For the Years of Investigation to Come: a Guide to Resources for Challenging Health Care Corruption

The Enduring Problem of Health Care Corruption

Now arrives the years of investigation.  Here in the US, a new majority in the US House of Representatives promises multi-pronged investigations of, among other topics, the corruption that now seems pervasive at the highest reaches of the US government, corruption that has badly affected efforts to truly reform US health care (look here).  Meanwhile, similar investigations are likely to get underway in various US states.  We can only hope that this flurry of activity will end up with some positive steps to reduce US health care corruption, an enduring problem about which we often write.

As we wrote in August, 2017, Transparency International (TI) defines corruption as

Abuse of entrusted power for private gain

In 2006, TI published a report
on health care corruption, which asserted that corruption is widespread
throughout the world, serious, and causes severe harm to patients and
society.

the scale of corruption is vast in both rich and poor countries.

Also,

Corruption might mean the difference between life and death for
those in need of urgent care. It is invariably the poor in society who
are affected most by corruption because they often cannot afford bribes
or private health care. But corruption in the richest parts of the world
also has its costs.

The report got little attention.  Health care corruption
has been nearly a taboo topic in the US, anechoic, presumably because its discussion would offend the people it makes rich and powerful. As suggested by the recent Transparency International report on corruption in the pharmaceutical industry,

However, strong control over key processes combined with huge resources
and big profits to be made make the pharmaceutical industry particularly
vulnerable to corruption. Pharmaceutical companies have the
opportunity to use their influence and resources to exploit weak
governance structures and divert policy and institutions away from
public health
objectives and towards their own profit maximising interests.

Presumably the leaders of other kinds of corrupt organizations can do the same. 

When health care corruption
is discussed in English speaking developed countries, it is almost
always in terms of a problem that affects some other places, mainly 
presumably benighted less developed
countries.  At best, the corruption in developed countries that gets
discussed is at low levels. 
In the US, frequent examples are the “pill mills”  and various cheating
of
government and private insurance programs by practitioners and
patients.  Lately these have gotten even more attention as they are
decried as a cause of the narcotics (opioids) crisis (e.g., look here).  In contrast, the US government has been less inclined to address the
activities of the leaders of the pharmaceutical companies who have
pushed legal narcotics (e.g., see this post). 

However, Health Care Renewal has stressed “grand corruption,” or the
corruption of health care leaders.  We have noted the continuing impunity of top health care corporate managers.  Health care corporations have allegedly used kickbacks and fraud to enhance their revenue, but at best such corporations have been able to make legal settlements
that result in fines that small relative to their  multi-billion
revenues without admitting guilt.  Almost never are top corporate
managers subject to any negative consequences.

We have been posting about this for years at Health Care Renewal, while seeing little progress on this issue.

Things only seem to be getting worse given the increasing evidence that the Trump administration is corrupt at the highest levels.   In January, 2018, we first raised the question about how health care corruption could be pursued under a corrupt regime.  We noted sources that
summarized Trump’s. the Trump family’s, and the Trump administration’s
corruption..  These included a website, entitled “Tracking Trump’s Conflicts of Interest” published by the Sunlight Foundation, and two articles published in the Washington Monthly in January, 2018. “Commander-in-Thief,” categorized Mr Trump’s conflicted and corrupt behavior.  A Year in Trump Corruption,” was a catalog of the most salient cases in these categories in 2017.

In July, 2018, we addressed the Trump regime’s corruption again  By then, more summaries of Trump et al corruption had appeared.   In April, 2018, New York Magazine published “501 Days in Swampland,” a time-line of  starting just after the 2016 presidential election. In June, 2018, ProPublica reviewed
questionable spending amounting to $16.1 million since the beginning of
Trump’s candidacy for president at Trump properties by the US
government, and by Trump’s campaign, and by state and local governments. Meanwhile, Public Citizen released a report on money spent at Trump’s hospitality properties.  Meanwhile, the voluminous Tracking Corruption and Conflicts of Interest in the Trump Administration summary appearing in the Global Anti-Corruption Blog has grown and grown. 

 So the driver of US health care corruption may now be the executive branch of government and its relationship with the Trump family and cronies, trumping even the influence of health care corporate corruption.  

However, in our work we have been heartened to find some useful resources (although unfortunately none specifically targeted at health care corruption in the US).  To inspire others to join the fight against health care corruption and related ills, I take this opportunity to post an idiosyncratic list of some of the most helpful resources I have found (including one very new one).  In alphabetical order:

Basel Institute on Governance

Located in Basel, Switzerland,

an independent not-for-profit competence centre working around the world
with the public and private sectors to counter corruption and other
financial crimes and to improve the quality of governance.

The Institute does not have a specific health care focus, but focuses on broad issues with applicability to health care: asset recovery, public governance, corporate governance and compliance, collective action, and public finance management.

Curbing Corruption

This is a new website staffed by anti-corruption experts mainly based in the UK, meant

to appeal widely to people who want to take action to reduce corruption
within their sector of society, and/or within their organisation. This
includes Members of Parliament, the private sector, civil society
organisations, professional associations, the media and the judiciary.

However, their main focus now are politicians and public officials.

The website includes sector specific resources, including a very extensive review document on the health sector.

Global Anti-Corruption Blog

A multi-author US based blog

devoted to promoting analysis and discussion of the problem of
corruption around the world. This blog is intended to provide a forum
for exchanging information and ideas across disciplinary and
professional boundaries, and to foster rigorous, vigorous, and
constructive debate about corruption’s causes, consequences, and
potential remedies.

It includes an extensive list of international anti-corruption resources (much bigger than this idiosyncratic list), but which tellingly has no organization specifically focused on health care, and no organization specifically focused on US corruption.

Transparency International

Perhaps the best known international anti-corruption NGO (non-governmental organization), based in Berlin, Germany.  It proclaims 
 

From villages in rural India to the corridors of power in
Brussels, Transparency International gives voice to the victims and
witnesses of corruption. We work together with governments, businesses
and citizens to stop the abuse of power, bribery and secret deals.

As
a global movement with one vision, we want a world free of corruption.
Through chapters in more than 100 countries and an international
secretariat in Berlin, we are leading the fight against corruption to
turn this vision into reality.

Its website is extensive.  It hosts more or less biannual International Anti-Corruption Conferences.  It provides many resources, including a well known annual international survey of corruption perceptions.  It has chapters in multiple countries (although, tellingly, its US chapter was dis-accredited in 2017, look here).

The TI UK chapter has a specific health care initiative focusing on the pharmaceutical industry.

U4 Anti-Corruption Resource Centre

Located in Bergen, Norway,

 U4 is a permanent centre at the Chr. Michelsen Institute
(CMI) in Norway. CMI is a non-profit, multi-disciplinary research
institute with social scientists specialising in development studies.

Its introductory statement

At U4, we work to reduce the harmful impact of corruption on society. We
share research and evidence to help international development actors
get sustainable results.

U4 provides publications and resources for various sectors, including health care.

Summary

Corruption in health care is a daunting problem, but 2018 showed us in the US that when people get upset enough about problems, things happen (albeit, not always great things).  So we urge all concerned about health care corruption to make things happen.  The resources above may help them do so.

We Must Stop Torturing Elderly Patients with Unnecessary Medical Procedures

Until this afternoon I was going to post a more policy-oriented
article, but I received a call indicating my father-in-law, who is 95 years
old, is now in a rehabilitation facility after a fall which did not result in any
broken bones. This event resulted in a cardiac surgeon installing a cardiac device
in his heart to keep it pumping rhythmically regardless of the patient’s
wishes. Mel was not in distress and at age 95 merely had a low heart rate,
because he is approaching the end of his life. At this point he is forgetful
and in the early stages of dementia. This invasive medical intervention was not
solicited by the family and was encouraged only by the medical providers.
Pacemakers are forced on elderly patients all of the time in
the United States. It often provides no improvement in quality of life and in
fact, contributes to the patient living longer to suffer through dementia,
incapacity to perform activities of daily living, and to lose other aspects of a
good life. I am anguished that my father-in-law has been subjected to this
treatment because it will only prolong his suffering and not improve his life.
His mother, Rosemary, died at age 93, active up until the end, so why deny Mel
this graceful exit.
 Further, there isn’t
a single clinician who would submit to this procedure at that age, so why are
they imposing it on their elderly patients?
To further understand how aberrations in the U.S. healthcare
system encourage overuse, sales of extremely expensive medical devices, and dehumanization
of healthcare, I encourage you to read Katy Butler’s Knocking on Heaven’s Door,
The Path Way to a Better Way of Death, which was published in 2013. It is her
personal story of how the cardiac pacemaker kept her 93-year-old father alive
through dementia and other misery. Here is a link to my review of her book in
the New York Journal of Books:
Cardiac surgeons are the top earners for physicians and
there are tremendous financial incentives to install pacemakers and other cardiac
devices on increasing numbers of patients, regardless of viability and efficacy.
Mel, with his private insurance can afford to pay whatever the procedures will
cost and this is like the “whale” in the healthcare system, the patient whom is
so lucrative he will provide financing for a whole host of things in the healthcare
system. Doctors in the U.S. don’t make any money for telling a patient to go
home and enjoy the last days of their life. They are paid to provide
intervention regardless of systemic costs and not to think holistically.
In 2013, my guidebook to the U.S. healthcare system devoted
a chapter to creating a good death and I encourage you to read that, so that
you may have more control over the last days of your life than Mel has. Here is
a link to that book, which is still selling in eBook and hardcover versions:
As for me, I hope my son will send me out on raft and set my
bones on fire in a true Viking send off in spiritual reverence for the veracity
with which I have lived my life.
And this is the healthpolicymaven signing off encouraging
you to draft medical powers of attorney and don’t leave it up to your children
to make these care decisions, appoint a professional clinical advocate.  A sound living will requires more than
designating treatments which you will eschew, you need to have a medical
advocate who understands the U.S. healthcare system.  And please don’t sign blanket releases when
you enter medical facilities, be clear on that for which you consent and that
for which you do not.
Roberta E. Winter an independent health policy analyst and
writer has continuously published this column since 2007. All opinions
expressed here are her own and not subject to any corporate or institutional
constraints.

2018 Top 10 Posts from Healthcare Marketing Matters

It’s that time of the year where a; the Top 10 lists come
out.  So, being a crowd follower (not),
here are the Top 10 posts for 2018 from Healthcare Marketing Matters top to
bottom.
Thank you for reading and best wishes for success and
prosperity in 2019.
1.
Increase the Power of Hospital Brand Marketing Using Your Triple Aim – Earned
Media, Public Relations & Social Media http://bit.ly/2umpiyy
2. Hospital Marketing Appears Random and Unconnected, Says
the Insured Healthcare Consumer http://bit.ly/2nj17MY
3. “Hey Alex, I Don’t Feel Well. Find A Physician Near Me.” Hospital
Marketer, Is Your Website Optimized for Voice Search? http://bit.ly/2MHMg9G
4. Social Media Use for Hospitals, the Easy Guide to Message and
Channel Integration http://bit.ly/2IyTrzi
8. Nine Essential Strategies for Engaging the Healthcare
Consumer & Patient 24/7, Because That is the World They Live In. http://bit.ly/2IVFOdA
10. It’s Not Social Media Anymore. Social Has Become the New
Mainstream Media. Now what? http://bit.ly/2JHfXdn
A note to my readers.
You may have noticed that haven’t been posting as frequently as before.
After 11 years of writing Healthcare Marketing Matters, the weekly research and
topic selection becomes a bit of a chore. While there has been much progress in
hospitals and marketing, it remains mired in a features approach looking at us and little content that fosters
true engagement with the patient and healthcare consumer.
The other reason is
semi-retirement.
Michael is a
healthcare business, marketing, communications strategist and thought-leader. 
As an internationally followed healthcare strategy blogger, his blog,
Healthcare Marketing Matters is read in  52 countries and listed on
the 
100 Top Healthcare
Marketing Blogs, and Websites
 ranked
at No. 3 on the list by Feedspot.com. Michael is a Life Fellow, American
College of Healthcare Executives, and a Professional Certified Marketer,
American Marketing Association. An expert
in healthcare marketing strategy, digital marketing & social media, Michael
is in the top 10 percent of social media experts nationwide and is considered
an established influencer. For inquiries regarding strategic consulting
engagements, call Michael at 815-351-0671. Opinions expressed are my own.

Health Care and Celiac Disease

Celiac
disease is a serious genetic autoimmune disorder, according to the Celiac
Disease Foundation, where the ingestion of gluten leads to damage in the small
intestine.  It is estimated to affect 1 in 100 people worldwide.  Two
and one-half million Americans are undiagnosed and are at risk for long-term
health complications.
If you have celiac disease, eating gluten triggers an
immune response in your small intestine. Over time, this reaction damages your
small intestine’s lining and prevents absorption of some nutrients
(malabsorption). The intestinal damage often causes diarrhea, fatigue, weight
loss, bloating and anemia, and can lead to serious complications, according to
the Mayo Clinic.
In children, malabsorption can affect growth and
development, in addition to the symptoms seen in adults. There’s no cure for
celiac disease — but for most people, following a strict gluten-free diet can
help manage symptoms and promote intestinal healing.
Because
people with celiac disease must avoid gluten — a protein found in foods
containing wheat, barley and rye — it can be challenging to get enough grains.
More information about this medical issue is located at this website: http://www.mayoclinic.org/diseases-conditions/celiac-disease/home/ovc-20214625
.
Celiac
disease cannot be “caught,” but rather the potential for celiac
disease is in the body from birth. Its onset is not confined to a
particular age range or gender, although more women are diagnosed than men,
according to the Celiac Support Association. It is not known exactly what
activates the disease, however three things are required for a person to
develop celiac disease:
·        
A
genetic disposition:

being born with the necessary genes. The Human Leukocyte Antigen (HLA) genes
specifically linked to celiac disease are DR3, DQ2 and DQ8…and others.
·        
An
external trigger:
some
environmental, emotional or physical event in one’s life. While triggering
factors are not fully understood, possibilities include, but are not limited to
adding solids to a baby’s diet, going through puberty, enduring a surgery or
pregnancy, experiencing a stressful situation, catching a virus, increasing
WBRO products in the diet, or developing a bacterial infection to which the
immune system responds inappropriately.
·        
A
diet:
containing
gluten and related prolamins.
·        
Auto-antigen
enzyme
, tissue
transglutaminase (TG2) also TG4 and TG6.
·        
Production
of proinflammatory cytokines
,
especially interferon (IFN-γ).
·        
Infants
and young children who have celiac disease are more likely to have digestive
symptoms, such as abdominal pain, vomiting, diarrhea (even bloody diarrhea) and
constipation, and may fail to grow and gain weight. A child may also be
irritable, fretful, emotionally withdrawn, or excessively dependent. If the
child becomes malnourished, he or she may have a large tummy, thin thigh
muscles, and flat buttocks. Many children who have celiac disease are
overweight or obese.
·        
Teenagers
may have digestive symptoms such as diarrhea and constipation. They may hit
puberty late and be short. Celiac disease might cause some hair loss (a
condition called alopecia areata) or dental problems.
·        
Adults
are less likely to have digestive symptoms. Instead, they might have a general
feeling of poor health, including fatigue, bone or joint pain, irritability,
anxiety and depression, and missed menstrual periods in women. Some adults may
have digestive symptoms such as diarrhea or constipation.
·        
Osteoporosis
(loss of calcium from the bones) and anemia are common in adults who have
celiac disease. A symptom of osteoporosis may be nighttime bone pain.
·        
Lactose
intolerance (a problem digesting milk products) is common in patients of all
ages who have celiac disease.
·        
Dermatitis
herpetiformis (an itchy, blistery skin problem) and canker sores in the mouth
are also common problems in people who have celiac disease.
Celiac
disease can develop at any age after people start eating foods or medicines
that contain gluten. Left untreated, celiac disease can lead to additional
serious health problems, as reported by the Celiac Disease Foundation, such as
these healthcare issues:
·        
Iron
deficiency anemia
·        
Early
onset osteoporosis or osteopenia
·        
Infertility
and miscarriage
·        
Lactose
intolerance
·        
Vitamin
and mineral deficiencies
·        
Central
and peripheral nervous system disorders, including ataxia, epileptic
seizures, dementia, migraine, neuropathy, myopathy and multifocal
leucoencephalopathy
·        
Pancreatic
insufficiency
·        
Gall
bladder malfunction
According
to this advocacy website, https://www.beyondceliac.org/celiac-disease/
, t
here are more than 300 symptoms of celiac disease, and symptoms can be
different from person to person. If you have symptoms of celiac disease,
especially ones that last a long time, you should ask your doctor for a celiac
disease blood test. Left untreated, people with celiac disease are at-risk for
serious health consequences, like other autoimmune diseases, osteoporosis,
thyroid disease, and even certain cancers.
According to the National Institutes for Health, foods such as meat, fish, fruits,
vegetables, rice, and potatoes without additives or seasonings do not contain
gluten and are part of a well-balanced diet. You can eat gluten-free types of
bread, pasta, and other foods that are now easier to find in stores,
restaurants, and at special food companies. You also can eat potato, rice, soy,
amaranth, quinoa, buckwheat, or bean flour instead of wheat flour.
In the
past, doctors and dietitians advised against eating oats if you have celiac
disease. Evidence suggests that most people with the disease can safely eat
moderate amounts of oats, as long as they did not come in contact with wheat
gluten during processing. You should talk with your health care team about
whether to include oats in your diet.
When
shopping and eating out, remember to:
·        
Read
food labels —especially on canned, frozen, and processed foods—for ingredients
that contain gluten.
·        
Identify
foods labelled “gluten-free;” by law, these foods must contain less than 20
parts per million, well below the threshold to cause problems in the great
majority of patients with celiac disease.
·        
Ask
restaurant servers and chefs about how they prepare the food and what is in it
·        
Find
out whether a gluten-free menu is available.
·        
Ask
a dinner or party host about gluten-free options before attending a social
gathering.
Foods
labeled gluten-free tend to cost more than the same foods that have gluten. You
may find that naturally gluten-free foods are less expensive. With practice, looking
for gluten can become second nature. If you have just been diagnosed with
celiac disease, you and your family members may find support groups helpful as
you adjust to a new approach to eating. A significant amount of additional
support material is found at this website: 
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024528/
.
According
to Today,
could a normally harmless virus cause a sensitivity to
gluten? A new study has found that a certain type of virus could trigger a
person’s immune system to overreact to gluten, leading to celiac disease. The
findings, published this month in Science,
provide an explanation for why certain people develop celiac disease.
People with celiac disease had more antibodies to
reoviruses in their blood compared to healthy individuals. Furthermore, these
people with more antibodies were found to have more of the celiac disease
inflammation. Whether a person was infected with reoviruses at some point in
the past could explain why they develop celiac at a certain age or had worse
symptoms compared to others who were not infected. More information about this research is found here: http://www.today.com/health/celiac-disease-may-be-caused-virus-new-study-finds-t110119
.



Regardless
of your sensitivity to gluten, you should take preventive measures to ensure
you have all the answers about celiac disease. You may suffer from it and not
even know you have it. See your family doctor or a health care specialist if
you have questions or may be experiencing some of the symptoms. Celiac disease
has definite consequences to your health. Don’t take chances.

Ambergan Prime

Dear primary care doctor, Jeff Bezos is about to devour your lunch. All of it. And then he’ll eat the table, the plates, the napkins and the utensils too, so you’ll never have lunch ever again. Oh yeah, and they’ll also finally disrupt and fix health care once and for all, because enough is enough already. Mr. Bezos, it seems, got together with two of his innovator buddies, Warren Buffet from Berkshire Hathaway and Jamie Dimon from J.P. Morgan, and they are fixing up to serve us some freshly yummy and healthy concoction.
Let’s call it Ambergan for now.

This is big. This is huge. It comes from outside the sclerotic “industry”. And it’s all about technology. The founders are no doubt well versed in the latest disruption theories and Ambergan will be a classic Christensen stealth destroyer of existing markets. When the greatest investor that ever-lived combines forces with the greatest banker in recent memory and the premier markets slayer of all times, who happens to be the richest man on earth, all to bring good things to life (sorry GE), nothing but goodness will certainly ensue.

Everybody inside and outside the legacy health care industry is going to write volumes about this magnificent new venture in the coming days and months, so I will leave the big picture to my betters. But since our soon to be dead industry has been busy lately bloviating about the importance of good old fashioned, relationship based primary care, perhaps it would be useful to understand that Ambergan is likely to take the entire primary care thing off the table and stash it safely in the bottomless cash vaults of its founders. It’s not personal, dear doctor. It’s business. Ambergan will be your primary care platform and you may even like it.

I am not sure what Mr. Buffet is contributing to this venture, other than cash and the warm bodies of his employees to pilot the venture. As to Mr. Dimon, he could probably run a modern analytics-based, risk-assuming health management entity, a.k.a. insurance company, while blindfolded and with both hands tied behind his back, so he may be useful in the short term. Let’s face it though, the most interesting actor here is Mr. Bezos and his Amazon platform of everything. Whatever else happens, it is probably safe to assume that within the next ten to twenty years, most people will be getting much expanded primary care services directly, and almost exclusively, from Amazon.

Amazon is a transactional platform, where people buy and sell things that Amazon does not make, and often does not even stock. With its more recent forays into TV, movies and music, Amazon also has some experience selling, mostly subscription based, services to consumers. As strange as it may sound though, most Amazon profits come from a very different source. Amazon Web Services (AWS), a computing platform (cloud) service, mostly for businesses and governments is a modest part of Amazon revenues, but a huge contributor to its profits. This lay of the Amazon land practically begs for a little cross pollination, and health care may very well be the ideal vehicle for that.

Cloud services like AWS are essentially eliminating inhouse professionals and expertise in maintaining the basic infrastructure of computing, outsourcing it all to Amazon. Rings a bell? You can almost see the Amazon ads for its primary care services, telling hospitals that they should concentrate on their core business, which is cutting people open and stitching them back together, and leave routine care to Amazon’s primary care platform, expanding or shrinking just in time to match organization demands, with guaranteed uptimes of 99.99999%, and so forth. And you can almost see the direct to consumer ads too, can’t you? Sure you can. You know you can.

A few days ago, before the Ambergan announcement sent the health care markets into a tailspin, Amazon hired a top doctor from one of those trendy primary care corporations that like to misrepresent themselves as Direct Primary Care (DPC).  People speculated that Mr. Bezos, who previously invested in another failed DPC organization, may be ready to try his own hand at fake DPC for his own employees. Meh…  It didn’t sound right to me, because with or without Ambergan, the Amazon stars were already aligning towards a massive thrust into health care, from the bottom up, as any good disruptor usually does.

A few weeks ago, Amazon offered us an opportunity to invite Jeff Bezos into our bedroom. No, he won’t interfere with anything. You won’t even know he’s there. He’ll just sit quietly beside your bed and watch you sleep, until you ask for something, if you do, and if you don’t, that’s fine too. It’s called Echo Spot and other than being unusually cute, the camera/microphone device that looks a little like an old-fashioned alarm clock, is just another extension of the Alexa line of surveillance/service products that run your home and your life, which is precisely what an ideal primary care doctor is supposed to do, i.e. keep you healthy, where health is defined as  “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. 

You will subscribe to Ambergan Health. You will be monitored by Alexa in your home and maybe a future tiny Echo will let Alexa go outside with you. Perhaps they’ll throw Apple a crumb here to keep an eye on you when you leave your home, although it’s becoming increasingly unclear why you should. When you feel sick, you will summon a doctor on your Echo screen, and eventually he will appear preemptively before you get inconvenienced by any symptoms. You will be examined, diagnosed, treated and monitored in your home. And this should take care of most needs of most people most of the time. Not only is this a good start, but it’s a foundational step, and a perfect place to practice, because you can’t cater to complex needs if you have no idea how to care for simple needs.

Will there be room for marginal plays in drug pricing and maybe devices or exclusive contracting with delivery systems, as most experts (who drove health care into the ground) seem to think? Maybe, but negotiating lower prices for bulk purchasing is neither unique nor disruptive. It does sound like Ambergan will begin by deploying its services to its own employees, but make no mistake, this cannot be about creating yet another middling scheme for self-insured employers. If that’s all Ambergan is, there will be no innovation and no disruption. This must be about the entire health care market. This must be about doing to health care what Amazon did to retail. Amazon didn’t kill retail by restricting consumer choice to idiotic narrow networks of starving suppliers. That’s the Walmart model. Amazon decimated retail in precisely the opposite way. This is a business venture gunning for large market shares, and yes, I know it’s not seeking profits right now, but the entire Amazon retail bonanza started without profit and it remains mostly so to this day.

If you’re a primary care doctor, soon you will be able to have your own little storefront on Amazon, instead of or in addition to some strip mall or non-descript medical building. You will have to provide specifications for your services and cash will be king. Remember those new interstate licensing compacts? That will help here and so are the ever more relaxed telehealth rules and regulations. How about the recent rise in burned out doctors and cash practices? It’s almost like this was meant to be.

For the initial enterprise offering, substitute doctor farm for server farm and you get the AWS of medicine. For the end result, add another layer to the AWS, and substitute each doctor in the farm for say, detergent or movie, and you get the grand idea. Since everybody is shopping for substitutable services, this is the perfect insertion of the high-volume retail model into the high-profit AWS model.

Ambergan need not buy clinics, employ doctors or contract with systems, although it might start out that way. It just needs to get as many doctors as possible on the Amazon Health platform and have them compete, while people review and rate them into oblivion or success. The Amazon platform IS the network, and there will be terms, conditions, stars and promotions. There certainly are many legacy obstacles to overcome, and perhaps that is why Amazon couldn’t or wouldn’t go it alone. Throwing highly regulated markets wide open requires two strong lobbying arms, and a federal government willing to play fast and loose. The stars are indeed perfectly aligned for the first true disruption of our health care since 1965.

Some Tips on Acne Prevention

In many cases acne can be avoided. There are lots of ways to avoid acne. Ways to avoid acne include dietary changes, skin care and home treatments.

This article will have information that explores ways to avoid acne.

Ways to avoid acne #1: Use a cleansing diet to get rid of the impurities in your system.

Ways to avoid acne #2: Clean your skin everyday.

Ways to avoid acne #3: Use a benzoyl peroxide lotion to keep blemishes at bay.

Ways to avoid acne #4: Check your cosmetics, foods and other products to make sure you are not having a problem with allergies that can be mistaken for acne.

Ways to avoid acne #5: If you eat a high-fiber, low-fat diet you are less likely to have problems with acne.

Already kicked your bad diet and threw out aggravating cosmetics? And do you still have acne? Check out Acne Free in 3 Days, a natural how-to book on how to get rid of acne once and for all. — Editors

Ways to avoid acne #6: Some vitamins will decrease your chances of acne. Check with your doctor to see what she suggests.

Ways to avoid acne #7: Drink six to eight glasses of water a day. Water is important for the health of your skin.

Ways to avoid acne #8: Some people feel that cutting down on sugar, flour and caffeine is one of the ways to avoid acne.

Ways to avoid acne #9: If you have small blackheads or pimples do not pop them. This can lead to even more skin problems.

Ways to avoid acne #10: Don’t use greasy lotions and cosmetics as they contain oils that can promote acne.

Ways to avoid acne #11: Try not to take any medications that contain iodides or bromides.

The above information should help you find ways to avoid acne.

Vitamin D to Reduce the Risk of Heart Attacks

Men deficient in vitamin D seem to have a higher risk of heart attacks than men whose blood levels of vitamin D are adequate. Medical records and blood samples of 454 men between the ages of 40 and 75 who had fatal or nonfatal heart attacks between January 1993 and January 2004 were compared with 900 men who had no history of cardiovascular disease.

The vitamin D connection remained significant even after researchers adjusted for such heart disease risk factors as family history of heart attacks, body mass index, alcohol consumption, physical activities, diabetes, high blood pressure, cholesterol levels, omega 3 intake and ethnicity. The study was conducted by researchers at the Harvard School of Public Health and Brigham and Women’s Hospital in Boston. The results suggest that current recommendations for vitamin D intake need to be increased to boost blood levels of vitamin D high enough to benefit health, the authors said. The study showed that men whose blood levels of vitamin D were 15 nanograms per milliliter or less were at increased risk. Sufficient blood levels of vitamin D were 30 nanograms per milliliter or more.