Can a Bone Marrow Transplant Cure Aids?

The following article, written by Mark Schoofs, appeared in today's Wall Street Journal.

"The startling case of an AIDS patient who underwent a bone marrow transplant to treat leukemia is stirring new hope that gene-therapy strategies on the far edges of AIDS research might someday cure the disease.
The patient, a 42-year-old American living in Berlin, is still recovering from his leukemia therapy, but he appears to have won his battle with AIDS. Doctors have not been able to detect the virus in his blood for more than 600 days, despite his having ceased all conventional AIDS medication. Normally when a patient stops taking AIDS drugs, the virus stampedes through the body within weeks, or days.
Dr. Gero Hütter isn't an AIDS specialist, but he 'functionally cured' a patient, who shows no sign of the disease. "I was very surprised," said the doctor, Gero Hütter. The breakthrough appears to be that Dr. Hütter, a soft-spoken hematologist who isn't an AIDS specialist, deliberately replaced the patient's bone marrow cells with those from a donor who has a naturally occurring genetic mutation that renders his cells immune to almost all strains of HIV, the virus that causes AIDS.
The development suggests a potential new therapeutic avenue and comes as the search for a cure has adopted new urgency. Many fear that current AIDS drugs aren't sustainable. Known as antiretrovirals, the medications prevent the virus from replicating but must be taken every day for life and are expensive for poor countries where the disease runs rampant. Last year, AIDS killed two million people; 2.7 million more contracted the virus, so treatment costs will keep ballooning.

While cautioning that the Berlin case could be a fluke, David Baltimore, who won a Nobel prize for his research on tumor viruses, deemed it "a very good sign" and a virtual "proof of principle" for gene-therapy approaches. Dr. Baltimore and his colleague, University of California at Los Angeles researcher Irvin Chen, have developed a gene therapy strategy against HIV that works in a similar way to the Berlin case. Drs. Baltimore and Chen have formed a private company to develop the therapy.

Back in 1996, when "cocktails" of antiretroviral drugs were proved effective, some researchers proposed that all cells harboring HIV might eventually die off, leading to eradication of HIV from the body -- in short, a cure. Those hopes foundered on the discovery that HIV, which integrates itself into a patient's own DNA, hides in so-called "sanctuary cells," where it lies dormant yet remains capable of reigniting an infection.

But that same year, researchers discovered that some gay men astonishingly remained uninfected despite engaging in very risky sex with as many as hundreds of partners. These men had inherited a mutation from both their parents that made them virtually immune to HIV.
The mutation prevents a molecule called CCR5 from appearing on the surface of cells. CCR5 acts as a kind of door for the virus. Since most HIV strains must bind to CCR5 to enter cells, the mutation bars the virus from entering. A new AIDS drug, Selzentry, made by Pfizer Inc., doesn't attack HIV itself but works by blocking CCR5.

About 1% of Europeans, and even more in northern Europe, inherit the CCR5 mutation from both parents. People of African, Asian and South American descent almost never carry it.
Dr. Hütter, 39, remembered this research when his American leukemia patient failed first-line chemotherapy in 2006. He was treating the patient at Berlin's Charité Medical University, the same institution where German physician Robert Koch performed some of his groundbreaking research on infectious diseases in the 19th century. Dr. Hütter scoured research on CCR5 and consulted with his superiors.

Finally, he recommended standard second-line treatment: a bone marrow transplant -- but from a donor who had inherited the CCR5 mutation from both parents. Bone marrow is where immune-system cells are generated, so transplanting mutant bone-marrow cells would render the patient immune to HIV into perpetuity, at least in theory.

There were a total of 80 compatible blood donors living in Germany. Luckily, on the 61st sample he tested, Dr. Hütter's colleague Daniel Nowak found one with the mutation from both parents.
To prepare for the transplant, Dr. Hütter first administered a standard regimen of powerful drugs and radiation to kill the patient's own bone marrow cells and many immune-system cells. This procedure, lethal to many cells that harbor HIV, may have helped the treatment succeed.
The transplant specialists ordered the patient to stop taking his AIDS drugs when they transfused the donor cells, because they feared the powerful drugs might undermine the cells' ability to survive in their new host. They planned to resume the drugs once HIV re-emerged in the blood.

But it never did. Nearly two years later, standard tests haven't detected virus in his blood, or in the brain and rectal tissues where it often hides.

The case was presented to scientists earlier this year at the Conference on Retroviruses and Opportunistic Infections. In September, the nonprofit Foundation for AIDS Research, or amFAR, convened a small scientific meeting on the case. Most researchers there believed some HIV still lurks in the patient but that it can't ignite a raging infection, most likely because its target cells are invulnerable mutants. The scientists agreed that the patient is "functionally cured."

Caveats are legion. If enough time passes, the extraordinarily protean HIV might evolve to overcome the mutant cells' invulnerability. Blocking CCR5 might have side effects: A study suggests that people with the mutation are more likely to die from West Nile virus. Most worrisome: The transplant treatment itself, given only to late-stage cancer patients, kills up to 30% of patients. While scientists are drawing up research protocols to try this approach on other leukemia and lymphoma patients, they know it will never be widely used to treat AIDS because of the mortality risk.

There is a potentially safer alternative: Re-engineering a patient's own cells through gene therapy. Due to some disastrous failures, gene therapy now "has a bad name," says Dr. Baltimore. In 1999, an 18-year-old patient died in a gene therapy trial. Even one of gene therapy's greatest successes -- curing children of the inherited "bubble boy" disease -- came at the high price of causing some patients to develop leukemia.

Gene therapy also faces daunting technical challenges. For example, the therapeutic genes are carried to cells by re-engineered viruses, and they must be made perfectly safe. Also, most gene therapy currently works by removing cells, genetically modifying them out of the body, then transfusing them back in -- a complicated procedure that would prove too expensive for the developing world. Dr. Baltimore and others are working on therapeutic viruses they could inject into a patient as easily as a flu vaccine. But, he says, "we're a long way from that."
Expecting that gene therapy will eventually play a major role in medicine, several research groups are testing different approaches for AIDS. At City of Hope cancer center in Duarte, Calif., John Rossi and colleagues actually use HIV itself, genetically engineered to be harmless, to deliver to patients' white blood cells three genes: one that inactivates CCR5 and two others that disable HIV. He has already completed the procedure on four patients and may perform it on another.

One big hurdle: doctors can't yet genetically modify all target cells. In theory, HIV would kill off the susceptible ones and, a victim of its own grim success, be left only with the genetically engineered cells that it can't infect. But so far that's just theory. All Dr. Rossi's patients remain on standard AIDS drugs, so it isn't yet known what would happen if they stopped taking them.
In 1989, Dr. Rossi had a case eerily similar to the one in Berlin. A 41-year-old patient with AIDS and lymphoma underwent radiation and drug therapy to ablate his bone marrow and received new cells from a donor. It is not known if those cells had the protective CCR5 mutation, because its relation to HIV hadn't been discovered yet. But after the transplant, HIV disappeared from the patient's blood. The patient died of his cancer 47 days after the procedure. Autopsy tests from eight organs and the tumor revealed no HIV."

How did the Medical Professionals Fare in the Congressional Elections?

On his Wall Street Journal Health Blog, Jacob Goldstein took a look at Tuesday's congressional elections. Check it out:

http://blogs.wsj.com/health/2008/11/06/how-many-doctors-are-in-the-house

"Enough with the Democrats and Republicans. How did doctors do in Tuesday’s Congressional elections?
Pretty well: There will be at least 14 MDs in the 111th Congress, a pickup of two seats from the current session, the AMA told us.
Ten of the docs are Republicans and four are Democrats. Don’t hold your breath for them to band together to overcome party differences and lead the nation toward health-care reform.
“You’d think the physicians’ caucus would provide leadership to the parties, but it hasn’t worked out that way,” Michael Burgess, a Texas ob-gyn first elected to the House in 2002, told the Health Blog. “In my humble opinion, there aren’t enough doctors in Congress. It leaves us with a pretty narrow group of individuals, and it’s a little harder to build consensus on common ground.”
Even issues where McCain and Obama shared common ground may prove thorny. Take, for example, moving Medicare payments away from the current fee-for-service payment model — an idea many doctors, including Burgess, are wary of. “Had Sen. McCain been successful, I was hoping to work on him about that,” Burgess told us.
All nine docs who ran for re-election in the House of Representatives held on to their seats, according to the AMA. Another, Florida Republican and internist David Weldon, retired. (A family doc ran as a Democrat to fill Weldon’s seat, but lost to a Republican Realtor who has served in Florida’s Legislature.)
There are two docs in the Senate: Tom Coburn (R., Okla.) ran for re-election and won; John Barasso (R., Wyo.) wasn’t up for reelection.
Three MDs were newly elected to the House; another 15 ran and lost (not as grim as it might sound, given the long odds against unseating incumbents). And one Maryland race, in which an anesthesiologist is running as a Republican for an open seat, is still too close to call, the Baltimore Sun reported this morning.
Specialty Bonus: Five of the 14 docs in Congress are ob-gyn, making it the most common specialty on the Hill. (Insert joke about a “national re-birth” or “delivering change” here.) Family medicine comes in second

Best and Worst Excuses for Not Going to Work

An amusing survey for a Friday courtesy of "HR Strange But True" and Careerbuilder.com .....enjoy!

"Employees have a variety of excuses to explain an absence from work to their employer. Some are typical (e.g., "I am sick") and some are atypical (e.g., "My psychic told me to stay home"). We have 11 more of the latter for you. Tell us if you think these are really good excuses or really bad ones.

CareerBuilder.com conducts an annual survey among employers and employees on absenteeism. This year, when the survey asked employers to identify the strangest reasons employees have given to explain an absence, they cited the following examples:
Employee's wife burned all his clothes, and he had nothing to wear to work.
Employee didn't want to lose the parking space in front of his house.
Employee hit a turkey while riding a bike.
Employee said he had a heart attack early that morning, but that he was "all better now."
Employee donated too much blood.
Employee's dog was stressed out after a family reunion.
Employee was kicked by a deer.
Employee contracted mono after kissing a mailroom intern at the company holiday party and suggested the company post some sort of notice to warn others who may have kissed him.
Employee swallowed too much mouthwash.
Employee's toe was injured when a soda can fell out of the refrigerator.
Employee was up all night because the police were investigating the death of someone discovered behind her house.

If one of your employees called you with one of those excuses, would you believe him or her?
The survey found that 33 percent of employees admit to calling work with a fake excuse to explain an absence at least once this year.
The top reasons for doing so included:
Needed to relax and recharge (30 percent)
Had to go to a doctor's appointment (27 percent)
Catch up on sleep (22 percent)
Run personal errands (14 percent)
Catch up on housework (11 percent)
Spend time with family and friends (11 percent)
Wanted to miss a meeting, buy some time to work on a project that was already due, or avoid the wrath of a boss or colleague (9 percent)
Are employees fooling their employers? Not all the time. The survey found that 31 percent of employers said they have checked up on an employee who called in sick.
The most common ways those employers checked up on employees included:
Requiring the employee to show a doctor's note (71 percent)
Calling the employee at home (56 percent)
Having another worker call the employee (18 percent)
Driving by the employee's house or apartment (17 percent)
The survey included more than 6,800 workers and 3,300 employers.

Obama v. McCain....how do healthcare plans stack up?

In addition to the general economy, business owners and managers want to know what will happen to their healthcare plans under a McCain administration or an Obama administration. Jacob Goldsteins blogs about this very subject in his blog on the Wall Street Journal website.

"....... nobody really knows how the Obama or McCain health plan would work in the real world. But some smart people have taken some educated guesses. In her healthy consumer column today, the WSJ’s Anna Wilde Mathews wades into the fray and returns with some figures.
Among families making between $50,00 and $149,000 annually, roughly 40% would save more than $2,500 a year on health costs under McCain’s plan in the short term, according to an analysis by the Lewin Group, a health care consultancy.
Those who come out best could be people who are young and healthy — those who are pretty cheap to insure. People who are older, or who have a history of health trouble, could have a harder time under the McCain plan.

Most American families in the short term would save money on health insurance or see little effect under the Obama plan, the group said. Among households earning between $50,000 and $150,000 a year, more than 60% would see health-insurance costs decline by $250 or more.
Low and moderate-income people might qualify for new assistance under the Obama plan. And those with health troubles would benefit from a rule that would require insurance companies to cover all comers. On the other hand, healthy people who don’t qualify for subsidies could see their insurance costs rise under the plan.

What happens in the long term is anyone’s guess. The Tax Policy Center, which is affiliated with the Brookings Institution and the Urban Institute, projected the Obama plan would cost $1.6 trillion over 10 years, and the McCain plan would cost $1.3 trillion. Lewin Group had different figures putting the cost at $2.1 trillion for McCain’s plan and $1.2 trillion for Obama.
The candidates say they are prepared to pay for the plans, but they rely heavily on cost savings gained from new efficiencies. And, as anybody who pays attention to health care knows, it’s easy to point to inefficiencies, but hard to realize significant cost savings.

Bonus Dollars: McCain has said folks who have a hard time buying insurance on the open market would get help from something called the Guaranteed Access Plan. McCain adviser Douglas Holtz-Eakin told the WSJ that the plan could cost the feds $15 billion to $20 billion a year. Other funding would come from states and insurers. The Lewin Group estimates that the program could for the federal government would rise each year, to as much as $33 billion a year after a decade."

Offshore Medical Services Increasing in the United States

The Wall Street Journal published an article by Amar Gupta about the information technology revolution in the medical field. Not only will your doctor not be in the room with you, but he may be half way around the world. Read on!

Health care has managed to avoid the information-technology revolution. But it won't for much longer.
By AMAR GUPTA

"The health-care industry is about to undergo a global revolution driven by a force it can no longer resist: information technology.
While hospitals and other care providers have long been quick to adopt breakthrough technology in medical devices, procedures and treatments, far less attention has focused on innovations in networking and communications.

This is partly because of concerns about breaches in security and patient privacy, and because health care until recently was a service always performed locally, and in person. Big computer networks and the core benefits they offer -- such as increased group productivity and access to data -- weren't on the health-care sector's radar screen.

But that is about to change. IT security will eventually meet the expectations of the health-care industry, just as has happened in other sectors, like banking. And when it does, powerful IT networks crisscrossing the globe will change the way much of health care is delivered: Outsourcing and offshoring of medical and nonmedical services will increase, providing more efficient health care at the most cost-effective rates; systems integrations will allow more medical records to be transferred swiftly and securely; efforts to monitor the safety of medicines will gain global access to data; and professionals and patients will find authoritative and up-to-date information on every specialty online.

In the future, there will be three often overlapping modes of delivering health-care services: services performed in person by humans, services that can be performed by people at a remote location, and services performed by computers without direct human involvement. Offshore outsourcing in combination with a 24-hour work cycle will be appropriate when certain conditions are met -- mainly, if the information involved in the task can be digitized, and if workers at different sites can do their jobs independently from one another.
These changes won't come quickly. There will be plenty of obstacles as institutions and networks reach across borders and encounter different laws as well as technical standards. Licensing, accreditation and accounting issues will arise as well. But eventually all such issues can be resolved by proper regulatory structures and market forces.

In the meantime, health-care organizations that don't join in the coming changes will incur higher costs and less integration. This will make them less competitive in the global health-care marketplace, just as is happening with companies that have resisted outsourcing and systems integration in other sectors.
What follows is a look at four major ways in which IT will revolutionize health care: more offshore services, integration of health-information systems, drug-safety monitoring on a global scale, and more high-quality information to doctors and patients.

The most noticeable changes will be the offshore outsourcing of diagnostic services -- particularly imaging, such as X-rays and mammograms -- and consultations by specialists.
Doctors in the U.S. and other countries have long practiced variations of telemedicine to provide care to patients in hard-to-reach and underserved locations. But in the future, telemedicine will be practiced more as a way of distributing work loads and lowering costs. Teleradiology in particular, in which X-rays are taken at one location and then transmitted to doctors at another site, appears ripe for expansion.

Forces driving the growth of teleradiology include a significant shortage of radiologists, aging populations and more use of imaging in trauma situations, which in turn has fueled a need for 24-hour radiological services in emergency rooms.
With robust IT networks, a single radiologist can support multiple hospitals, or large hospitals can serve as central image-reading sites, spreading the work among a staff of radiologists. Remote sites can be set up with just imaging equipment and technicians, extending radiology services to underserved regions. Offshore outsourcing, meanwhile, can mean that images taken in the middle of the night are still read right away by a wide-awake radiologist working at the height of his or her powers.

The Past: Health care mostly ignored information technology for years. Goals such as linking groups of workers and improving communication weren't priorities for an industry more concerned with delivering services in person and protecting privacy.
The Present: Now, improvements in network security and the ability to transmit images and data around the world have opened the door to changes that will revolutionize the sector.
The Future: Most noticeably, robust IT networks will allow offshore outsourcing of certain medical and nonmedical services and integration of information systems, making health care more efficient and cost-effective. Groups that don't adopt some form of outsourcing will fail to keep up with competitive cost pressures, as has happened in other industries.
The biggest hurdles to the expansion of teleradiology may be the credentialing and billing processes. While many countries will give a doctor a license to practice anywhere in that nation, the practice in the U.S. is to issue licenses at a state level. This creates more bureaucracy. Most states require medical professionals to be U.S. citizens or legal residents in order to be licensed. Also, it is difficult for doctors abroad to get reimbursement from insurance companies in the U.S. for telemedicine services.

Another reason to outsource more medical services abroad: The World Health Organization and the American Cancer Society have identified working at night as a possible cause of cancer. Such a finding may help fuel efforts to wean medical workers from graveyard shifts. Video cameras and other equipment can monitor sleeping hospital patients in other cities, states or countries. Similarly, sleep studies, in which the patient is observed for a full night at a sleep center, can base patients in one country and technicians in another. If the patient develops unusual symptoms, medical personnel can be summoned on the scene.
Over time, the offshore outsourcing of more medical services will benefit developed countries because it can provide faster diagnosis and lower overall costs. Offshore outsourcing also can benefit developing nations, by giving patients more access to expert health care. However, there is a shortage of medical professionals both in developed and developing countries, and the diversion of such resources to foreign patients can potentially aggravate the shortage. These issues, and others, will be partly resolved by market forces.

Globally integrated health-information systems are evolving, along with standardized formats for patient records -- making the charts easier to translate.
A detailed medical history can be critical if a person suffers an illness or accident far from home. Integrated information systems and records that translate easily would be of enormous help in natural disasters and other mass-casualty situations in which the victims come from many different places.

But current hospital information systems were designed to function as islands with their own rules and formats, making a patient's file at one hospital difficult for another to read. Not only are different languages and measures sometimes used, but conflicts between encryption and other software can make it impossible for systems to exchange data electronically.
Computer programs and Internet technology will play big roles in overcoming such obstacles. But experts in IT and medicine will also be indispensable at every stage, whether for building the tools for integration or assisting in specific records transfers.
Hospitals and other health-care organizations in the U.S. have started to make a dent in this area, using domestic medical and IT personnel to develop systems for the electronic exchange of medical records. But so much remains to be done, the higher cost and relative scarcity of U.S. labor available for this work is most likely to lead the industry to outsourcing abroad.
Meanwhile, a precedent already exists for fast and secure international transmissions of U.S. medical records. U.S. hospitals and doctors increasingly rely on workers abroad to transcribe audio recordings into written notes. Typically, the audio recording will be sent in the evening, U.S. time, to transcriptionists in India, for whom it is morning. A written version of the recording is then available to the doctor over the Web before the next day shift begins in the U.S.

As people become more mobile, an international database on drug safety will be created.
Various programs currently do this kind of work in their home countries, including MedWatch, an initiative of the U.S. Food and Drug Administration that investigates and reports on adverse drug reactions and other safety issues involving medical products. MedWatch gets reports from a wide network of domestic sources, including pharmacy companies, insurers and professional associations in the medical, dentistry and nursing fields. But no agency routinely collects and shares information between countries. So, incidents involving medicines purchased abroad can fall through the cracks. This is a growing concern in the U.S. not only because people are traveling more, but also because U.S. residents increasingly purchase prescription drugs from pharmacies in Canada and other countries because of lower prices.

A possible prototype for a global watchdog already exists, designed by researchers from the University of Arizona for the Critical Path Institute. Co-founded by the FDA, C-Path is a nonprofit based in Tucson, Ariz., and Rockville, Md., that researches areas related to drug development and safety. The prototype envisions a network that would connect and share data among multiple organizations including: companies or groups that tested or helped produce the drug; the FDA and equivalent agencies in other countries; and the doctor or organization that prescribed the medication. Individual pharmacies, too, would participate directly -- a critical contribution, since they have the information about buyers, dates and quantities.
Serious challenges to this vision exist, such as different reporting procedures in various countries, and potential conflicts in software and Web protocols. The technical conflicts can be solved over time by IT experts working toward standardization. As with systems-integration challenges, costs and labor shortages will drive the use of offshore labor.
Meanwhile, with the right infrastructure and incentives, pharmacists and pharmacy technicians could replace the current hodgepodge of reporting methods by becoming designated agents for collecting raw information on patients' medication histories, including adverse reactions.

The latest medical knowledge will appear on Web sites edited by eminent specialists in those fields.
Doctors and scientists from around the world will contribute material, and automated search tools will capture updates from, say, a trusted clinical study. The reliance on IT and editorial workers in less-expensive countries, meanwhile, will help make such endeavors more economically viable.
Such sites are likely to take shape as hybrids of information sources and tools, drawing from online textbooks, medical journals, wiki-style editing and automatic updates from various trusted data sources. While the sites will have human editors, developers are working on tools to help comb through the large number of newly published and potentially relevant articles that need to be considered each week. The goal will be not just to increase the amount of medical information at people's fingertips, but also to make it specific, up-to-date, reliable and easier to find.
The detailed nature of this kind of work, and competitive cost pressures, will mean that a mix of medical and IT professionals will have to be employed both in the U.S. and abroad.
The eventual benefits, meanwhile -- from all of the advances predicted -- will be universal."
—Dr. Gupta is the Thomas R. Brown professor of management and technology at the University of Arizona. He can be reached at reports@wsj.com.

Motivating Your Team in Difficult Economic Times

In this economic climate, it is imperative to keep your staff motivated. Nancy Mobley, an Inc.com blogger had some terrific ideas. Read on:
"It’s challenging to keep up morale and motivate staff when the marketplace is filled with uncertainty. Having survived several economic cycles, I’ve seen the benefits of investing in staff even during the lean times. During those times, I’ve been able to count on employees to keep my business engine going and as the market opens up, they've been there to help the company take advantage of new opportunities.
Even when budgets are tight, there are ways to reward and recognize employees without spending a lot of money. One obvious but often overlooked approach is to make it a regular practice to thank employees and acknowledge their contributions. I’m always amazed at how far a simple “great job” goes in generating goodwill.
Some other ways to let employees know that they are appreciated, include:
• Establishing a special award, such as a “Star for the Day,” to recognize outstanding performers. You might give them a gift certificate to a mall, or token gift to show your appreciation.
• Planning get-togethers to bring employees together. Create opportunities for employees to socialize, such as Friday afternoon get-togethers, impromptu pizza parties and celebrations for birthdays, team accomplishments, and other occasions.
• Establishing holiday traditions, such as annual volunteer day or company outings.
• Pulling together a cross-functional team to serve on the fun committee and build up company spirit.
• Using e-mail, a company newsletter, or bulletin board to praise individual and team accomplishments and recognize birthdays and other occasions.
It’s always important to keep the lines of communication open, offer a flexible and family/friendly environment, and make sure that everyone feels respected. By rewarding your employees, you’ll reap the benefits of a strong and dedicated team. It’s a terrific competitive advantage."

People at Work May Create Problems to Get Ahead...Munchausen at Work Syndrome

Have you ever worked with someone who created drama and problems at work just to get ahead? Well, this type of behavior has a name: Munchausen Syndrome at Work. It was reported on ABC Good Morning America last week.

Lying to Get Ahead at Work
Some Workers Exaggerate or Create Problems so They Can Be the Fixing 'Hero'
By SCOTT MAYEROWITZ ABC NEWS Business Unit
Aug. 26, 2008—
"Surviving the daily trials and tribulations of work is tough enough. But now you may need to be on the lookout for co-workers who are creating or exaggerating problems just to make themselves look better when they miraculously solve the issue.
Call it Munchausen at work.
Munchausen by proxy is a disorder in which caretakers harm people under their supervision to get attention for themselves. Think about a mother who poisons her child so that health care workers will pay as much attention to her as to the sick child.
Nathan Bennett, a business professor at Georgia Institute of Technology who also does management consulting, coined the phrase "Munchausen at work" for a situation he says many clients have described to him.
One executive told him about an assistant who regularly told detailed stories of the personal heroics necessary to correct travel agency mistakes for him. The boss's hotel room wasn't booked, and now there was a convention in town. Or a flight was full and she couldn't get him a good seat. Turns out that there were never any such problems with the travel agency, Bennett said. The assistant just made them up to make herself look better. The boss only learned so after she left the company.
Bennett shares such stories whenever he meets with groups of executives. "You can see heads nodding in agreement," he said.
The workplace disorder involves an individual with a high need for attention and a distorted sense of responsibility, a victim who is unable to see the threat and a third party -- such as a boss -- who can give positive reinforcement.
"It's something I have seen repeatedly but not regularly," Bennett said.
In another case, a salesman kept telling his boss that the company risked losing some big clients who were extremely dissatisfied. He then proceeded to smooth things over. Well, it turns out that there were never any problems with the clients, Bennett said.
There are even more drastic examples.
Last year, a California volunteer firefighter was arrested for setting forest fires. The 24-year-old wanted to pursue a career as a firefighter and was described by his supervisors as being "young, eager and very enthusiastic."
Alan Graham, a Park Ridge, Ill., psychologist specializing in leadership and executive coaching as well as individuals with attention deficit disorder, is skeptical of Bennett's description of Munchausen at work.
"The fact is that people will spread false rumors, but that's not Munchausen," he said. "Certainly, people lie all the time to advance themselves.
"They're just trying to do it an unethical way."
More common, he said, are problems in which workers become suspicious that company reorganization plans don't include them.
Graham, who has been doing executive coaching for 11 years, said that sometimes workers fabricate something if they believe their position is threatened.
"In most organizations, that gets found out," he said. "The more that doesn't get found out, the more dysfunctional the organization is."
He said that there is also a situation in which some people with attention deficit disorder find the need to create excitement.
"There are some people who, when things get boring, they need to spice things up," he said.
But he warned that "Munchausen is a rare disorder" and that he has never encountered it in the workplace.
Nicholas DiFonzo, a psychology professor at Rochester Institute of Technology and author of "The Watercooler Effect," which looks at why people spread rumors in the workplace, said that such actions are "obviously self-enhancing."
"You don't need to be a Ph.D. in psychology to see that this will get you some points, socially or professionally," DiFonzo said. "In any group there is always a group that is favored."
But DiFonzo warns that your boss is probably going to find out what you are doing. Look at it this way: There wouldn't be all these case studies if nobody got caught.
"I think they underestimate the likelihood that they will get caught," he said. "It's only a matter of time."
So next time a co-worker panics and tells you that disaster is imminent & well, think twice before you panic, too."
Copyright © 2008 ABC News Internet Ventures

WellPoint Increases Its Profits By Increasing Premiums

In today's Wall Street Journal, Sarah Rubinstein reports on the growing trend of health insurers....raising premiums in order to boost profits. Is there light at the end of the tunnel?

"The high cost of health insurance has aggravated patients and employers and generated plenty of debate on the campaign trail. But there’s one constituency that tends to stomach price hikes just fine: investors.
One giant health insurer that’s certainly aware of the phenomenon is WellPoint, which has seen its profits drop 17% so far this year after underestimating how quickly health-care costs would rise. In an attempt to regain investor’s confidence, CEO Angela Braly has been boosting the monthly premiums that customers have to pay for WellPoint’s plans — in some cases quite a bit.
The result: In the first six months of the year, WellPoint lost 189,000 members in the business and individual plans that it insures, the WSJ reports this morning. The company projects an additional overall 150,000-member decline by December. Other corporate clients are shifting more of their costs to employees, to lessen price increases. Meanwhile, WellPoint’s share price has recovered somewhat since it plunged after the company cut its earnings forecast in March, but it’s still off around 40% this year.
Kenneth Goulet, head of WellPoint’s commercial-business division, says it would be irresponsible to set premiums that cut deep into margins or lose money. “That’s not sustainable,” Goulet says. “We’re developing products that meet the needs of customers, then pricing them with very good discipline.”
The WSJ notes that the conundrum of how to reassure investors that profit will be maintained without losing business is confronting the entire health-insurance industry. Other major insurers that have reported enrollment losses in employer plans since the first quarter include UnitedHealth Group, Health Net and Coventry Health Care."

Can a Large Not-for-Profit Hospital System be a Monopoly?

Today on its website, Kaiser Permanente discusses the Wall Street Journal's story regarding Carilion Health System, a large not-for-profit hospital system in southwestern Virginia and whether it has created a monopoly for health care services in the area. Read on:

"According to the Journal, not-for-profit hospitals, which account for the majority of U.S. hospitals, receive tax exemptions and "are supposed to channel the income they generate back into operations, while providing benefits to their communities." However, not-for-profit hospitals have "come under fire from patient advocates and members of Congress for "stinting on charity care, even as they amass large cash hoards, build new facilities and award big paychecks to their executives," the Journal reports.In the case of Carilion, the Department of Justice in 1989 filed a failed antitrust lawsuit in an effort to block a merger between Carilion and a local hospital over concerns that the move would create a monopoly on health care services in the area. Almost 20 years later, health care costs in the area are "soaring," and health insurance premium rates in the area have increased from the lowest in the state to the highest, the Journal reports. Carilion charges four to 10 times as much for some health care services as other providers in the area, but, with eight hospitals, 11,000 employees and $1 billion in assets, residents in most cases must seek care through the hospital system or travel outside the area. In addition, although Carilion receives about $50 million annually in tax exemptions, the hospital system spent only $42 million in charity care in 2007 and only $30 million in 2006. Carilion officials maintain that the hospital system does not have a monopoly on health care services in the area because of competition from Lewis-Gale Medical Center, a hospital owned by for-profit chain HCA. In addition, "Carilion says it charges more for certain procedures because it has to subsidize operations such as an emergency department and treatment for the uninsured," according to the Journal. Carilion CEO Edward Murphy also said that the increase in health care costs in the area is part of a national trend and has resulted from overuse of services"(Carreyrou, Wall Street Journal, 8/27).

Universal Healthcare is a big issue in Campaign '08

Emily P. Walker, Washington Correspondent, MedPage Today, published the following article from Denver regarding Sen. Hillary Clinton's stance on universal healthcare and its mention in her speech at the Democratic National Convention last night.

" Despite tortuous battles during the presidential primaries over the nuances of healthcare reform, Sen. Hillary Clinton was ringing in her support for Sen. Barack Obama's goals at the Democratic National Convention here.
In a so-called unity speech last night, Clinton said that she ran for president in part to "create a healthcare system that is universal, high quality, and affordable so that parents no longer have to chose between care for themselves or their children or be stuck in dead-end jobs simply to keep their insurance."
She added, "I can't wait to watch Barack Obama sign a healthcare plan into law that covers every single American."
Clinton, who was in charge of the failed healthcare reform initiative during her husband's presidency, was scheduled to headline a forum today called "Winning Healthcare Reform in 2009."
Earlier yesterday, some figures in the entertainment world took advantage of the massive press turnout here to draw attention to the plight of children with type 1 diabetes in developing nations.
Among the famous faces were film stars Susan Sarandon, Anne Hathaway, Zooey Deschanel, and Matthew Modine, and hair-guru Paul Mitchell.
The celebrities are all part of the Creative Coalition, a Hollywood non-partisan political and social advocacy group.
At the luncheon, sponsored by Creative Coalition, a clip of a documentary was shown, called "Life for a Child," produced by the International Diabetes Fund and drug-maker Lilly. It tells the story of kids living with type 1 diabetes in Nepal.
Still earlier, Family USA responded to new Census Bureau figures that showed that more Americans had health insurance coverage in 2007 than in 2006.
Families USA, which advocates universal healthcare access, said the increase in insured Americans stems in part from people trading in their employer-sponsored plans for Medicaid.
In fact, healthcare coverage for workers is getting worse, said Ron Pollack, executive director of Families USA. According to Pollack, in 2000, 64.2% of the public was covered by employer-sponsored insurance. In 2007, it was reduced to 59.3%.
"As employer-sponsored health coverage continues to erode, it is important that meaningful healthcare reform become the top and earliest domestic priority of the next president and Congress," said Pollack. "

Can anyone bail out Grady Memorial Hospital in Atlanta?

Grady Memorial Hospital has been a thorn in the side of Atlanta's healthcare community and city, county and state government for many years. Noone has been able to "fix" Grady's health. Grady does have a new CEO named Michael Young, the former president and CEO of Erie County Medical Center Corporation in upstate New York, and I think that he may be the man to heal Grady. Many have profited from Grady's woes. It appears that PricewaterhouseCoopers had a large bounty at stake in the event they can improve the hospital's profitability. My favorite healthcare blogger, Sarah Rubenstein at the Wall Street Journal takes on the Grady issue. Read on.

"PricewaterhouseCoopers has taken on the job of helping fix Grady Memorial Hospital, the public hospital in Atlanta that has been bleeding money for years. The firm had hoped to save Grady $65.5 million in 2008, but the hospital fell $7.7 million short of a mid-year goal, according to a report obtained by the Atlanta Journal-Constitution. By year end, Grady could miss out on $10 million to $20 million in savings because of the setbacks, the consultant said.
Here are problems the AJC lists from an August presentation on the hospital:
“Cultural and behavioral barriers regarding accurately charging patients for services rendered.”
“Inefficient contracting process; Missing sense of urgency and accountability; Lack of aggressiveness with vendors.”
Resistance from physicians involved in surgery, delays due to time needed to address executives’ concerns and difficulty recruiting and retaining qualified staff.
A “higher degree of uncertainty than typical,” and delays in starting initiatives.
Consulting firms themselves have a cost. As of early August, PWC had won $6.2 million in fees through a two-year contract that pays the firm as much as one-fifth of what it saves Grady, according to the AJC. The consultant could make up to $26 million, but will earn less if it saves less. Still, PWC has saved Grady more than $34 million between October and June 30, the report said."

Online office visits may be a wave of the future

Can you imagine having a doctor's appointment over the internet instead of getting into the car, driving to the office, parking the car and waiting to see the physician? Sounds enticing for minor ailments. The following written opinion of Benjamin Brewer, MD in favor of online internet office visits is published in today's Wall Street Journal.

"My patient probably would have rather been anywhere else. He and his wife were in my office to discuss his erectile dysfunction for the first time. He looked uncomfortable. For a guy who doesn't go to the doctor much, a medical office can seem as foreign and intimidating as the dark side of the moon. His exam was normal, but he needed to quit smoking. Would it have been easier for you to fill out a questionnaire on the Internet and skip the office visit? I asked. "You bet," he replied.

The way I see it, he didn't really need to come in at all. He needed a risk assessment for heart disease, a prescription for medication, counseling and help with stopping smoking. The results would have been the same online or in person.

How would you feel about "visiting" your doctor online for routine medical issues such as allergies or sinus infections, or potentially embarrassing ones like erectile dysfunction?
The average American's health-care experience is fraught with high cost, poor service and uncertain quality. But the prudent practice of medicine online would improve health care on all three counts.

Patients want access to safe, reliable medical care on the Internet, just like banking, shopping or booking a flight. Eighty percent of the public want doctors to use email to communicate with patients, but only 9% of physicians actually do that even occasionally. I think 20% of my routine office visits could be handled safely and less expensively over the Internet. There is nothing magical about the four office walls that make face-to-face visits superior. Demanding an in-person visit for every little thing is based on tradition and consensus opinion -- not science.
Doctors trot out excuses about why they don't use the Internet as a tool for working with patients. I think doctors' big fear is that the online discussions with patients will eat up time, with little or no extra payment for the service. A big impediment is that in most states it is illegal to prescribe drugs for a patient based on an online evaluation. That seems strange to me because physicians have been prescribing medicines by telephone for simple things without the safety net the computer provides. Of course, there have been cases of inappropriate prescribing of narcotic medications in my home state, Illinois, and others. And regulators put the clamps on even legitimate use of Internet medicine without a face-to-face physical exam.
The medical establishment has been reluctant to embrace online medicine. Indeed, medical societies and the Federation of State Medical Boards have taken a very aggressive position against Internet prescribing in the name of patient safety. In their world, only in-person visits are thought to be safe.

Are the boards of medical examiners' policies really protecting patient safety or only mandating face-to-face office visits as economic protection for doctors, I wonder. If I tried to prescribe ED drugs today based on an Internet questionnaire and email correspondence, the state medical board could take my license away and fine me thousands of dollars for every patient I treated.
I have no desire to be a Viagra prescription mill. I bring up the medicine because ED care over the Internet is probably the most studied of online options.

There are broader applications for Internet treatment beyond ED. And to be absolutely clear, there's no evidence that only face-to-face office visits are safe, effective and high-quality.
Traditionalists in medicine may be afraid to learn how good Internet medicine can be. One of the first substantial studies of Internet medicine was conducted by the University of Utah and published this month in the journal Mayo Clinic Proceedings. The researchers compared traditional office treatment of erectile dysfunction versus Internet practice.
The patients treated online had no face-to-face exam. The traditional doctors had the benefit of a computerized record system but they still lost out to the Internet doctors, who took a more thorough history and provided more counseling with the aide of a standardized Internet-based system.

Internet practice for ED was equal to traditional office practice or safer in all areas studied.
As a small-town doctor who still makes house calls, the prospect of an Internet practice is quite a departure from business as usual. As the Internet-savvy population ages and the number of primary care doctors dwindles, the demand for safe online medicine will grow. Until the regulators come around to the advantages of Internet medicine, patients will continue to miss work over minor ailments and I'll keep seeing them at the office."

10 Items Which Undo Proper HR Documentation

Proper documentation is essential in human resources. Failure to properly document any issue may lead to your failure to defend or file a lawsuit. The

HR Manager's Legal Reporter published a list of items that sink HR documentation. Here are the top ten:

"1. Unsigned or undated documents. This is the number one failure in documentation. Sign and date everything! Have the employee do the same.

2. Illegibility. You didn't go to med school, so leave the scrawl to the doctors. In court, neatness counts!

3. Late documentation. Judges and juries look askance at disciplinary or other reports written weeks or months after the incident they describe.

4. Inaccuracy. That document looks perfect, but the facts are wrong. Even one error makes the entire document suspect.

5. Unsupported conclusions. Don't write, "Worker X was drunk" without documenting the reasons you think so, e.g. "liquor on breath, slurred speech." Statements by objective witnesses will buttress your conclusion even more.

6. Waffling. If Mike isn't making 200 widgets per hour, don't just write, "Mike's performance must improve." The judge will ask, "Improve from what to what?" Be specific.

7. Don't make excuses. Statements such as "You failed-but I know we've all been pushing hard lately," may win you a nice guy award, but it won't win your case.

8. Don't lie ... even to be nice! Saying someone was let go due in a layoff rather than for cause, if there was cause, can backfire big time in a wrongful termination suit.

9. Be consistent. If you've written up Sally for an infraction, you'd better have written up everyone who did it. Otherwise you're open to a charge of discrimination.

10. Don't over or under focus. Writing up every tiny infraction makes you seem petty. But writing only the job-ending incident makes you appear emotion-driven."

Ten Important Steps Before Terminating an Employee

One of the most unpleasant experiences as a manager is to terminate someone's employment; especially if you like the employee personally. It is never easy. It is important not to let emotions get in the way and stick to corporate protocol. The following tips from HR Factfinder set forth an excellent foundation for handling the process. Check it out.
"90 percent of discrimination charges are discharge-related. The reasons are obvious: Terminations cause hard feelings, create economic need, and destroy feelings of loyalty, says today's expert. What can HR do?
Expert James W. Bucking, partner and co-head of the Employment Department at Foley Hoag LLP in Boston, blogging on HR FactFinder, offers 10 tips for handling terminations and avoiding lawsuits. Here's some of what he says.

1. Know the Facts. As an employer, you have broad authority to compel employees to talk to you. Take advantage of this right, says Bucking. Talk to supervisors, co-workers and subordinates, and make a record of what they tell you. Speak with the employee involved because it's a lot better to know his or her story at the time of termination than to hear it first at a deposition.

2. Review ALL the documents. Be especially wary of "stellar" performance reviews, says Bucking. Also review the disciplinary records of other employees in the same job or area. "There may be perfectly good reasons for treating employees who seem similarly situated differently, and you need to consider these differences in advance," he says. Also, look everywhere documents concerning the employee may exist, including the files, electronic records, and e-mails of the supervisor and everyone else involved.

3. Create new documents. "Sometimes the problem with a termination is that there are few documents supporting your decision. "There is nothing wrong with creating such documents-in fact, it is a good idea," Bucking writes. But never make things up on or backdate the documents you create.

4. Beware the electronic scourge. Many people and documents are typically involved in discharge decisions, and today's technology preserves every bit of the "untidy, behind-the-scenes process." Litigation discovery can reveal it for the world to see. Have an attorney involved at all stages, Bucking advises, as this brings things under attorney/client privilege. If an attorney is not involved, then avoid creating a permanent electronic record.

5. Don't lie. "The worst thing to do when terminating an employee is to be dishonest as to why. Yet this is a common mistake," Bucking says. Like most people, employers hate confrontation and hard truths, so firing for poor performance is often disguised as a layoff. "But most discrimination allegations turn not on direct evidence (like racial slurs), but on 'pretext,'" he says. "An employer gives a false reason for termination, creating the inference that the real reason was unlawful."

6. Don't be cruel. To you, a termination may be just business, but there's no way to avoid an employee taking it as personal. That's likely to lead to a lawsuit, where "cold-heartedness does not play well before a judge, and especially a jury," Bucking says.

7. Conduct the termination respectfully. Don't fire in public. Instead, be as private, respectful, and decent as possible.

8. Have backup. Two people should be present at the termination, says Bucking, and both should take detailed notes. Record anything material that the employeesays, and also what you say, especially on the reason for your action. Be sure that what you tell the employee agrees with your previous oral and written statements.

9. Pay all compensation. Make sure that all monies due to the employee are paid immediately. In many states, all compensation owed must be paid on the day of discharge.

10. Don't forget about non-compete, non-disclosure, severance, and other agreements. Make sure you live up to any obligations to departing employees, and make sure they understand any obligations they owe you. Bucking also suggests considering new agreements such as a release from legal action based on the termination. "It may be a great investment to pay a few weeks of severance for absolution from litigation," he says.In an article on HR.BLR.com, private investigator George Scharm offered some other helpful termination tips, including:--Never fire someone while you're angry. You want to diffuse emotion, not compound it.--If an employee has a poor relationship with his immediate supervisor, get someone else to conduct the firing.--Plan every step of the meeting in advance: what you will say, how you will respond if the employee reacts with anger or hysteria.--Beyond forestalling litigation, as Bucking suggests, severance pay can also be an investment in company security. Be courteous, but firm. Leave nothing open to negotiation.--Have the exit preplanned. Escort the employee out the door and to his or her car."

Medicare..Can Physicians Save Move and Improve Care?

Anna Wilde Mathews, a blogger for the Wall Street Journal tackles a tough issue which is the subject of constant buzz in the healthcare community..Medicare reform. It seems a group of doctors participated in a pilot program run by the Centers for Medicare and Medicaid Saving which offered efficient practices incentive payments. Check it out.

"Washington is revving up for a big debate next year over health care — which, realistically, is likely to end up centering around some form of Medicare reform. Everybody wants to somehow save money while also improving care. Proof that trick can be performed consistently in the real world is hard to come by, despite the flurry of concepts and buzzwords being shopped to congressional staffers as the hope for tomorrow.

Some encouraging data are just out from a closely watched demonstration project on incentive payments for doctors being run by the Centers for Medicare and Medicaid Services. The project focuses on 10 physician group practices that can earn extra money by improving efficiency and hitting various quality benchmarks.

The groups scored nearly perfectly on quality measures for diabetes, heart failure and coronary artery disease, with half achieving the targets for all 27 bogeys, and all of the groups meeting at least 25. But only four achieved the CMS efficiency targets and won the extra payments tied to saving the government money and achieving quality standards.

The savings were measured in a typically convoluted way-– the doctor groups got the bonus if the growth of the demonstration participants’ Medicare costs was at least 2% slower than the growth for other beneficiaries in their geographic areas.

John Pilotte, the CMS project director for the pilot, told the Health Blog he felt the savings results were still “very positive,” and better than the first year, when just two groups achieved the goal. Still, he added, “it sort of underscores the challenges and the difficulties in managing care for the Medicare population.”

So what worked? Pilotte and officials from a number of the clinics flagged various things, including those policy-wonk favorites: chronic disease management and coordination of complex cases.

Theodore Praxel, a medical director at Wisconsin’s Marshfield Clinic, one of the four savings-bonus winners, said there was “no single answer,” but he gave a lot of credit to yet another wonkish fave, an electronic medical record that helped track and alert personnel to what services patients needed. He also pointed out that savings from better prevention of health problems can take years to show up."

Stanford Study Proves Running Slows the Aging Process

I do not enjoy running but I do enjoy how I feel when my run is completed. In addition to the endorphins running releases, running also slows the aging process. Stanford released the following regarding its long term study. I think I'll go for a run this afternoon.

"The Stanford University School of Medicine has released the results of a long-term study that explores how a lifetime of running affects the aging process. The multitude of benefits derived from running have surprised even the research team.
In 1984, James Fries, MD, and his team of research colleagues enlisted 538 runners, all older than 50, and a similar group of nonrunners. Each year since then, the study participants have completed questionnaires about their personal lives, including their ability to groom, dress, and walk themselves as well as to their ease in getting up from a chair and gripping various objects. Their running patterns have been documented through the years as well.
When the study began, the runners averaged about four hours of run time each week. Twenty-one years into the study, run time has diminished to only 76 minutes per average week but the runners were still reaping the benefits of their active lifestyle nonetheless.
After 19 years of study, only 15% of the runners had died, from any cause, compared to 34% of the group of nonrunners. As was expected, the rate of death due to cardiovascular disease was much lower in the group of runners but the running group also had fewer deaths attributed to cancer, infection, and neurological disease, among others.
By the 21st year of the study, participants in both the running and nonrunning groups had started bearing signs of advanced age. They are now all in their 70s and 80s. What has proven to be quite remarkable is that the age of decline is dramatically later in the runners than in the nonrunners.
The onset of initial disability occurred 16 years later, on average, in the group of runners than in the group not running. Even more surprising is that, as age advances, the gap between the health of the runners versus the health of the nonrunners widens, in effect compressing the ill effects of old age into the shortest amount of time possible.
Indeed, it was Fries’ theory of “compression of morbidity” that led to the study in the 1980s. At that time, critics of the new running craze said the exercise would lead to injuries of the knee and other joints that would cause osteoporosis and other crippling disabilities as age advanced.
Fries’ thoughts were that a lifetime of regular exercise, such as running, would extend the runner’s life while enhancing vitality and improving its quality at the same time. His extensive study has proven his hypothesis correct.
Fries is emeritus professor of medicine at Stanford’s medical school and is the senior author of the paper describing his study of running. The Archives of Internal Medicine carries the full details in its August 11 issue.
The National Institute on Aging and the National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded grants for the Fries study."
Source: Stanford School of Medicine and Medheadlines Posted August 13, 2008

Keep Moving to Keep Your Brain Stimulated

As the baby boomer population grows older, the good news is that they are living longer. The downside is that statistics show that 1 in 8 adults over age 65 are affected by Alzheimer's disease. As a person living with a parent with the disease, I personally understand the implications. According to the following article written by Caryn Rabin in the New York Times, mental and physical exercise do help your cognitive functions as you grow older.

"AMERICANS may worry about heart disease, stroke and diabetes, but they downright dread Alzheimer’s disease, a recent survey found.
For good reason. One in eight adults over 65 is affected by the disease. Those who are spared know they may end up with the burden of caring for a parent or a spouse who is affected. Even though the number of older adults with dementias is rising rapidly, only a few drugs that have been approved to treat symptoms are on the market, and they slow down the disease but do not cure it.
Researchers, however, are more optimistic than ever about the potential of the aging brain, because recent evidence has challenged long-held beliefs by demonstrating that the brain can grow new nerve cells.
“For a long time, we held the assumption that we’re born with all the nerve cells we’re ever going to have, and that the brain is not capable of generating new ones — that once these cells die we’re unable to replace them,” said Molly V. Wagster, chief of the Neuropsychology of Aging branch of the National Institute on Aging. “Those assumptions have been challenged and put by the wayside.”
The birth of new nerve cells, she said, “has been shown to occur in the adult — not only in adult rats and monkeys, but also in older adult humans.” Most of the areas that show neurogenesis and that have been investigated so far are important for learning and memory, particularly the hippocampus, she added.
So how does one stimulate neurogenesis?
Scientists do not have all the answers, but studies of older people who have maintained their mental acuity provide some clues. They tend to be socially connected, with strong ties to relatives, friends and community. They are often both physically healthy and physically active. And they tend to be engaged in stimulating or intellectually challenging activities.
The big question is whether they remain mentally alert because they engage in these activities, or whether they are able to engage in these activities because they are cognitively intact.
“We don’t know whether this is an example of reverse causation or not — it’s probably a two-way street,” said Bruce S. McEwen, who heads the neuroendocrinology lab at Rockefeller University in New York.
But some interventional studies that have introduced older adults to exercise regimens have reported remarkable results. Researchers at the University of Illinois at Urbana-Champaign recruited a group of sedentary adults between the ages of 60 and 75, assigning half of them to an aerobic exercise program that met three times a week to walk, while a control group did anaerobic stretching and toning.
The scientists measured the group’s cognitive function before and after the six-month program and found improvements among those who had done the walking.
“Six months of exercise will buy you a 15 to 20 percent improvement in memory, decision-making ability and attention,” said Arthur F. Kramer, a professor of psychology at the University of Illinois. “It will also buy you increases in the volume of various brain regions in the prefrontal and temporal cortex, and more efficient neuronetworks that support the kind of cognition we examined.”
Other studies have found improvements in cognitive function after a combined regimen of physical exercise and cognitive training.
But skeptics say there is no guarantee that intellectual stimulation will prevent Alzheimer’s disease or other forms of dementia. “Maybe it does, but I don’t think we have a shred of evidence,” said Dr. Robert N. Butler, a psychiatrist and gerontologist who is president of the International Longevity Center-USA. “What it does is maintain good health,” he said, adding, “I don’t think we can go much further than that.”
But there is consensus among scientists on a few recommendations for action that, most agree, cannot hurt.
Regular physical activity may improve brain function, both by increasing blood flow to the brain and stimulating the production of hormones and nerve growth factors involved in neurogenesis. Animal studies have found that physically active animals have better memories and more cells in their hippocampus. Exercise also plays a role in countering diseases like Type 2 diabetes, which increases the risk of dementia. Cholesterol and hypertension, which affect vascular health, also need to be kept in check.
Seeking out stimulation through interesting work, volunteer opportunities or continuing education is beneficial. Travel, read, take up a new language or learn to play a musical instrument. Staying socially connected is also associated with brain health, as is managing stress effectively. Chronic stress can lead to the rewiring of areas of the brain that are involved in emotion, memory and decision-making, Dr. McEwen said, “and the brain becomes more biased toward more anxiety, more depression, less flexibility in terms of decision-making and becomes less able to store information.”
Most scientists recommend eating a Mediterranean-style diet, including fish and nuts containing omega-3 fatty acids, antioxidant-rich fruits and vegetables, olive oil and possibly some red wine. (Blueberries are also recommended.) Some also suggest avoiding playing games like football, because of the risk of head injuries, staying away from pesticides and insecticides that contain neurotoxins and not drinking excessively.
“Another thing that’s important as people get older is to maintain flexible attitudes and be willing to try new things,” said K. Warner Schaie, who in 1956 started the Seattle Longitudinal Study, which follows the psychological development of participants through adulthood. “You have to expect things will shift over time and won’t be the same as when you were young. Those who manage to roll with the punches, and enjoy change rather than fighting it, tend to do well.”

What do McCain and Obama have to say about employer sponsored health coverage?

I am a fan of the Wall Street Journal's healthcare blogs. Today Sarah Rubenstein tackled the question about the candidates' stands on employer sponsored health coverage. Check it out.

"When it comes to health insurance, it’s usually easier to have an employer provide it than to buy it for yourself. So when health-policy advisers for Barack Obama and John McCain participated in an online debate on WSJ.com about their bosses’ respective health care plans, much of the focus was on how each plan would affect the employer-sponsored market.
A quick backgrounder: Obama wants private plans and one new government-run plan to compete to sell insurance, with government subsidies for low-income customers. McCain would change the tax treatment of health insurance in a way that would encourage Americans to buy insurance on the open market, eliminating the current bias toward employer-sponsored coverage.
Naturally, each debate participant thought the opposing candidate’s plan would do more harm than good to employer-sponsored coverage. But here’s what they said about their own men’s plans:
David Cutler, Obama’s adviser, said that Obama’s plan will “shore up the employment-based system, not tear it down: lower premiums that firms face through investments in information technology and prevention; create a setting where individuals and small firms can buy insurance the way that large firms do; make sure that insurers cannot exclude firms because one employee is sick.”
Jay Khosla, McCain’s adviser, said McCain’s plan “simply aims to bring equity and choice to our healthcare system, including allowing American families to keep their current coverage. The McCain plan gives American families a $5,000 refundable tax credit ($2,500 for individuals) to give them more choices to purchase portable coverage that would stay with them from ‘job to job’ or ‘job to home.’ His plan directly and comprehensively addresses the single biggest threat to [employer-sponsored insurance] –- rising costs.”"

Employee Compensation Issues for Small Business Owners

One of the major issues discussed with our clients is salary. It is particulary an important subject in today's economy. In the Atlanta medical community, most office managers want to pay competitive salaries, especially for hard to fill positions such as RNs. I found the following article, by Michael Alter posted on the Human Resources Blog in Inc. magazine, very informative about setting salary levels.

"Compensation is a hot-button issue for employees, but it's an even bigger deal for small-business owners these days. With shrinking profits in this tight economy and costly benefits hanging over your head, there's no room for error in defining employee salary levels. Here are some tips on how to set your salary levels.
I run a payroll service and as you might expect, I hear a lot of feedback from our small-business customers regarding employee compensation.
My conversations with business owners have made one thing clear -- many business-owners struggle with the right amount to pay new employees.
It's a tricky issue. Overpay your employees and profits may drop. Underpay your employees and you'll get inadequate employees or you'll lose them over time to the competition.
The bottomline? Today's competitive business environment necessitates a solid basis for defining compensation levels. Here are a few things to consider when you define the target salary for a new hire.

National Salary Averages Are Irrelevant
Always think local. National salary averages mean nothing if you are located, say, in a small town in Kansas. In fact, salary levels for any given position are very location dependent.
If you are doing salary research, it's imperative that you look for salaries in your town or in towns that are very similar to yours.
Similarly, salary ranges vary considerably by industry. When looking at salary benchmarks, it's important to only look at those from your industry whenever possible.
In addition, the job description, not the job title, should be on center stage when researching salaries. It's what the person will do and what's at stake that matters, not the title that will go on their business card.

Online Salary Wizards
So where can you go to research salaries and why is salary research important?
Before prospective employees start interviewing, they will often check out online salary calculators such as the Salary Wizard at Salary.com.
To understand the expectations of your prospective hires, it's important that you find out what the online salary wizards are saying.
Unfortunately, some of the salary estimates that come from these online tools are way off the mark. In part, that's because the salary wizards are usually geared toward larger businesses, not small businesses. They also are usually bases on title, rather than job responsibilities.
For example, a customer of ours who owns a small PR firm informed me that the Salary.com salary wizard pegged the average starting salary for a Media Relations Specialist in Chicago to be $45,000. In fact, he explained, a more typical range for that particular position is $25,000 to $32,000.
How's that for a scenario? You are ready to offer $31,000, near the high end of what you believe to be the salary range for a position, and the employee, armed with what they believe to be the right salary, says they'd like to get $45,000.
As you can see, regardless of whether the online salary wizards are right or not, it's well worth your time to find out what they say you should be paying.
If what you'd like to pay and what the online salary wizards say you should pay are way out of whack, you'll do well to check some other sources and be ready to present that data to any misinformed candidates.

Industry and Trade Associations

Industry trade associations and HR organization are an excellent source for salary data. Most have undertaken extensive industry salary surveys and have salary data that you can access and evaluate. A quick call to your industry trade association will help you find out if they have the data you are seeking.
You can also ask for the data from associations you don't belong to. In many cases, the results of comparative salary surveys are available on association websites.
Peer Organizations
Talking to peers about current salary levels is always a good idea. Look for an organization that you don't compete with. Maybe you own an ice cream shop and the guy next door owns an apparel store. Since you are not directly competitive, you should have no problem sharing salary information for positions like a bookkeeper. By finding out what your peers are paying, you can get a good sense for market salary rates.

Competitive Research
Getting data about what your competitors are paying their staff is a much tougher assignment but it's doable. When a competitor advertises a position for hire, you might give their HR manager a call and ask what the salary range is for the position. Borderline unethical? Not really. This is routine competitive intelligence gathering in my opinion.

Think In Terms of Ranges
You should always have a salary range that you are willing to pay for any given position. Locking in on a single number is a mistake.
The reason you need to think in terms of salary ranges is that every job candidate has slightly different experience. You should be willing to pay more for a more experienced candidate because, in theory, their prior work experience will make them more productive in your organization relative to a worker with less experience.

Ask Candidates About Salary Before You Tell Candidates About Salary
It's always best to ask prospective recruits what their salary expectations are. Ask early in the interviewing process to avoid a scenario in which you both invest a lot of time only to find out that your expectations are completely misaligned.
Don't ask what a prospective employee wants in the way of salary. Instead, ask them what they need. Your top recruit might desire to earn $75,000 but maybe they only need to earn $55,000. Knowing what they need can help you to define the right salary.
Don't forget that compensation is much more than just cash. You need to tout the benefits of working at your organization and make sure prospective employees understand that value proposition. This can include typical HR benefits such as good health insurance but it should also touch on opportunities for advancement in the organization, training, mentoring, a friendly and fun work atmosphere, and the work itself.

Revisit Your Salaries Often
Salary ranges change constantly based on supply and demand. In a bullish economy, talented recruits are a scarce commodity and you may have to pay higher salaries. In bearish times, you can pay less. Currently, because of the economy, it's a buyer's market for employees. In other words, you can afford to offer a lower salary this year relative to prior years.
If your salary levels are based on research you did years ago, you'd do well to take a fresh look at current salary levels.
If you are not sure what to pay, my recommendation is that you err on the side of paying more than the market because talented and motivated employees can do amazing things. There a lot of areas in business where you can scrimp but paying your employees shouldn't be one of them."

Thoughts about Social Network Sites for Business

I am a fan/student of technology, the internet and any new and exciting trends for business. I have been researching the use of social networking sites for business purposes and have even joined Linked In and My Space and have linked them to my website. I think the following article by Karen E. Klein in Business Week aptly discusses this subject. Enjoy.

"To get the most out of social networking sites, small companies should look past the hype, set concrete business goals, then start experimenting. Social networking online seems to be exploding: Facebook, LinkedIn, Twitter, Digg, and so on. When I ask how these sites can help my business, the answers can be vague. I am trying to relate it to face-to-face networking, which includes sharing ideas, information, and resources with other businesses. Are these sites useful for those goals? There is only so much time in my day and I need to use it effectively. —B.H., Scarborough, Me.

You are correct that social networking is a rapidly growing, headline-grabbing phenomenon. The question for entrepreneurs is how to tap into this trend as a business opportunity, rather than simply a way to connect—or reconnect—with people, says Peter Delgrosso, strategic vice-president for corporate communications with Web.com (WWWW).
"For the most part, these social networking sites should be viewed as complementary to your online presence. Think of it as a nice-to-have, not a must-have," he says. "When used properly, it is something that can gain your business some attention. However, you need to realize it shouldn't be seen as a replacement to your traditional online presence."
Greg Sterling, of Sterling Market Intelligence, considers social network sites primarily for meeting people, asking for advice or referrals and, carefully, doing online marketing. The uses vary by application or site, he notes: "Sites such as LinkedIn can be helpful in connecting with people you want to meet for one reason or another. Twitter and Facebook can be helpful when you're trying to notify a group of people about something you want to promote or about a happening of some kind."

Find Your Networking Niche

Take a few minutes—it doesn't have to be extensive—to look over the top sites and experiment to see what works for you. Even an hour or two a week can help you figure out which sites you like best and are most effective for your particular business. "The viral nature of social networking is quite extraordinary and something that can garner a lot of attention to your efforts in a hurry," Delgrosso says.
He thinks the best site for both networking and human resources purposes is LinkedIn. "The site requires some résumé creation, then offers the opportunity to link in to other like-minded professionals. When used selectively, it can be a very powerful tool for identifying new business partners, new employees, or simply building your personal or business presence," he says.
For gaining exposure to larger audiences, he recommends Facebook: "Consider establishing or joining a network on Facebook based on your business or industry category to tap into people's affinity for the topic. By doing this, you'll cut through the clutter and clearly establish your niche, keeping the interaction focused on the specific subject matter."
Rick Julian, CEO and chief creative officer of Quo Vadis, a startup brand communications agency, says he's getting a positive return on his investment from using social media sites for the past year. "It puts a human face on your business and allows people to get an impression of what a relationship with you would be like. When all things remain equal, people want to work with people they think they'll have an interesting relationship with," Julian says. His firm is represented on five major social networking sites, including YouTube (GOOG) and his blog, and a couple of smaller ones.

"Geometric Extension" and Search Optimization
It sounds like a full-time job, but Julian points out that you can cut and paste some of your content from site to site. "If I put up a YouTube video to create awareness, I might have some discussion on YouTube with the responders and then also put it on my blog, on my Facebook company page, and promote a link to it on Twitter. Just by generating that single asset, I've populated all those networks with content without having to come up with an original piece of content for each of them. There's a geometric extension of your reach," he says.
Robert Jenson, CEO of the Las Vegas-based realty firm the Jenson Group, takes a strictly corporate approach to social networking. "Rather than blogging stream-of-consciousness opinions or using the venue as a diary of sorts, I educate visitors on important, universal industry matters. I try my utmost to ensure the content I post is not just applicable and of interest to those in Las Vegas, where I operate, but also to any real estate consumer nationwide," he says.

He puts bylined articles he's written on his own blog and on social networking sites and uses them to establish his credibility as a real estate expert. "This serves as a 'risk reliever' for both prospective consumers and business affiliates, while also increasing my chances for media coverage by establishing myself as a reliable expert source," Jenson says.
Last, but definitely not least, is the value of social networking sites to search engine optimization (BusinessWeek, 6/20/08). The more sites that include your name and link back to your Web site or blog, the higher your profile rises in search engines, where more and more of your customers are likely to find you, Jenson says. "