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Fighting the Number-One Killer In the US With Data
mattydread23 writes "Often, the signs of eventual heart failure are there, but they consist of a lot of weak signals over a long period of time, and doctors are not trained to look for these patterns. IBM and a couple heathcare providers, Sutter Health and Geisinger Health System, just got a $2 million grant from NIH to figure out how better data analysis can help prevent heart attack. But the trick is that doctors will have to use electronic records — it also means a lot more tests. Andy Patrizio writes, 'What this means is doctors are going to have to expand the tests they do and the amount of data they keep. Otherwise, the data isn't so Big.'"
We can save your life citizen... if you just give us all your data and submit to daily analysis and processing.
Also we will protect you from what you eat and drink... unless we're paid more to forget that.
This is the perfect use of government money: projects which are promising (though they may not pan out in the end), which will help many people, and which will not be subsidized by industry because they will not make money in the next three quarters. I don't expect any real results from this study for many years, but I think it's a very important study to do.
If you want to prevent heart disease, stop eating saturted fat and cholesterol and stick with a low-fat whole-plant-based diet. This knowledge is not new; this stuff has been known for almost a hundred years now, yet we're still spending money dancing around the fact that eating animals and their byproducts leads to heart disease.
Source: http://www.plantpositive.com/
Wouldn't it be better use of our resources to combat the "killers" of people in their twenties and thirties? Those killers being suicide, homicide, and "accidents."
In all seriousness:
extra points for bacon!
If you want to prevent heart disease, stop eating saturted fat and cholesterol and stick with a low-fat whole-plant-based diet.
That helps to reduce the risk, not prevent heart disease. That's something that makes me cringe - this idea that diet is a panacea for one's ills. Lately, the vegans (Engine Co. 2 for example) have been proselytizing their way of life and selling it by over stating the health benefits. When I see folks who claim that their cancer was cured by switching to a vegan diet, I just think of all the other reasons why they were "cured" - the cancer going away when she switched to a vegan diet was most likely just a coincidence.
This reminds me of a patient of my wife's. He was a cardiologist, avid marathon runner, ate impeccably, and ended up with a heart attack at 42. When my wife asked him what he was doing there (in the hospital), he responded, "Tell me about it!". He also had familial history of heart disease.
Genetics also have a lot to do with it, too.
Yes, eating more plants and less animals (even fish) is better for our health, our ecosystem, and our wallets, but let's not over state the benefits, please. The research is still in its infancy - and there have been some compelling things - but never the less, the benefits have been overstated. But that does NOT mean to say, "Fuck it! I'm eat'in steak and potatoes because it doesn't matter!". Let's not go apeshit the other way either.
from heart disease, what will they then die from? And how much will that cost?
If you only eat meat once or even twice a week (what some dieticians recommend), you will save money on your food bill. I know because I have done it. And I saved even more (and got a new hobby) by having a garden - even in Winter: kale, chard, arugula, and some other Winter veggies.
it's frankly irresponsible to not provide information about how much it reduces the risk.
Irresponsible? Why? Because that one study says so? Done in England with more than likely with a homogenous racial group (or made up of mostly one race).
Let's see that study reproduced among different populations and lifestyles. It may be a larger percentage or even a smaller one.
Reading the title I thought this would be about excessive fighting, as in fist fights.
It is a hypothesis that collecting more data will find a pattern that will predict heart failure earlier, and that will lead to earlier interventions.
They haven't demonstrated that it works.
In order to demonstrate it, they have to do a controlled trial. They have to use these data collection systems in a group of 5,000 patients, and use the usual methods in another 5,000 similar patients, and see if there's any difference in a meaningful outcome. Do the patients live any longer? Are they any less likely to get strokes?
Sometimes it works, sometimes it doesn't. The New England Journal of Medicine just published a report on the use of a high-tech surgical intervention -- implanting cardiac resynchronizing devices in a new subset of heart failure patients. http://www.nejm.org/doi/full/10.1056/NEJMoa1306687 It turned out the resynchronization patients had more deaths than the control group, and they stopped the study early. You don't know until you've done the randomized, controlled trial. That's the method of science, the experimental method. You take your brilliant ideas and put them to a test.
That's science. Everything else is bullshit.
There was a study of using an electronic medical record in a pediatric intensive care unit. The patients with the EMR had a higher death rate than the control patients. The doctors said that when they needed to write a prescription in a hurry, they would just take out their Rx pad and write it. When they needed to write it with the EMR, they had to sign in, go through screens, and find what they were looking for.
EMR replaced a simple, effective system -- paper and pen -- with a more difficult system. What's the point?
Read what doctors are actually saying about electronic medical records, http://www.kevinmd.com/blog/ http://www.nejm.org/
There are systems that actually make it easier to treat patients. As I understand it, the Veterans Affairs and Kaiser Permanente have systems that actually collect useful data. The Scandinavians have great useful databases. http://www.bmj.com/content/347/bmj.f5906 But a lot of the new systems, particularly the ones that are merely being installed because they're required and subsidized under new federal regulations, are driving doctors crazy. They complain that they have to log in, go through screens, fill out checklist after checklist, and wind up with records that go on for hundreds of pages that nobody ever looks at again. Traditionally, on paper, they were forced to write a concise narrative for their colleagues and themselves, of useful information that got to the point and helped them make a decision about what to do next. These poorly-designed EMRs stopped forcing doctors to think. It simply forced them to collect a lot of data. Data isn't information. Useless data is noise.
And maybe most of all, they complain that instead of looking at their patients, they're looking at a computer screen. If you have to tell somebody that he's going to die in 6 months if he doesn't stop smoking, you shouldn't be looking at your computer screen. Maybe there's an element of human communication that computer nerds don't appreciate.
In any computerized records, there's a tradeoff between how much data you collect, and how much time you have to spend entering data. You can spend an extra hour a day just entering more data. Is this pill a tablet or a capsule?
And more important than time, when you write a medical record, you should be filtering information for just the important information. Otherwise you're just adding noise to the record, and making it harder for the humans to spot patterns.
If you want to prevent heart failure, the basic job is to stop smoking, lose weight, and exercise. When patients get outside of certain well-understood parameters, you can give the
Without gobs of blue cheese dressing.
Walking a bit would help too.
The whole cholesterol thing and low fat part have been proven wrong. Carbs, most notably sugar, have now proven to be way more important in both weight gain than (animal) fat in general. Check http://ds9a.nl/new-consensus/ for links to the full explanation and scientific studies to prove this.
I was promised a flying car. Where is my flying car?
We are all Going to die.So fighting heart failure is a waste of time. We already know you have to quite or dont start smoking at all. Exercise and eat right. And you will add maybe 15 years but your still going to die. we already have powerful drugs that are adding years but we are still going to die. I think that money should be used in another way Education,Disease that only affect a small amount of people that kinda use is better IMO.
Jack of all trades,master of none
I just bought this iphone case with built in wireless ecg. Its a little disappointing as I don't get the display thats on the picture. All I get is a notification box that says "normal" with no readouts or gauges, and not even what my heart rate was. Theres an option to turn on prescription mode, but you have to get a prescription from your doctor, scan it, and send it in to the manufacturer. I think this is a good start, but it would be better if it had the option of adding more electrodes and actually showing the user some useful information.
As a practicing physician, I see two major flaws with this initiative as described in the link above
First, the link implies that this study pertains to heart failure. Heart failure usually starts suddenly, most commonly after a heat attack. Patients with heart attacks are already monitored closely for heart failure, and an expansive review of records really isn't necessary. Other less common causes of heart failure, such as viral infection, start suddenly as well. A long term review of records probably won't reveal much. While there are certain situations where heart failure can slowly progress (such as valve problems), we often don't treat until symptoms develop. It's not at all clear that earlier detection will lead to better outcomes for most patients.
Second, this appears to be a retrospective approach. The problem with retrospective studies is the inconsistency in documentation. For example, changes in blood pressure as a person goes from sitting to standing can sometimes be a sign of heart problems. However, if someone comes to the office with a cut on their finger and no history of heart trouble, I am going to focus on the issues at hand (suturing, infection, tetanus, etc.) and probably won't check blood pressure in multiple positions. Regardless of whether the records are computerized or not, the data simply won't be there. In modern practice, insurance companies barely allow enough time to perform a basic exam with special focus on the issue at hand. If I document everything I can possibly document on every patient, my practice will be bankrupt by the end of the month.
IBM's latest business model seems to be suckering governments to increase the complexities of life. They've finally given up on real business.
Shhhh
....or cancer
And they live longer with arthritis, osteoporosis, a failing immune system and dementia. Yeah, sounds like fun.
The Torchwood mini-series "Miracle Day" springs to mind.
"Life is pain Highness. Anyone who says otherwise is selling something"
Westly, The Princess Bride
http://www.drfuhrman.com/disease/HeartDisease.aspx
http://www.heartattackproof.com/
Don't let the naysayer comments get you down.
Also, if arteries in you heart are all clogged up, then what about arteries in you arms, legs, liver, and brain? Cardiovascular disease affects every system in the body -- it is just that heart problems tend to be more tragically obvious than other clogs. So, the best approach is not to unclog a little part of the hearth that will just clog back up soon, but to unclog everything by eating differently.
A story from: ...
http://www.drmcdougall.com/health/education/health-science/stars/stars-written/robert-cross/
-----
Robert Cross: Formerly Dying from Heart Disease
Further research led me to Dr. McDougall, and registered dietitian Jeff Novick. All these people gave hope for arresting, and perhaps reversing, my condition through diet and lifestyle modifications. In contrast, neither my internist, nor my cardiologist, was aware of these doctors or their programs or any significant benefit to lifestyle modification. They discouraged me from delaying the surgery, but accepted my decision to at least give diet and "medical management" a try.
My early results were promising. My first blood test on the diet showed my cholesterol was now down to 120 mg/dL and my LDL was 60 mg/dL. My internist was astounded. Medication had only lowered my numbers slightly. I was on Dr. Esselstyn's exact program, which is virtually identical to that of Dr. McDougall, and I hired the McDougall Program dietitian, Jeff Novick, RD, as my coach. I found that everything I needed was available immediately and for free through Dr. McDougall's website. I learned that my results would directly reflect my compliance with the program. I resolved that I would do this program 100 percent. If I could not be 100 percent on my own or failed to get my doctors' support, then I was going to go to the McDougall Live-in Program without delay. (I still plan on going.) I owed that to myself and my family.
Almost immediately, my chest pain went away. My internist asked how I had accomplished this and my dramatic cholesterol drop, and then became quite interested in my program. I needed his help because of the side effects of the medications that occurred once I changed my diet. I had to quickly get off my blood pressure medications because my readings were extremely low and I was feeling light headed. My blood sugars came way down and I had to terminate my diabetes medication. I eventually stopped all of my Lipitor, yet my total cholesterol stayed at 160 mg/dL (my LDL cholesterol remained at 60 mg/dL). I have lost over 60 pounds since beginning my new diet and exercise program in January of 2008, and I continue to lose as my energy increases. I have had no more kidney stones.
After following my progress for almost a year and a half, the cardiologist wanted to repeat the nuclear heart scan. My internist agreed. He was also sure that I was wrong when I had told him that many clinical trials have shown no important benefits other than pain relief for the surgery they had proposed for me more than a year and a half ago. Despite my many obvious improvements, the cardiologist still believed that coronary artery disease is always progressive, and told me not to get my hopes up about the new test. I repeated the exercise nuclear heart scan on May 5, 2009.
This time, I felt great running on the treadmill. I took my heart rate beyond the maximum expected for my age, and had no pain. The monitors I was connected to indicated no problems. Immediately after the test, I spoke with my cardiologist, who seemed somewhat perplexed. He chose his words very carefully. He wanted to know if I had felt chest pain on the first exam in 2008. I think he did not believe the prev
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
"Meat is often a cheaper source of your necessary nutrients than vegetables."
Ignoring how meat does not have essential phytonutrients in it (as you mention), consider the political reason of why that is the case as far as "calories":
http://www.seriouseats.com/2007/11/the-subsidized-food-pyramid.html
"The Physicians Committee for Responsible Medicine has posted an easy-to-understand visual on its site that shows which foods U.S. tax dollars go to support under the nation's farm bill. It's titled "Why Does a Salad Cost More Than a Big Mac?" and depicts two pyramids -- subsidized foods and the old recommended food pyramid. It's interesting to note that the two are almost inversely proportional to each other."
Also, consider how externalities of meat production such as destroying marine ecosystems from overfishing, manure runoff polluting fresh water supplies, and the destruction of so many forests and other land ecosystems to produce cattle feed:
http://www.westernwatersheds.org/watmess/watmess_2002/2002html_summer/article6.htm
On your other points, most vegetarians' diets probably aren't very good. They may have too many refined sugars and too few vegetables, too little variety, and too little of things like iodine. It takes a lot of learning and opportunity and time to eat well as a vegetarian. But what is important to acknowledge is that there are plant-based diet styles that will reverse heart disease. So that 32% figure might be some kind of average, but it does not reflect the best possible outcome for someone who is really trying to reverse or prevent heart disease. See my other post here for links, or see as one example, Dr. Esselstyn' work:
http://www.heartattackproof.com/
I'd agree though that some small amount of free-range organic grass-fed meat or other similar animal products can potentially be part of a reasonably healthy diet -- other ethical and financial and scalability and externality questions aside. Even Dr. Fuhrman agrees on that part as far as the research -- that if you get 10% or less of your calories from animal products, you are doing pretty well.
http://www.drfuhrman.com/library/foodpyramid.aspx
https://www.drfuhrman.com/library/article5.aspx
"Therefore I encourage consumption of a carefully planned vegetarian diet or one that includes a small amount of animal products, perhaps 10% of total calories or less, rather than 40 -60 % that children eat today. An animal-product-rich omnivorous diet cannot be considered nutritious food or called healthful."
High fat diets of animal products laced with growth hormones and such are probably bad for children in general. And also, there are few to no purely vegan diets in history. Even gorillas get some small percentage of their calories from termites and other insects they eat incidentally. B12 is another nutrient than can be an issue, usually provided by animal products, and some say can be supplied from dirty vegetables. Our food supply is in that sense too "clean" to be a pure vegan in (without special effort and selected supplements, if that). Vegans who are also neat freaks may be setting themselves up for disaster in that sense; yet on the other hand, since much "organic" food is grown using animal manure from livestock operations, not washing your vegetables well is a health risk too from E.coli contamination.
It does not take much animal products though to provide some essentials. Related example:
http://drbass.com/generations.html
"This text is still extremely important, since similar mistakes are still being made today, typically by aspiring vegans and vegan raw-foodists. Deficiencies th
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
ADon't lie to your doctor. If you don't want to answer, fine. Just say so. If you don't want to take a pill, just say so. But it's impossible to help you if we don't know the truth.)
If you don't want patients to lie to you, then you should start by not lying on our charts. If we say we don't want to answer the question of whether we smoke, don't write down the lie "patient smokes." If we say we have a glass of wine on Friday nights, don't write down the lie "patient is a moderate drinker."
You assholes have decided that every patient lies (under reports healthy behaviors and over exaggerates pain) to you that you've left those of us who were telling the truth no choice but to lie so that you don't slander us.
After you stop lying on our charts you could try not lying to our health insurance about diagnoses like "pre diabetic" that label us with made up pre existing conditions just to give you an excuse to get our health insurance companies to reimburse you for visits and pills.
There are disagreements on the effect of starch on health, one being between Dr. Joel Fuhmran (advocating more calories from leafy green vegetables, other non-starchy vegetables, and beans) and Dr. John McDougall (advocating calories more from starchy plants like sweet potato and whole grains, in part on pragmatic grounds). Even as they both agree that starch should be the basis of calories for humans. See:
http://www.lanimuelrath.com/diet-nutrition/mcdougall-vs-fuhrman-notes-for-you-from-the-great-plant-based-doctors-debate/
See my other posts here for other related links and also agreement that many vegetarians' diets are pretty bad for reasons like you mention, and also pros and cons on some degree of animal products (up to 10% or so of calories)
In general, the longest lived societies get moderate exercise in the sunshine (vitamin D) and eat a lot of legumes (lentils, beans, etc.) and only limited animal products. Ref:
http://en.wikipedia.org/wiki/Blue_Zone
http://upload.wikimedia.org/wikipedia/en/1/12/Vendiagram.gif
http://www.bluezones.com/
"The people inhabiting Blue Zones share common lifestyle characteristics that contribute to their longevity. The Venn diagram at the right highlights the following six shared characteristics among the people of Okinawa, Sardinia, and Loma Linda Blue Zones:[8]
Family -- Family is put ahead of other concerns.
No smoking -- Smoking is not found in large quantities.
Plant-based diet -- Except for the Sardinian diet, the majority of food consumed is derived from plants.
Constant moderate physical activity -- Moderate physical activity is an inseparable part of life.
Social engagement -- People of all ages are socially active and integrated into their communities.
Legumes -- Legumes are commonly consumed."
However, for people who have serious heart disease, then things change. Meat may have a much worse effect then. If such a person wants to reverse their heart disease, they may have to go on a diet without probably any meat (or very very little) for a time: ...
http://www.heartattackproof.com/huffpost.htm
"Answer: In an intensive 5 hour counseling session for a group of heart patients my first priority is to eliminate the mystery of what causes their disease. It has not been stress, or genes. It is their western diet of processed oil, dairy, and meat. Hypertension, diabetes, and smoking must be controlled but food trumps all. I spend at least an hour defining the protective role of endothelial cells and nitric oxide functioning as the ultimate guardians of our blood vessels. They quickly understand that their lifetime of ingesting these harmful products has totally overwhelmed and destroyed their endothelium to an extent where it is unable to protect them. They fully grasp that they must forever eliminate ingesting foods that will further destroy their already compromised endothelium. They understand heart disease is a food borne illness.
They understand that they can halt their disease. They are presented with my scientific articles demonstrating reversal of disease. They learn that anginal chest pain may diminish or disappear within 10-14 days in some patients while others may take longer. We share our data confirming reversal of carotid artery disease to the brain, coronary artery disease of the heart, peripheral vascular disease in the extremities, and the reversal of erectile dysfunction. They are made to appreciate how rapidly and powerfully the endothelial
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
I work in healthcare, actually for one of the organizations mentioned in the article.
Healthcare organizations have a big incentive to show "meaningful use" to the federal government. The federal government will reimburse healthcare organizations a substantial amount - up to $44,000 per physician under Medicare or up to $65,000 over six years, under Medicaid - if they adopt electronic medical records and show "meaningful use" of those EMRs to improve patient care. (Note: this money doesn't go to physicians, it goes to healthcare organizations.)
What we are seeing in this article are 2 healthcare organizations trying to show a tiny bit of "meaningful use" so that they can partake of the federal government's financial largesse. Nothing more.
The study described in the article would be an "observational" study. Observational studies are one of the weakest forms of medical evidence. A positive finding would indicate something that should be investigated further. What we are really interested in in medicine are randomized controlled trials showing an intervention results in a positive (good) outcome and, for big data in medicine, such studies aren't even on the horizon.
This s not a bs privacy issue like the ones the fako-libertarian standard /. crowd always emerges from the basement to rag on the government about.
This is an issue about cellar-dwelling lardo-butts not hitting the running track. Remember you armchair Mitty's, video games = artery-clogger. Hit the track, fat asses, I'm tired of seeing your pasty tubby bodies among the hard toned lithe runner who give a damn about looking good naked!
The "Number-One Killer In The US" is medical mistakes. Sad but true.
There are a lot fo good advices here "eat healthy food", but few hint of what healthy food is.
Cardiovascular failure is caused by thrombosis. This is a trend of the blood to clog too easily, caused by an imbalance of omega 3 vs omega 6 fatty acids in the food. Fixing this means eating less industrial meat (which concentrate omega 6 since we do not feed animals with grass, but with omega 6 rich corn and soja), and eating a bit more fish.
"Weak signals over a long period of time" screams of "we don't understand a damn thing, but we might be able to get it if we play around long enough".
Only thing is, we already got it hundreds of years ago. Stop eating so many carbs/sugar. Fat and cholesterol have nothing to do with heart disease. The opposition claims that's incorrect...yet the trends still show increasing death due to heart disease. Simple conclusion...the opposition is wrong.
If we say we have a glass of wine on Friday nights, don't write down the lie "patient is a moderate drinker."
Huh? I don't get it. Is one glass of wine a week not drinking in moderation?
What label would you have used instead?
Esli epei etot cumprenan, shris soa Sfaha.
...SMART for the heart!
At any rate, I was reminded of SMART for hard drives, which also work by monitoring lots of individual data points over time and trying to detect things which point to a future problem before it occurs.
Esli epei etot cumprenan, shris soa Sfaha.
When are Americans going to address the real issue which happens to be unhealthy eating habits and lifestyle?
Oh wait, if we all ate better and got more exercise, the pharma companies would go out of business.
My bad.
Carry on chomping on that hormone pumped McMeat. And don't forget your 'diet' coke..
I wonder why they call it healthcare? The healthy don't need it. They should call it Sickcare.
Nothing worse than poor statistics to make people think whatever it is the government wants us to think. Heart attacks are not the #1 killer in the US. Come on people, DEATH is the #1 killer in the US.
Geez.
Pax Vobiscum