Why doesn’t technology provide an economic payoff in healthcare?

Answers in a great post from Healthcare Renewal who have by far the most comprehensive views on technology implementations in health systems that I have come across.

“I do not think “political appeal” is a good justification for a multi-billion dollar cybernetic experiment in medicine, where the risks of the technology are considerable and where basic healthcare needs are not being well met among the poor and underprivileged.
Former ONC Chair David Brailer is quoted:
“People confuse information automation with creating the kind of work environment where productivity and creativity can flourish,” said Dr. David J. Brailer, who was the national health technology coordinator in the George W. Bush administration. “And so little has gone into changing work so far.”
Brailer was little better than Jha, and moves the goalposts with a type of circular logic.  He appears to be saying that technology that will revolutionize medicine can’t work until we change how things are done in medicine so the technology can revolutionize medicine.1
This may be why there is an increase in technology companies partnering with big pharma so that regulation can be skipped which means the several hundred year old issues of marketing a product with claims that cannot be clinically or scientifically proven will continue and there will not be an economic dividend other than short term benefits for the boards and senior members of those companies.
I covered this briefly and partly incoherently (according to my reviewer) in Computers, Code and Conflict.
This is not just systems, devices, apps – there are some obvious incredible benefits with development of radiotherapy, key hole surgery, robotic surgery in some cases etc
It’s the claims of the rest without scrutiny about their safety and efficacy. Advanced algorithms (now commonly called & hyped AI) and doctors/nurses vocation are not interchangeable. Do no harm is commonly used in scifi and technology literature but do no harm is at the core of the humans that are in clinical professions especially those in public services. They are not concepts that politicians and technology companies can understand  in the same way unless they have previously worked in those professions or partly in similar public services protecting public safety.

On a related note, The Politics of NHS Market Reforms

1. Silverstein S (2016)NY Times/Steve Lohr asks “Why the Economic Payoff From Technology Is So Elusive.” The answer in medicine is obvious, http://hcrenewal.blogspot.co.uk/2016/06/ny-timessteve-lohr-asks-why-economic.html

Royal Marsden & cancer therapies for children

The hospital I work in is always carrying out amazing research into care, treatment and prevention.

There are so many brave patients here especially the younger ones sometimes with terminal illnesses. The staff don’t give up either, working tirelessly to improve health and their care before, during and after.

A British Gem – Ken Loach releasing his films on youtube

The British film industry has a wonderful reputation for producing hard hitting dramas but so few can reach into the guts of humanity in the face of constant political upheaval with a consistent message about how we treat each other. His most recent film which he came out of retirement to produce once the Conservative party came into full government-  I, Daniel Blake has recently won the Palme D.Or at Cannes, portraying the practical, physical and mental struggles that someone in 2016 Britain faces when life throws constant challenges at them.

Up and down the country, you can hear people discussing Ken Loach films and how they have been touched by his devotion to filming real lives e.g. Kes is an outstanding and eye-opening story for British children to read who have not experienced the same background, beautifully filmed by Ken Loach and many stories for adults including Spirit of 45, Cathy Come Home.

A lovely, warm, passionate, talented man

Pharma & water sanitation eLearning projects on People’s University

I first heard of People’s University from a fantastic semi-retired doctor when we were marching down the length of the country over a 300 mile route in approx 3 weeks –  unlike me, he completed the full 300 miles albeit with some impressive blisters (I managed over 210 but due to commitments could not be there every day). We were raising awareness that our NHS was under threat of extinction and should be publicly funded, accountable and publicly delivered. Walking together over many miles provided many opportunities to talk about other stuff too.

I have recently reconnected with colleagues / ex colleagues from MHRA and decided to also link in ex colleagues who run an international centre of excellence in water sanitation. We have been talking about doing things like this for years but never got round to it.

People’s University is a nice home for the projects because they will complement their existing clinical and public health content. With all the changes in patient involvement in health, technology developments and resources supporting these – it’s an opportunity to links some of these together alongside the traditional drug/device R&D & regulatory affairs.

If anyone is interested in becoming involved, especially multi-lingual contributors please contact me on Skype nicola.avery, twitter @nicolaavery or via this blog. Everyone is contributing on a voluntary basis.

Outline ideally drafted by late September, possibly parallel development for both projects depending on scope.



Leaving the NHA Party

I am no longer a member. The party is unrecognisable from the one I joined a few years ago.

There are several reasons – including standing an NHA candidate against a brilliant health campaigner with claims that NHA would do much better. They didn’t and it had major resource implications for other candidate campaigns.

And the Clive situation was final straw.

I don’t have a political home at the moment, the actions of the Labour party and their refusal to be a credible opposition, with other so called left-leaning parties constant use of Marx, Lenin,Trotsky is really irritating.

Vile cowardly right wing thinking with pathetic greedy claims that markets are objective is not an option. As is still being shown -mass murderer Bliar and his team are still destroying public services without the Tories needing to do anything. The curse of Westminster and Oxbridge narrow thinking & academics who care only about their careers.


Essential part of any taekwondo training. Previous training included squats repetition at mid level with front kicks from mid level squat in between.

Will be returning to those in autumn bit recently doing low level squats with a longer hold (previous back/hip injuries) and have noticed slight flexibility change in hamstrings when done regularly.

This video is good

Interval Study on blood donation frequencies success

Well done to the NHS. In the UK currently less than 4% of the eligible population donate blood and that is likely to decrease with aging population. A large study (n=50k approx) of this kind is helpful not just in England but for other countries to analyse the results. This was only possible in a national health service where the demographics made it possible to get a large cohort with a consistent approach.

table of donation frequencies for men and women in Europe

“No one knows what the optimum interval between donations is, blood donation services in different countries have developed varying customs. In England, men are invited to donate every 12 weeks and women every 16 weeks. This is a relatively long interval compared to other European countries; the figure below shows inter-donation intervals for men and women across 14 European countries.Between June 2012 and June 2014, the INTERVAL study recruited about 25,000 men and about 25,000 women at NHS Blood and Transplant (NSHBT) blood donation centres across England” 1

During the study participants were asked to give blood either at usual donation intervals or more frequently. Men donated every 12, 10 or 8 weeks and women every 16, 14 or 12 weeks. The researchers are comparing the amount of blood donated and measures of well-being in people asked to give blood at standard intervals versus those asked to give blood more frequently.

It was incredibly easy to take part because they just did as part of the regular donation and it’s great for the researchers to provide a really useful outcome.

1. http://www.intervalstudy.org.uk/about-the-study/why-is-it-important/

Banning clean athletes is cruel especially vulnerable athletes

I’m currently in the middle of compiling a series of different blogs and articles which have made legitimate scientific, ethical criticism of WADA & McLaren report – some of which have made it into some mainstream media but not all.

The ethics of deciding to ban a Paralympic team based on that report with no further ‘evidence’ openly provided is appalling. How can someone who has had to fight & knows how hard it is to get sporting achievements be so blase about destroying clean athletes with a collective punishment.

It’s difficult enough in the UK – in certain sports at international level as the government has repeatedly cut funding for certain paralympic sports because it doesn’t fit their national policy. Over £35k needed and that doesn’t include any specific allowances for additional equipment or aids so that you can live a decent life. These allowances have also been repeatedly cut by the government in a relentless inhumane pattern of punishing vulnerable people so that they can reward elites.

Imagine in another country where living conditions are different too, how is not possible to work with another country to sort out infrastructure problems etc instead of making political statements that don’t do anything. As before re all the pointlessness of talking deterrents but not actually doing anything that is a deterrent. WADA lost that one years ago with it’s processes and allowances for some athletes & not others. There is no sensible message other than improving how things are done & if the agency or other sports organisations cannot achieve that by themselves, work with other regulators who can.

Out in the real world where people actually care about Russian health and don’t just talk about what it means for Putin (143million people and the media only talk about one), but what it might mean for clean paralympians in Russia who have made phenomenal efforts to get to compete on the international stage. What it means to their careers, their families who made sacrifices, their trainers and coaches who have encouraged them never to give up.

The only humane thing that can be done is to continue to fight back as an international community to ensure that these decisions can never be made again, to help other countries if we have something that may be of use or people who are useful to talk with, to get on and deal with issues quickly instead of stringing them out over multiple cycles. We owe it to all of us.



Aaron Cook – always a legend

Gutted today. Hope to see Aaron competing again soon. Fantastic fighter.

Martial Arts Summer Camp 2016

I visited over the weekend – it didn’t really get going until today but they are running tai chi, taekwondo, hapkido, aikido, kungfu, broadsword sessions as a minimum and whatever else anyone who turns up wants to do.

This video has terrible sound quality but did ad hoc with my phone. However it contains rare ‘footage’ of Master Mark Worsfold from whom I’ve learnt taekwondo and also has been teaching taichi for over 30 years. He has a background of teaching martial arts including many years in the Army and has worked in theatre so combines both very well. He was diagnosed with Parkinson’s a number of years ago but still makes it look effortless. A truly great martial artist.


Russia, part 2

Prior to finding out about the Olympics, I think I had a mostly positive but limited opinion about Russia. I read Cancer Ward by Alexander Solzhenitsyn which was very moving and I was equally deeply moved by a video of his Harvard speech and an interview.

I was born and lived in the 70s to give some context, I have also lived in Turkey and was married to a Turkish man at one point for a number of years. I have read very little about Russia over the years. I remember commenting on a martial arts blog about Steven Seagal and Vladimir Putin but that’s about it. One of my martial arts instructors has lived and taught in Poland.

I have seen some fantastic, beautiful photos of natural scenery in Russia and heard from people who have visited and loved the warmth of people, the hospitality and friendliness – their eyes light up & they smile when they talk about their experiences and planning future trips.

So as I’ve tried to find out more incl context of Eastern Europe & Central Asia I’m really shocked and outraged again at what I have been reading in articles and social media. The appalling #Russiaphobia would have seemed unbelievable previously but sadly Brexit has shown in the UK that if you allow zenophobic messages to be delivered in multiple channels and formats then people say & do increasingly aggressive actions.

I am trying to figure out on Twitter for example who are bots or not, with computational propoganda on the rise, I will no doubt make mistakes.

I have been learning the Cyrillic alphabet via a really good app- Read Russian in 3 hours which does exactly what it says on the tin (albeit quite a lot of fast food references) and I have found a recent Russian newspaper to try and delve into. Am not really up to reading tweets or short posts yet as have not done the fundamentals of the actual grammar but can recognise odd words.

I have read some books about Russia / EE / Central Asia, in the middle of another and attended a talk at Pushkin House following a duckduckgo search on ‘cultural events in London’. I am somewhere to forming an opinion about the ‘British establishment’ view of Russia but not ready to be coherent – other than those of similar backgrounds who visit or live briefly in Russia and meet people briefly will form certain kinds of opinions. That could apply anywhere too.

I will continue to fit in learning Russian so that I can read Russian perspective rather than English language views / versions of views. I am also part way through reading about Russian healthcare – more on that another time.

I recently took my twin niece & nephew to Greenwich and did a rather inadequate job of explaining lines such as Meridian, longitude, latitude and how people’s assumptions can be based on where a group of people gathered / shared ideas at a certain point in time. We also had fun with finding different types of music from different countries on youtube. We went to the Maritime museum where they can run over the giant map upstairs and see that America and Russia are really neighbours ‘across the pond’ which is the Bering Sea.

Why should their imaginations be limited by prejudice?





Russia, Olympics part1

I like others are furious at the treatment of Russian athletes before and during the Olympics. I first became aware of what was happening a couple of weeks before Brexit I think. As someone who helps coach young martial artists from time to time I am completely appalled at how the process has been handled. As principles – if you cheat it is an injustice to other athletes, if you call for/impose a punishment on clean atheletes it is an injustice. You cannot say to young people you can achieve anything you want if you train hard etc

It is good to see a Canadian starting to uncover more of the process and the report: https://marknesop.wordpress.com/2016/08/10/guilty-until-proven-guilty/

I have previously worked for a drug regulator (not in regulatory role but working in learning & development means you get to talk to different staff around the organisation) and have written some thoughts whilst I was blogless:

In short, technology is changing, drugs or other methods of substance delivery are changing, supply chains are changing and I don’t think a WADA can achieve what it is trying to do re enforcement and regulation. Whilst reading the report and other information about the sporting bodies – I am concerned about the lack of diversity of WADA, IAAF (headed by a British establishment Tory peer), IPC (headed by another Brit) executive & decision making representatives.

Political messages inflame expressions of hatred as evidenced by fans behaviour both on and offline at the Olympics. There is no point in putting Russia or other countries into some kind of political sin bin – it’s ridiculous – why not work with other regulators to actually put in place a realistic long-term deterrent if there is credible evidence but the hype and hastily assembled report makes assertions that it cannot back up (it looks like the author wants to dine out on it academically for a number of years). Russia can lead the way in anti-doping as an example to other countries.

I have been trying to follow bits of the Olympics and as a person interested in sporting achievements – whilst I support Britain (what a legend Mo Farah & others continue to be), it is brilliant to see clean Russian athletes great achievements – a lesson to all of us re indomitable spirit !