Tag Archives: health

Healthcare innovation

m2graphicThis link (via Gayle D.) is pure awesome. Turns out someone has decided to offer prescription drugs via an ATM. For policy wonks, this has all the hallmarks of a disruptive innovation.

I suspect that in the pharmaceutical industry the 80/20 rule is in effect. That being 80% of  patients are using only 20% of the available drugs. So a small number of drugs account for the vast majority of all prescriptions filled. That means you could service a huge part of the market with only a handful of drugs on hand.

This is precisely what this ATM for drugs allows you to do. Moreover, it allows you to do it faster, cheaper and with a better experience for customers. That is precisely what a disruptive innovation is.

Indeed, you can see the early signs of its disruptive nature in the way it is being talked about.

The Canadian Pharmacists’ Association has endorsed the machine, but it appears oblivious to the machine’s implications (despite the very clear case study of the decline of bank tellers after the introduction of ATMs – although perhaps the idea of pharmacists comparing themselves to bank tellers is so threatening that they ignored that data):

Some pharmacists will undoubtedly feel threatened by the technology, says Jeff Poston, executive director of the Canadian Pharmacists’ Association.

But he predicts the machines will have only a niche role, likely in remote communities that have limited pharmacy services, since the devices offer patients a “lesser” form of communication with the druggist.

“I tend to think the face-to-face encounter with the pharmacist would win hands down,” he said.

Niche role? I suppose, if you count 80% of the pharmacy business as niche. I suspect this service will take off – and we’ll need fewer pharmacists. On the flip side, the pharmacists we keep will have to very good since they’ll be focused on the more dangerous, complicated and difficult prescriptions – which really is the best use of their time.

What about people’s alleged preference for face-to-face encounters? Perhaps this is a preference. But how strong is that preference? For me, it isn’t so strong that I’m willing to hang around in the pharmacy for 30 minutes while my prescription is being filled, or worse, to come back they next day. I suspect that the overwhelming majority of us will use the ATMs – just like we do at the bank.

Indeed, the president of the company that creates the ATMs for drugs – who is quoted later in the article – knows what’s really going on:

Just over 800 patients used the machines at Sunnybrook to obtain 1,200 prescriptions between June and September. A survey of 108 of them indicated that more than 95% received their drug in less than five minutes and would use PharmaTrust again, said Peter Suma, president of PCA. None of the prescriptions was incorrectly filled, he said.

Not everyone, however, was able to take advantage of the pharmaceutical ATMs. About a third of patients who tried discovered that their medicine was not available, said Dr. Domb, though PCA offers to deliver those orders to the patient’s home the next day.

Despite such limitations, Mr. Suma predicts his kiosks will be embraced by consumers accustomed to instant, technologically aided service, especially when the devices are “deployed ubiquitously.”

95% satisfaction rate? This technology is killer. And check out the different perspectives of the two quotes.

On the one hand, the industry expert and entrenched actor (the pharmacists association executive director) believes the ATMs will be restricted to a niche market (such as rural markets). In contrast, the disruptor (the president of PCA) sees these machines as being “deployed ubiquitously.”

They can’t both be right.

Why Insite Matters

insiteFor those who have not seen it there is a stunning piece on the 5th Estate about Insite – the Supervised Injection Site in the Downtown Eastside of Vancouver – where TV cameras are allowed inside the facility for the first time.

I wish I could embed the video in this blog post and walk you through it, but sadly the CBC doesn’t allow me to do this. To view the piece you have to go to the 5th Estate’s website.

The piece is long, so below I recommend some specifics point that touched me. You can scroll directly to them:

02:20 – A basic video walk through of Insite that explains, plainly how it works.

04:15 –  Interview with Darwin Fisher – the Insite intake manager – who shares with us the logic of Insite. In short, the facility connects some of the most marginalized citizens with society, giving us an opportunity to provide them with services, develop relationships, and keep the door open to the possibility of getting into detox programs.

09:58 – An interview with a user – David Brodrick – who talks about why he uses Insite and his desire to respect his community. Insite’s critics sometimes want us to forget these people are humans – living in our own backyard – this clip makes that impossible to do.

25:09 – A discussion about how the Federal Government is trying to shut Insite down and how four successive Vancouver Mayors – from across the political spectrum – are supportive, along with the community, local business and the BC Government (who funds it).

31:00 – It is hard not to be blunt here. But for those who don’t support Insite, are you prepared to tell this person, their friends, and their family, that you believe their addiction comes from a moral failing and that they should either go into detox right now, or die on the streets of Vancouver? Without Insite, this is essentially the choice we are putting before people like David. Insite is not the solution, but it is a step in the process that helps us address the problem.

My only critique of the piece is that it opens by stating Insite is experimental and controversial. This language that perpetuates a false story. Insite is no longer experimental. It is a piece of the healthcare system in Vancouver that is proven – in peer reviewed medical journals – to be an effective way to save lives. Moreover, it is proven, by a federal government report, to save taxpayers’ money. Finally, in Vancouver, Insite is not controversial. It enjoys overwhelming support, among business leaders, community groups, within conservative and liberal political parties and among the public at large. Insite – and harm reduction strategies – are about as controversial in the lower mainland as public transit. The debate isn’t about whether it should exist, but how we can do more of it.

If you are intersted in supporting Insite – consider visiting this website.

the misguided bottled water debate

The debate over bottled water continues… with those who dislike bottled water continuing to miss the point.

Just over a year ago I wrote this piece on why bottled water haters have it wrong. Today, anti-bottled water activists press on, trying to get municipalities to ban bottled water sales. This quote in the Globe and Mail by Joe Cressy, the Polaris Institute’s drinking-water campaign coordinator again shows the problematic thinking behind the campaign.

“(This) resolution is a resounding victory and the latest indication that bottled water’s 15 minutes are up and the tap is back.”

“In the same way that Coca-Cola doesn’t sell Pepsi in its buildings, we’re very pleased to see the FCM encouraging municipalities not to provide bottled water on city property.”

So three comments on this quote.

First, there are all sorts of other drinks that will continue to be sold on city properties: Coke, Orange Juice, Fruitopia all of which contain a lot more sugar and are generally less healthy for you than… water. Banning water may be seen as a victory, unless it means someone is going to buy something else, something that is less healthy and will increase health costs over the long term.

Second, the line about Coca-Cola not selling pepsi in their building reveals a lot about the flawed logic. Anti-bottle water activists will claim that people should be drinking tap water, not bottled water, because it is just as good. But this usually isn’t why people drink bottled water. People don’t just drink it for the flavour or safety (if they do at all) but because it is convenient. I always drink water from the tap if a restaurant provides me a glass, but what if I want to head out around town? Or am in my car? I’m now essentially being told I should make a less healthy choice – since I can’t buy water, I’ll have to buy pop or juice. Not everyone wants to, or will, carry around a water bottle everywhere they go and fill it up with tap water. Many (if not most) people simply prefer not to. If you try to force them, most will probably end up making a worse choice, like buying a Coke.

Finally, those opposed to bottled water are part of two distinct camps. The first are those who are opposed to someone charging for water under any circumstances. I’ve already noted that people aren’t buying the water, they are buying convenience. The second group of people are those who are concerned about the waste generated by bottled water. I am squarely in this camp – deeply concerned about the environmental impact of these containers. Here, however, we have lots of models that are less radical than an outright ban. Legislating, or simply encouraging, bottled water manufacturers to create a deposit system for their bottles would be a good first start. I suspect that if 100% of water bottles were recycled (as they should be) support for bottled water bans would dry up pretty fast.

Let’s hope a sensible solution for the challenge of bottled water waste emerges. One that doesn’t drive consumers to purchasing the diabetes-inducing sugar drinks that are the real competition.

Wedding Open Source to Government Service Delivery

One of the challenges I’m most interested in is how we can wed “open” systems to government hierarchies. In a lecture series I’ve developed for Health Canada I’ve developed a way of explaining how we do this already with our 911 service.

To begin, I like using 911 as an example because people are familiar and comfortable with it. More importantly, virtually everyone agrees that it is not only an essential piece of modern government service but also among the most effective.

What is interesting is that 911, unlike many government programs, relies on constant citizen input.  It is a system that has been architected to be participatory. Indeed it only works because it is participatory – without citizen input the system falls apart. Specifically, it aggregates, very effectively, the long-tail 0f knowledge within a community to deliver, with pin point accuracy, an essential service to the location it is needed at a time it is needed.

I’ve visualized in this slide below (explanation below the fold)

long tail public policy

Imagine the white curve represents all of the police, fire and ambulance interventions in a city. Many of the most critical interventions are ones the police force and ambulance service determine themselves (shaded blue). For example, the police are involved in an investigation that results in a big arrest, or the ambulance parks outside an Eagles reunion concert knowing that some of the boomers in attendance will be “over-served” and will suffer a heart attack.

However, while investigations and predictable events may account for some police/fire/ambulatory actions (and possibly those that receive the most press attention) the vast majority of arrests, fire fights and medical interventions result from plain old 911 calls made by ordinary citizens (shaded red). True, many of these are false alarms, or are resolved with minimal effort (a fire extinguisher deals with the problem, or minor amount of drugs are confiscated but no arrests made). But the sheer quantity of these calls means that while the average quality may be low, they still account for the bulk of successful (however defined) interventions. Viewed in this light 911 is a knowledge aggregator, collecting knowledge from citizens to determine where police cars, fire trucks and ambulances need to go.

Thus to find a system that leverages citizens knowledge and is architected for participation we don’t need to invent something new – there are existing systems, like 911, that we can learn from.

With this in mind, two important lessons about 911 leap out at me:

1) It is a self-interested system: While many 911 callers are concerned citizens calling about someone else I suspect the majority of calls – and the most accurate calls – are initiated by those directly or immediately impacted by a situation. People who have been robbed, are suffering from a heart attack, or who have a fire in their kitchen are highly incented to call 911. Consequently, the system leverages our self interest, although it also allows for good Samaritans to contribute as well.

2) It is narrowly focused in its construct: 911 doesn’t ask callers or permit callers to talk about the nature of justice, the history of fire, or the research evidence supporting a given medical condition. It seeks a very narrow set of data points: the nature of the problem and its location. This is helpful to both emergency response officials and citizens. It limits the quantity of data for the former and helps minimize the demands on the latter.

These, I believe, are the secret ingredients to citizen engagement of the future. A passive type of engagement that seeks specific, painless information/preferences/knoweldge from citizens to augment or redistribute services more effectively.

It isn’t sexy, but it works. Indeed we have 20 years of evidence showing us how well it works with regards to one of our most important services.

Fatness Index – Canada vs. United States

Yesterday I noticed that Richard Florida and Andrew Sullivan re-posted a map (created by calorielab) that color coded US states by the percentage of the population that was obese. I wondered if a similar map existed for Canada. Although there are several that highlight obesity – such as this one and this one – none are quite like this one. More importantly, none allowed for an easy and direct comparison between the two countries.

So I’ve taken the calorielab map, remade it, and extend it to all of North America by applying its criteria to Canadian provinces (and by using some Statistics Canada figures found here). The result is a “green armband” (of relative health) stretching across the continent.

Obese Map of NA 2

If Canadian provinces were ranked along side US States, they would rank 1st (BC), 2nd (QC), 3rd (ON), 4th (AB) and tied for 5th (MB) (YK) as the least obese provinces/states. Colorado would be the first American state placing 7th, with the provinces of NS in 8th and SK in 9th. PEI and NB would appear 15th and 16th and NFLD would appear 19th. NWT and NU would close out in 30th and 31st position. You can see the original chart at the bottom of this page.

Actually even some of the grimmer looking patches of Canada’s map have a silver lining. The Arctic Territories, specifically Nunavut (NU) and the North-West Territories (NWT), appear obese and thus unhealthy. However, Statistics Canada notes that obesity criterion for Inuit populations should be more relaxed since a high BMI does not appear to have the same health risk for Inuit as for non-Inuit. Interesting, eh?

And here is the original map I’m riffing off of…



Tory logic: Injection sites in Quebec = good, in BC = bad

So Yaffe’s Wednesday column (which I talked about yesterday) about how Insite would not be challenged by the conservative government if it were in Quebec has turned out to be sadly prescient.

Today, the Globe is reporting that Federal Conservative Health Minister Tony Clement is willing to consider Quebec’s request for an injeciton site even as he works to shut down the site in Vancouver. For a party that was supposed to let the west in, this is a complete outrage.

Health Minister Tony Clement says his government will not necessarily oppose safe-injection sites for illegal drugs in Quebec even though it will appeal a court decision allowing a similar facility in British Columbia…

…”I am obligated to consider each situation as a unique situation. That’s my obligation as the Minister of Health.”

Appalling. Apparently the local consensus reached in Vancouver about this approach means nothing to this government. Nor apparently, do the votes in Vancouverites. With this move it is hard to imagine the Conservatives winning any seats in Vancouver.

FireFox 3 Beta and other cool gadgets

If you aren’t technically inclined, but are interested in impressing your co-workers, consider downloading the recently released beta version of FireFox 3.

This is your chance to look cooler than everybody else in your cubicle farm… pimping out your computer with the latest in open-source coolware.

And since we are speaking of gadgets… Gayle D. recently gave me this very cool pedometer. As some of you know, I try to walk at least one direction to all my meetings. This little device isn’t radically radically changing my life… but it is keeping me aware of my decision to walk everywhere. More importantly it’s enabled me to both set a target of taking 10,000 steps and given me the capacity to measure my progress. This is definitely pushing me make better, healthier decisions.

I’d heard a while back that Ontario Health Promotion Minister Jim Watson pitched to Research in Motion the idea that Blackberry devices should have an integrated pedometer.

I thought was a fantastic idea. Obviously it hasn’t gone anywhere – and to be fair, these advanced pedometers would add to the size of any Blackberry device… but I hope RIM hasn’t dropped the idea altogether.

The Walking Strategy

As my friends are all too aware, I’ve adopted the “walking strategy” in my life. My rule is that, whenever in Vancouver, I must walk at least one direction to any meeting. Why?

Well here are 3 few reasons:

  • Having spent a decade away from Vancouver, I thought walking the city would help me get reacquainted with it (it has!)
  • After learning that you essentially burn as many calories walking a specific distance as running it, I thought this might enable me to maintain my love affair chocolate chip cookies and brownies
  • My job – which has me on the road a lot – has few demands of me when I’m in Vancouver, so I have the time

However, two other technologies really clinched it for me.

The first was the discovery of books on CD, or, more precisely, books on MP3. The number of lectures (such as those by Larry Lessig) and books (such as the beautifully narrated A Short History of Nearly Everything) that I’ve been able to devour through my shuffle has been astounding.

The second has been the mapping software made possible by Web 2.0 technologies. I use GMaps Pedometer to map out my routes (in part because I’m A-type) but more because, by knowing the distance I can gauge how long it will take me to walk to my destination. This ensures that I arrive (mostly) on time. Also, I can plan out the quietest routes (away from traffic) to ensure I can hear my lecture or book.

I’d also talk about the benefits of keeping one’s carbon emissions low, but with the amount of air travel I engage in, I cannot , at the moment, even begin to go down that road.

So, in short: It’s summer, and you have to try it.

All you nee is an ishuffle. Some books on MP3 and access to Gmaps.

The Fit City: Five Days, Five Ideas (part 2)

Had an interesting time at the Fit City/Fat City dialogue the other week. As a result of the event and suddenly realizing that it’s the 5 year anniversary of Building Up (the Canada25 report on cities) I thought I would dedicate this week’s posts to public policy ideas for creating healthy cities.

Idea #2: Listen while you walk: A health city is a walking city. A walking city is a quiet city.

I travel for work, so when I am in Vancouver I’ve resolved to walk at least one direction to all my meetings (in an effort to get reacquainted with the city and keep in shape). Like virtually everyone else under 35 years of age I see walking and taking the bus I take my iPod with me everywhere. I know some people listen to podcasts, others music and others lectures. My shuffle always have a book on tape loaded up (hey, if you’ve got an 8km walk ahead of you it’s a lot easier if your listening to something).

All this to say that walking in cities is a surprisingly noisy affair. Indeed, after pointing this out during the dialogue another participant came up to me and claimed that if the sidewalks of even a moderately busy street were a work zone, workplace regulations would require you wear earplugs. Now that’s fascinating. Whether you listen to an MP3 player or not it’s hard to imagine that walking is an appealing option when it is so loud it runs the risk of damaging your ears. What to do? We have demarked bike paths in the city, so why not walking paths? These paths, which could link high-traffic/high density neighbourhoods in the city, might be extra wide, better lit, traffic quietened, lined with cross-walks, and a balance between the shortest route and flattest route.

[tags]health, fitness, urban planning, health policy[/tags]

The Fit City: Five Days, Five Ideas (part 1)

Had an interesting time at the Fit City/Fat City dialogue the other week. Meant to blog on it sooner, but trips got in the way. However I’ve now had a week to reflect on the dialogue, and suddenly realizing that it’s the 5 year anniversary of Building Up (the Canada25 report on cities – can’t believe it’s been that long already) so I thought I would dedicate this week’s posts to public policy ideas for creating healthy cities.

Summary of the Fit City/Fat City Dialouge

Despite it’s title The Fit City/Fat City Dialogue was interesting, but didn’t feel much like a dialogue. It was more of a traditional public event with the panellists making presentations and the subsequent discussion essentially limited to a Q&A session.

Unfortunantely, rather than use the Q&A as an opportunity to develop ideas for advancing a fit city the panel fell into two traps. First, the panel kept dwelling on limited power of municipalities. True, cities don’t regulate food or manage healthcare, and their limited power of taxation constrain program delivery. But let us not underestimate the enormous influence they have on health issues. Indeed, given that municipal governments determine the physically environment in which citizens live, they probably control the single most important tool.

Secondly, the panel was dismissive of partial solutions. As Roland Guasparini, the Chief Medical Health Officer Fraser Health Authority stated: “What’s the point of designing a community that encourages walking when all it means is that people walk to the local store to buy a chocolate bar?” I couldn’t disagree more. Not only is this an opportunity for cities to lead, but the benefits of a walking community are significant no matter what its citizens eat. Yes, it would be nice if all three levels of government agreed to a single plan, but is it necessary? Moreover, the time consumed by such negotiations would be horrendous. In short, this problem can be addressed incrementally, knowing that we can’t solve the whole thing with a single policy doesn’t mean we shouldn’t act to solve some of it.

So, in the spirit of adding to the pool of ideas in support of a ‘healthy city’ here are my five policy suggestions in five days, one for each year of Building Up:

Idea #1: Physical Education: make it mandatory… and fun.

As this publication notes participation in physical education dropped from 70% to 60% in the province of Ontario. A trend that many Canadians believe is limited to the Unites States is indeed occurring here. Should we be surprised that an increasing number of young Canadians (not to mention Canadians generally) are becoming obese? Public Schools play a powerful role in instilling civic values and establishing behaviours. When we lower the expectations around physical education in our school we send a powerful message to all Canadians about the value we place on physical exercise.

Making PE mandatory feels like a good first step. But why not try some more creative ideas? Some American schools have been using the video game Dance Dance Revolution to encourage kids to get active (Norway even made it a national sport) and this blogger used his Wii game console to lose 2% of his body fat in 6 weeks. As Stephen Johnson notes in his book, video games can cultivate problem solving skills, if they can also help burn calories… why not?

[tags]health, fitness, urban planning, health policy[/tags]