This Implementation Guide provides a standards-based mechanism to electronically send PHR data from a predecessor to a successor health plan," said Dan Kazzaz, Chair, ASC X12. "It provides needed support to health plans in the role of maintaining longitudinal PHRs for individuals and moving PHRs from health plan to health plan whenever individuals' or companies' health plan coverages shift."
This implementation guide builds on the pioneering work of the Blue Cross and Blue Shield Association and America's Health Insurance Plans (AHIP) in their 005010 implementation guide of the same name. The document brings together work of several standards-setting organizations to describe the business process, message structure, data elements and examples and includes a glossary.
"This announcement by ASC X12 is good news for consumers who, when they change coverage, want to transfer their PHRs to their new health plans and continue with all of the advantages that PHRs bring with them," said AHIP President and CEO Karen Ignagni. "We are pleased that the new standard builds on the work of AHIP and BCBSA, which was designed to be consistent with that of the standards organizations, and to be a building block for their future efforts," Ignagni said.
"BCBSA believes the increased use of personal health records will allow consumers to take a greater role in their own healthcare and ultimately improve quality and health outcomes," said Scott P. Serota, BCBSA president and CEO. "BCBSA is proud of its partnership with ASC X12 and other organizations to promote the use of PHR standards."
The Healthcare Information Technology Standards Panel (HITSP), a cooperative partnership between the public and private sectors has named ASC X12 and Health Level Seven (HL7) standards in their Interoperability Specifications. The "Personal Health Record Transfer Between Health Plans Technical Report" benefits from ASC X12 and HL7 standards. This implementation guide for ASC X12's Patient Information Transaction Set 275 describes a standard method to encapsulate an HL7 Plan-to-Plan Personal Health Record Data Transfer (P2PPHR). Neither the ASC X12 guide, nor the HL7 guide are standalone documents. The X12 guide relies on the HL7 guide, which relies on and references other HL7 documents.
X12 standards provide robust acknowledgments at several levels, from transmission to implementation guide adherence. HL7 standards provide a thorough collection of clinical-based data elements and a rich vocabulary gleaned from other well-known standard coding systems, such as, SNOMED, CPT, and LOINC.
Applications of this standard include:
-- When an employer or coverage sponsor changes from one health plan to
another, the new health plan may request the prior plan to transfer PHR
information of covered individuals.
-- When an individual changes jobs and elects coverage under a new health
plan, he may request the transfer of PHR information for covered
individuals. The prior health plan, with the individual's authorization,
will transfer the PHR information to the new health plan.
-- When an individual or subgroup of individuals changes from one health
plan to another, the new health plan may request the prior health plan to
transfer the PHR information of those covered individuals.
The combination of X12 and HL7 specifications incorporate Clinical Document Architecture (CDA) Release 2 (R2)-defined eXtensible Markup Language (XML) in the 275 transaction to delineate the data elements that are supported by health plan claims, administrative functions, clinical actions, medications, providers, facilities, and other data directly entered by individuals into their PHR.
About ASC X12
Celebrating 30 years of Business Process and Technical Expertise in the Development and Adoption of Electronic Data Exchange Standards
The ASC X12, chartered by the American National Standards Institute (ANSI) in 1979, develops EDI standards and documents for national and global markets. With more than 315 X12 EDI standards and increasing X12 XML schemas, ASC X12 enhances business processes, reduces costs and expands organizational reach. Members include standards experts from health care, insurance, transportation, finance, government, supply chain and other industries. To participate in ASC X12's vital standards-setting role, visit www.X12.org :, or call 703-970-4480.
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Lean: A term coined by those who compared Toyotas methods to those of other manufacturers: Lean is the antidote to waste It provides a way to specify value, line-up value-creating actions in the best sequence, conduct these activities without interruption whenever someone requests them, and perform more and more effectively (Womack et al. 1990; Womack and Jones 2003).
Value-added work: Work that adds value from the perspective of the client or customer; it is the kind of activity or service for which end users are willing to pay. In healthcare this could be the taking of blood for a medically necessary test or patient time spent with an examining physician.
Waste or muda: Activities of overproduction, waiting, transportation, processing, inventory, movement and defective products. Type 1 muda represents activities that cannot be avoided immediately given current policies, assets and technologies. If a physician cannot eliminate the need to fill out a drug allergies form because of an existing policy, that muda is categorized as type 1. In contrast, type 2 muda is clearly wasteful activity; it is the prime target for immediate elimination. An example of type 2 muda is the time that staff spend looking for equipment that isnt stored or categorized in a sensible way. This wasted time can be immediately removed by re-organizing storage areas for example, moving blood pressure cuffs to one standardized location so they can be easily found.
Value stream map: Visual presentation of activities required to bring a service or product from customer order to delivery. Value-added steps and muda are most easily identified on a value stream map. The mapping starts with defining what the customer demands (in the top right corner) and then captures all the steps required to fulfillment. The current state value stream map represents the steps as they exist today. The future state value stream map is a visual representation of an idealized state. Improvement activities (like kaizen events below) undertaken by front-line staff move the process toward the future state.
Gemba: In Japanese, gemba means actual place. In the Lean context, it refers to the place where value is actually created: the shop floor in manufacturing, or a clinic (e.g., emergency department, outpatient dialysis unit, or operating room) in the healthcare setting. The concept of gemba is important because it emphasizes the Lean principle that value what customers actually want is created on the front lines, not in boardrooms. The value stream mapping exercise forces workers to walk the gemba to see value and the process that creates it.
Kaizen event or rapid improvement event (RIE): Kaizen means in Japanese, and kaizen events are focused on implementing improvements to the process of meeting customer demands. In healthcare, these week-long events provide the opportunity for front-line workers from different disciplines to work together to rapidly plan, implement, measure and adjust improvements.
Kamikaze kaizen: Kaizen activities that improve an isolated segment of a process but negatively affect the entire process are referred to as kamikaze kaizens.
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Executive summary
The Privacy Commissioner has conducted an inquiry into the practice of some insurance companies of collecting full medical notes for a specified number of years.
The inquiry concludes that insurers that collect full medical notes - even for a specified period - are at risk of breaching the Health Information Privacy Code. This is because insurers can only collect personal health information that is necessary to make insurance decisions, such as calculating whether to insure someone or whether to pay out on a claim.
Insurers do need to collect detailed medical information to make insurance decisions, and their clients need to be completely open and honest about that information. However, this should usually take the form of asking for answers to particular questions. Not all the information contained in medical notes is necessarily relevant to an insurance decision. For instance, medical notes may contain family or relationship information - the medical practitioner may have treated a person as a whole, in their individual circumstances and context. This will not always be relevant to the decisions the insurer has to make about cover or claims.
Occasionally, an insurer will be entitled to collect full medical notes, if the more specific information does not provide the detail the insurer needs to make the decision. However, these situations should be rare.
FULL ARTICLE:
http://www.privacy.org.
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The goal of this campaign is to adopt EHR technology to replace the current paper and fragmented computer files maintained by the vast majority of hospitals and physicians. Imagine a health information technology system that includes all of a patients diagnoses, medical history, laboratory and test results, medications prescribed, payor claims data, hospital records and other pertinent data. That system would be available to a patients health plan, hospital, pharmacy and doctors. Payors and regulators also can use this type of system to reduce fraud, waste and duplication, as well as control processing costs and improve disease-state management programs. EHR technology promises to reduce medication and other medical errors and streamline clinical decision-making and communication.
That holy grail has been envisioned by many participants in the health care industry today, but unfortunately it is not achievable under the current patchwork of federal and state laws and most existing health IT systems. In its ambitious effort to hasten the advent of EHR for the 21st century, the federal government actually may be working at cross-purposes with privacy protections established under federal and state law. Heres why.
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Senate Notice Paper No. 66 on 12 May 2009:
*1495 Senator Ludlam: To ask the Minister for Broadband, Communications and the
Digital Economy
(1) With reference to the hearings of the Environment, Communications and
the Arts Committee additional estimates of 23 February 2009, in which an
officer of the Australian Communications and Media Authority (ACMA)
stated 'As you may recall, Senator, every six months those overview
profiles of the number of investigations that we have done and the
breakdownwhether it was RC [Refused Classification], child
pornography, X and so onare tabled in parliament. If we look at one of
those six-month reports, there is a lot of information on what we do
regarding our investigations there' (Committee Hansard, 23 February 2009,
ECA 108): was the officer referring to the Co-regulatory Scheme for
Internet Content Regulation reports; if so, have those reports been prepared
and tabled since the report for the period July to December 2005; if so,
where can copies of these reports, for the 3 years since 2005, be obtained.
(2) If the answer to (1) above is no:
(a) what are the six-monthly reports to which the officer referred to;
and
(b) where can copies of these reports be obtained.
(3) Does the ACMA charge a fee to filter suppliers for the ACMA's blacklist
and/or updates to the blacklist; if so:
(a) is the fee $15 000 (as reported by a filter supplier on 26 March 2009
at http://www.crikey.com.au); if not, how much is the fee;
(b) for what period of time does the fee cover (for example, annually,
half-yearly, monthly, etc); and
(c) when did the ACMA commence charging a fee.
(4) Does the ACMA charge a fee, or does it intend to do so in future, for the
supply of its blacklist to Internet Service Providers (ISPs) who provide
server-level filtering; if so, how much.
(5) What procedures or systems does the ACMA have in place to ensure that
filter suppliers promptly add and delete Uniform Resource Locators (URLs)
on notification of updates by the ACMA, for example, does the ACMA
undertake audits of filter suppliers' copies of the ACMA's blacklist; if so,
how often.
(6) In regard to media reports in March 2009 that the ACMA stated that a page
containing photographs by Mr Bill Henson had been incorrectly added to
the ACMA's blacklist as a result of a 'caching error': (a) what is a 'caching
error'; and (b) can the ACMA prevent a 'caching error' happening in
future; if so, how.
(7) When the ACMA adds to its blacklist the URL of a hacked page on an
overseas-hosted web site, that is operated/maintained by an Australian
resident or Australian-based business, does the ACMA notify the
Australian resident/business of the existence of the prohibited content so
that it may promptly delete such content and have its page promptly
removed from the blacklist; if not, why not.
(8) How does the ACMA determine whether web page content has 'an
Australian connection', for example, does the ACMA base this
determination on the geographical location of the business/person to whom
the IP [Internet Provider] address of the web site's domain has been
allocated, the geographical location of the business/person identified as the
registrant the administrative or the technical contact of the domain in the
'whois' information.
(9) In regard to the ACMA's blacklist:
(a) how many URLs on the blacklist are main domain addresses, for
example, http://www.example.com (not the address of a sub-page
on a web site);
(b) when the ACMA notifies filter suppliers of a domain address, are
filter suppliers required to block only that particular page (that is,
the site's 'home' page), or all pages on the domain; and
(c) if filter suppliers are required to block all pages on a domain, by
what means does the ACMA determine that there is a substantial
likelihood that all pages on the domain are, if classified,
potential/prohibited content.
(10) In regard to the ACMA online content statistics for the month of December
2008, ACMAsphere No. 38, states that 237 overseas-hosted items were
actioned and 22 items were 'R18+ Language', while the ACMA's Internet
statistics web page states that 253 overseas-hosted items were actioned, no
items were 'R18+ Language' and 22 items were 'X 18+ Actual sexual
activity' and given that there are also other discrepancies between the two
sets of reported statistics:
(a) which statistics are accurate; and
(b) what caused the discrepancies.
(11) For each of the following periods: 20 January to 31 June 2008 and 1 July
2008 to date:
(a) how many items of Internet content did the ACMA submit to the
Classification Board for the purpose of complying with clause 116
of Schedule 7 (samples of content to be submitted for classification)
of the Broadcasting Services Act 1992; and
(b) how many of these items were content that did not have an
'Australian connection'.
(12) In regard to ACMA Internet content assessors:
(a) why are the names, dates of appointment and short biographies of
the assessors not made publicly available (as has long been the case
in relation to members of the Classification Board and Classification
Review Board);
(b) are content assessors, like members of the classification boards,
appointed by the Governor-General; if not, who appoints them;
(c) in selecting and appointing content assessors, are there requirement
that they have the capacity to assess, identify and represent
community standards;
(d) are content assessors initially appointed for a fixed term of service;
if so, what is that period of time;
(e) is there a statutory or other limit on the maximum term of service
for a content assessor; and if so, what is that period of time;
(f) for each content assessor, what was the date of their initial
appointment;
(g) how many content assessors are:
(i) former full-time or part-time members of the Classification
Board,
(ii) former temporary/casual members of the Classification
Board,
(iii) current temporary/casual members of the Classification
Board,
(iv) former members of the Classification Review Board, and
(v) former employees, in any role, of the former Office of Film
and Literature Classification; and
(h) for each content assessor referred to in (12)(g) above, what is each
of their total period of service in the abovementioned former roles.
(13) Do ACMA content assessors undergo regular training by the Classification
Board to help ensure consistency of decisions; if so, how often does such
training take place.
(14) How many content assessors view and assess an item of Internet content
prior to an ACMA determination that it is 'potential prohibited content'
because there is a substantial likelihood that it would be classified by the
Classification Board as:
(a) RC, 'RC-Child Depiction';
(b) RC, for any other reason;
(c) X18+;
(d) R18+; and
(e) MA15+.
68 No. 6612 May 2009
(15) In regard to the page on an anti-abortion web site that was determined by
the ACMA to be 'RC-Violence' in January 2009 and the criteria for RC in
the national classification code:
(a) was the content determined to be prohibited/potential prohibited
content under clause 1(a) of the criteria for RC (depictions of
violence that offend against the standards of reasonable adults) or
under clause 1(c) (promote, incite or instruct in matters of crime or
violence); and
(b) how many content assessors participated in making a decision that
there was a substantial likelihood that the content would be RC if
classified.
(16) In regard to the ACMA's 'Restricted Access System Declaration 2007', the
explanatory statement to the declaration and the ACMA's web page titled
'new restricted access arrangements' state that the requirements in the
declaration apply only to content that has an 'Australian connection' (is
hosted in Australia or provided from Australia):
(a) what procedures/systems are available to providers of
overseas-hosted content to enable them to ensure that content they
provide that is, or would be classified R18+ or (commercial)
MA15+, is not added to the ACMA's blacklist; and
(b) if these procedures/systems comply with the 'Restricted Access
System Declaration 2007', how can the ACMA, and Australian
Internet users, know that an overseas content provider is complying
with the Australian National Privacy Principles under the Privacy
Act 1988, as required by the Restricted Access System Declaration
2007, in relation to use/disclosure etc of proof of age
documentation/information they acquire and are required to keep for
2 years.
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"We need advancements in health information technology across the board to improve the quality of care Americans receive," said Senator Rockefeller, Chairman of the Senate Finance Subcommittee on Health Care. "To make this happen, we need universal access to affordable and interoperable health information technology - from small, rural health clinics to large, urban hospitals."
Open source software refers to a computer program with unrestricted source code that does not limit the use or distribution by any organization or user.
Senator Rockefeller continued, "Open source software is a cost-effective, proven way to advance health information technology - particularly among small, rural providers. This legislation does not replace commercial software; instead, it complements the private industry in this field - by making health information technology a realistic option for all providers.
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"At 2231:53, the captain called for the first officer to rotate. The first officer attempted to rotate the aircraft, but it did not respond immediately with a nose-up pitch. The captain again called 'rotate' and the first officer applied a greater nose-up command. The nose of the aircraft was raised and the tail made contact with the runway surface, but the aircraft did not begin to climb. The captain then selected TOGA on the thrust levers, the engines responded immediately, and the aircraft commenced a climb."
"The crew notified air traffic control of the tail strike and that they would be returning to Melbourne. While reviewing the aircraft's performance documentation in preparation for landing, the crew noticed that a take-off weight, which was 100 tonnes below the actual take-off weight of the aircraft, had inadvertently been used when completing the take-off performance calculation. The result of that incorrect take-off weight was to produce a thrust setting and take-off reference speeds that were lower than those required for the actual aircraft weight.
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Health care reform:
FOB: Waxman cant get his bill out of committee. Likely booted to next year.
Comparative Effectiveness: will be a committee in the fall that sponsors research and promulgates guidelines.
1) Medicare has tried to implement some CE: functional equivalence (legislated away), least costly alternative (e.g., wheelchairs) tried to apply to Sepracor, got sued, lost on appeal; tried to take accelerated approval drugs out of reimbursement, didnt fly. Legislation likely to pass giving CMS back authority to do least costly alternative reimbursement.
Large private plans have hundreds of physicians and thousands of clinicans, CMS has at best 25 physicians. E.g., have made 160 decisions on cancer product reimbursement without a single oncologist on staff.
2) Price controls: private market will be increasingly able to pay off medicade pricing schedules. Drug benefit for dual-eligible patients will be moved to medicade best price schedule.
Similar changes: medicare advantage plans will want to be able to price off medicare if their reimbursement rates are cut.
Also,
Regulatory creep at the FDA: balance shifts on approval metrics debates because of increased public desire for and tolerance of regulatory caution.
Medical devices: changing regulatory paradigm for diagnostics. Laboratory-developed tests will likely be regulated as devices. Kennedy has a bill pending.
I asked about the regulatory environment for personalized medicine, and Scott pointed interestingly to different regulatory approaches taken in the U.S. vs EU to screening HER-2 as a precursor to Erbitux treatment for colon cancer. EU uses it based on retrospective data, U.S. has wanted to do dedicated prospective controlled trials.
Dani asked about drug reimportation: Scott thinks it will happen, but regulatory structure and currency changes will increase cost, and increased drug reimbursement in the U.S. will decrease demand.
Brian Bloom, a banker at Bloom Burton, asked about how the Obama administrations vocal support for innovation meshes with the health care reforms and comparative effectiveness initiatives. Scott diplomatically focussed on the administrations support for basic reseach, then segued less diplomatically to predict the end of cancer drug development that he says could follow if the NICE model in the UK is globalized.
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However, because the Veteran's Health Information Systems and Technology Architecture, or VistA, was developed over a 20-year period with several billions in taxpayer dollars, its source code is now part of the public domain. That means software developers can use the code at no cost and introduce additional features without restrictions. As a result, although the software still costs money to install and maintain, it frequently costs less than other options from private companies.
In addition, VistA, which is now used at more than 1,400 VA medical facilities, offers a standardized program that facilitates seamless transfer of patients' records between different hospitals and facilities, a benefit that private commercial vendors of EHR systems do not provide. The standardized software also reduces implementation costs and potential errors for users, according to the Journal. Furthermore, VistA provides the same benefits of most other EHR systems, which advocates say will reduce medical costs, medical and prescription errors, and increase efficiency and quality of care.
Kenneth Kizer -- chair of Medsphere and former undersecretary for health at VA, who oversaw the development of VistA -- said his company can implement its OpenVistA system "in one-third the time and for about one-third the cost" of other private companies that offer proprietary systems. Medsphere is one of several startups that has begun using VistA's open-source platform. However, Dan Garrett, a PricewaterhouseCoopers consultant, said that while VistA could be beneficial for some hospitals, the system's advantages have not been widely proven commercially like those offered by private companies.
The Journal profiled one hospital in Texas that has been using VistA, which cost the hospital $7 million to implement (Landro, Wall Street Journal, 4/30).
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29 A
09 | Un cerebro centenario
"Cuando ya no pueda pensar, quiero que me ayuden a morir con dignidad"
El 22 de abril cumplió 100 años Rita Levi-Montalcini.
ElPaís,Madrid
La científica italiana, premio Nobel de Medicina, soltera y feminista perpetua -"yo soy mi propio marido", dijo siempre- y senadora vitalicia produce todavía más fascinación cuando se la conoce de cerca. Apenas oye y ve con dificultad, pero no para: investiga, da conferencias, ayuda a los menos favorecidos, y conversa y recuerda con lucidez asombrosa.
Sobrada de carácter, deja ver su coquetería en las preciosas joyas que luce, un brazalete que hizo ella misma para su gemela Paola, el anillo de pedida de su madre, un espléndido broche también diseñado por ella. Desde sus ojos verdes vivísimos, Levi-Montalcini escruta a un reducido grupo de periodistas en la sede de su fundación romana, donde cada tarde impulsa programas de educación para las mujeres africanas.
Por las mañanas visita el European Brain Research Institute, el instituto que creó en Roma, y supervisa los experimentos de "un grupo de estupendas científicas jóvenes, todas mujeres", que siguen aprendiendo cosas sobre la molécula proteica llamada Factor de Crecimiento Nervioso (NGF), que ella descubrió en 1951 y que juega un papel esencial en la multiplicación de las células, y sobre el cerebro, su gran especialidad. "Son todas féminas, sí, y eso demuestra que el talento no tiene sexo. Mujeres y hombres tenemos idéntica capacidad mental", dice.
Con ella está, desde hace 40 años, su mano derecha, Giuseppina Tripodi, con quien acaba de publicar un libro de memorias, La clepsidra de una vida, síntesis de su apasionante historia: su nacimiento en Turín dentro de una familia de origen sefardí, la decisión precoz de estudiar y no casarse para no repetir el modelo de su madre, sometida al "dominio victoriano" del padre; el fascismo y las leyes raciales de Mussolini que le obligaron a huir a Bélgica y a dejar la universidad; sus años de trabajo como zoóloga en Misuri (Estados Unidos), el premio en Estocolmo -"ese asunto que me hizo feliz pero famosa"-, sus lecturas y sus amigos (Kafka, Calvino, el íntimo Primo Levi), hasta llegar al presente.
Sigue viviendo a fondo, come una sola vez al día y duerme tres horas. Su actitud científica y vital sigue siendo de izquierdas. Pura cuestión de raciocinio, explica, porque la culpa de las grandes desdichas de la humanidad la tiene el hemisferio derecho del cerebro. "Es la parte instintiva, la que sirvió para hacer bajar al australopithecus del árbol y salvarle la vida. La tenemos poco desarrollada y es la zona a la que apelan los dictadores para que las masas les sigan. Todas las tragedias se apoyan siempre en ese hemisferio que desconfía del diferente".
Laica y rigurosa, apoya sin rodeos el testamento biológico y la eutanasia. Y no teme a la muerte. "Es lo natural, llegará un día pero no matará lo que hice. Sólo acabará con mi cuerpo". Para su centenario, la profesora no quiere regalos, fiestas ni honores. Ese día dará una conferencia sobre el cerebro.
Pregunta. Cómo es la vida a los cien años?
Respuesta. Estupenda. Sólo oigo con audífono y veo poco, pero el cerebro sigue funcionando. Mejor que nunca. Acumulas experiencias y aprendes a descartar lo que no sirve.
P. Se arrepiente de no haber tenido hijos?
R. No. Era adolescente cuando decidí que nunca me casaría. Nunca habría obedecido a un hombre como mi madre obedecía a mi padre.
P. Recuerda el momento en que decidió estudiar? Qué dijo su padre?
R. Era el periodo victoriano. Mi padre era una persona de gran valor intelectual y moral, pero un victoriano. Desde niña estaba contra eso, porque veía a mi padre dominar todo, y decidí que no quería estar en un segundo plano como mi madre, a la que adoraba. Ella no mandaba. Dije a mi padre que no quería ser ni madre ni esposa, que quería ser científica y dedicarme a los otros, utilizar las poquísimas capacidades que tenía para ayudar a los que necesitaban. Que quería ser médica y ayudar a los que sufrían. Él me dijo: "No lo apruebo pero no puedo impedírtelo".
P. Qué momentos de su vida han sido más emocionantes?
R. El descubrimiento que hice, que hoy es más importante que entonces. Cuando cada experimento confirmaba mi hipótesis, que iba completamente contra los dogmas de ese tiempo, viví momentos emocionantes. Quizás el más emocionante. Por el resto, el reconocimiento de Estocolmo me dio mucho placer, claro, pero fue menos emocionante.
P. Su tesis demostró que, de los dos hemisferios del cerebro, uno está menos desarrollado que el otro.
R. Sí, el cerebro límbico, el hemisferio derecho, no ha tenido un desarrollo somático ni funcional. Y, desgraciadamente, todavía hoy predomina sobre el otro. Todo lo que pasa en las grandes tragedias se debe al hecho de que este cerebro arcaico domina al de la verdadera razón. Por eso debemos estar alerta. Hoy puede ser el fin de la humanidad. En todas las grandes tragedias se camufla la inteligencia y el razonamiento con ese instinto de bajo nivel. Los regímenes totalitarios de Mussolini, Hitler y Stalin convencieron a las poblaciones con ese raciocinio, que es puro instinto y surge en el origen de la vida de los vertebrados, pero que no tiene que ver con el razonamiento. El peligro es que aquello que salvó al australopithecus cuando bajó del árbol siga predominando.
P. En cien años usted ha conocido esos totalitarismos. Cómo se puede evitar que vuelvan?
R. Hay que comenzar en la infancia, con la educación. El comportamiento humano no es genético sino epigenético, el niño de dos o tres años asume el ambiente en el que vive, y también el odio por el diferente y todas esas cosas atroces que han pasado y que pasan todavía.
P. Qué aprendió de sus padres? Qué valores le transmitieron?
R. Lo más importante era comportarse de una manera razonable, saber lo que vale de verdad. Tener un comportamiento riguroso y bueno, pero sin la idea del premio o el castigo. No existía la idea del cielo y el infierno. Éramos religiosos, pero la actitud ante la vida no tenía que ver con la religión. Existía el sentido del deber, pero sin compensación post mortem. Debíamos comportarnos bien, eso era una obligación. Entonces no se hablaba de genética, pero era ese espíritu. Sin premio ni miedo.
P. Su origen es sefardí. Hablaban español en casa?
R. No, nunca tuvimos mucha relación con esa lengua. Sabíamos que veníamos de la parte sefardí y no de la askenazi, pero no se hablaba de ello, no nos importaba mucho ser de una u otra. Spinoza me hacía feliz, era un gran referente cultural, y todo lo que sabíamos procedía de los grandes pensadores hebreos, pero no había un sentido de orgullo, de ser mejores, nunca pensamos así.
P. Basta un siglo para comprender a Italia?
R. Es un país maravilloso, por el clima, por la historia del Renacimiento, y por sus enormes contribuciones, su historia formidable de capacidad y descubrimientos. Me sentí siempre judía e italiana, las dos cosas al 100%. No veía dificultad en eso.
P. Cómo ve a Italia hoy?
R. Tiene un fortísimo capital humano, capacidad innovadora y de convivencia, orgullo del pasado, y no se siente demasiado afectada por las cosas negativas, como la mafia. Siempre sentí que era un país del que era una suerte formar parte y haber nacido. Ser italianos era parte de nosotros, nadie nos preguntaba si éramos italianos o no. También era una suerte ser judía. No conocí la Biblia, no tuve una educación religiosa, y me reflejaba en el capital artístico y moral italiano y judío. No pertenecí a una pequeña minoría perseguida, sabía que eso ocurría, pero no me sentía parte de ello. Desde niña me sentía igual que los demás. Cuando me preguntaban "cuál es tu religión?", contestaba: "Yo, librepensadora", y nadie sabía qué era eso. Y tu padre qué es: ingeniero.
P. Cómo vivió el fascismo?
R. No siento rencor personal. Sin las leyes raciales, que determinaron que los judíos éramos una raza inferior, no hubiera tenido que recluirme en mi habitación para trabajar, en Turín y luego en Asti. Pero nunca me sentí inferior.
P. Así que no sintió miedo?
R. Miedo, no; desprecio y odio sí, netamente por Mussolini. A mi profesor Giuseppe Levi lo seguí paso a paso y era feliz por lo que él valientemente osaba hacer y decir. Nunca sentí la persecución porque mis compañeros de universidad católicos me consideraban igual. Y no tuve sensación de peligro. Cuando empezaron las persecuciones, eran tan inmundas las cosas que se decían que no me daba por aludida. Estaba ya licenciada en 1936, había estudiado con Renato Dulbecco, católico, y Salvatore Luria, judío, y no tenía sensación de ser distinta.
P. Cree que hay peligro de que vuelva el fascismo?
R. Sí, en los momentos críticos prevalece más la componente instintiva del cerebro, que se camufla de raciocinio y anima a los jóvenes a razonar como si fueran parte de una raza superior.
P. Ha seguido la polémica sobre el Papa, los preservativos y el sida?
R. No comparto lo que ha dicho.
P. Y qué piensa del poder que tiene la Iglesia? Es demasiado?
R. Sí. Fui la primera mujer admitida en la Academia Pontificia y tuve una buena relación con Pablo VI y con Wojtyla, también con Ratzinger, aunque menos profunda que con Pablo VI, al que estimaba mucho. No la tuve en cambio con aquel considerado el Papa Bueno, Roncalli (Juan XXIII), que para mí no era bueno, porque era muy amigo de Mussolini y cuando comenzaron las leyes antifascistas dijo que había hecho un gran bien a Italia.
P. Ha cambiado mucho su pensamiento a lo largo de la vida?
R. Poco, poco. Siempre pensé que la mujer estaba destruida porque el hombre imponía su poder por la fuerza física y no por la mental. Y con la fuerza física puedes ser maletero, pero no un genio. Lo pienso todavía.
P. Le importó alguna vez la gloria?
R. Para mí, la medicina era la forma de ayudar a los que no tenían la suerte de vivir en una familia de alto nivel cultural como la mía. Esa línea recta no ha cambiado. La actividad científica y la social son la misma cosa. La ayuda a las mujeres africanas y la medicina son lo mismo.
P. El cerebro sigue siendo un misterio?
R. No. Ahora es mucho menos misterioso. El desarrollo de la ciencia es formidable, sabemos cómo funciona desde el lado científico y tecnológico. Su estudio ya no es un privilegio de los expertos en anatomía, fisiología o comportamiento. Los anatomistas no han hecho gran cosa, quitando algunos. Ahora ya no hay barreras. Físicos, matemáticos, informáticos, bioquímicos y biomoleculares, todos aportan cosas nuevas. Y eso abre posibilidades a nuevos descubrimientos cada día. Yo misma, a los 100 años, sigo haciendo descubrimientos que creo importantes sobre el funcionamiento del factor que descubrí hace más de 50 años.
P. Hará fiesta de cumpleaños?
R. No, me gustaría ser olvidada, ésa es mi esperanza. No hay culpa ni mérito en cumplir 100 años. Puedo decir que la vista y el oído han caído, pero el cerebro no. Tengo una capacidad mental quizá superior a la de los 20 años. No ha decaído la capacidad de pensar ni de vivir...
P. Díganos el secreto.
R. La única forma es seguir pensando, desinteresarse de uno mismo y ser indiferente a la muerte, porque la muerte no nos golpea a nosotros sino a nuestro cuerpo, y los mensajes que uno deja persisten. Cuando muera, solo morirá mi pequeñísimo cuerpo.
P. Está preparada?
R. No hace falta. Morir es lógico.
P. Cuánto desearía vivir?
R. El tiempo que funcione el cerebro. Cuando por factores químicos pierda la capacidad de pensar, dejaré dicho en mi testamento biológico que quiero ser ayudada a dejar mi vida con dignidad. Puede pasar mañana o pasado mañana. Eso no es importante. Lo importante es vivir con serenidad, y pensar siempre con el hemisferio izquierdo, no con el derecho. Porque ése lleva a la Shoah, a la tragedia y a la miseria. Y puede suponer la extinción de la especie humana.
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An anonymous reader optimistically writes that new legislation has been introduced in the Senate that would call for a nationwide adoption of electronic health records built on open source. The bill does not seek to supplant proprietary alternatives, but instead to either augment or offer a cost effective alternative.
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The Handbook
Begin by looking at the Handbook for an overview of the ecologies and the strategies. The handbook will also provide you with simple directions for how to go about reading and analyzing the ecologies and the strategies. Once you have read the handbook, dive into the ecologies and the strategies!
The Superstruct Ecologies
Illustrating the links among the many superstructures created by our 7000+ Superstruct players, the ecologies begin to depict possible future institutional landscapes.
The Appleseed Ecology
Starting from a game that taps real-life gardens to advance urban farming through “simfarms”, this ecology describes a new infrastructure for securing food, repurposing waste, and creating new forms of exchange.
The Natural Currency Ecology
This ecology re-envisions our capital systems as tied, not to gold or GDP or other commodities, but to environmental measures, linking sociability to sustainability.
The Community Works Ecology
Recognizing thet “large-scale problems do not require large-scale solutions,” this ecology creates superstructures for replicating local solutions across large-scale systems.
The Open Fab Initiative Ecology
The Open Fab Initiative is the starting node for a densely interconnected ecology of superstructures that explicitly link new very small-scale fabrication tools and practices to solving the problems of distressed communities-creating new local material and economic realities.
The Quantum Governance Ecology
Building on the desire to create a new post-Newtonian model of governance, this ecology is thick with superstructures that help citizens make sense of the world-bridging across realities.
The Superstruct Matrix Card
Begin the Superstruct Strategies by reading the Matrix Card. It will give you 5 simple rules to follow as you look at Superstructing your own organization or life. The Matrix card will also help know what to look for as you discover the separate Superstruct Strategies.
The Superstruct Strategies
The Superstruct game is not only a forecasting game designed to anticipate new kinds of superstructures. It’s also an experiment in superstructing. Out of the experiences of both the designers-the IFTF team-and the people who have played the game, seven basic strategies for superstructing have emerged.
Evolvability
Nurture genomic diversity and generational differences.
Extreme Scale
Layer micro and massive scales for rapid adaption.
Ambient Collaboration
Leverage stigmergy with environmental feedback.
Reverse Scarcity
Use renewable and diverse resources as rewards.
Amplified Optimism
Link amplified individuals at massive scales.
Adaptive Emotions
Confer evolutionary advantage with awe, appreciation, and wonder.
Playtests
Challenge everything and everyone in fun, fierce bursts.
The Perspectives
The perspectives take a closer look at 5 of our forecast from our 2009 Map of the Decade. Each perspective includes an analysis of the forecast, an interview with an expert, and examples of what superstructig this perspective looks like.
Design: Post-Newtonian Governance
The Newtonian politics that emerged at the end of the 18th century were a triumph of human ingenuity and foresight, applying the latest technologies and a scientific understanding of the universe to the design of governance. However, there has been little true innovation in governance since the creation of the U.S. Constitution. All that is about to change.
Civil Society: Networked Citizens
The citizen of the future is a native of the network; and that changes everything. It tempers border-based identities. It refocuses political action on issues that are both more local and more global at the same time. It links expressiveness to empowerment and turns the smart consumers of the early Internet era into activist citizens of the coming decades.
Environment: Geoengineering
With broad scientific consensus that global warming requires deep cuts in carbon emissions, what remains unanswered is the question of whether we’ll have enough time to implement the economic, social, and technological changes necessary to reduce our carbon footprint. In the face of massive, irreversible changes in our living ecologies, a growing number of scientists have a backup plan: large-scale geoengineering.
Culture: Superstructed Realities
As physical and digital realities are seamlessly integrated, cyberspace is not a place that people go; it’s a new layer in their reality. It’s a superstructure of that will serve as our outboard brains and senses, remaking the basic concept of self and changing how we keep ourselves physically sound.
Cognition: Beyond FOXP2
It’s been at least 40,000 years since modern humans-Homo sapiens-became the only sapient life on earth, set apart by a critical mutation in the so-called language gene, FOXP2. But that isolation won’t last much longer. In a quest to augment our own intelligence with biotechnology and digital tools, our first experiments are re-engineering animal brains. What happens when we “uplift” our fellow species and potentially create a new cross-species politics?
Map of the Decade
This year’s map blends forecasts of innovation and disruption with a handful of Superstruct Ecologies-along with dozens of signals on the horizon-to create a map that features five big shifts: Extreme-Scale Collaboration, Alternative Wealth, Superstruct Ecologies, Mega-Structures, and A Governance Renaissance.
Overview
The Future is a chance to be new. This year’s TYF research delves into issues from a collapsing economy paving the way for new kinds of value to a new voice rising from the Global South plotting a new path for the next big economy to extreme climate conditions wiping the landscape clean to a new neuroscience presenting an extrodinary new picture of humans, and much much more.
The Overview gives an intro to the Perspectives, Superstruct Handbook, Signal Survey, and the MOTD.
50-Year Outlook
The Choices we make make in the next decade will set the course for the century. Likewise, our visions of what the world could be in 30 or 50 years shape the decisions we make today, both directly and indirectly. Looking long, we offer the following three scenarious:
The long Crisis plots a path of slow response, resistance to change, and attempts to maintain current power relationships.
Emergence follows a course of rapid adaptation from the bottom-up, without much unifying direction.
The Great Transition envisions a world re-made by technology, a challenge to the planetary dominance of humans as a species.
TYF Signals Survey
Using more traditional survey research methods, this year’s Signal Survey probed the edges of innovation with questions about personal avatars in online virtual worlds, about mobile health practices, sustainable medicine, new forms of political engagement, and the kinds of bonds that form so-called “new diasporas.” The survey results point to the waves of social innovation we can expect in the coming decade.
Agenda Booklet
Take a look at the attendees and researchers involved in the conference, along with how we went about unfolding our research over two days.
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On April 21, 2009, CDC reported that two recent cases of febrile respiratory illness in children in southern California had been caused by infection with genetically similar swine influenza A (H1N1) viruses. The viruses contained a unique combination of gene segments that had not been reported previously among swine or human influenza viruses in the United States or elsewhere . Neither child had known contact with pigs, resulting in concern that human-to-human transmission might have occurred. The seasonal influenza vaccine H1N1 strain is thought to be unlikely to provide protection. This report updates the status of the ongoing investigation and provides preliminary details about six additional persons infected by the same strain of swine influenza A (H1N1) virus identified in the previous cases, as of April 24. The six additional cases were reported in San Diego County, California (three cases), Imperial County, California (one case), and Guadalupe County, Texas (two cases). CDC, the California Department of Public Health, and the Texas Department of Health and Human Services are conducting case investigations, monitoring for illness in contacts of the eight patients, and enhancing surveillance to determine the extent of spread of the virus. CDC continues to recommend that any influenza A viruses that cannot be subtyped be sent promptly for testing to CDC. In addition, swine influenza A (H1N1) viruses of the same strain as those in the U.S. patients have been confirmed by CDC among specimens from patients in Mexico. Clinicians should consider swine influenza as well as seasonal influenza virus infections in the differential diagnosis for patients who have febrile respiratory illness and who 1) live in San Diego and Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset.
CDC - Influenza (Flu) Swine Influenza
Human cases of swine influenza A (H1N1) virus infection have been identified in the United States. Human cases of swine influenza A (H1N1) virus infection also have been identified internationally. The current U.S. case count is provided below.
Investigations are ongoing to determine the source of the infection and whether additional people have been infected with swine influenza viruses.
CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization. This includes deploying staff domestically and internationally to provide guidance and technical support. CDC has activated its Emergency Operations Center to coordinate this investigation.
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Although I suppose somebody else would have invented it earlier or later if you hadn't, I just wanted to say thank you for having done such incredible pioneer work on a sector that has changed the lives of us all. Would you Curly Johnny got out in homicide occurrence bad! But a leader of Germany's Turkish community said it was time Muslims accepted freedom of expression in art. Meanwhile, the non-state sector (min yin qi ye) has grown by leaps and bounds. In addition, a number of adult education programs and workplace training schemes - in line with Chile's policy of building labor skills - provide our less-qualified citizens with opportunities to better their employment prospects. Pirmas albumas buvo puikus, rekomenduoju paklausyti. D'aquesta manera, va realitzar la multiplicaci? dels pans. I believe in Ann's ability to organize it well. Chisapiaki and growth trinds of the network named NextG network . END OF /sites/kiyavia/lnd/htdocs/generator/eng/o
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Using knowledge to create knowledge is the major concept of the emerging knowledge society. This way, knowledge becomes sustainable and a tool to realize the millennium goals. But to achieve this in the most effective way, we will have to make inventories of knowledge.
ICMCC (International Council on Medical Care Compunetics) is an international foundation operating as the knowledge centre for medical and care compunetics, making information on medicine and care available to patients using compunetics as well as distributing information on the use of compunetics in medicine and care to patients and professionals.
Knowledge is derived from the synthesis between information and experience. ICMCC is becoming the global guiding platform in bringing information and experience related to medical and care compunetics together, thus creating the necessary inventories of knowledge. As we are aiming at both the patient/citizen and the professional we also target and facilitate the shifting relationship between the two.
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mbenjamin at salon.com
"I am under a lot of pressure to not diagnose PTSD"
A secret recording reveals the Army may be pushing its medical staff not to diagnose post-traumatic stress disorder. The Army and Senate have ignored the implications.
By Michael de Yoanna and Mark Benjamin
http://www.salon.com/news/special/coming
Editor's note: Last June, during a medical appointment, a patient named "Sgt. X" recorded an Army psychologist at Fort Carson, Colo., saying that he was under pressure not to diagnose combat veterans with post-traumatic stress disorder. Listen to a segment of the tape here.
Apr. 08, 2009 |
"Sgt. X" is built like the Bradley Fighting Vehicle he rode in while in Iraq. He's as bulky, brawny and seemingly impervious as a tank.
In an interview in the high-rise offices of his Denver attorneys, however, symptoms of the damaged brain inside that tough exterior begin to appear. Sgt. X's eyes go suddenly blank, shifting to refocus oddly on a wall. He pauses mid-sentence, struggling for simple words. His hands occasionally tremble and spasm.
For more than a year he's been seeking treatment at Fort Carson for a brain injury and post-traumatic stress disorder, the signature injuries of the Iraq war. Sgt. X is also suffering through the Army's confusing disability payment system, handled by something called a medical evaluation board. The process of negotiating the system has been made harder by his war-damaged memory. Sgt. X's wife has to go with him to doctor's appointments so he'll remember what the doctor tells him.
But what Sgt. X wants to tell a reporter about is one doctor's appointment at Fort Carson that his wife did not witness. When she couldn't accompany him to an appointment with psychologist Douglas McNinch last June, Sgt. X tucked a recording device into his pocket and set it on voice-activation so it would capture what the doctor said. Sgt. X had no idea that the little machine in his pocket was about to capture recorded evidence of something wounded soldiers and their advocates have long suspected -- that the military does not want Iraq veterans to be diagnosed with PTSD, a condition that obligates the military to provide expensive, intensive long-term care, including the possibility of lifetime disability payments. And, as Salon will explore in a second article Thursday, after the Army became aware of the tape, the Senate Armed Services Committee declined to investigate its implications, despite prodding from a senator who is not on the committee. The Army then conducted its own internal investigation -- and cleared itself of any wrongdoing.
When Sgt. X went to see McNinch with a tape recorder, he was concerned that something was amiss with his diagnosis. He wanted to find out why the psychologist had told the medical evaluation board that handles disability payments that Sgt. X did not, in fact, have PTSD, but instead an "anxiety disorder," which could substantially lower the amount of benefits he would receive if the Army discharged him for a disability. The recorder in Sgt. X's pocket captured McNinch in a moment of candor. (Listen to a segment of the recording here.)
"OK," McNinch told Sgt. X. "I will tell you something confidentially that I would have to deny if it were ever public. Not only myself, but all the clinicians up here are being pressured to not diagnose PTSD and diagnose anxiety disorder NOS [instead]." McNinch told him that Army medical boards were "kick[ing] back" his diagnoses of PTSD, saying soldiers had not seen enough trauma to have "serious PTSD issues."
"Unfortunately," McNinch told Sgt. X, "yours has not been the only case ... I and other [doctors] are under a lot of pressure to not diagnose PTSD. It's not fair. I think it's a horrible way to treat soldiers, but unfortunately, you know, now the V.A. is jumping on board, saying, 'Well, these people don't have PTSD,' and stuff like that."
Contacted recently by Salon, McNinch seemed surprised that reporters had obtained the tape, but answered questions about the statements captured by the recording. McNinch told Salon that the pressure to misdiagnose came from the former head of Fort Carson's Department of Behavioral Health. That colonel, an Army psychiatrist, is now at Fort Lewis in Washington state. "This was pressure that the commander of my Department of Behavioral Health put on me at that time," he said. Since McNinch is a civilian employed by the Army, the colonel could not order him to give a specific, lesser diagnosis to soldiers. Instead, McNinch said, the colonel would "refuse to concur with me, or argue with me, or berate me" when McNinch diagnosed soldiers with PTSD. "It is just very difficult being a civilian in a military setting."
McNinch added that he also received pressure not to properly diagnose traumatic brain injury, Sgt. X's other medical problem. "When I got there I was told I was overdiagnosing brain injuries and now everybody is finding out that, yes, there are brain injuries," he recalled. McNinch said he argued, "'What are we going to do about treatment?' And they said, 'Oh, we are just counting people. We don't plan on treating them.'" McNinch replied, "'You are bringing a generation of brain-damaged individuals back here. You have got to get a game plan together for this public health crisis.'"
When McNinch learned he would be quoted in a Salon article, he cut off further questions. He also said he would deny the interview took place. Salon, however, had recorded the conversation.
On the tape and in his interview with Salon, McNinch seemed to admit what countless soldiers not just at Fort Carson but across the Army have long suspected: At least in some cases, the Army tries to avoid diagnoses of PTSD. But McNinch did not directly address why the Army discourages these diagnoses, in either the interview with Salon or the tape-recorded encounter with Sgt. X.
The answer probably has to do with money. David Rudd, the chairman of Texas Tech's department of psychology and a former Army psychologist, explained that every dollar the Army spends on a soldier's benefits is a dollar lost for bullets, bombs or the soldier's incoming replacement. "Each diagnosis is an acknowledgment that psychiatric casualties are a huge price tag of this war," said Rudd. "It is easiest to dismiss these casualties because you can't see the wounds. If they change the diagnosis they can dismiss you at a substantially decreased rate."
A recently retired Army psychiatrist who still works for the government, speaking on the condition of anonymity for fear of retribution, said commanders at another Army hospital instructed him to misdiagnose soldiers suffering from war-related PTSD, recommending instead that he diagnose them with other disorders that would reduce their benefits. The psychiatrist said he would be willing to say more publicly about the cases and provide specific names, but only if President Obama would protect him from retaliation.
Salon has dubbed the soldier in this article Sgt. X because he asked not to be identified for fear that it might affect the medical evaluation process meant to gauge his level of disability. He was highly reluctant to speak, but agreed to do so after learning Salon obtained the recording and other information about it from a medical worker at Fort Carson and a congressional aide.
The sergeant spoke with Salon in the presence of his Hogan Hartson attorneys who are helping him to secure a proper disability discharge from the Army for PTSD and a brain injury, diagnoses now affirmed by independent doctors. Sgt. X never planned to go to the media -- he says, if asked, he will not talk further about the recording with news organizations.
Sgt. X probably received his traumatic brain injury when his Bradley Fighting Vehicle buckled in an explosion during his second deployment to Iraq in 2005-06. It was the worst of a handful of nearby blasts he'd survived, and it knocked him unconscious for 30 seconds.
When Sgt. X regained consciousness, he saw that the toes of another soldier had been sheared off. The tank hull had buckled and the inside had filled with smoke. Some of his fellow soldiers were soaked in blood..
Even after that, as a point of pride, the crew insisted on accompanying their disabled tank back to their headquarters. Besides causing his brain injury, the blast had exacerbated an injury to Sgt. X's hip, but he faced the problem with little complaint. He numbed the pain with Motrin. "You don't report problems," he said. "It's a stigma."
When Sgt. X returned from the war to Colorado Springs, though, he had a problem with anger. After he terrified his young son by screaming at him, Sgt. X's wife suggested he seek help.
Nearly breaking into tears while recounting the screaming bout to Salon, Sgt. X said he agreed to his wife's request and sought mental care for the first time in his 16-year military career. Sgt. X, like so many others on the post, went to the fourth floor of Evans hospital in search of mental-health assistance.
There is some evidence that Sgt. X's experience with McNinch represents part of a broader scandal, as suggested by the former Army psychiatrist who told Salon about identical problems at another post. Last year, VoteVets.org and Citizens for Responsibility and Ethics in Washington (CREW) released an e-mail from Norma Perez, a psychologist in Texas, to staff at a Department of Veterans Affairs facility there. In addition to the Army, that department also provides veterans with benefits. "Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out," Perez wrote in the e-mail dated March 20, 2008. She suggested the staff "consider a diagnosis of Adjustment Disorder." As opposed to those with PTSD, veterans with adjustment disorder, a temporary condition, typically do not receive disability payments from the government.
Then-Illinois Sen. Barack Obama fired a letter off to the V.A. about that previous controversy, calling the e-mail "outrageous," demanding an investigation. The Senate Veterans' Affairs Committee last June held a hearing on that e-mail. Perez claimed she sent that e-mail "to stress the importance of an accurate diagnosis." End of story.
VoteVets.org and CREW, the two groups who unearthed the V.A. e-mail, reacted viscerally to this new tape obtained by Salon. "This is further evidence our troops are not receiving the mental health treatment they need and deserve," said Melanie Sloan, CREW executive director. "The president and congressional leaders must hold those responsible accountable and make sure the message is sent far and wide that our returning troops are to be diagnosed as their symptoms, not the military's finances, dictate."
"We've heard all kinds of stories from vets who had trouble getting PTSD diagnoses," said VoteVets.org Chairman John Soltz. "It's crucial that we have department-wide investigations at the Departments of Defense and Veterans Affairs to determine if this came from someone high up, and how many troops and veterans were jilted out of a proper diagnosis from the government."
Many publications, including Salon, and even some government agencies have documented other instances of reluctance to recognize mental wounds caused by war at bases across the country.
A recent weeklong series in Salon showed how apparent resistance to identifying combat stress ends up grinding down the lowest-ranking troops, sometimes with deadly results. Those articles included, for example, the story of Pvt. Adam Lieberman, who suffered with severe symptoms of PTSD. For two years, the Army blamed his problems on a personality disorder, anxiety disorder or alcohol abuse but resisted diagnosing him with PTSD until after his suicide attempt last October.
The Government Accountability Office, Congress' investigative arm, last October questioned why 2,800 war veterans were labeled with personality disorder diagnoses, another cheap label the Army has been accused of plastering on soldiers instead of PTSD.
In November 2005 the Department of Veterans Affairs halted a review of 72,000 veterans who receive monthly disability payments for mental trauma from war. The department wanted to make sure the veterans were not faking their symptoms. Salon first exposed the review that August. Then Daniel L. Cooper, the V.A.'s undersecretary for benefits, told Salon at the time that, "We have a responsibility to preserve the integrity of the rating system and to ensure that hard-earned taxpayer dollars are going to those who deserve and have earned them." The department stopped the process a month after a Vietnam veteran in New Mexico, agitated over the review, shot himself to death in protest. .
In early 2005, Salon exposed a pattern of medical officials searching to pin soldiers' problems on childhood trauma instead of combat stress at Walter Reed Army Medical Center.
Salon will explore Thursday how the Army was made aware of Sgt. X's tape, how the Senate Armed Services Committee declined to conduct an investigation, and how the Army absolved itself of any blame for wrongdoing. A unit of the Army's Medical Command (which oversees Fort Carson's Department of Behavioral Health) conducted an "informal" investigation last summer that found potential "systemic" problems that could influence diagnoses, but determined that no one in the Army's Medical Command was to blame. In a report dated July 28, it specifically found that no Fort Carson or Medical Command staff "attempted to coerce or otherwise influence" diagnoses. This directly contradicts McNinch's statements on the tape and in his interview with Salon.
If you are aware of a soldier who has served or is serving in the Iraq or Afghanistan conflicts and is having trouble getting a PTSD diagnosis or proper benefits, please contact Mark Benjamin at mbenjamin (at) salon (dot) com.
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VA Watchdog dot Org will follow VA news and let you know about policy, regulation and benefit changes at the Department of Veterans' Affairs. And, what you won't find here is as important as what you will find. You won't find rumors, rants or conspiracy theories here... there are no Black Helicopters on this site.
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Fewer than 50 million people searched online for any health information in 2002; that reached 150 million in 2008.
MR's database is very rich and large, enabling the firm to examine subgroups of people searching conditions from "A to V:" from acid reflux to Viagra.
Who is the average ePharma Consumer? He/she is married with median income of $55,400, and is 41 years old (the mean age). She is equally probable of being a He.
What's striking about this year's ePharma Consumer poll is the proliferation of sites that citizens are using to access prescription drug information. General health portals such as WebMD, EverydayHealth, Yahoo!, Mayo Clinic, Drugs.com, and Drugstore.com are core health consumer destinations. But increasingly, ePharma Consumers are looking to blogs, government sites (esp. CDC, FDA, and NIH), wikis, and drug ratings sites.
A growing destination for ePharma Consumers is online video. Including but not limited to YouTube, citizens are visiting WebMD and AOL to view videos not just for pure information, but to learn "how to's" such as tips for self-injecting meds where the image-in-action adds value to the online experience.
The number of health insurance company sites is also a fast-growing category, even for ePharma visitors.
And then there's Google: still the granddaddy of health search, and for ePharma searchers, too. New this year is MR's ability to help clients do search analytics on Google, targeting organic search, paid search (in the main results or on the "right-side" of the page), etc. One intriguing finding Bard mentioned was that older ePharma consumers are more likely to click on paid-search results.
40% of ePharma Consumers visited pharmaceutical corporate websites in 2008. Johnson Johnson's site appeared to be the most highly rated, albeit not the most-visited; more visited sites included Pfizer, Merck and GSK.
Manhattan Research polled 6,566 U.S. adults 18 and over online in the fourth quarter of 2008.
Health Populi's Hot Points: ePharma Consumers, and I would posit health citizens overall, use different websites at different times on the health care continuum. Consider the newly-diagnosed individual with a new prescription versus someone who has been managing diabetes for a decade and is looking for some disruptive innovation in personal chronic care.
One key finding stands out for me in this version of the ePharma Consumer data: that is, consumers' high value on the pharma company's quality of online service. This extends to user-friendliness, accessible information, clear explanations, transparency, and coupons as money-saving tools.
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