Hacking Health Care: Innovating Dental Care

For decades (at least since 1995 according to this report from the American Heart Association) health experts have been calling for more integration between dentistry and medical health care. That’s because besides losing your teeth, oral health is important to a person’s overall well-being. Oral exams can detect the symptoms of medical conditions in the mouth as well as other parts of the body. And poor dental hygiene has been linked to kidney and heart disease and low birth weights. There are ongoing investigations into these links.

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Illustration by Uncle Louis for Healthy States

That said, roughly 60% of Americans don’t go to the dentist annually. In most cases it’s because they can’t afford it. Significant racial, ethnic and economic disparities exist because of cost and access to care.

Healthy States’ third “Hacking Health Care” event brought together a diverse group of young people to come up with solutions to this, and other important problems in health care. We asked: What can be done to make oral care more of a priority in overall health?

Their response? SIMPLIFY! Integrate dental and medical care and coverage.

First, hackers said it would be much easier to think about oral care if doctors asked about it during medical visits. They already ask all sorts of intimate questions about healthy habits, so throw a few in there about brushing and flossing. It would help make the connection between oral health and overall well-being.

Turns out this is an idea backed by – among others – the American Heart Association.

It is clear that viewing oral health as separate from general health has become obsolete. Challenges to our understanding of oral and systemic disease connections arise in part from the compartmentalization of dental care and medical care that exists in the United States.

Second, hackers want one insurance plan to cover both oral and medical services. Again, they’re on to something here. A 2008 study by the Centers for Disease Control and Prevention shows 45 million Americans have no dental coverage. And those without coverage generally go without care. Experts agree that more people would go the dentist regularly if their visits were covered by medical insurance.

Lastly, hackers want to dentists to be more visible. Be at clinics located in pharmacies and urgent care centers and have pop-up dental events staffed by dental students at work sites and at schools. In other words, dentists need to get out the office and go where the people are.

This Hacking Health Care event was made possible in part by Delta Dental of Minnesota.

Hacking Health Care: Improving Wearables

One in ten adults in the U.S. use an activity tracker like Fitbit or Jawbone. That’s according to a recent report from a strategy consulting firm focused on digital technologies. The firm observes the devices have achieved “mass market penetration in the U.S.” primarily among millennials. Just this week the Fitbit company announced three new versions of its wearable activity tracking device.

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Illustration by Uncle Louis for Healthy States

The digital wristbands track everything from activity to sleep to food consumption. Even as they gain in popularity, there is room for improvement. According to the report more than half of the people who use the devices quit within 24 months.

Why? Psychologists cite a number of reasons why people quit the devices. One issue is that wearable activity trackers don’t connect your behavior to your desired health outcomes. From the report:

The best engagement strategies for wearables will move beyond presenting data (steps, calories, stairs) and directly address the elements of the habit loop (cue, behavior, reward) and trigger the sequences that lead to the establishment of new, positive habits.

A diverse group of smart, funny young people came together for Healthy States’ third “Hacking Health Care” recently to brainstorm innovations in health and health care.

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Discussing innovation while “Hacking Health Care” in St. Paul.

They told us they think wearable activity trackers have potential – with one possible improvement. What if your activity data was linked to an avatar of your future self?

For example, you replace eggs and pop tarts with kale smoothies for a week and voila – your online avatar suddenly has a stronger heartbeat and fewer wrinkles. You take up riding your bike to trivia night at the bar instead of driving your car, and your future self has a slimmer waistline and greater lung capacity. Conversely – if you secretly raid some kid’s plastic pumpkin the day after Halloween (yea, we know all about that) your avatar is going to give you away. Your avatar would also have a wallet. Changes in health habits would control how much money your future self spends on medications and medical procedures.

It’s an idea with potential. After all, this comprehensive industry analysis suggests wearable activity trackers will have better staying power if they “build a stronger connection between people and their health.”

Our millennial hackers came up with more great ideas. Keep an eye out here for more of them.

This Hacking Health Care event was made possible in part by Delta Dental of Minnesota.

Kaiser Health Poll: Uninsured know little about health law

Hisham Uadadeh enrolls in a health insurance plan under the Affordable Care Act.  Joe Raedle/Getty Images

Hisham Uadadeh enrolls in a health insurance plan under the Affordable Care Act.
Joe Raedle/Getty Images

Open enrollment for the second year of the Affordable Care Act — commonly known as Obamacare — begins Nov. 15, and Kaiser Health News reports that nine out of 10 uninsured people don’t know that.

Kaiser’s poll — conducted this month —  contacted 1,503 adults. The results of the poll show that many uninsured people don’t know much about the new law.

Eighty-nine percent of uninsured people polled don’t know open enrollment starts in November, 66 percent said they knew little or nothing about the health insurance marketplace and 53 percent said they didn’t know the health reform law provides financial help to low and moderate income Americans.

Even though they might not understand the new health insurance marketplace, 60 percent of the uninsured people polled said they planned on getting insurance in the next few months.

Nearly half of those polled said they view the law unfavorably.

You can see all the results of Kaiser’s poll here.

The New York Times today offers this detailed interactive that concludes the President’s new health law is largely delivering on its goals.

Eric Dishman’s Story of Health and Transformation

Health care insiders know Eric Dishman as an Intel Fellow and general manager of the corporation’s Health and Life Sciences Group. When he spoke this year at the Mayo Center for Innovation’s Transform Symposium, he chose not to present his usual address about technology in health and health care. Instead, he shared a riveting story of his own experience with cancer he titled “A Short Tragicomedy in Five Acts with a Happy Ending.” He explains that cancer taught him how unprepared American health care providers are for patients who are proactive and expect to be in charge of their health.

Avoiding medical tests: is ignorance bliss?

A sign for free HIV testing. Mario Tama/Getty Images

A sign for free HIV testing. Mario Tama/Getty Images

People avoid going to the doctor or getting medical tests for different reasons — some don’t have money or insurance, some are anxious and others are apathetic. The Atlantic looked into the phenomenon, called information aversion.

It’s also called the “ostrich effect,” which comes from the idea that ostriches bury their heads in sand when faced with danger.

While ignorance can be bliss, The Atlantic says it is also dangerous because putting off a medical test could lead to a late diagnosis or unknowingly spreading a disease.

In a recent study, many college students opted out of a free herpes test, listing unnecessary stress or anxiety as the reason.

The Atlantic talked to Katrina Walker, a Michigan native who has a 50 percent chance of having Huntington’s disease. Her mom has the degenerative disease, so Walker could have the gene. There are tests available, but she doesn’t want to know.

She told The Atlantic the thought she might have the gene makes her anxious and sad — she would rather live her life without a 10 to 20 year life sentence hanging over her head.

“Some people avoid tests because they don’t want to deal with the stress right now and just want to enjoy life,” says Dr. Ghadeer Okayli, a psychiatrist who specializes in anxiety.

You can read the full article here.

Poop pills help fight against antibiotic-resistant diseases

Researchers are turning to fecal transplants to fight certain antibiotic-resistant illnesses like Clostridium difficile, commonly known as C. diff. The latest form of the transplants comes in a frozen poop pill.

The L.A. Times says the idea is that a healthy person’s poop contains the right mixture of gut bacteria, and transplanting that into a person suffering from C. diff can help get their GI tract working properly again. C. diff is a bacteria that causes diarrhea and nausea. According to the CDC, people who are taking antibiotics are more susceptible to contracting the infection, which is spread through fecal matter, mostly in health care settings.

The L.A. Times reports that doctors are becoming more open minded about unconventional treatments as antibiotic-resistant bacteria become more prevalent.

Before the pill, NPR reports fecal transplants required a fresh poop donation from a relative, which was then delivered via colonoscopy.

The pills have been administered with success to people involved in a handful of studies. The most recent was a group of 20 involved in a study by a team from Massachusetts General Hospital, Boston Children’s Hospital, Harvard Medical School and Tel Aviv University in Israel published in The Journal of the American Medical Association.

It took four days for the pills to work, and they were successful in 90 percent of the patients in the study — some of whom were suffering from diarrhea up to 30 times a day.

Researchers say the results of the study are preliminary, but could help make fecal transplants more accessible. This Discovery Channel “DNews” video sums up the new treatment approach.

Profiles in Health: Dr. Maria Veronica Svetaz

By Jennifer Vogel

Being an immigrant is like having a chronic illness, says Dr. Maria Veronica Svetaz, a native of Argentina who runs a health program on Lake Street in Minneapolis tailored to the needs of Latinos. “Somehow it never goes away and will always be there, for good and for bad.” Svetaz is referring to the “extra layer of complexity” that can infuse virtually every aspect of an immigrant’s life, from the ability to communicate to the opportunity to earn enough money to the fortitude needed in navigating a byzantine immigration bureaucracy. “It makes you more vulnerable in some ways but also stronger and savvier in others.”

Dr. Maria Veronica Svetaz

“All of us can belong to lots of places…And we all have the ability to help the other to feel that they belong – with something so simple as a question or a word.” Caroline Yang / For Healthy States

Svetaz’s bilingual, bicultural health program, called Aqui Para Ti, which translates as “Here For You,” is part of Hennepin County Medical Center’s East Lake Clinic. It provides a range of services to young Latinos and their families including mental health and substance abuse counseling, assistance with birth control and prenatal care, and even help strengthening communication between parents and children who may not speak the same language, literally or figuratively.

“Mental health issues are higher in Latinos, particularly in Latino girls,” says Svetaz, 47, an energetic presence in a small, homey office, surrounded by cards and memorabilia. “It’s mainly depression. And suicide attempts, they are number one. One out of seven Latina teens will try to kill themselves. It’s the pressure of the two cultures. They get entangled.”

On the wall above her desk hangs a colorful collage of a woman with the inscription “No soy la mujer maravilla” or “I am not wonder woman.” The painting, from an art fair in Buenos Aires, is a reminder of how demanding Svetaz’s work can be and that, no matter how much she wishes the contrary, she can’t do it all. Working to close the health equity gap for her Latino clients and realizing that all many need is “a little love and tender care, puts you at moments at odds with trying to do too much,” she says. “And when you have so much passion, I learned that you need to ‘curb your enthusiasm’ as burn out is for real.” Continue reading

U.S. Ebola Guidelines Criticized as Lax

Obama on Ebola

Cabinet members and others listen as US President Barack Obama (R) makes a statement for the press after a meeting in the Cabinet Room of the White House October 15, 2014 in Washington, DC. Obama canceled campaign and fundraising travel for Democrats to attend the meeting on Ebola after a second case of the disease was contracted inside the United States. Brendan Smialowski/AFP/Getty Images

In response to the news that a second nurse at Texas Health Presbyterian Hospital has been diagnosed with Ebola, the Centers for Disease Control and Prevention acknowledged this week that its guidelines for protecting care workers needed to be stricter. Medical experts have called the original CDC caregiver guidelines for protection from Ebola “irresponsible.” The new federal guidelines come closer to those recommended by Doctors Without Borders, an organization with many years of experience with Ebola.

On Wednesday it was revealed that the second nurse who has been diagnosed with the virus was given the ok by the CDC to fly on a commercial airliner just hours before she was diagnosed, while she was reporting a mild fever.

Public health officials and the White House continue to assure the country that while Ebola is serious, it is not a significant threat to most Americans.

Congress will hold hearings today on the Ebola response. The head of the CDC, Dr. Thomas Friedan, is expected to apologize for not responding more vigorously to the Texas cases.

See NPR’s coverage of Ebola for more information.

ALS and the end of life

“Death Focuses You” – Bruce Kramer

This week MPR News aired Cathy Wurzer’s most recent conversation with Bruce Kramer. Wurzer has been recording conversations with 58-year-old Kramer since he was diagnosed with ALS, or Lou Gehrig’s Disease, in 2010. Kramer is a former academic dean at the University of St. Thomas and lives in the Twin Cities. He is married with two grown sons and one young granddaughter.

In this conversation we learn that Bruce is in the final stages of the disease. Kramer says they are working through their fear of death in order to accept the reality that he will die sooner than anyone wants. They are sad. And yet they are grateful for the chance to focus so keenly on how much they love one another.

What I have learned in this past four years is that death focuses you. It brings what’s important right to the front, and it cuts through the things that just really don’t need to take priority anymore.

Kramer says he is embracing this perspective to handle his own death. He also sees his purpose as helping others develop the same perspective.

I’m looking for the alignment of love and gratitude and acceptance and trying to help people, as they come in to see me, to have a little space for that in their lives. If they could find that same space for acceptance and gratitude, maybe it doesn’t take facing something like ALS to bring that along. And maybe that’s opportunity for tremendous growth as a human.

ALS is a disease that affects a person’s musculature but not one’s cognitive ability. Some have described the condition as “a living death” and those afflicted often struggle to maintain a will to live. People living with terminal illness have written about the power of dismissing fear and accepting death. They say it can dramatically improve quality of life — even if it’s just for one’s last few months.