Recently, the US Senate has passed a bill that would repeal the Affordable Care Act, commonly referred to as “Obamacare.” This is hardly the first time such an action has been attempted. Since the bill was passed, there have been more than fifty attempts to repeal the law, in whole or in part, but this particular attempt deserves a special mention because it is the first time that the Republicans in Congress have attempted a repeal since gaining a slim majority in the Senate. The natural question that arises then, is what are the risks? Is it possible that ACA could be repealed? If that were to happen, what would the implications be to health care in general? What (if anything) would replace the current law?

 

These are complex questions, but we’ll attempt to answer them in brief below. They matter because of course, this repeal attempt comes at a time when the health care industry as a whole is still, or has just completed (in some areas) adjusting to the changes brought about by the new law. Whether you like and approve of the new law or not, the reality is that a change now would be both costly and time consuming.

 

The reality is that the House of Representatives will almost certainly pass some version of the Senate bill, which the President will promptly veto. It is inconceivable that he would allow the repeal of what he regards as his signature achievement without a fight, so these actions are virtually guaranteed. Congress lacks the votes needed to override a Presidential veto, so the chances of the law being overturned are virtually nil.

 

Even if it were to happen, there’s currently no evidence of any proposal to replace the legislation, so if the unthinkable were to happen, it would essentially mean a rollback to the way things were in the pre-ACA world.

 

One thing that will likely occur, however, in light of this latest attempt is that when the Democrats regain control of the Senate (which they are likely to do in 2016, as the Republicans will be defending more seats), there will be a renewed push to shore up or make improvements to areas of weakness in the ACA. This is not at all unexpected. Social Security and Medicare both went through a period of expansion and improvement after their passage, and ACA can certainly be expected to follow a similar arc of development.

 

What this means for you, as a member of the health care industry, is that the current plate of changes you’re currently looking at are, in all probability, all you’ll have to contend with in terms of new legislation, at least until 2016. At that point, we may see some incremental tweaks and changes to the system, but the expectation is that none of these will be large or paradigm shifting.

 

This is good news for the industry as a whole. It means that for the immediate future, we have a certain measure of stability and predictability, which will allow us all to focus less on process, and more on producing good healthcare outcomes for our patients.

 

Sometimes, it’s easy to get so focused on the day to day crush of patient needs and health care outcomes that you lose sight of the larger picture. Despite the fact that health care demand is surging to the point that the existing system is feeling the strain, the reality is that the world has actually become a significantly safer place, this, according to data gleaned from a report called the “Global Burden of Diseases, Injuries, and Risk Factors (GBD). This annual report, commissioned by the World Bank, has been produced since the 1990’s, and in it, we can chart a dramatic decrease in almost all of the risk factors tracked by the report.

 

What are the risk factors tracked? There are too many to list here, but it’s important to note that these are accidents and injuries that require some form of health care, ranging from emergency treatment to hospital admissions.

 

The single largest category is auto accident, which represents 29% of the total. Self-harm is second, representing 17.6%, falls represent 11.6% of the total, and violence accounts for 8.5%, so collectively, these four of the twenty-six causes and 47 types of injury tracked account for 66.7% of the total.

 

The first year that the report was commissioned, there were 1,231,000 instances of such injury requiring some level of intervention by health care professionals. In the most recent study, that number had fallen by nearly a third, to 973 million. What makes this drop even more impressive is the fact that in 1993, the world’s population was 5,526,000,000. In 2013, the most recent year for which the stats have been compiled and finalized, world population had swelled to 7,086,000,000.

 

Consider that for just a moment. During a period in which we saw global population rise by nearly a third (28%) we saw a 31% decrease in the number of accidents, worldwide, requiring medical intervention. That’s a staggering, mind boggling achievement. The report does not attempt to draw conclusions about exactly how and why the number has dropped by such a degree, and one can imagine that given the width and breadth of injury types covered, the driving forces behind the precipitous decline are numerous and complex. The fact that we don’t have enough information to say with any degree of certainty why the drop is occurring, however, in no way detracts from the amazing accomplishment itself.

 

Better education and increased product safety almost certainly play at least some role in the decline, and it’s not at all difficult to imagine this trend of decline to continue on into the future, though the data will certainly tell the tale in future years. The good news, however, is that the current strains on the US health care system are temporary in nature, and will inevitably sort themselves out, and that globally, accident rates requiring hospitalization are falling quickly, even as our population expands. The medical community is certainly in no danger of running out of patients to care for, but there’s an unmistakable trend here. The world is becoming markedly safer, and that’s a very good thing.

 

The Affordable Care Act (ACA – often called “Obamacare”) has ushered in an era of unparalleled change in the medical industry. One of the largest seismic shifts in the industry has been a dramatic increase in the level of transparency in the medical community. Over the longer term, this increased transparency stands to be one of the primary drivers of ongoing change in the industry. Access to more and better information in all areas of health care will drive better policy decisions and help to create a virtuous cycle of continuous improvement.

 

One of the more common practices in the industrialized world has been to augment permanent nursing and support staff with low cost, temporary staff trained in other countries during times of increased demand. Doing so has always been seen as a smart, cost-effective move to shore up staff during those periods.

 

A recently published study, however, reveals that this may not be the optimal response strategy after all. In the largest such study ever conducted, involving more than 12,000 patients, and conducted jointly by the NHS in England and the University of Pennsylvania, it was found that for every ten percent of nursing and other support staff trained abroad in a given hospital, there was a corresponding ten percent decrease in the chance of that hospital achieving an “excellent” or “very good” rating on patient satisfaction. That is to say, a hospital with 30% of its staff trained abroad was 30% less likely to receive an “excellent” or “good” rating.

 

The study was motivated by an earlier US study which documented higher mortality rates in hospitals which employed higher proportions of nurses trained abroad.

 

Staffing has always been one of a hospital’s biggest challenges, and in the post-ACA world, with rising demand for health care, there seem to be few short term alternatives but to look beyond the borders of the US for qualified staff to fill desperately needed positions. The flip side of that coin though, as highlighted by this and the prior study, is the reality that health care outcomes tend to be poorer, and overall satisfaction lower, the more heavily one relies on nurses and support staffed trained abroad.

 

In the longer term, the expectation is, of course, that we will train a sufficient number of medical professionals at all levels here at home, such that we will no longer need to place such heavy reliance on foreign-trained talent, but that is small consolation in the near term. In that near term, hospitals who are forced by circumstance to place increasingly reliance on talent from abroad will almost inevitably find their patient satisfaction scores dropping, and given the increased transparency and global visibility of such metrics, those hospitals may find themselves in a downward spiral from which it will be difficult to escape.

 

There are (perhaps) some strategies which could be implemented to mitigate this trend and minimize the potential financial fallout that arises as a consequence of it, but the truth is that it’s such a recent revelation that no one is sure how effective those mitigation strategies might be. Time will tell, and in the meanwhile, the road could get rocky.

 

If you haven’t heard of graphene, you’re not alone. While it has been making headlines in the realm of physics since its discovery in 2010 (which netted its discoverer a Nobel Prize), it has only been more recently that people have begun to think about graphene’s implications for the medical field. Those implications, as it turns out, are both rich and numerous.

 

Graphene has been heralded as the first two-dimensional substance. It has no height that can be measured. When it was first discovered, there was great hope that it could be used in computers to build chipsets that would provide processor speeds literally orders of magnitude greater than the top of the line CPU’s available today. Sadly, there are some technical complications that make such chips possible.

 

Computers are binary. They deal in 1’s and 0’s. That gets expressed electronically by opening and closing circuits, but graphene doesn’t come with an off switch. Once electricity begins flowing through it, there’s no way to shut it off, or at least, nothing that has been found thus far. Nonetheless, there are a great number of potential use for the substance in the medical field.

 

The first use of the substance is in the realm of biosensors. Organic material tends to create strong bonds with graphene, and experiments are currently underway to make the bonding selective, such that on the material being detected for will form the bond.

 

Given its light weight and strength, it’s also possible to use hollow graphene tubes as bone replacement. Dentists are currently experimenting with using it as a filling compound.

 

Cancer researchers have also begun experimenting with graphene nanotubes as a means for more effective and efficient drug delivery. The honeycombed structure of the tubes give them an enormous surface area. The drug can be bonded to this surface area, which can deliver appropriately scaled quantities of a cancer fighting drug straight to cancerous cells.

 

For years, medical science has been exploring the possibilities of carbon nanotubes, and the thinking is that graphene may be a replacement in some, and perhaps even many cases where carbon nanotubes are used now. Graphene is incredibly inexpensive to produce, but carbon nanotubes aren’t all that expensive either, so further research will be needed to determine if there’s anything other than a marginal cost savings to be realized by making the switch. It may well be the case that in coming years, medical science will use the two (carbon and graphene nanotubes) interchangeably.

 

Since graphene is such a newly discovered substance, there is one potential area of concern. Namely, toxicity. While there have been a few preliminary studies on the possible toxic side effects of the material, much more research is needed before we can say with certainly that it has no toxic side effects in the short or long term. Nonetheless, it’s such a remarkable material with so many novel and intriguing possibilities that research on potential applications continues apace, even as the research on its long term impact is ongoing.

 

Is it possible to use Virtual Reality (VR) tech to treat, or perhaps even cure chronic pain? On the face of it, the idea seems silly, but on closer review, there’s more to it than you might think.

 

Recently, Daniel Harvie, a Ph.D. candidate at the University of South Australia, conducted a remarkable experiment utilizing VR technology that sheds the first rays of light on just how powerful the mind can be in terms of pain and its management.

 

In the experiment, twenty-four chronic pain sufferers were asked to sit in a chair while wearing VR goggles. The display of the goggles was manipulated so that viewers were turning their heads more (or less) than they actually thought they were.

 

The thinking behind the experiment was that it at least some cases, chronic pain owes its existence to neural pathways which are no longer relevant. That is to say that the brain “thinks” it’s going to hurt when you turn your head past a certain point, and so, the pain signal is sent, regardless of whether or not the initial conditions which caused the pain are still present. If that hypothesis is true, then it should be possible to use virtual reality in those particular cases to retrain the brain not to expect pain, and over time, eliminate it.

 

The results of the experiment were interesting, and more significant than you might expect.

 

When the virtual reality displays were manipulated such that wearers weren’t turning their heads farther than they thought they were, they wound up rotating 7% less than they did without the goggles. In circumstances where the subjects thought they were turning their heads less than they actually were, they wound up being able to turn their heads 6% more. This seems to bear out the notion that at least some of the pain these sufferers experience is “all in their heads,” and the implications are staggering.

 

Obviously, this study has limitations, and we cannot take a single study with only twenty-four participants as the final word on the matter, but it poses some interesting questions and paves the way for exciting new studies in the future.

 

Should the day come that we can differentiate between genuine pain, and improperly firing pain signals in the brain, then we can, at least in those specific instances, begin retraining brains in such a way that those signals stop firing improperly.

 

Increasingly, we are living in a world in which the digital realm can have impacts on the physical which are both real and profound. We see this trend manifesting itself in a variety of ways, including new technologies that can be worn by the blind that can constantly scan the space around the blind person and guide them to their destination unassisted, and even recognize faces and facial expressions.

 

The possibilities are nearly without limit, bound only by the limits of our imaginations. We are increasingly finding ourselves in the position of being able to solve for very real health care issues in ways we’ve never before dreamed. It’s an exciting time to be a part of the health care profession.

 

It’s a myth we hear talked about all the time. The idea that human beings only use ten percent of their brains. In fact, a blockbuster 2014 movie called “Lucy” explored this very idea. In it, an innocent woman (played by the lovely and talented Scarlett Johansson) was accidentally dosed with a new drug, which turned her into a Brainiac with an assortment of supernatural powers as it came closer and closer to “unlocking” all of the unused potential in her brain. The problem, of course, is that it simply isn’t true.

 

An extensive search for the origins of this myth has turned up no definitive smoking gun. Some have attempted to attribute the quote to Albert Einstein, but no such quote exists on the Einstein archive online. There was a definitive reference to it by Lowell Thomas, who attributed the quote to William James in the preface to Dale Carnegie’s “How to Win Friends and Influence People,” but again, a search of William James quotes does not reveal anything.

 

It’s a comforting myth, of course, and often, one that circulates without harm, as it prompts people to strive to push themselves and their creativity beyond its usual limits. The darker side of the myth though, is that it has created something of a cottage industry, with a variety of hucksters and snake oil salesmen hawking all manner of “brain boosting” products to legions of unsuspecting customers, eager to magically unlock more of their brain’s potential.

 

What we do know is this: After years of studying the brain and mapping out its functional areas, there have been no cases of whole regions of the brain that have been found that serve no discernable purpose. We also know that no patient can suffer an extensive brain injury without significant loss of functionality, to speech, motor skills, cognition, etc. Certainly, no patient has ever survived anything close to an injury involving ~90% of his or her brain.

 

Finally, we know that every other system in the body has been designed and refined by the process of natural selection. It seems unlikely in the extreme that an organ that uses some 20% of the body’s total energy would be allowed to grow so large and consume so many resources, simply to have 90% of that organ lie fallow and unused. It makes no sense at all, given everything we know about biology.

 

Myths though, are notoriously resistant to fact. We’ve seen this time and again, especially with the rise of the internet, as old classics get new life breathed into them circulating around the net, and sometimes going viral on social media sites like Facebook. All that to say that over the course of your career, this question is almost certain to come up. When it does, a careful, patient explanation will (hopefully) set the record straight, at least for that one individual. What, if anything can be done to actually kill the myth once and for all, however, remains a mystery.