain solution to the industry –a solution that will allow providers, GPOs and manufacturers to collectively automate their shared business processes.

Yesterday, GHX announced its acquisition of a technology called “Beep N Track” from a French orthopedic company  named Implanet. As a point of interest, the roots of the company’s name are not derived from the words “implant” and “planet”or meant to symbolize a global domination mentality (silly me). Rather, it’s a contraction of the words “implant” and “Internet.”  It’s meant to represent how the company’s products are encoded for intelligent traceability and that you only need access to the Internet to enjoy all the related benefits.

In fact, what GHX just bought is a comprehensive product information tracking system capable of being abstracted for use across an entire industry.  Although it’s a proven technology (already in use) that was specifically developed and refined to manage the complexities of Implanet’s implant systems, GHX will extend the system’s capabilities to manage the similarly intricate and sophisticated information management requirements of other physician preference items (PPI) and make it available to all manufacturers.

At all meaningful touch points, the Beep N Track system automatically captures all relevant supply chain and regulatory data –from the point of manufacture through the point of use. It enables a complete audit trail for manufacturers, intermediaries and hospital staff alike; is “open” in the sense that it can leverage any smart device capable of reading a tag/logging an event along the way; and uses the Internet to ensure secure transmission and on demand access to all the relevant information by any/all authorized stakeholders.

Just like we’ve been told this stuff is supposed to work.

But you need a company capable of pulling it off at scale –and that’s why this announcement is meaningful. You need a company that has already earned “the trust” by successfully integrating the shared business processes of the manufacturers, GPOs and providers throughout the chain. And with several GPOs, more than 85% of the hospitals in the US and 80% of the suppliers already connected, GHX is the logical choice.  Hat’s off to GHX for going after this solution and kudos to Implanet for recognizing the right home for its technology.

If all goes well in the pilots that are now getting started, GHX expects to have this system fully integrated with its other core systems and ready for launch by this time next year.  There will be lots to talk about between now and then and we intend to stay abreast.

So back to Derek’s point, GHX just bought an enabling technology in support of a big idea. And when GHX completes the task of combining and/or integrating it with its other cloud-based supply chain applications, the benefits should be game changing.

—Tom Finn

CLASS (the Community Living Assistance Services and Supports program) was a voluntary, long-term care insurance program that was signed into law as part of the Affordable Care Act –and then killed by Congress. Why? Because it wasn’t deemed financially sustainable by the Congressional Budget Office (CBO) at a time when even the Act’s most ardent supporters were abandoning ship amidst a siege of fictitious claims, including the “government’s takeover of healthcare” and the existence of “death panels.”

• By the way, those phrases are in quotes because they were both Politico “Political Lie of the Year” award winners (2009 and 2010 respectively).  FYI: The Democratic claim that “Republicans were trying to kill Medicare” was the winner in 2011.

Anyway, I have this image of a ship taking on water with Democratic lawmakers furiously bailing away and wondering/bickering  aloud about who put death panels into the Act without telling anyone, lending credence to Nancy Pelosi’s famous gaff. But I digress. The fact is, millions of American families are dealing with a system that requires them to spend down their life savings before prematurely condemning their parent(s) or loved ones to a nursing home or some other qualified care facility where the government/Medicaid is actually obliged to pay. Yes, the status quo –the current way of taking care of Mom and Dad– is broken, and despite bi-partisan acknowledgement of this fact, Congressional lawmakers killed the CLASS program without even offering an alternative.

Many of you may recall that the late Sen. Ted Kennedy introduced this legislation (intended to be his legacy), that the bill was co-sponsored by Mike DeWine (R-OH) and enjoyed broad bi-partisan support. A Kaiser Family Foundation survey found that 76% of Americans supported CLASS (at the time of the survey), including 69% of Republicans, 71% of Independents, and 87% of Democrats. Given the bi-polar composition of our current congress, should it even be a surprise that solutions that do, in fact, enjoy bi-partisan support, can’t get off the dime?

• For the record, almost 10,000 baby boomers are turning 65 each day and the fastest growing segment of our population –those over 85—have already missed the window. For more than 20 years, Congress debated how to address the problem and landed on a solution that called for (drum roll here) a high degree of personal responsibility. It was based on voluntary premiums that could be set aside, tax free, for the purpose of funding care at home.

It’s bad enough that CLASS hasn’t been re-visited, but the fact that lobbyists continue to stall yet another inevitability  –the coming convergence of home care, telemedicine and self-service– is simply too much. The lack of alignment between payor networks and new age care teams –the home care space technology providers, caregivers, family members and patients—is a huge problem in search of a solution that actually requires government intervention. The Home Care Technology Association of America (HCTAA) is working hard to introduce standards that would tie reimbursements to outcomes. Obviously, they’ve got the right spirit, but electronic verification of “visits,” including “electronic visits” needs to be sorted before the kind of alignment required will free up the flow of reimbursements.

If reform efforts successfully resolve such misalignment(s) and give providers some incentive to subsidize home care technologies and services, maybe there’s a way to back-into some kind of long care solution. Provided a patient’s actual home can be considered part of his/her medical home and/or part of an authorized accountable care organizational network (i.e. part of a shared-risk payment model), then we’ve got a collective chance to accomplish something rational –and fiscally responsible.

Concerns about fraud have become a fully applied brake on attempts to enact any kind of change to a system that is already getting pilfered. Technology-enabled home care models are tailor-made for an aging population, an increasing chronic-disease care management focus and a system in desperate need of an end of life care model that won’t bankrupt a country –one family at a time. Let’s hope an intelligent implementation of ACOs will make room in our national debate for a little class.

—Tom Finn

I’ve managed to avoid the subject of healthcare “rationing” for the better part of six months, but a Star Trek episode this past weekend convinced me that a little opinion mongering on the subject might finally be in order.

First of all, let’s consider a definition of healthcare “rationing” that, for obvious reasons, enjoys a reasonable level of bi-partisan support.

• “To ration healthcare is to intentionally withhold at least some useful medical services from at least some of the people who would benefit from them.” Yes, and “to not reform healthcare is to intentionally withhold at least some useful medical services from at least some of the people who would benefit from them.”

One side of the definition reflects a perspective that says the rationing of healthcare is some sort of covert government enterprise and the other holds that a more equitable and intelligent allocation of our increasingly scarce healthcare resources, actually isn’t code for rationing. Apparently, the term “rationing” offends our American sensibilities. We like to think of ourselves as a nation without limits, so we can’t talk about rationing without being labeled in some circles as “un American.”

Sigh.

“Healthcare is a scarce resource and all resources are rationed in one way or another.” President Obama has not only said that, but in the same discussion he pointed out how US healthcare is rationed on the basis of income, insurance coverage, employment type, pre-existing conditions and access. But he then went on to state that the Affordable Care Act will eliminate rationing? In support of that same sentiment David Axelrod demonstrated his formidable doublespeak skills when saying: “It’s a myth that reform will lead to rationing. To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.”

One would think that bi-partisan recognition of reform’s inevitability would create an opportunity for some honest dialogue about rationing, but apparently, we’re not quite there yet. Because the government is already in the business of rationing healthcare and has been for decades, the question isn’t about whether rationing is going to happen, the question is about whether and when rationing is going to be done better.

Supply chain professionals who seek to standardize physician preference items and help reduce physician variance by playing back outcomes data in more meaningful ways (e.g. in a supply utilization context), are maneuvering to reduce costs while improving patient care.  Taken in this context, rationing is not only the right thing to do, tis noble.

The fact that the Act is promoting shared savings opportunities (e.g. ACOs) and that opposition to Comparative Effectiveness Research (CER) is on the wane are meaningful and hopeful trends. And whether they like it or not, supply chain professionals are at the front line of a larger debate that is attempting to distinguish between withholding care and eliminating waste, without using the term “rationing.” It’s a debate that is largely centered on semantics, unless you believe your congressman actually knows the difference.

Where is Spock when you need him?

—Tom Finn

Ok, I admit it. I spent the past week reading French Women Don’t Get Fat (to the chagrin and scrutiny of my currently-reading-Hemingway-why-aren’t-you-reading-real-literature boyfriend). Looking past the ooh la la-factor, I came to a powerful realization: Americans don’t believe in moderation, and are sadly lacking in willpower. Think about it: our diet books are plentiful and all of them are strict (South Beach, paleo, even the slow-carb diet, with its cheat day). Our workout crazes (crossfit, P90X, marathon running) require maximum effort and a lot of time. When we fall off the wagon, it’s to wallow in a sea of guilt and eat an entire pizza because “the diet is ruined anyway, why not?” Why are we so focused on “NO!” instead of “yes, but in moderation?”

Chowing down in Paris

Yes, my current workout schedule is a bit insane (six days a week, four of those days including two workouts). But I actually enjoy it. 85% of the time, I’m perfectly happy lacing up my running shoes and rolling out my yoga mat — I don’t feel like I’m dragging my butt to the gym because I “have” to. And that other 15% of the time? I do drag myself there — because I know I’ll feel better for doing it.

But this week, I fell off the wagon more than once. Sunday’s 2.5-mile training run? Skipped. Wednesday’s 35-minute cross training session? Replaced with wine, cheesy pasta, sweat pants, the couch, and two hours of French verb drills. And yes, I felt the guilt. Where’s my willpower on those days?

Let’s talk willpower, in fact. I found an interesting article in The Guardian (Why willpower matters – and how to get it). Professor Ray F Baumesiter “orders a lunch of fish and chips, and then decides not to eat the chips. ‘I won’t eat something that’s not good for me unless it’s absolutely perfect, and it’s going to give me real pleasure,’ he says.” Très français, n’est pas? Baumeister has collaborated with New York Times science writer John Tierney to produce a report titled Willpower: Rediscovering Our Greatest Strength. Over a 30-year study, the researchers discovered,

“Those with low willpower, the study discovered, fared less well academically. They were more likely to be in low-paying jobs with few savings, to be overweight, to have drug or alcohol problems, and to have difficulty maintaining stable relationships (many were single parents). They were also nearly four times more likely to have a criminal conviction. “Willpower,” concludes Baumeister, “is one of the most important predictors of success in life.”

And apparently, you can “work out” willpower just as you work your own muscles:

“As with a muscle, though, you can train your willpower. Even small, day-to-day acts of willpower such as maintaining good posture, speaking in complete sentences or using a computer mouse with the other hand, can pay off by reinforcing longer-term self-control in completely unrelated activities, Baumeister has found. People previously told to sit or stand up straight whenever they remembered later performed much better in lab willpower tests.”

His advice? “Build up your self-control by exercising it regularly in small ways. Learn to recognise signs that your willpower may be waning. Don’t crash diet. Don’t try to do too much at once. Establish good habits and routines that will take the strain off your willpower. Learn how to draw up an effective to-do list.”

Maybe next week I’ll be more French (my French language classes do start on Monday, so it’s a good time): “real” food in careful moderation. No guilt about skipped workouts or cheesy pasta binges: compensate and correct (I’ll make it to the gym tonight to do that 35 minutes of cross training). Maybe I’ll forgo a two-a-day and add in some small “willpower workouts,” as Baumeister calls them. Most importantly, next week is Valentine’s Day! I’m going to buy the fanciest ice cream I can find, and I’m going to eat it for pure pleasure, savoring every bite, parce que cela est que ma grand-mère ferait.

- Sheena Moore

I just left this year’s American Academy of Orthopedic Surgeons (AAOS) Show in San Francisco.  This was my third AAOS in a row and I must say, San Francisco (at the Mascone Center) is really a great spot to host an event of this magnitude.

Other than marveling at how massive and well attended this show was/is (e.g. I’ve been to trade shows smaller than Zimmer’s booth this year), the number of well dressed, in-shape and yes, I’ll say it, “fine-looking human beings” did catch my attention. I now better appreciate what Ethan Hawke’s character was feeling in the movie Gattica. Although I can’t say I’ve developed an uncontrollable urge for space travel, I did feel genetically inferior and found myself imagining what it would be like to be a rock star orthopedic surgeon (RSOS).

One such RSOS I had the pleasure of meeting was Dr Joshua Jacobs. Among other impressive credentials, Dr. Jacobs is the current Chair of Orthopedic Surgery at Rush Hospital in Chicago; he is also the Academy’s first incoming Vice President and an expert in bio-compatibility issues with implants.

Dr. Jacobs provided a small group of us with an update on the well publicized 2010 DePuy recall of a certain metal on metal hip system. To be specific, I’m talking about the DePuy ASR™ XL Acetabular Total Hip System that was voluntarily recalled by DePuy, based on data pulled from the UK joint registry indicating the revision rates within 5 years were approximately 13 percent.

Some General Information –because that is all that’s available:

• An estimated 93,000 patients received the ASR XL System.
• Metal on metal systems were re-introduced in the 90’s because from a design engineering perspective, they outperform the other options –and the evidence suggests that they still do for a majority of patients.
• Before the recall, about 33% of the total hip implant procedures being performed were metal on metal.  Today, that number is 3%.
• Total hip resurfacing procedures still require a metal on metal solution to this day.
• A small percentage of patients who received this implant system have symptoms that include soft tissue deterioration, bone loss, heightened levels of metal ions in their blood and pain.
• $1.5 billion was set aside for revisions but no one yet knows how many have been performed.
• There is no protocol for determining whether or not a patient should receive a revision surgery. If a patient isn’t complaining or symptomatic, then the prevailing wisdom is, “leave well enough alone.”

Dr. Jacobs rattled off these and a few other general observations throughout our briefing, but when pressed for more specifics, he either deferred to a member of the media who seemed more knowledgeable of the latest estimates or fell back to the point he made at the opening of our meeting:

• The United States has no national registry for tracking such things.  What data that do exist in the area of Total Joint Replacements (TJR) are highly nuanced and hard to interpret.  In fact, the data taken from the UK registry that served to cause DePuy to pull the ASRs may not even be statistically valid from a US perspective. But it was used anyway.  Better safe than even more sorry.

Dr. Jacobs talked with pride and hope about the ongoing development of the American Joint Replacement Registry (AJRR), a non profit organization formed by his colleagues in 2009 that represents a private sector attempt at a registry solution for his area of specialization.

The AJRR finished its inaugural test/trial in July of last year during which it successfully demonstrated an ability to enlist hospitals and collect data on about 7,000 procedures. And during this year’s AAOS, the AJRR announced its intent to move to a production system based on a partnership with InVivoLink.  The partnership will provide the AJRR a technology that would automate the feed of orthopedic implant data to its registry platform. According to the press release, “the new partnership will provide a direct link between InVivoLink’s registry data acquisition tools and the AJRR database.”

Although this is good news, doesn’t it grab your goat that it’s news to begin with –that the US doesn’t have a national registry system –or at least one that is in development? Clearly, there is a role for government involvement that even the most conservative, free enterprise wielding, private market solution fan among us would concede to in this context? Or would it be the liberals among us who would be opposed? I can’t tell anymore.

Helping to fund the creation and sustainability of non profit enterprises like the AJRR and collaborating with medical specialties in ways that further aggregate, analyze, dis-aggregate and play back meaningful information at the specialty level is a practical and proper way to justify reimbursement policy.

Sitting through the Jacob’s briefing solidified my resolve on this point. And walking around San Francisco later that evening confirmed my opinion on one other front:  Men should not wear capri’s.

—Tom Finn