News Article | December 1, 2016
You may not know the name Dr. Patrick Soon-Shiong, but the White House certainly does. Earlier this year, Vice President Joe Biden tapped the billionaire surgeon and biotech entrepreneur to advise the Obama Administration's Cancer Moonshot program to develop genetically tailored cures for the diseases. On November 19, the man Biden described as a "brilliant, sometimes controversial guy" had dinner with two other controversial guys, President-elect Donald Trump and Vice President-elect Mike Pence. Of the meeting at Trump's New Jersey golf course, the transition team said in a statement that the trio discussed "innovation in the area of medicine and national medical priorities that need to be addressed in our country." Soon-Shiong (who donated $50,000 to Hillary Clinton's campaign effort, according to the FEC) thinks big, puts himself at the center of issues, and doesn't mind taking credit for things he isn't wholly responsible for (like the advancement of immune-based therapies). "I'm sort of this doctor with a complete scientific bent," Soon-Shiong told Fast Company in one of several conversations from the past few months. Though many experts have been working to harness the body's own immune system to fight off cancer, Soon-Shiong's name has been widely associated with the concept. "Maybe in my lifetime, we can maybe find a way to cure cancer," he says. The 64-year-old surgeon and entrepreneur has made a fortune and won praise for his health tech ventures, such as creating Abraxane, the targeted chemotherapy for breast cancer that made him a billionaire. (Forbes estimates his net worth at $9.8 billion.) But he's also drawn warnings from federal regulators, spurred lawsuits, and received a skeptical reaction from some peers in the medical community. While aiding the government's Cancer Moonshot program, Soon-Shiong also launched his own private-sector effort with the confusingly similar name Cancer MoonShot 2020. It's an outgrowth of his company NantWorks, a conglomerate of firms that aims to play a role in every aspect of cancer research and treatment, from genetic testing and analysis to chemotherapy development to hospital information systems to immunotherapies. He says that immune-system treatments might tackle catastrophic viral infections like Zika and Chikungunya, too. Instead of assaulting the patient's body with devastating blows of toxic chemicals or radiation, Soon-Shiong advocates coaxing its immune system to discretely attack just cancer cells—the way it does so effectively against invaders like viruses and harmful bacteria. This requires priming the immune system, like with a vaccine developed from the defective proteins in a patient's own tumors, what Soon-Shiong calls neoepitopes. "So it's like an infection," he says. "So think of . . . treating yourself for flu or treating yourself for strep throat." Cancer research has been heading in this direction for years, and Soon-Shiong is an eloquent advocate of the approach. In March, at the Future of Genomics conference in San Diego, cardiologist and geneticist Eric Topol interviewed Soon-Shiong in front of some of the world’s top genetics and cancer researchers after the billionaire’s keynote address. "Nobody could ever accuse you of not thinking big," Topol said. "You're basically this portal from challenging dogma to building hope." Like Trump, Soon-Shiong has made bold promises that beget skepticism. "These guys that make wild claims are inherently not to be trusted. We’re told in the scientific community that the data should speak for itself," says Dr. Ethan Weiss, a cardiologist and professor at the UCSF School of Medicine, when asked about Soon-Shiong's bold assertions. "He’s a hype merchant propping up a lucrative empire with almost no real substance," tweeted Daniel MacArthur, a genetics researcher at Massachusetts General Hospital, regarding Soon-Shiong's meeting with Trump. (MacArthur later deleted his Tweet, telling Fast Company over Twitter, "It was an ill-advised joke that was taken out of context—now deleted.") In 2014, a thorough profile of Soon-Shiong by Matthew Herper in Forbes surfaced a common complaint among medical experts: the doctor's penchant for pushing dramatic claims over details. He promised, for example, that in just 47 seconds, NantWorks' total health solution would be able to analyze a cancer patient's genetic makeup from a blood sample and recommend the specific protein to be targeted by medications. That was based on an average calculation for the efficiency of the entire computing system. The actual time Soon-Shiong was targeting for a real patient, Herper noted, would be about 24 hours—still very quick. "Which raises the question: Why the unnecessary, counterproductive hyperbole?" Herper wrote. "How easy it could have been to instead take a bow for the hardware and the high-speed data connections he has built." Legal controversies follow Soon-Shiong. He's been sued by employees and shareholders, with allegations of fraud; companies associated with him have been cited by the FDA for safety violations and making unsubstantiated medical claims. Soon-Shiong's ambitions are huge and his rhetoric sometimes gets him in trouble. But given the success he's already achieved, he’s not likely to change his approach anytime soon. Born in South Africa in 1952 to a healer who specialized in traditional Chinese herbal medicine, Soon-Shiong earned his medical degrees in Johannesburg and Vancouver. Shortly after joining UCLA Medical School in 1983, he directed the university’s pancreas transplant program and became famous for performing the first pancreas transplant on the West Coast. He's married to actress Michelle B. Chan (best known for her role in '80s series MacGyver), owns one of the largest homes in L.A., and purchased Magic Johnson's share of the L.A. Lakers. In May, he invested $70.5 million in Tribune Publishing, the newspaper group that owns the Los Angeles Times and the Chicago Tribune. The deal includes Soon-Shiong giving Tribune access to 100 technology patents that the doctor says will allow more interactive and immersive experiences for readers. Details remain vague. Soon-Shiong built his fortune by developing Abraxane, a reformulation of an existing chemotherapy treatment for breast cancer, paclitaxel (the generic form of Taxol). As explained in the original research paper, Soon-Shiong encapsulated paclitaxel in albumin, a common protein, making it more effective at penetrating the affected tissue. "When I launched Abraxane, they said Abraxane was just another Taxol generic," Soon-Shiong says of critics in the cancer field, adding that "they had no appreciation" for the mechanism it used to access cells. The commercial success of Abraxane helped make Soon-Shiong one of the richest people in his adopted hometown of Los Angeles. (Some estimates have him as the richest person.) Though he speaks about disease as a battle or war, Soon-Shiong criticizes the scorched-earth practice of traditional high-dose chemotherapy. "My job over the next five years is to break that," he says. Despite his claim to be leading the charge, the truth is, over the past decade, the oncology community as a whole has already been moving away from heavy-dose chemo and towards-immune system-based treatments. "Immunotherapy, after a long and difficult struggle over decades, has emerged as one of the most exciting developments in cancer in a long time," said Dr. Francis Collins, director of the National Institutes of Health in a briefing with reporters on the government's Cancer Moonshot back in January. The latest criticism of Soon-Shiong is that he has fed on the publicity associated with federal government anticancer work. On January 11, the morning before Barack Obama's final State of the Union Address in which the president announced the government's National Cancer Moonshot, Soon-Shiong held a webcast with a group of powerful allies in the medical world to announce the private sector-led Cancer MoonShot 2020. (A press release had gone out the day before.) "This is very much what we call a 'do tank,'" Soon-Shiong said. "It’s not a think tank." The initiative’s ambitious goal is to enroll 20,000 patients, covering 20 types of tumors, in clinical trials that lead to FDA-approved treatments by 2020—a blink of an eye in the slow, methodical world of medical research. Following the live webcast, Soon-Shiong released a multicam video of the event overlaid with inspirational background music. "The essence of the goal is to move something that would normally take five years, 10 years, 20 years, into a highly ambitious goal, having it done by 2020," Soon-Shiong says. But the timing of Soon-Shiong's announcement rankled some, leading to claims that he intentionally scooped the president of the United States. At the very least, didn't he create confusion between the two similarly named efforts? "I had no idea what they were going to announce at the State of the Union," he says. In reference to MoonShot 2020, he adds, "All of that was planned one year in advance. We initiated this in 2014." Soon-Shiong claims to have a close relationship with and to bear some influence on Vice President Biden, whom he first met while Biden was seeking advice for his son Beau during Beau's struggle with brain cancer. (He died in May 2015.) Soon-Shiong takes credit for introducing the "moonshot" concept to Biden months before the State of the Union address. And when he talks about this transaction, he is very specific about the details. "By October, I gave [Biden] a white paper that talked about the moonshot," he told the audience in San Diego. "By November, he visited us, and by December, he invited me to present this entire program." The presentation took place on December 1, 2015, at Biden's residence at the U.S. Naval Observatory; Soon-Shiong invited many people who would become members of his private MoonShot 2020, including Independence Health Group CEO Dan Hilferty and Columbia University researcher Dr. Azra Raza. Some supporters of MoonShot 2020 come from universities and research centers. Staff from government institutes such as Walter Reed Medical Center and the National Cancer Institute (NCI) have also attended meetings or released statements of support—but they did so strictly as individuals, not as official representatives of their respective institutions. "We're looking for people doing the work. This is not about a name thing," Soon-Shiong says. Still, according to the industry newsletter The Cancer Letter, government officials asked Soon-Shiong to take all mentions of federal agencies off the press release announcing his initiative. The creation of Abraxane is the central element of Soon-Shiong's origin story: It provided the personal vindication and wherewithal for the doctor to build his anticancer empire and shoot for the moon. The FDA's approval of Abraxane in 2005 allowed Soon-Shiong to fund a complex multibillion-dollar web of companies under the umbrella group NantWorks that target the entire cancer-care life cycle—including computing and artificial intelligence used to collect and analyze medical data. NantWorks also branches into other areas, like managing patient electronic health records. NantWorks even owns a sound studio near its headquarters in Culver City, where neighbors include Sony Pictures. According to the company website: Even the company name is multifaceted and hard to pin down. "'Nant' is nantan, which is the Native American that speaks for the people," Soon-Shiong explains. "'Nant' could be nanotechnology, 'Nant' could be neural network. 'Nant' is new approaches to neoepitope therapy." The goal is to make Nant the "Bell Labs of health care," he says, referencing the great research institution founded by AT&T in 1925 and now part of Alcatel-Lucent. The NantWorks accounting is complex, with money moving back and forth between entities. For instance, In 2010, Soon-Shiong sold Abraxis BioScience (the maker of Abraxane) for $2.9 billion to Celgene. (Soon-Shiong was the largest individual shareholder in both companies, according to Forbes.) Then in 2014, Celgene put money back into NantWorks by investing $25 million in NantHealth and $75 million in NantBioScience, a Soon-Shiong company developing more chemotherapies. Health care IT company Allscripts purchased a 10% equity stake in NantHealth for $200 million in cash, while Soon-Shiong invested $100 million in Allscripts. (Meanwhile, a Celgene lobbyist is reportedly on Trump's transition team.) One of NantHealth's projects is GPS Cancer, a reading of a patient's genome (DNA), transcriptome (RNA), and proteome (proteins) to develop targeted treatments for specific tumors. "So it's like a target, right?" he says. "GPS-ing your cancer." That's expensive, up to $50,000 per patient, but according to Soon-Shiong, in the long run, it's a cheaper treatment if the technique can someday cure the patient's cancer, when more advanced chemo- and immunotherapies become available. Independence Blue Cross was the first health insurance provider to cover GPS Cancer, which Soon-Shiong says was the trigger for formally launching MoonShot 2020. (Other insurance carriers have since come aboard, such as South Dakota-based Sanford Health Plan.) There are links between these entities: An affiliate of Independence was a minority owner of NaviNet, which provides a portal linking physicians and insurance providers. NantHealth purchased NaviNet in January. As if dominating cancer care weren't ambitious enough, NantHealth also aims to transform electronic health record keeping with software that collects and consolidates data from hospital devices like vital signs monitors and dialysis machines. Another offering gathers data from blood pressure cuffs and other home-care machines. The company promises that another product, NantOS, "will bring together the clinical, financial, operational, and environmental data to identify and solve complex health care problems such as quality, cost, and outcomes at a health system level, hospital level, service line level, physician level, and the patient level." NantHealth went public in June of this year for a valuation of about $1.5 billion. In July, Soon-Shiong's NantKwest, which is dedicated to activating the immune system's "natural killer" cells to fight cancer, had a public offering valued at $2.6 billion. In an interview with Bloomberg, Soon-Shiong said that he had two more IPOs in the pipeline for other companies in the Nant umbrella: NantBioscience and diagnostic company NantOmics. Soon-Shiong's recent IPOs provide a glimpse into the discord that follows him and his businesses. The Securities and Exchange Commission filing for NantHealth made quick mention of a whistleblower lawsuit. Two fired executives, Stephanie Davidson and William Lynch, filed a wrongful termination suit alleging that they were let go for calling attention to shortcomings and fraudulent activities, including the violation of health privacy requirements. Fast Company's calls to their attorney, Mitchel L. Feldman, have not been returned. Meanwhile, NantKwest was hit in June with a class-action lawsuit from investors. Plaintiffs say the company made false and misleading financial statements, in part due to high stock-based awards given to Soon-Shiong. In July 2015, NantHealth parted ways with its first customer, Providence Health and Services, where Soon-Shiong also served as global director of cancer services and bioinformatics. In an announcement, he said the 27-hospital system’s leadership "is not ready to blur science and clinical practice." Controversies are nothing new for Soon-Shiong, and they haven't slowed him down. In 2006, he received a warning letter from the FDA that called out "significant" deficiencies at the Abraxis Bioscience manufacturing facility in Illinois that led to microbiological contamination. The letter also chastised Soon-Shiong's slow response to remedy the problem. None of this seems to have hurt his lucrative 2010 sale of Abraxis to Celgene, after which controversy continued. In 2011, the FDA cautioned Celgene against making several unsubstantiated claims about Abraxane at an oncology conference. These included the assertion that Abraxane could treat other forms of cancer, such as non-small-cell lung cancer, for which it had not yet been approved. In 2012, the FDA did approve Abraxane for lung cancer treatment, vindicating the company's optimistic claims. (It also won approval for pancreatic cancer in 2013.) Abraxane could be a metaphor to describe Soon-Shiong's unconventional, sometimes confrontational, approach to both medicine and business. The doctor gives off a whiff of impatience with the world around him. Critics didn't understand the Abraxane breakthrough, he says, but they were proved wrong. Celgene started to brag about new uses of Abraxane before it had all the evidence in place, but ultimately, the FDA came around. Likewise, employees and shareholders have faulted Soon-Shiong's recent startups, but he's propelled the companies to multibillion-dollar valuations. There are parallels with the president-elect, who was continually underestimated over the past 18 months, right up to election night. Now it's time to see if each man can deliver the results he has promised.
News Article | December 14, 2016
St. Louis, MO, December 14, 2016 --( “MaryBeth is uniquely qualified to help hospitals and health systems define the organizational structure and leadership roles required for successful clinical integration of physicians and medical groups, which has become essential to meeting newer healthcare reform standards,” said Paul Esselman, Cejka Executive Search senior executive vice president and managing director. For nearly two decades, Cruz served in leadership roles for Providence Health and Services, spearheading physician services and development at the system-level and designing and overseeing talent acquisition operations responsible for hiring healthcare leaders, physicians and other clinicians. Her leadership experience from within a large, diversified medical system allows her to skillfully guide healthcare organizations on identifying the right leadership talent, physician engagement structure and incentives to advance business objectives in an evolving healthcare organization structure. Cruz is a member of the Medical Group Management Association (MGMA) and the Association of Staff Physician Recruiters (ASPR). Since 2012, she has served on the Board of Trustees for Trillium Family Services, a not-for-profit organization, supporting the mental and behavioral health of children and teens in Oregon. About Cejka Executive Search Cejka Executive Search, http://www.cejkaexecutivesearch.com, is a nationally recognized executive and physician search organization providing services exclusively to the health care industry for more than 35 years. Partnering with our client organizations to identify and present the best talent, Cejka Executive Search completes assignments across all levels of the health care continuum and is a market leader in providing flexible, innovative search and leadership development services. Cejka Executive Search is a part of Cross Country Healthcare, Inc., a leading provider of health care staffing services in the United States. St. Louis, MO, December 14, 2016 --( PR.com )-- Cejka Executive Search today announced that MaryBeth Nicholas Cruz has joined the team as executive vice president and managing principal. The announcement underscores the firm’s continued expansion into high-demand areas of healthcare executive search, including clinical integration.“MaryBeth is uniquely qualified to help hospitals and health systems define the organizational structure and leadership roles required for successful clinical integration of physicians and medical groups, which has become essential to meeting newer healthcare reform standards,” said Paul Esselman, Cejka Executive Search senior executive vice president and managing director.For nearly two decades, Cruz served in leadership roles for Providence Health and Services, spearheading physician services and development at the system-level and designing and overseeing talent acquisition operations responsible for hiring healthcare leaders, physicians and other clinicians.Her leadership experience from within a large, diversified medical system allows her to skillfully guide healthcare organizations on identifying the right leadership talent, physician engagement structure and incentives to advance business objectives in an evolving healthcare organization structure.Cruz is a member of the Medical Group Management Association (MGMA) and the Association of Staff Physician Recruiters (ASPR). Since 2012, she has served on the Board of Trustees for Trillium Family Services, a not-for-profit organization, supporting the mental and behavioral health of children and teens in Oregon.About Cejka Executive SearchCejka Executive Search, http://www.cejkaexecutivesearch.com, is a nationally recognized executive and physician search organization providing services exclusively to the health care industry for more than 35 years. Partnering with our client organizations to identify and present the best talent, Cejka Executive Search completes assignments across all levels of the health care continuum and is a market leader in providing flexible, innovative search and leadership development services. Cejka Executive Search is a part of Cross Country Healthcare, Inc., a leading provider of health care staffing services in the United States. Click here to view the list of recent Press Releases from Cejka Executive Search
Fonda Allen J.,George Washington University |
Stoll K.,Genetic Support Foundation |
Stoll K.,Providence Health and Services |
Bernhardt B.A.,University of Pennsylvania
Seminars in Perinatology | Year: 2016
Genetic carrier screening, prenatal screening for aneuploidy, and prenatal diagnostic testing have expanded dramatically over the past 2 decades. Driven in part by powerful market forces, new complex testing modalities have become available after limited clinical research. The responsibility for offering these tests lies primarily on the obstetrical care provider and has become more burdensome as the number of testing options expands. Genetic testing in pregnancy is optional, and decisions about undergoing tests, as well as follow-up testing, should be informed and based on individual patients' values and needs. Careful pre- and post-test counseling is central to supporting informed decision-making. This article explores three areas of technical expansion in genetic testing: expanded carrier screening, non-invasive prenatal screening for fetal aneuploidies using cell-free DNA, and diagnostic testing using fetal chromosomal microarray testing, and provides insights aimed at enabling the obstetrical practitioner to better support patients considering these tests. © 2016 Elsevier Inc.
Crawford J.D.,Oregon Health And Science University |
Ansteth M.,Legacy Cancer Institute Portland |
Barnett J.,Providence Health and Services |
Glissmeyer M.,Legacy Cancer Institute Portland |
Johnson N.G.,Legacy Cancer Institute Portland
American Journal of Surgery | Year: 2013
Background: The current practice of completion axillary lymph node dissection (ALND) for patients with a positive sentinel lymph node (SLN) is being questioned. This led us to examine the outcomes of patients with positive SLNs undergoing mastectomy who underwent ALND compared with those who did not. Methods: A retrospective review of cancer registry data identified 561 women with stages 1 to 3 breast cancer with positive SLNs who underwent mastectomy between 2000 and 2010. Four hundred twenty-six women underwent formal ALND and 135 were managed expectantly. Recurrence-free survival was defined as no locoregional or distant metastases. Results: Mean time to recurrence was 29.9 months. Mean follow-up for patients without recurrence was 40.3 months. Survival curves showed no significant difference in recurrence-free survival between the 2 groups (P =.23). Conclusions: In our experience, there is no significant difference in recurrence-free survival in patients with positive SLNs undergoing mastectomy when completion ALND was not performed, suggesting that a closer look at the indications for ALND in early breast cancer be further explored. © 2013 Elsevier Inc. All rights reserved.
Koster J.,Providence Health and Services |
Stewart E.,Seattle Childrens Research Institute |
Kolker E.,Seattle Childrens Research Institute |
Kolker E.,Seattle Childrens Hospital |
And 2 more authors.
Academic Medicine | Year: 2016
Today's consumers purchasing any product or service are armed with information and have high expectations. They expect service providers and payers to know about their unique needs. Data-driven decisions can help organizations meet those expectations and fulfill those needs. Health care, however, is not strictly a retail relationship-the sacred trust between patient and doctor, the clinician-patient relationship, must be preserved. The opportunities and challenges created by the digitization of health care are at the crux of the most crucial strategic decisions for academic medicine. A transformational vision grounded in data and analytics must guide health care decisions and actions. In this Commentary, the authors describe three examples of the transformational force of data and analytics to improve health care in order to focus attention on academic medicine's vital role in guiding the needed changes. Copyright © by the Association of American Medical Colleges.
News Article | November 29, 2016
Healthcare IT Leaders, a national IT consulting and recruitment firm for leading healthcare employers, today announced the hire of Vicki Davis as Vice President for Training and Activation. In this role, Davis will help hospitals prepare and train their end-users for EMR activation, adoption and long-term success. Davis comes to Healthcare IT Leaders with 20+ years of healthcare and project management experience, including recent leadership positions at Stanford Health Care as the IT Program Director for Epic Beaker, and Providence Health and Services, where she was Senior Director, Epic Training and Deployment. She has led large-scale training and delivery teams and has overseen classroom-based and online learning programs for tens of thousands of end-users over the past decade. At Healthcare IT Leaders she will head up the company’s EMR Training and Activation practice offering the capability to deploy large-scale Go-Live and Support teams. “Vicki has played a key role in EMR implementation and training programs at some the nation’s most respected health systems. Her depth of knowledge in training and activation makes her a valuable resource for our customers who seek scalable solutions for EMR adoption and long-term success,” said Bob Bailey, Managing Principal. “Mergers and large distributed workforces require hospitals to adopt creative training and support strategies for EMR implementations and upgrades,” said Davis. “I look forward to offering our clients industry best practices combined with innovative learning tools to help them achieve their training and activation goals.” About Us Healthcare IT Leaders is a national leader in IT workforce solutions, connecting healthcare provider and payer organizations with experienced technology talent for consulting and full-time hiring. Areas of focus include EMR, ERP, CRM, and testing. Based in Greater Atlanta, our company is the fastest growing IT staffing company in the U.S., according to Staffing Industry Associates (2016) and has twice-ranked on the Inc. 5000 (2016, 2015). We have also been named a Best Place to Work by the Atlanta Business Chronicle and Staffing Industry Associates. Learn more at http://www.healthcareitleaders.com.
Pickette S.G.,Providence Health and Services |
Muncey L.,Providence Sacred Heart Childrens Hospital |
Wham D.,Saint Patrick Hospital
American Journal of Health-System Pharmacy | Year: 2010
Purpose. The implementation of a standard pharmacy clinical practice model in a multihospital health system is described. Summary. An initiative to enhance the quality and scope of pharmacy clinical practices by transitioning from a pharmacy practice model focused on order entry and distributive functions to a patient-centered model focused on drug therapy management and documentation was begun within the Providence Health and Services System. After demonstrating favorable results during pilot testing in the system's largest hospital, the pharmacy practice model was implemented at two facilities, which took approximately six months. A documentation program was implemented at each hospital to provide a baseline for measuring the impact of changes in practice and to standardize clinical activity at each hospital. Changes implemented in the distribution process at the two facilities freed up as much pharmacist time as possible. These changes included the optimization of technology, automated dispensing cabinets, order-image scanner technology, and an automated telephone tree to route distribution-related calls to a technician. At both hospitals, the number of interventions documented by the pharmacists increased from 2005 (before implementation) to 2008. The associated cost avoidance also increased, and the daily supply expense per case-mix-adjusted patient day decreased during this time. Based on the positive data from these facilities, wide distribution of this clinical practice model is being adopted. Conclusion. The implementation in a multihospital system of a patient-centered clinical practice model was achieved through a well-coordinated effort that included gaining support of hospital administration by demonstrating the impact of clinical pharmacy services on patient care and hospital finances. Copyright © 2010, American Society of Health-System Pharmacists, Inc. All rights reserved.
News Article | March 16, 2016
Autumn leaves crunch underfoot as I stroll down a path in Rock Creek Park, an urban woodland in Washington DC. I take a deep breath and feel my mood lift. Driving through the busy urban streets to reach the park, I had been worrying about work and what I was going to cook for my family for dinner that evening. Urban green spaces have value beyond their beauty and environmental importance. Nature improves mental health — people are less depressed when they have better access to green spaces. The beneficial effect is not just a matter of physical exercise, although that is part of the picture. There is something about natural environments that improves people's well-being, says Richard Mitchell, an epidemiologist at Glasgow University, UK. Put simply, being in nature feels good. Researchers and policymakers are increasingly interested in the link between green spaces and mood because of the implications it could have for preventing and treating mental-health problems in society, says Hannah Cohen-Cline, a researcher at Providence Health and Services in Portland, Oregon. Spending time outdoors in natural environments not only improves people's mental health, but it could also help to reduce health inequalities between the rich and the poor. “Being around nature makes people feel better mentally. This has important policy implications,” says Cohen-Cline. Poor mental health is one of the biggest public-health problems in Western nations. For instance, the Organisation for Economic Co-operation and Development calculates that mental-health conditions such as depression cost the United Kingdom £70 billion (US$100 billion) annually in health-care spending and lost productivity. And the epicentre of these problems is cities: a 2010 meta-analysis showed that urban dwellers are roughly 20% more likely to develop anxiety disorders than their rural counterparts, and nearly 40% more likely to develop mood disorders1. Improving access to green space — such as parks or gardens incorporated into housing developments — in cities could help to cut urban stress, improve city dwellers' mental health and reduce the strain on health-care systems. But until recently, most studies that showed a link between green space and mental health were small, short term and involved groups of similar people, such as students. “These studies have major limitations,” says Mathew White, a social and environmental psychologist at the University of Exeter, UK. It's not clear whether the results are applicable to wider populations or that the beneficial effects persist over time, he says. This is problematic for policymakers who want to see the benefits before investing in health and social interventions. Scientists are working to tackle these limitations and strengthen the evidence base. White and his colleagues were the first to study changes in mental health over several years as people moved within urban settings. They found that when people moved to areas with more green space, including tree-lined streets, private gardens and public parks, they were happier for at least three years after their move, and that this feeling of contentment grew over time2. The research ranked movers' well-being using the short-form General Health Questionnaire (GHQ; a standard clinical tool for measuring anxiety and depression on a scale of 0 to 12). White used an inverse of the GHQ scale so that higher scores represented better mental health. The findings showed that when people moved to areas with more green space, their average GHQ score rose from 9.8 two years before their move to 10.1 three years after their move. The durability of the happiness effect surprised White. He expected the boost to be short-lived because “people adapt to things quickly.” Winning the lottery, for instance, typically makes people happier for up to one year, he says. The benefits of moving to greener areas may last even longer than 3 years (the team only looked at 5 years of data in total) — White is planning a larger study to find out. White acknowledges that, despite lasting longer than expected, the benefits to mental health seem small. Moving to a greener area is only around one-tenth as important for people's happiness as becoming employed, and has one-third of the impact that marriage does, he says. But, White points out, green space has a greater effect on happiness than low crime rate, which is often cited as a key determinant of well-being. And if the small effect of a green space is multiplied by the thousands of people who use it, that adds up to “a large public-health impact,” he says. Until recently, most studies had been unable to control for the genetic variation that sees some people respond more positively to green space, so it has been difficult to definitively say whether the benefits are due to the green space or to a person's genetic makeup. But Cohen-Cline has unpicked the drivers of mental health using twins. Because twins share at least half of their genes, and those who took part in the study were raised in the same environment, the researchers were able to control both the genetic and environmental factors3. “This is important because we know that genetics and childhood environments play a key role in the risk of developing mental-health issues,” says Cohen-Cline. The authors found that green spaces have a direct mental-health impact. People with better access to green space had slightly fewer depressive symptoms than those in less green areas. Independent of any potentially confounding factors, such as childhood environment and genetics, “there is something about green space itself that benefits people's mental health,” says Cohen-Cline. Although the twin study shows that green spaces make people happier, it does not say how this works. “It is doing it through several different pathways, and we are still trying to tease that apart,” she says. Exercise is known to improve mood, but Cohen-Cline's study found no evidence that it substantially changed people's depressive score, “suggesting that it is not what is driving the association.” One route could be that parks allow people to socialize, which in turn improves their mood. “Social ties are very strongly associated with mental health,” says Cohen-Cline. Mitchell is putting his money on another route — people's perception of nature causes physiological changes, such as reducing the stress hormone cortisol and lowering blood pressure. “You perceive nature with your senses,” Mitchell says. “Your brain processes those sensory experiences and triggers physiological responses.” Evidence for why this would be is so far thin, but theories abound. One possibility is that people's brains are overexposed to stressful stimuli such as noise and overcrowding in urban environments. By contrast, Mitchell says, natural environments give the brain an opportunity to recover from mental fatigue. It's also possible that our evolutionary heritage means we are simply hard-wired to respond positively to the green spaces that our ancestors grew up in. “We're faced with stressful, noisy environments. When we encounter an environment that is more in keeping with our evolution, that we might innately perceive as more supportive, our bodies and minds react favourably; we literally relax”, says Mitchell. Whatever the underlying explanation, there is evidence that green spaces elicit a direct physiological response, says Mitchell. In Japan, for example, people who spent time participating in Shinrin-yoku — sitting or walking in a forest — had lower cortisol concentrations, pulse rates and blood pressure than when they visited the city4. And it's not just parks and forests; blue spaces such as the sea, canals and lakes may give an even bigger boost to people's mood5. As the evidence grows, policymakers will be able to design health interventions that use natural resources. The therapeutic and societal value of green spaces is already starting to draw attention. “Policymakers are taking on the message that they have a resource that might be good for people's health and well-being,” says Mitchell. The £8.9-million restoration of Clissold Park in northeast London in 2011, for instance, was highlighted by the UK government agency Public Health England in 2014 as an example of a local health intervention. But creating the spaces isn't enough — says White, there are strong “psychological barriers” that prevent some people from using green space. Just 40% of the UK population will spend time near nature in any given week, and although a lack of time is the main reason given, he says, others say they don't enjoy spending time outside, or that it's not part of their culture. To engage those most in need, White thinks that health services should offer people with depression 'green prescriptions', which would encourage them to join walking groups or allotments, for example. Physicians could offer this before or as well as drug treatments. White is attempting to work out how these green prescriptions could work in practice, and the potential cost saving for health services. If participation can be improved, one area that may benefit the most is health inequality. Contentment is not evenly distributed across the socio-economic spectrum: affluence is generally associated with greater happiness. But evidence is beginning to show that green spaces could narrow this gap. Mitchell and his colleagues found that access to green spaces could reduce inequality in mental well-being by 40%6. “It is a sizable reduction. Nothing else governments have tried has really had much impact,” says Mitchell. The study has its limitations — despite the strong association between green space and decreasing mental-health inequality, there's no proof of causation — but Mitchell is clear: “having a park in your neighbourhood has a greater benefit on poorer people.” “The effects are largest in poorer communities,” says White. “Rich people are healthy already.”
Allen H.,Columbia University |
Wright B.J.,Providence Health and Services |
Harding K.,Providence Health and Services |
Broffman L.,Providence Health and Services
Milbank Quarterly | Year: 2014
Context The Affordable Care Act provides new Medicaid coverage to an estimated 12 million low-income adults. Barriers to access or quality could hamper the program's success. One of these barriers might be the stigma associated with Medicaid or poverty. Methods Our mixed-methods study involved 574 low-income adults and included data from an in-person survey and follow-up interviews. Our analysis of the interviews showed that many participants who were on Medicaid or uninsured described a perception or fear of being treated poorly in the health care setting. We defined this experience as stigma and merged our qualitative interviews coded for stigma with our quantitative survey data to see whether stigma was related to other sociodemographic characteristics. We also examined whether stigma was associated with access to care, quality of care, and self-reported health. Findings We were unable to identify other sociodemographic characteristics associated with stigma in this low-income sample. The qualitative interviews suggested that stigma was most often the result of a provider-patient interaction that felt demeaning, rather than an internalized sense of shame related to receiving public insurance or charity care. An experience of stigma was associated with unmet health needs, poorer perceptions of quality of care, and worse health across several self-reported measures. Conclusions Because a stigmatizing experience in the health system might interfere with the delivery of high-quality care to new Medicaid enrollees, further research and policy interventions that target stigma are warranted. © 2014 Milbank Memorial Fund.
Rozenfeld Y.,Providence Health and Services |
Johnson T.,Providence Health and Services |
Klug C.,Providence Health and Services
Osteoporosis International | Year: 2010
Summary: A survey was conducted to assess interest in an osteoporosis website. Two thirds of respondents indicated they would read about osteoporosis on a website, and half reported they might use the website more interactively. Women were receptive to the concept of web-based education and management of osteoporosis care. Introduction: As Americans increasingly use the Internet as a source for health information, healthcare providers continue to develop disease management and education websites. Providence Health & Services conducted a survey among female patients eligible for osteoporosis screening to assess interest in a physician-prescribed osteoporosis website. Methods: In 2006, a self-administered survey designed to assess osteoporosis status, Internet use, and the likelihood of using an osteoporosis website for information and disease management was sent to 3,000 active female patients between the ages of 50 and 85 in the Portland, Oregon metropolitan area. Results: Among 778 respondents, 80% reported having access to the Internet, and 70% indicated they were likely to use the Internet for health-related information gathering. While 65% of respondents indicated they would be likely to read about osteoporosis on a dedicated website, only about half reported they might use the website for more interactive disease management activities such as scheduling appointments, receiving test results, or consulting with their physician. Both Internet access and interest in the osteoporosis website declined significantly with age. Conclusions: These data suggest that middle-aged women are moderately receptive to the concept of web-based care for certain components of osteoporosis management and education. © International Osteoporosis Foundation and National Osteoporosis Foundation 2009.