How Walking Benefits Your Health and Longevity


Story at-a-glance

  • Inactivity is the fourth biggest killer of adults worldwide, responsible for 9 percent of premature deaths. Walking more, ideally daily, can go a long way toward reducing this risk
  • Walking for 20 to 25 minutes per day has been found to add anywhere from three to seven years to your life span. Smokers may also increase their life span by nearly four years by walking regularly
  • Walking can be tremendously beneficial for those struggling with chronic diseases such as obstructive pulmonary disease and cardiovascular disease
  • Walking has also been shown to lower your risk of Type 2 diabetes, depression, dementia, hormonal imbalances, arthritis, PMS, thyroid disorders, fatigue, varicose veins and constipation
  • British research suggests that when it comes to weight management, regular walking can be just as beneficial, or more, than working out in a gym

By Dr. Mercola

While a regimented fitness routine is certainly part of a healthy lifestyle, what you do outside the gym is equally important. Most adults spend 10 hours or more each day sitting, and research1,2 shows this level of inactivity cannot be counteracted with a workout at the end of the day. To maintain health, you really need mild but near-continuous movement throughout your waking hours.

One strategy that has been shown to have a positive impact is simply to stand up more. Increasing your daily walking is another key strategy that pays significant dividends, both short term and long term. According to the World Health Organization, inactivity is the fourth biggest killer of adults worldwide, responsible for 9 percent of premature deaths,3 and walking more could go a long way toward reducing this risk.

Walking Produces Beneficial Biochemical Changes in Your Body

The short video above reviews what happens in your body while walking. For starters, when you take your first few steps, your body releases chemicals that give your body a quick boost of energy. Once you get going, your heart rate will increase, from about 70 to about 100 beats per minute. This boost in blood flow will warm up your muscles. As you move, your body will also increase production of fluid in your joints, thereby reducing stiffness.

Walking for six to 10 minutes can raise your heartbeat to about 140 beats per minute and trigger your body to start burning up to six calories per minute. While your blood pressure will rise from the exertion, this increase is counteracted by chemicals that help expand your blood vessels, such as nitric oxide. This expansion in turn allows greater amounts of oxygen-rich blood to reach your muscles and organs, including your heart and brain. Over time, taking regular walks will help lower your blood pressure if it tends to be high.

Walking for 11 to 20 minutes results in an increase in body temperature and sweating as blood vessels closer to the surface of your skin expand to release heat. At this point, you start burning about seven calories per minute. The increase in heart rate also causes you to breathe deeper. Epinephrine (adrenaline) and glucagon also begin to rise at this point to boost muscle activity. Epinephrine helps relieve asthma and allergies, which helps explain why walking and other exercises tend to have a beneficial impact on these ailments.

At 21 to 45 minutes, you’ll start burning more fat, courtesy of a drop in insulin. This is also when you’ll start experiencing greater physical and mental relaxation as your brain starts to release “feel good” endorphins. Walking has also been shown to boost memory and creative problem-solving,4 so taking a walk when you’re puzzling over a problem may allow you to come up with better solutions. One Stanford University study found walking increased creative output by an average of 60 percent, compared to sitting still.5

After 30 to 45 minutes, you’re really oxygenating your whole body, burning more fat, strengthening your heart and cardiovascular system, and boosting your immune function. Provided you’re walking outdoors and the weather complies, an hour of sunshine will also help boost your mood and provide a number of beneficial health effects associated with vitamin D production.

Those struggling with depression would do well to get out of the concrete jungle and into nature, as nature walks have been found to be particularly beneficial for your mood by decreasing rumination — the obsessive mulling over negative experiences.

Walking Boosts Health and Longevity

Several studies have confirmed that walking boosts health and longevity. For example:

In one, walking for 20 to 25 minutes per day (140 to 175 minutes per week) was found to add anywhere from three to seven years to a person’s life span.6

Research7 published last year found that as little as two hours (120 minutes) of walking per week may reduce mortality risk in older adults, compared to inactivity. Meeting or exceeding the activity guidelines of 2.5 hours (150 minutes) of moderate activity per week in the form of walking lowered all-cause mortality by 20 percent.

Research published in 2012 found brisk walking improved life expectancy even in those who are overweight.8

Smokers may also increase their life span by nearly four years by engaging in physical activity9 such as walking. Former smokers who kept up their physical activity increased their life expectancy by 5.6 years on average, reducing their all-cause mortality risk by 43 percent.

Smokers who were physically active were also 55 percent more likely to quit smoking than those who remained inactive, and 43 percent less likely to relapse once they quit. A Norwegian study10 also showed that regular exercise is as important as quitting smoking if you want to reduce your mortality risk.

About 5,700 older men were followed for about 12 years in this study, and those who got 30 minutes of exercise — even if all they did was light walking — six days a week, reduced their risk of death by about 40 percent. Getting less than one hour of light activity per week had no effect on mortality in this study, highlighting the importance of getting the “dosage” right if you want to live longer.

Walking Is Good for Whatever Ails You

Other studies have shown walking can be tremendously beneficial for people struggling with chronic diseases such as obstructive pulmonary disease (COPD) and cardiovascular disease. In one, COPD patients who walked 2 miles a day or more cut their chances of hospitalization from a severe episode by about half.11,12

Another study13 found that daily walking reduced the risk of stroke in men over the age of 60. Walking for an hour or two each day cut a man’s stroke risk by as much as one-third, and it didn’t matter how fast or slow the pace was. Taking a three-hour long walk each day slashed the risk by two-thirds. Walking has also been shown to lower your risk of:14,15

Type 2 diabetes Depression and anxiety
Dementia and Alzheimer’s Arthritis
Hormonal imbalances PMS symptoms
Thyroid disorders Fatigue
Varicose veins Constipation

So, while walking might not seem like it would be “enough” to make a significant difference in your health, science disagrees. It makes sense that walking would be an important health aspect considering humans are designed for walking. And, in our historical past, before conveniences such as automobiles and even the horse and buggy, humans walked a lot. Every day.

Walkers Generally Weigh Less Than Other Exercisers

Research16 from the London School of Economics and Political Science suggests that when it comes to weight management, regular walking can be just as beneficial, or more, than working out in a gym. To reach this conclusion, the researchers assessed the effects of a number of different workouts, comparing health markers in more than 50,000 adults who were followed for 13 years. Activities were divided into:

  • Brisk walking
  • Moderate-intensity sports (examples: swimming, cycling, gym workouts, dancing, running, football, rugby, badminton, tennis and squash)
  • Heavy housework and/or walking with heavy shopping bags
  • Heavy manual work (examples: digging, felling trees, chopping wood, moving heavy loads)

The big surprise? People who regularly walked briskly for more than 30 minutes generally weighed less than those who hit the gym on a regular basis and/or exclusively did high-intensity workouts. According to the press release, these results were “particularly pronounced in women, people over 50 and those on low incomes.”17 According to the authors:

“Given the obesity epidemic and the fact that a large proportion of people … are inactive, recommending that people walk briskly more often is a cheap and easy policy option. Additionally, there is no monetary cost to walking so it is very likely that the benefits will outweigh the costs.

It has also been shown by the same authors that walking is associated with better physical and mental health. So, a simple policy that ‘every step counts’ may be a step toward curbing the upward trend in obesity rates and beneficial for other health conditions.”

Indeed, walking has been a longstanding recommendation to meet fitness guidelines, and the U.S. Centers for Disease Control, the American College of Sports Medicine and the American Heart Association have all recommended getting 30 minutes of brisk walking several days a week for general health and disease prevention.18,19

Walking Can Also Be a High-Intensity Exercise

While taking daily walks forms a great foundation upon which to build your health, research also shows that to really maximize health and longevity, higher intensity exercise is called for. Based on two large-scale studies20,21 the ideal amount of exercise to promote longevity is between 150 and 450 minutes of moderate exercise per week. During the 14-year follow up period, those who exercised for 150 minutes per week reduced their risk of death by 31 percent, compared to non-exercisers.

Those who exercised for 450 minutes lowered their risk of premature death by 39 percent. Above that, the benefit actually began to diminish. In terms of intensity, those who added bouts of strenuous activity each week also gained an extra boost in longevity. Those who spent 30 percent of their exercise time doing more strenuous activities gained an extra 13 percent reduction in early mortality, compared to those who exercised moderately all the time.

Besides doing high-intensity exercises on an elliptical, bike or treadmill, super-slow strength training is another excellent high-intensity exercise worth considering. That said, if you’re out of shape and/or overweight, the idea of high intensity interval training can seem too daunting to even attempt. The elderly may also shy away from high intensity exercises for fear of injury. My recommendation? Don’t allow such concerns to overwhelm you and prevent you from getting started.

Once you’re walking on a regular basis, you can easily turn this activity into a high-intensity exercise simply by intermittently picking up the pace. Japanese researchers, who developed a walking program designed specifically for the elderly, have shown that a combination of gentle strolling and fast walking provide greater fitness benefits than walking at a steady pace.22,23

The program they developed consists of repeated intervals of three minutes of fast walking followed by three minutes of slow strolling. Completing five sets of these intervals, totaling 30 minutes of walking, at least three times a week, led to significant improvements in aerobic fitness, leg strength and blood pressure.

Everyone Can Benefit From Walking More Each Day

As mentioned, walking can be an excellent entry into higher intensity training, regardless of your age and fitness level. Personally, I typically take an hourlong walk on the beach every day that I’m home. As you’ve probably heard by now, chronic sitting is the new smoking — it actually has a mortality rate similar to this toxic habit.24 It even raises your risk of lung cancer by over 50 percent. What’s worse, it raises your risk of disease and early death independently of your fitness and other healthy lifestyle habits.

According to Dr. James Levine, codirector of Obesity Solutions at Mayo Clinic in Phoenix and Arizona State University, you need at least 10 minutes of movement for every hour you sit down. I recommend limiting your sitting to less than three hours a day, and to make it a point to walk more every day. I suggest aiming for about 10,000 steps per day, over and above any other fitness routine you may have.

A fitness tracker can be a very helpful tool to monitor your progress and ensure you’re hitting your mark. Just be sure that you are using one that does not have Bluetooth enabled (the Oura ring and Apple Watch are the two that I know of that allow you to turn off the Bluetooth). Tracking your steps can also show you how simple and seemingly minor changes to the way you move around at work can add up. For example, you can:

  • Walk across the hall to talk to a co-worker instead of sending an email
  • Take the stairs instead of the elevator
  • Park your car further away from the entrance
  • Take a longer, roundabout way to your desk
  • Take a walk during your lunch hour (importantly, this habit has been shown to reduce work-related stress25).

Watch the video. URL:https://youtu.be/A7vk13pOn4s

It’s time for tech to put the human touch back into healthcare


I’m sick of hearing that “healthcare is broken.” Google broken health care system — you’ll get 97 million results.

Healthcare is not broken. That all-or-nothing characterization doesn’t work when we’re talking about such a complex industry. It overshadows the fact that we are living in a glorious time scientifically and experiencing a veritable renaissance in our understanding of the human body.

We discovered penicillin less than 100 years ago. That is literally a blip in the timescale of humanity. Much of what we consider to be modern medicine was born in the period since, including antibiotics that drove out infection as a top killer and vaccines that eradicated horrendous diseases like polio and smallpox. In the last 100 days alone, we’ve witnessed the first-ever FDA approval of gene therapy for an inherited disease.

These advancements have significantly elongated life expectancy; we live almost 40% longer today than we did 100 years ago. This progress has also paved the way for targeted, personalized medicine that we will all likely benefit from in our lifetimes. So no, healthcare is not broken. It is magnificent and awe-inspiring. Where we’re falling down is how we organize and deliver healthcare. It just isn’t keeping up with the complex care needs that come from people living longer and often with multiple chronic diseases.

As Zeke Emanuel and Ann Lamont recently noted, we’re past relying on policymakers to address the problems with delivering and financing care. Instead, startups are leading healthcare transformation by driving technology and innovation in the delivery system.

While high-tech medicine is speeding along, we’re experiencing an acute shortage of doctors, particularly primary care providers. Those we have are burning out because we make them click boxes all day and close medical records all night and weekend. It’s telling that more than half of physicians report feelings of burnout in survey after survey.

We have devalued the human touch at the center of delivering healthcare and forced people in the trenches of this work into horrendous workflows. So while patients should be able to turn to primary care to help them navigate care, there’s only so much that doctors can do with limited time, information, and enablement.

Technology can have an immensely positive impact in addressing these challenges. Consider, for example, that over 70 percent of people with depression turn to their primary care doctor for answers. The reality is that those providers often don’t identify underlying mental health issues, and even when they do, they don’t have the resources and support to get their patients the care they need.

By designing algorithms to recognize the characteristics of underlying mental health conditions, we can proactively recognize when patients could benefit from specialized care. We can also use sophisticated matching algorithms and modes of modern communication to connect those people to the treatment pathway most likely to work for them, all with the primary care physician at the center of their care.

The potential goes beyond improving mental health. Tech companies can, and should, build products to help those on the front lines: empowering providers with a full picture of patient health, seamlessly connecting primary care to specialist networks, and making efficient collaboration possible.

These are the things we know how to do well in the technology world. Unfortunately, much of the technology in the healthcare system to date was designed to meet the needs of administrators and bureaucrats rather than the end users. I’m confident if we refocus our efforts on the actual providers and teams delivering patient care, technology can be a catalyst in putting the caring back into healthcare.

Can Apple Take Healthcare Beyond the Fax Machine?


Despite spectacular advances in diagnostic imaging, non-invasive surgery, and gene editing, healthcare still faces a lackluster problem: many patients can only get health records from their doctor if the fax machine is working. Even when records are stored electronically, different chunks of every patient’s health information sit in the non-interoperable, inaccessible electronic record systems in different doctor’s offices.

Anyone who needs her medical files gets them either printed or faxed, or has to log on into separate portals for each doctor and hospital, and even then getting view-only access. View-only apps can’t access data to help patients share information with family and healthcare providers, make decisions, monitor disease, stay on course with medications, or just stay well.

On the positive side, this is changing, sort of. Using the iPhone Health app, patients will soon be able to download and view health records on their phones. On the one hand, don’t get too excited–it will initially only work for patients at a handful of institutions, Android users are still out in the cold, and the data available will be limited. And, some dismiss the impact of Apple’s move because of others’ failures to give patients control of their records.

However, Apple’s move is a decisive and consequential advance in patients’ struggle to get a copy of their own health data. Apple wisely chose to use open, non-proprietary approaches that will float all boats–even for Android users.

Every patient deserves a ‘bank account’ of her health data, under her control, with deposits made after every healthcare encounter. After my colleagues and I demonstrated an open, free version of a “bank account” to companies in 2006, Google and Microsoft launched similar personally controlled health records — GoogleHealth and Microsoft Healthvault. Walmart and other employers offered our version, Indivo, as an employee benefit. Unfortunately, even these industry giants couldn’t shake loose data from the proprietary computer systems in doctors’ offices, or make the case to patients that curating the data was worth the effort.

But 12 years later, Apple’s product enters healthcare under different circumstances.  A lot more patient data is electronic after a $48 billion federal investment in promoting the adoption of information technology to providers. But those products, mostly older software and purchased at enormous expense, still don’t promote record sharing with doctors or patients.

Recognizing this unacceptable limitation and having received a generous grant comprising a tiny fraction of that federal investment, our team created SMART on FHIR. SMART is an interface to make doctors’ electronic health records work like iPhones do. Apps can be added or deleted easily. The major electronic health record brands have built this interface into their products.

Apple uses SMART to connect the Health app to hospitals and doctors offices. The good news for patients, doctors, and innovators is that Apple chose a standardized, open connection over a proprietary, closed one. This approach lets any other app, whether running on the web,  iPhone, or Android, use that very same interface to connect.

So Apple will compete on value and customer satisfaction, rather than on an exclusive lock on the data. Does Apple’s approach help Americans trying to stay well or manage their conditions? Yes. But only with follow-through by Apple, health systems, technology companies, patient groups, policy makers, and government regulators. The emerging ecosystem’s nuances must be appreciated.

First of all, the floodgates for patient information are at least a crack open and will be very hard to close. As patients gain access to their data, they will recognize it is incomplete and feel frustrated it’s not available everywhere. But, patients in need will drive demand for data access in their role as health consumers.

Secondly, the government is effectively using law and regulations to compel an open interface. By selecting SMART on FHIR, Apple and its healthcare launch partners mark the importance of standardization. A uniform approach is critical for scale. Imagine if every electrical product required a differently shaped 120V outlet. Understanding this, Google, Quest Diagnostics, Eli Lily, Optum, and many other companies are using the same interface to plug into healthcare.

Thirdly, Apple’s first version of health records brings data onto the phone, but from there, like the portals many patients are already familiar with, the data are still “view-only.”  In 2009, I had the chance to meet with Apple’s rockstar Bud Tribble and talk about how the iPhone could serve healthcare. We concluded that crucial data–like the medication list–had to be as easy for iOS developers to use in their apps as contacts and location are now.  I would not be at all surprised if this is the next step in Apple’s journey–making the health records available to iPhone app developers. Here too is an opportunity to chose open interfaces, and to allow patients to export the data to another device.

Lastly, competition in healthcare IT is hot. Amazon, Google, Apple and Facebook all have healthcare divisions.  Apple’s extraordinary hardware, including sensors in the phone and watch, will monitor patients at home.  Google’s artificial intelligence will lead doctors and patients to diagnoses and decisions.  Amazon is rumored to be eying pharmacy management. Facebook has sifted through posts to detect and possibly intervene when users may be suicidal.

There are so many opportunities to compete. Locking up a patient’s data should never be one of them.

Ken Mandl, MD, MPH directs the Boston Children’s Hospital Computational Health Informatics Program and is the Harvard Medical School Donald A.B. Lindberg Professor of Pediatrics and Biomedical Informatics.

Is Healthcare a Right or an Entitlement? 


Some of you who have followed my posts over the past few years know that I am a cancer survivor. It’s been almost two years since I was very unexpectedly diagnosed with ovarian cancer. I have shared some of what it’s been like to suddenly find myself in the position of being a patient after spending a career caring for people who are sick, believing I wouldn’t find myself on the other side of this equation. I still struggle with the reality that I have had cancer and that I will have to monitor for it rearing it’s ugly head, for the rest of my life. What I haven’t shared is how the costs of healthcare contributed to my situation, delayed diagnosis and increased my chance for a recurrence. I am sharing it now because as I continue on this journey, I am starting to think the current system is discriminatory and I know it needs to change.

When I was diagnosed with ovarian cancer, I hadn’t been to my doctor for my yearly recommended examination for about 20 months. When I called to make my yearly appointment, I was told I had an outstanding bill I had been unaware of because I had moved and they didn’t have my new address. The bill was a result of “coinsurance” that was from a necessary and fairly routine procedure, still it was substantial enough that I had to set up payments over time because I couldn’t afford to pay it in full. I was told I could not see my doctor until there was a zero balance. I felt fine and had no concerns of any illness so I skipped my routine exam that year. Fast forward almost 2 years later when an unusually potent migraine resulted in a suggestion by my neurologist that I get my hormone levels checked. I contacted a new gynecology group because I couldn’t be seen by my regular ob/gyn because of the balance that still remained. On this routine exam, a very large mass was found on my ovary. So large that even though I was assured it was benign, it needed to be removed. During the surgery, the mass ruptured but the doctor told me not to worry because “It’s not cancer.” She told me the rupture was because it was so large that it made it difficult to remove. She called me about a week later to tell me it was in fact, cancer and the rupture, unfortunately complicated the staging and made recurrence more likely. The fact is, if I had gone to my regular appointment, it would have been discovered when it was much smaller and may not have ruptured. I am not blaming the doctor or the organization where I received care but, it wasn’t discovered because I owed the clinic money and they wouldn’t see me until the bill was paid. I don’t let myself think about that too much, but it’s the truth and it’s the way healthcare works in our current system.

The cost of just the surgery to remove the cancer was over $250,000. This included just one night in the hospital and no chemotherapy or radiation treatment. I had a good insurance plan but even with that, my responsibility was over $30,000. I can safely say most Americans would find it a challenge to add that expense to their yearly budget. The ongoing costs of testing for a possible recurrence are approximately $20,000 every year. That is on top of the nearly $10,000 I pay in premiums each year because I am self employed. I can’t afford this so I stretch out the time between scans and labs further than my doctor recommends.

In the back of my mind I know this could mean I don’t detect something as soon as I should again and that it can literally mean the difference between life or death.

I also know that if I owe a balance again at the hospital where I get my testing, they can refuse to treat me and I have been down that road before.

So as I write this, I find myself waiting again to find out if something discovered on a diagnostic test done almost 9 months after the doctor ordered it, is something that could take my life. Not only that, I brace myself for the cost of repeated imaging, biopsies and what may follow and I am angry, frustrated and of course, afraid. I know I am not alone and for many, it has been worse. I have worked in healthcare long enough to remember when people were denied insurance coverage because they had an illness like cancer or diabetes or a heart defect. I heard the desperation of new mothers who were grateful their precious newborn had received life saving heart surgery but had already reached their life time insurance maximum and had no idea how they would pay for the ongoing care their child needed to stay alive. The Affordable Care Act changed some of that, at least we aren’t denied coverage but it costs too much and patients can still be denied care if they owe a system money. So we constantly pray we don’t get sick again and try to find the right balance between what we can afford and what will keep us alive.

For those of you out there who say “Healthcare isn’t a right,” I tell you to save your breath unless you have faced a condition that could take your life or the life of someone you love.

To those of you who say patients should forego a smartphone or daily “fancy” coffee drink in order to pay for healthcare I say, what fantasy world do you live in where eliminating those things would make even a miniscule dent in the healthcare costs millions face?

You can also put aside the delusion that someone is sick because they did something wrong. I hate to break it to you but just because you exercise, eat healthy or have no family history of disease doesn’t mean you are magically immune to a life changing diagnosis. It can happen to anyone and I am walking proof of that reality. I ate right, exercised, never smoked, have no family history of cancer and like millions of others in this country I got sick anyway.

I find it especially ironic as I travel to other nations and collaborate with healthcare leaders to improve delivery of care to their citizens that I, a struggle to access the care I need in the United States of America. So I pose the following to ponder:

Should we get the same rights as prisoners?

Shouldn’t we at least get the same rights that criminals in this country get? The supreme court has held that those under government control must have “ Adequate food, clothing, shelter, and medical care as a component of the protections accorded by the Eighth Amendment and that “Deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain,’… proscribed by the Eighth amendment,” equating this pain with cruel and unusual punishment. Does “Cruel and unusual punishment” only apply to prisoners? It seems pretty cruel to make law abiding citizens suffer because they can’t afford medicine or treatment or to force them to choose between food or medical care.

Are we discriminated against if we are sick?

It used to be that healthcare provided through programs like Medicare, Medicaid and CHIP seemed sufficient to mitigate an accusation that there was discrimination based on a citizen’s ability to pay for adequate healthcare. Unfortunately, over time there has been an increasing group of Americans that don’t meet the criteria to receive these supplementary services but also can’t afford the cost of the healthcare available to them. I don’t consider myself poor but I can’t afford $30,000 a year or more for basic healthcare. Do I have the same rights to life and general welfare as anyone else? If treatment to save my life is available, should I be denied it because I don’t have the ability to pay? Did the founders of our country mean to make good health only available to the wealthy? It isn’t just what used to be considered the poor or elderly who can’t afford basic healthcare or medication anymore. Hard working people who have made contributions to their communities and are necessary to our countries security and growth can’t afford necessary care. This is a problem for all of us.

Where do we draw the line?

For those of you who continually argue that the government doesn’t pay for our car insurance or life insurance I will explain the difference. Driving a car isn’t necessary for survival, neither is providing an inheritance for your heirs. These things aren’t the same as access to professional healthcare services that prevent you from dying. Suggesting these things as examples of why healthcare isn’t a right, is a faulty argument and insulting to anyone who is sick. Our founding fathers and leaders were concerned for the health and welfare of our citizens. Franklin D. Roosevelt even tried to enact a “Second bill of rights” that included access to adequate medical care and the opportunity to enjoy good health. They couldn’t have imagined how costly healthcare would become as the model ushered in with the advent of health insurance, has progressed and costs have skyrocketed.  I am not even insisting the government cover the cost. Even making it affordable, meaning something I can pay for that doesn’t consume my entire grocery budget for a year is a good place to start. At the very least, insuring people with truly life threatening disease have an opportunity to take advantage of the treatment we can provide seems reasonable to me and maybe it’s time to make it an undeniable right of every American.

By

Michelle Chaffee

Republican aide says Donald Trump ‘didn’t care or particularly know about healthcare’


Claim comes after President admits ‘we learned a lot about loyalty’ in wake of repeal bill defeat

President Donald Trump “didn’t care or particularly know about health care” despite trying to push a major reform bill through Congress, a senior Republican aide has reportedly claimed.

Mr Trump and top House Republican Paul Ryan tasted defeat on Friday when they were forced to pull the bill, designed to replace Barack Obama’s flagship Affordable Care Act, because they could not get enough votes within their own party to pass it.

The President blamed Democrats for failing to support the plan, but the self-professed dealmaker also said: “We learned a lot about loyalty, we learned a lot about the vote-getting process.” He insisted “Obamacare will explode” eventually and that opposition politicians would see the light and work with him on a new plan.

Vice President Mike Pence and budget director Mick Mulvaney joined Mr Trump in aggressive lobbying for votes with members of the dissenting Republican Freedom Caucus faction, and the President had also tried to court moderates.

However, a Republican congressional aide told CNN: “He didn’t care or particularly know about health care. If you are going to be a great negotiator, you have to know about the subject matter.”

CNN also reported that during a meeting with moderate Republicans, when Pennsylvania congressman Charlie Dent said he did not support the repeal-and-replace bill, Mr Trump said: “Why am I even talking to you?”

In his meeting with the Freedom Caucus the President reportedly urged sceptical legislators to ignore the “little s***” of the policy detail and give him the support he needed.

Among the group’s objections was the “essential health benefits” clause of the bill.

It said that requiring insurance companies to cover a list of items—including, but not limited to, access to mental health services, substance abuse counselling, physical therapy, maternal care and paediatric care like vaccinations—would raise premiums.

The American Health Care Act, Mr Trump and Mr Ryan’s proposed plan, would have left 24 million people uninsured by 2026 according to an analysis by the Congressional Budget Office (CBO).

The CBO also said that while it would have saved the government money, people’s insurance premiums would have risen by between 15 and 20 per cent above the expected increase under Obamacare.

How the Brexit Decision Might Affect Healthcare


The world is reeling from the United Kingdom’s (UK) historic vote on Thursday to leave the European Union (EU). The ramifications will be felt in all aspects of life, from economic, to travel and immigration, to national security, and not the least, to health.

The future of the UK’s National Health Service (NHS) featured prominently in the run-up to yesterday’s referendum, and will figure prominently in the changes brought about by the decision.

 While the “Leave” camp claimed the cash that the UK currently gives to the central leadership of the EU in Brussels, Belgium could now be ploughed back into health services, the “Remain” camp warned that economic turmoil from the British Exit (Brexit) threatened the fragile finances of the NHS.

But the bell has been rung. Now that 51.9% of the UK’s citizens chose to get out of the EU, while 48.1% backed remaining part of the club of 28 nations, what might the impending exit mean for the future of health and social care in the UK?

Timing

Firstly, nothing significant is going to change today or tomorrow.

Soon after the result was declared, Prime Minister David Cameron announced he would stand down in the autumn, by which time another member of the conservative party will be chosen to be the new leader in the UK.

 It will be up to the next prime minister to decide when to pull the lever to leave the EU, known as Article 50 of the Lisbon Treaty, which would give the UK 2 years to negotiate withdrawal terms.

Will There Be More Cash for the NHS?

Supporters of Leave originally claimed that quitting the EU would give the UK an additional £350 million a week to spend on health and other public services.

 However, an analysis this month by the Institute for Fiscal Studies (IFS) disputed this figure, saying that after taking into account money received back from the EU, the UK’s net contribution was £150 million a week.

However, this takes no account of any financial turmoil that could hit government finances.

The IFS analysis predicted that Brexit will add an additional 2 years of austerity to the UK’s economy. Carl Emmerson, IFS deputy director and an author of the report, said: “the overwhelming weight of analysis suggests that the economy would shrink by more than enough to offset the positive effect on the public finances of the reduced financial contribution to the EU budget.”

Will Containing Immigration Cut NHS Costs?

Immigration and its effect on health and other public services was a key topic during the referendum campaign.

 A recent analysis by the Nuffield Trust estimated that in 2014, migration from the EU added £160 million in additional costs for the NHS across the UK.

However, it says this was a relatively small sum when set against the £1.4 billion in additional costs caused by other factors such as treating an ageing population and migrants from outside the EU.

The report also pointed out that immigrants are taxpayers as well as patients and that they could even be making a net contribution to available resources.

Will Health Insurance Cards Still Work in the EU?

British travellers to EU and European Economic Area (EEA) countries can carry a European Health Insurance Card (EHIC) giving them the right to access state-provided healthcare on temporary stays at a reduced cost or, in many cases, for free.

 But once the UK leaves the EU, and if it also left the EEA, British tourists and retirees abroad would have to cover health care costs from their own pockets or from travel insurance in these countries.

However, it is possible that the UK could negotiate specific agreements with EU and EEA countries for EHIC to remain valid.

What About the NHS Staff?

A total of 55,000 out of the 1.2 million staff in the NHS in England are citizens of other EU countries — equivalent to 5% of NHS workers.

That is close to the 4.7% of the UK population who were born in other EU countries.

According to the Nuffield Trust, 10% of physicians and 4% of nurses are from other EU countries.

The NHS’s most senior physician, Sir Bruce Keogh, MD, has called on NHS leaders to send out a message to European staff working in the health service that they are valued and welcome in the wake of the referendum result. Sir Bruce told the Health Service Journal: “It is really important we make them feel welcome.

“If you are a European doctor or nurse you might not feel too welcome at the moment.”

The British Medical Association (BMA) urged politicians not to play games with the UK’s health services. BMA council chief, Mark Porter, MD, said in a statement: “We stand together as one profession with our colleagues from Europe and across the world, with whom we live, work and study and on whom the NHS depends.”

What About Medical Research?

UK medical science has benefited from EU funding for decades.

In the wake of the result, several leading experts issued statements about what it could mean for research.

 Nobel Laureate Sir Paul Nurse, PhD, director of the Francis Crick Institute, said: “This is a poor outcome for British science and so is bad for Britain.

“Science thrives on the permeability of ideas and people, and flourishes in environments that pool intelligence, minimise barriers, and are open to free exchange and collaboration.

“British scientists will have to work hard in the future to counter the isolationism of BREXIT if our science is to continue to thrive.”

 Professor Anne Glover, PhD, vice-principal external affairs and dean for Europe at the University of Aberdeen, said: “I am personally heartbroken and I have great concern for the future of British science, engineering and technology.

“Our success in research and resulting impact relies heavily on our ability to be a full part of European Union science arrangements and it is hard to see how they can be maintained upon a Brexit.”

Could the Exit Affect Access to Medicines?

Leading figures from the life sciences industry recently expressed their fears that Brexit could jeopardise the UK’s central role in the European pharmaceutical industry and call into question the country’s access to innovative medicines.

 Following the result, Mike Thompson, the head of the Association of the British Pharmaceutical Industry (ABPI), said in a news releases that leaving the EU would create “immediate challenges for future investment, research and jobs in our industry in the UK.”

Meanwhile, the BioIndustry Association (BIA) said in a statement that “key questions about the regulation of medicine, access to the single market and talent, intellectual property and the precise nature of the future relationship of the UK are now upon us.”

Before the vote, the ABPI, BIA, and business leaders and organizations for the life-sciences industry, had signed a letter warning that the UK leaving the EU would put access to cutting-edge medicines at risk, according to the ABPI release.

 An early sign of the threat posed to the UK’s position came as the association representing Germany’s pharmaceutical industry, Beraten Analysieren Handeln, called for the European Medicines Agency (EMA), the UK’s equivalent to the US Food and Drug Administration, to be relocated from its central seat in London to Bonn, Germany following the UK’s departure from the EU.

Excerpt From ‘The Digital Doctor’.


An insider’s view of the digitization of healthcare delivery.

In retrospect, we were bound to be disappointed. Our daily experience has taught us that all we need to do is turn on our iPhone, download an app, and off we go — whether we’re buying a book, making a restaurant reservation, finding a favorite song, or getting directions to the nearest Starbucks. It was only natural for us to believe that wiring the healthcare system would be similarly straightforward. Perhaps if Apple had done it, it would have been.

But healthcare’s path to computerization has been strewn with land mines, large and small. Medicine, our most intimately human profession, is being dehumanized by the entry of the computer into the exam room. While computers are preventing many medical errors, they are also causing new kinds of mistakes, some of them whoppers. Sensors and monitors are throwing off mountains of data, often leading to more confusion than clarity. Patients are now in the loop — many of them get to see their laboratory and pathology results before their physician does; some are even reading their doctor’s notes — yet they remain woefully unprepared to handle their hard-fought empowerment.

While someday the computerization of medicine will surely be that long-awaited “disruptive innovation,” today it’s often just plain disruptive: of the doctor-patient relationship, of clinicians’ professional interactions and workflow, and of the way we measure and try to improve things. I’d never heard the term unanticipated consequences in my professional world until a few years ago, and now we use it all the time, since we — yes, even the insiders — are constantly astounded by the speed with which things are changing and the unpredictability of the results.

Before I go any further, it’s important that you understand that I am all for the wiring of healthcare. I bought my first computer in 1984, back when one inserted and ejected floppy disks so often (“Insert MacWrite Disk 2”) that the machine felt more like an infuriating toaster than a sparkling harbinger of a new era. Today, I can’t live without my MacBook Pro, iPad, iPhone, Facetime, Twitter, OpenTable, and Evernote. I even blog and Tweet. In other words, I am a typical electronically overendowed American.

And healthcare needs to be disrupted. Despite being staffed with (mostly) well-trained and committed doctors and nurses, our system delivers evidence-based care only about half the time, kills a jumbo jet’s worth of patients each day from medical mistakes, and is bankrupting the country. Patients and policymakers are no longer willing to tolerate the status quo, and they’re right not to.

For decades, healthcare’s immunity to computerization was remarkable; until recently, in many communities the high school was more wired than the local hospital. But over the past 5 years, tens of billions of dollars of federal incentive payments have helped increase the adoption of electronic health records by hospitals and doctors’ offices from about 10 percent to about 70 percent. When it comes to technology, we’ve been like a car stuck in a ditch whose spinning tires suddenly gain purchase, so accustomed to staying still that we were totally unprepared for that first lurch forward.

When I was a medical resident in the 1980s, my colleagues and I performed a daily ritual that we called “checking the shoe box.” All of our patients’ blood test results came back on flimsy slips that were left, in rough alphabetical order, in a shoe box on a small card table outside the clinical laboratory. This system, like so many others in medicine, was wildly error-prone. Moreover, all the things you’d want your physician to be able to do with laboratory results — trend them over time; communicate them to other doctors, patients, or families; be reminded to adjust doses of relevant medications — were pipe dreams. On our Maslow’s hierarchy of needs, just finding the right test result for the right patient was a small, sweet triumph. We didn’t dare hope for more.

For those of us whose formative years were spent rummaging through shoe boxes, how could we help but greet healthcare’s reluctant, subsidized entry into the computer age with unalloyed enthusiasm? Yet once we clinicians started using computers to actually deliver care, it dawned on us that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America’s leading hospitals (my own) give a teenager a 39-fold overdose of a common antibiotic, despite (scratch that — because of) a state-of-the-art computerized prescribing system? How could a recruiting ad for physicians tout the absence of an electronic medical record as a major selling point? Logically, we pinned the problems on clunky software, flawed implementations, muscle-bound regulations, and bad karma. It was all of those things, but it was also something far more complicated — and far more interesting.

As I struggled to answer these questions, I realized that I needed to write this book — first to explain all this to myself, and then to others.

What I’ve come to understand is that computers and medicine are awkward companions. Not to diminish the miracles that are Amazon.com, Google Maps, or the cockpit of an Airbus, but computerizing the healthcare system turns out to be a problem of a wholly different magnitude. The simple narrative of our age — that computers improve the performance of every industry they touch — turns out to have been magical thinking when it comes to healthcare. In our sliver of the world, we’re learning, computers make some things better, some things worse, and they change everything.

Harvard psychiatrist and leadership guru Ronald Heifetz has described two types of problems: technical and adaptive. Technical problems can be solved with new tools, new practices, and conventional leadership. Baking a cake is a technical problem: follow the recipe and the results are likely to be fine. Heifetz contrasts technical problems with adaptive ones: problems that require people themselves to change. In adaptive problems, he explains, the people are both the problem and the solution. Leadership, he once said, requires mobilizing and engaging people around a problem “rather than trying to anesthetize them so you can go on and solve it on your own.”

The wiring of healthcare has proven to be the Mother of All Adaptive Problems. Yet we’ve mistakenly treated it as a technical problem: simply buy the computer system, went the conventional wisdom, take off the shrink-wrap, and flip the switch. We were so oblivious to the need for adaptive change that when we were faced with failed installations, mangled workflows, and computer-generated mistakes, we usually misdiagnosed the problem; sometimes we even blamed the victims, both clinicians and patients. Of course, our prescription was wrong — that’s what always happens when you start with the wrong diagnosis.

Making this work matters. Talk of interoperability, federal incentives, bar coding, and machine learning can make it seem as if healthcare information technology is about, well, the technology. Of course it is. But from here on out, it is also about the way your baby is delivered; the way your cancer is treated; the way you are diagnosed with lupus or reassured that you aren’t having a heart attack; the way, when it comes down to whether you will live or die, you decide (and tell the medical system) that you do or you don’t want to be resuscitated. It is also about the way your insurance rates are calculated and the way you figure out whether your doctor is any good — and whether you need to see a doctor at all. Starting now and lasting until forever, your health and healthcare will be determined, to a remarkable and somewhat disquieting degree, by how well the technology works.

While this is a book about the challenges we’re facing at the dawn of healthcare’s digital age, if you’re looking for Dr. Luddite, you’ve come to the wrong place. Part of the reason we’re experiencing so much disappointment is that in the rest of our lives, information technology is so astonishing. I have no doubt that, even in medicine, our bungling adolescence will ultimately mature into a productive adulthood. We just have to make it through this stage without too much carnage.

Of course, if you picked up this book looking for breathless hyperbole, you won’t find that here, either. We are late to the digital carnival, but there are barkers everywhere telling us that this or that app will transform everything, that the answer to all of healthcare’s ills is being developed — even as we speak — by a soon-to-be billionaire twentysomething tinkering in a Cupertino garage. This narrative is seductive; some of it may even be real. But for now, despite some scattered rays of hope, the digital transformation of medicine remains more promise than reality. Lycra bike shorts that take our pulse, count our steps, and read our moods are pretty nifty, but they aren’t the change we need.

What you’ll find in these pages is an insider’s unvarnished view of the early days of healthcare’s transformation from analog to digital, with tales of modest wins as well as surprising obstacles. Notwithstanding the latter, the answer to what ails healthcare is not going to be found in romanticizing how wonderful things were when your doctor was Marcus Welby. We can — in fact, we must — wire the world of medicine, but we need to do it with our eyes open, building on our successes, learning from our mistakes, and mitigating the harms that are emerging.

To do so effectively, we need to recognize that computers in healthcare don’t simply replace my doctor’s scrawl with Helvetica 12. Instead, they transform the work, the people who do it, and their relationships with one another and with patients. Sorting out all these issues will take deep thought and hard work on the part of clinicians, healthcare leaders, policymakers, technology vendors, and patients. Sure, we should have thought of this sooner. But it’s not too late to get it right.

Xavier X-Ray Design by Danwei Ye.


Portable X-ray scanner

Medical staff are real heroes when they have to provide the necessary assistance to survivors, in disaster areas. The Xavier Portable X-Ray by Danwei Ye was designed to enable medical teams to perform even better care in harsh conditions. It is no secret that their performance is often affected by the limited access to useful devices, in problematic zones. X-ray machines are the perfect illustration of that. They are indeed so heavy that transporting them turns out to be a real ordeal. Add to this the fact that even the smallest ones require an expert to operate them…

The Xavier Portable X-Ray is unique in its kind: it is both compact and easy to transport. Laminographic scanning will enable any user to identify the location of a broken bone. No worries about facing a power outage disruption: a built-in rechargeable battery as well as a power generator are included to the genius system. These units can be activated to generate extra power, simply by pulling the handle they are connected to. The X-Ray device folds into a small rubber case for simplified transportation. Perfectly portable, unfoldable in seconds and convenient to operate. Heroes now have powerful tools to assist them in their mission!

Atomic Toolbox: Manufacturing at the Nanoscale .


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Scientists are building the next generation of atomic-scale devices

For decades industrial manufacturing has meant long assembly lines. This is how scores of workers—human or robot—have built really big things, such as automobiles and aircraft, or have brought to life smaller, more complex items, such as pharmaceuticals, computers and smartphones.

Now envision a future in which the assembly of digital processors and memory, energy generators, artificial tissue and medical devices takes place on a scale too small to be seen by the naked eye and under a new set of rules. The next few years begin an important era that will take us from manufactured products that simply containnanotechnology—sunscreen with UV-blocking bits of titanium dioxide, as well as particles for enhancing medical imaging, to name two—to products that arenanotechnology.

Source: scientific American

 

 

 

 

 

Understanding the Effect of Healthcare Workers’ Hand Hygiene.


Using a novel method, investigators revealed marked heterogeneity in healthcare worker interactions and in the potential consequences of their hand hygiene.

Attempts to understand disease transmission in healthcare settings have generally assumed that healthcare workers (HCWs) move and interact uniformly. However, observational studies have suggested the possibility of peripatetic “superspreaders” who have greater-than-average mobility and interactivity — and thus more opportunity to spread infection. In a recent study conducted in the medical intensive care unit of a university hospital, researchers assessed this possibility.

The researchers used small electronic badges worn by HCWs, together with fixed-position beacons, to determine patterns of HCW movement and interactions within this 20-bed unit. They then used these data to mathematically model the effect of HCW hand hygiene on pathogen transmission.

During the 48-hour period of analysis, the average number of contacts (HCW–HCW and HCW–patient) per HCW was 80.1 for day shifts and 76.1 for night shifts. However, a few HCWs were responsible for a disproportionately large share of the contacts. Modeling the effect of hand-hygiene activity on disease transmission showed that spread of a pathogen would be significantly greater with noncompliance of a few high-contact staff members than with noncompliance of an equal number of low-contact workers.

Comment: Hand hygiene is a central tenet of infection control, yet since the original work of Semmelweis, there has been relatively little research on the direct effects of hand-hygiene behavior on disease transmission. Hornbeck and colleagues have provided new insights into HCW contacts, which can help us to understand the role of hand hygiene in preventing nosocomial spread of pathogens and thus to develop more-sophisticated approaches for improving its efficacy.

Source: Journal Watch Infectious Diseases