text:
- Christina Nesheva
- London
- United Kingdom
GlaxoSmithKline plc
This conversation is closed.
What is the future of healthcare? How can it become health care vs sickness treatment? What role do technology and innovation play?
Healthcare costs are rising, the population is aging and medical needs are greater than ever. How can patients receive better quality care at an affordable price? How can we leverage technology to provide better and more affordable healthcare around the world?
Lauri Baker
Oct 19 2011: Technology is great, but I think the idea of caring for our health should also include consideration of what we're being told is food. Put obvious junk food aside for a moment, and just consider what we're being told about which foods are healthy. I have my beliefs about what we're being told, but there are lots of contradicting thoughts about what's healthy to eat and why, that it gets confusing. Modern medicine doesn't seem to be focusing much on this, to get to the bottom of all of it and promote what's truly healthy to take in as our nourishment and body's fuel. The government has taken the role of food approval, and alternate ideas are brushed off as fanatical. Are we eating what's truly proper food for the human body, or are we being told what's food based on politics, economics and government subsidies? Our bodies can't be healthy if we don't eat what they're meant to live on.
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Oct 20 2011: Well said.
The role of government is to do things that individual cannot do. Regulating markets, ensuring advertisements are truthful, ensuring food is food and food is healthy etc.
The problem I see in western countries is the "hyper" faith in market economy. Frankly, free market works only when the participants are moral. When there are crooks and there are people feeding on gullibility of the vulnerable, government needs to step in to regulate. When you last saw an advertisement for a farmer market when nutrition are sold at cost. I bet you see much cheap calories ads from the fast food outlets.
When an item is sold as food, it should be food. Who should enforce this? Self regulation does not work because there are always crooks everywhere. If government cannot step up to fulfill this, citizens may consider changing the government. :-)
Hazem Ali
Oct 17 2011: As a medical graduate who is trying to find a residency spot in U.S I found your topic very interesting to me. I'll tell you something I heard from Dr. Conrad Fischer the author of Routine Miracles. He was talking about the importance of preventive medicine and said : How many people got killed because of the terrorism? and How many people die everyday because of diabetes and coronary heart disease ?
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How much money spent on overseas wars compared to money spent on prevention of diabetes ?
79 thousands die every year because of diabetes ? If this is was a military attack on U.S soil the country will unify overnight and say we got to solve that problem.
Albert Ip
Oct 17 2011: Arafat,
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Well said. Sometimes we wonder how government can get the priority so wrong, or is it something else working against the better vision of those who really want to help?
USA is a "free" society. But what is actually FREE? Free to misled people, to give false information, to advertise to sell products which are harmful. I watched a documentary "Killer at large" just last night. Surgeon General (2002-2006) Dr Richard Carmomna said something which is important. See http://www.youtube.com/watch?v=cPNw-kIPy8I
Will our children live shorter than we are? Yes, very likely unless our focus on health care is to make healthcare professionals to focus on health, not just disease treatment. It is more than preventive medicine. I am taking a lot of pills to prevent my blood pressure to burst my veins. Is that preventive medicine. In a way yes, but in essence, healthcare professionals should help me exercise and reduce my waistline. I know, it is my fault that I do not exercise. But for a society to be healthy, the environment needs to support active lifestyle in a more engaging way.
By the way, I have started exercising and I hope I can get rid of my medication in 1 year. Wish me luck.
Sten Ekberg
Oct 19 2011: First we need to understand what health is. Health is when everything in the body is working the way it is supposed to. The health of any tissue and the health of any body part can only be as healthy as the care and support it receives. And by care and support I mean the quality of the nutrients provided through the blood, and the blood supply and regulation provided by the brain and nervous system.
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We need to understand that there is a built in intelligence that created the body from 2 cells, and that intelligence hasn't left the body. It is still there - running the show. Most people would agree that there is no process in the body that happens independently of the brain. If we truly understand this fact, we also must understand that any dysfunction (except acute injury, and a handful of congenital errors) is the result of aberrant function in the brain.
Therefore healthcare isn't health care, but rather merely disease management, unless it addresses brain function. Perhaps the most revolutionary discovery and paradigm shift in the past decade is that the brain changes. Neuro-plasticity. The principle and fact that the brain physically changes size, shape, pathways, wiring and strength based on our environment and exposure in order to learn and adapt.
It is possible to measure the function of the brain and define the parameters of normal or optimal. We can do this with posture, balance, muscle testing, reaction time, qEEG etc... If we can then render care and show improvement toward optimal, we have improved health, reduced the probability of disease, and slowed or reversed parameters of aging.
This is the only way health care can go. We have to let the medical "disease care system" take care of emergencies which they do brilliantly, but stop giving people drugs to mask symptoms.
Go to the source of the problem. Chiropractors have done that for over a hundred years.
Neuro-science is just now catching up with the mechanisms why it works.Oct 19 2011: The key components necessary to correct the problems with health care delivery within the United States include:
1. Better adoption of evidenced based practices. We spend far to many dollars of unnecessary, ineffective and overpriced interventions when the clinical evidence contradicts these interventions.
2. Expansion of patient empowerment. We need to invest much more time and resources into education of the public in the appropriate management of their health and their illnesses. This is where technology can play a vital role in developing targeted educational products that individuals can easily access and utilize. These educational interventions must be cognizant of literacy limitations and language barriers AND be free of profit driven bias.
3. Development of a universal health delivery system for all United States Citizens. As a health care provider in the emergency room I see the economic and human costs of people not having access to care on a daily basis. We have an opportunity to look at other systems and develop the most effective and efficient. Unfortunately we are all aware of the barriers to this.
4. Increased individual responsibility. We have become a nation of hypochondriacs. We believe that every complaint or symptom is a disease pathology and believe that the solution comes in the form of a pill. This is, in large measure, the result of out direct to consumer marketing. We must shift back to a system where individuals recognize their role in their health and accept the responsibility for adopting a healthy lifestyle.
These are just a few of my observations as a health care provider. Change is not only necessary, but vital, if our strained healthcare system is to survive.
Oct 19 2011: Well said Edward!Oct 19 2011: Edward, what you say resonates strongly with me, particularly the personal responsibilities and empowered patients.Oct 20 2011: Quote: "We believe that every complaint or symptom is a disease pathology and believe that the solution comes in the form of a pill."
That's what I see a lot of and never understood. My observation is even the opposite. Pills can make people sick.
For instance, if there's a little problem like headache a pill can give release if one believe this but the chance the headache will come back increases while as the body or the person itself solves the problem the risk of getting a headache decreases.Oct 19 2011: Healthcare needs product innovation but these product can only be successfully useful when process innovation will be there. To lower the healthcare cost weneed disruptive innovation in healthcare we need to change tradition healthcare process.
Tony Gruber
Oct 19 2011: I agree with most respondents; Education is the key to health care vs. sickness treatment.
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My problem with the US medical care debate is the automatic assumption that Health Insurance should be part of the solution. Insurance is traditionally purchased to protect yourself against something that you don't want to happen. It can't work, economically, when the general population uses insurance to pay for events that are certain to happen, or that you hope will happen.
1. Treatment of chronic illness. You know you need the treatment, so it will cost more overall to indirectly pay for it via Insurance.
2. Health care. Again; you want to be healthy, so paying an insurance policy to pay for your efforts to remain healthy is more expensive than paying it yourself.
3. Sickness treatment. This is the only aspect of Medical care that works as an insurable event. You don't want to get sick, so you don't want to use your health insurance policy for this. Therefore; this represents an economically insurable risk. But sickness treatment is only 1 of 3 broad categories within the Medical care arena that are economically insurable.
These aren't the only problems with using insurance to pay for Medical care, but I hope they illustrate the problem. ?
Oct 19 2011: I wonder if at the moment Insurance is given such an important role because it offers the necessary effectiveness metrics for treatment. Metrics drive innovation, insurance companies and consortiums drive metrics. I'd be nowhere in my team's innovation without ICD-9, but coding today is done mostly for billing purposes, driven again by insurance companies. And this is just one example.
Also we have to consider the economic value of stability. Paying more is not always bad. You don't just pay tfor treatment, you pay for the safety net that WHILE you're getting your treatment, chronic or not, any sudden hikes in costs or changes in standard of care, or acute incidents, and incedental trauma will not take unexpected $20,000 out of your pocket, derailing your entire financial life (thinking of average americans here).
I'm not saying insurance today isn't flawed throughout. I am FAR FROM defending today's model, but it's not just something that you deprioritize or think of ways to get rid of. I think it's something which needs re-design, but should always be a part of the system when considering the holistic "health CARE", not just incedental medical treatments. And it should reward behaviors such as healthy diets, supplementation, and exercise or active lifestyle, which should become increasingly easy in the world of Big Data.
Oct 19 2011: You miight consider if science and evidence -based practice offers the necessary effectiveness metrics for treatment, not insurance companies.Oct 20 2011: Insurance is not flawed, in my opinion. And insurance has it's place in health care.
I'm suggesting we insure the 'insurable' portions of health care, and recognize that some health care costs are not 'insurable'. Here's an illustration:
You insure a house against catastrophic damage (something that you hope will never happen), but you don't insure the house against regular maintenance, because that would bring an additional cost into the equation - the cost of the insurance company itself. Hiring an insurance company to pay for your yard work and house maintenance would be much more expensive that paying for it yourself, right? That is also true for routine medical visits and treatment of chronic illness.
It's another matter entirely to say "I want a collective group to subsidize my chronic health issues and routine office visits". This is a valid concern for the poor, but this issue should be treated as another matter entirely.
If someone wants/or needs that kind of financial help, it's less expensive in the long run to treat that as the separate issue that it truly is.
Insurance is a very expensive way to pay for routine expenses, and that's a big reason health costs are increasing rapidly.Oct 20 2011: Insurance is obviously part of the problem, so should be part of the solution. -in my humble opinion, Insurance companies act like gangsters: you have to purchase the policy for you to be protected, if not you will die. period!
Oct 23 2011: Like gangsters? Wow. I think you need to change insurance companies. Mine never came to my house and gave me an "offer I could not refuse".
To me, I CHOSE to buy insurance to mitigate the risk. I could take the same amount of money and save it in the event of some catastrophe, but I make a CHOICE to buy insurance. And the neat thing is that I can CHOOSE a lower price by doing everything I can to stay healthy.
However, now if the government REQUIRES me to buy insurance... well, then I suppose the government is now becoming a gangster, but that is a different story.
Oct 24 2011: seems that you had many alternatives to choose your health insurance. Can you tell us? and, YES, it is precisely that I had received: an "offer I could not refuse", again, gangsters or even worse -I did not realize they were making more profits by avoiding the costs of visiting me at home, as you pointed out.Oct 24 2011: Edgar, yes. There are websites which list many alternatives. Do you really want me to advertise them here? Some are more expensive than others, but that is the free market. Why are you limited?
You say they are making a "profit", but you are likely misusing terms. They bring in more money than they spend on YOU, but that is how they work. Somehow, they have to pay for the extra costs that occur. Many people get much more paid for them then they ever paid into insurance (which is the whole point of insurance). That money does not grow on trees. It comes from managing costs. If, in the end, the net of all revenue less all costs is positive, THEN they have a profit. To me, that is fine since that is what businesses strive to do(but not all do). Would you rather the insurance companies scrape by? Or, perhaps you prefer they lose money and go out of business?
Oct 24 2011: Let me ask you something. What if you decide not to buy a health insurance policy? Simple, you will not be able to solve even a regular health event by yourself, quickly the situation will get worse for you, and sooner or later you will be at high risk of death. So, back to the beginning of this conversation, you do not have a better choice Drew, you are forced to accept that "offer I could not refuse", imposed by the current health system through insurance companies, whatever that nice webpage you were close to advertise. It is buy or not to buy, if you do not buy then you will die! --- Sorry, I still find this modus operandi similar to the gangsters!Oct 24 2011: Edgar, I am not sure what you expect. You say how important insurance companies are yet you don't want them. Which is it?
As you point out, you DO have a choice not to go with insurance companies. Many people do and they are not dead. Yes, it is very risky (FYI: there are many things about life that are risky.) But without insurance companies, how else would you manage the risk?
I think you real issue is with the cost of healthcare, not the cost of insurance. If your issue is with the cost of insurance, then please respond to the second part of my previous response.
Oct 24 2011: They are not dead yet, but will be soon if they are not cared. That's my point, the fact that one of two choices is equivalent to shorten lifetime or an early death [I can't imagine to whom I would give that kind of alternatives to elect]. That's absolutely unethical, and sadly nobody seems to notice! We have accepted that doing bussiness with the pain and suffering of people is a good thing. As in Stockholm syndrome, we have learnt to love our captors, sometimes to the point of defending them.Oct 24 2011: Edgar, I am not sure what you expect. You say how important insurance companies are, yet you don't want them. Which is it?
Oct 25 2011: That's the easy part: I would like to have a system where everyone equally has the best possible health --- How to get to that system? would be possible if at least we were looking in that direction. --- I do not see insurance companies in any role in that world. I really do not hate insurance companies; I just simple believe that health should not be their business. Moreover, health of people should not be a business the way it is in these days. Let me explain, insurance companies base their income on an adverse events that are more common among the people every day, so that their businesses will eventually become unsustainable, simply because you cannot expect to increase premiums forever. And they know about it, so they are just taking advantage of such widespread pathological optimism, and continue to use a wonderful business tool they have what is increasing premiums at will, until the government decides to put a stop to these guys and take seriously this problem.Oct 25 2011: Now, it is not a secret that health is related to economy in several ways. So. health-related areas of economy should also be matter of intervention. In general, you will have few healthy people generating the resources to maintain or recover a lot of unhealthy people; so, economy won't grow. On the other hand, economy in their hurry of growing is pushing people to consumerism; as result you have a money-driven society with all the harmful consequences that implies; or just a typical individual, eager for junk food and banal things, propelled by advertising, that is becoming more obese every day, illiterate, unsatisfied, irritable, and anxious, in other words, an army of unhealthy people that contributes nothing to society and economy. We have to do something smart about that, soon!Oct 23 2011: In future technology driven by innovation (i.e. humane genome project) will track down diseases much earlier so tackling that will be rather cheaper and in that case it will be real healthcare then instead of current sickness care.
Oct 25 2011: Yes, but innovation costs money. It also comes from many efforts, mostly failures. Who should ultimately pay for that? I think its fair that the ultimate consumers of it pay for it. As such rising costs will continue to be a factor with healthcare.
Oct 25 2011: Cost of innovation always included cost of failure & money also always went out of the pocket of consumer in any industry. Healthcare industry is now striving to keep down the cost of innovation down looking in to different model , some of which seems to me to be counter productive even i.e. outsourcing R&D.
Whenever someone talks about healthcare cost, immediately most of us talk about cost of medicine , but we need think of what % cost goes to medicine cost in to the total cost structure ?
Even with a product of innovation once econmy of scale is there cost of products goes down.However here the point I focuesed is Human Genome project , which can offer us the ability to detect many diseases much earlier of it's outbreak so can take preventive measures.
Usually preventive measure is cheaper.
Please check the link below , which says how genome project cost can go down
http://www.ted.com/talks/richard_resnick_welcome_to_the_genomic_revolution.htmlOct 23 2011: The issue in the US, in my opinion is not the concept of health insurance, which seem quite viable. You can insure yourself against a catastrophic and unforeseen/unavoidable event. The issue, as I see it, is that we as consumers have deferred our "health responsibility" to an industry whose job (as an industry, I am not referring to a doctor who has taken an oath) is to be profitable and to which this industry has exercised its right to partner with other industries like pharmaceutical. This is an unnatural relationship for an industry to bear and the result is that our medical system is clogged with patients who are not actually participating in their own recovery. What should be "diagnosis, advice, short term care and recovery" is instead "diagnosis, advice, prescribe, and long term care".
Using Medicare spending as a model, "the big four" illnesses by cost are Heart Disease, Diabetes, Stroke and Lung Disease. The total medicare spend on these four was nearly $500 Billion in 2007 compared to $10 Billion on Cancer. The issue is that ALL of these are lifestyle related and controllable diseases. These huge numbers however are clear evidence that we are not changing our lifestyle or controlling these diseases, we are opting for long term care.
The answer to the growing health care crisis is for us as consumers to address what is making us sick, seek expert advice, take advantage of the most advance health care available on the planet for short term care and whenever possible, take responsibility to change whatever you need to recover.
It is possible that the collapse of the current health care model will finally drive that change in our collective psyche.
Oct 25 2011: You make a good point. One respondant to another thread of this discussion felt that he had no choice about paying an insurance company. Yes, going with insurance is "safer" but its not the only choice. As you mention, it may take a collapse for some people to see the situation from a different perspective.
Anne Dagen
Oct 21 2011: Healthcare costs are not rising as much as many people think. A substantial proportion of the increase in cost relates to bureaucracy, not actual healthcare. One of the main uses of technology in healthcare is to reinforce bureaucratic overheads.
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An increase in professionalism and a reduction in bureaucracy would both reduce costs and improve health. The reason it would improve health is that it would provide people with timely and appropriate treatment, reducing the inevitable health decline which comes when an illness goes a long time without treatment.
A side effect of this would be that a highly professional healthcare sector, without the deadweight of excessive bureaucracy, would have the time and the knowledge to keep up to date with developments and discuss the options openly with patients.
Drew Bixby
Oct 25 2011: Yes! Excellent point all around. It is bureaucracy in healthcare, like bureaucracy in government or business, which can have some of the biggest (negative) impacts in cost. Bureaucracy also diffuses individual responsibility so individuals have a less clear view of how their actions affect others.Oct 20 2011: Must see about the future of health(care) : the most underutilized resource is the patient : Let patients help http://www.ted.com/talks/lang/eng/dave_debronkart_meet_e_patient_dave.html
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more video's to be seen on http://www.tedxmaastricht.nl/videos/ (where Daniel Krafy gave his great talk "there is an app for that"
or join us on the second TEDxMaastricht "the future of health" April 2nd www.tedxmaastricht.com
Lucien Engelen Founder and Curator TEDxMaastricht (@zorg20)
Oct 23 2011: Lucien, thank you for posting these links. I have seen some of the videos but not all.
Jo Rowkins
Oct 20 2011: Many of today's illnesses are due to lifestyle factors. We are in a position whereby we treat illness once it has set in, rather than encouraging wellness, so that illness doesn't set in. The only solution is preventative medicine, through dietary and lifestyle changes, that encourages optimum health and vitality. Of course, "the sickness industry" wouldn't make any money if that were the case, so many people are still trapped in the illusion that there is no other way. Virtually all of today's degenerative diseases are preventable. Technological solutions could involve wellness testing for prevention of sickness. Currently most medical technology is designed to find, diagnose and confirm sickness, rather than prevent it. In nutritional therapy clinical practice, tests can be run to look for minor imbalances in bodily systems and to treat those imbalances before they become clinical pathologies.Oct 19 2011: There are many things wrong with how North American's view their health and the systems that delivery healthcare. To summarize, they fall into the following 6 categories:
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1. Citizens have to take responsibility for their personal health. When over 60% of all North Americans are now either overweight or obese bad health has reached epidemic levels. It's going to bankrupt our country, or many people will die young with poor quality of life.
2. We have to change the system from Illness care centric to health care. Currently we don't have a "healthcare" system, as the only time you use the system is when you're ill.
3. Doctor's compensation must be completely overhauled. Currently doctors are compensated on treatment, not outcomes. Your doctor is not incented to make you healthy, only treat your illness and the associated symptoms.
4. The cure too many diseases is prevention. Charities that raise billions each year on the "cure" should be redirected to Prevention initiative. Also, Big Pharmaceutical organizations have to invest more in prevention and not treatment through pills. The result of the current model is our Doctors are simply drug pushers for the Big Drug Company Cartel.
5. Government has stop subsidizing "Big Food" and the unhealthy products they market to us and our children that are known to cause long term degenerative diseases and start supporting the natural (organic if possible) foods that will have positive health outcomes.
6. Understand that the lifestyle choices made today will impact the long-term health outcomes decades into the future and leverage "behavioral economic" techniques that incent people for the good choices they make today that have long-term positive health outcomes in the future.
For more, go to www.nofinishlineblog.com
Shaju Davis
Oct 19 2011: I believe that healthcare issues can be corrected only if all parties involved are properly incentivised. In the US the employer generally pays the insurance premiums to the health insurance companies. The insurance companies pays the doctors and the hospitals. And they inturn are expected to provide service to the employee or the patient. Remember all parties want to improve their net returns. So the employee has less incentive to take care of his health because it costs him less to go to the doctor for any symptom of illness. This results in poor health and more visits to the doctor. The doctors or the medical establishmenst would like to increase their revenue. So they encourage multiple visits and also prescribes unnecessary tests and costly procedures and medicines. Also because of the malpractice issue they are more likely to play it safe by requirng MRi's and CTscans and other such tests to confirm diagnosis with high levels of accuracy. This increases the overall cost of treatment while increasing the profitability of the medical industry. The insurance companies then average the costs over their insurers and go back to employers for more premiums every year. The employers therefore have inherent incentive to reduce salaries and employment. Eventually it is the employee that is hurt in the long run.
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If everyone is brought under this umbrella insurance the insurance costs will explode or the quality of service will take a significant hit with no long term solution.
So maybe
1. Increase the deductible that the employee has to pay for healthcare while simultaneously requiring employers to transfer a certain said sum as healthcare allowance. This sum will accrue to the employee if he does not have to visit doctors as much. This will give hime an incentive to live healthier.
2. Increase the level of education about health through nationwide campaigns.
3. Maybe spend billions on nationwide get- fit programs instead of supporting defunct bankrupt institutions.
Harish Patel
Oct 19 2011: Personal responsibility is, in my view, the key to health. Many people, myself included, take our health/ wellbeing for granted, until everyday life is interrupted by illness. I've learned through illness that maintaining my health is key to me enjoying and getting the best out of life. It's taken until my 40s for me to learn this lesson even though I'm a healthcare practitioner who has been studying & working in health care for 17 years.
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The challenge I see is communicating this effectively to people across the planet. People in societies with more money should have more resources to tackle this but ironically health concerns such as obesity tend to be higher in the developed, economically better off world.
Technology is improving but talk of things like 3d printers coming up with ready made organs sounds like fantasy at present but may become reality- possibly at a huge cost. Healthy solutions need to be cost effective for individuals for them to be feasible for society otherwise there will always be a divide between the haves and have nots.
Prevention agendas, in my experience, tend to focus on preventing particular illnesses, diseases or illness producing behaviours such as smoking which focusses the mind on these illnesses rather than wellness.
There's a lack of focus on the paradox that is both the joy of health and the inevitability of death that can focus peoples awareness on their individual circumstances and responsibility... to themselves and their own futures.
Oct 20 2011: Harish,
You have identified an important distinction which we need to make when talking about preventive medicine: prevention of particular illnesses vs general health or well being.
The first type of prevention is for genetically biased illnesses of diseases and the second is for the general public. If someone's family members have been identified for a particular genetically related diseases, preventive measure should be taken for each and every members who may be affected.
General public awareness of health and the benefit of being well should be communicated to the public and must not be overwhelmed by misinformation (in form of advertisement of bad food). To prevent the overwhelming of misinformation, corporations should be held responsible for the claims they make in any advertisement and held corporations to moral guidelines to the same standard we held moral guideline to persons. If anything, corporation's moral obligation should be set higher than personal because they have the resources to properly investigate the statements they are making is evidence-based. CEO or executive officers of corporation should be held responsible *personally* for *repeated* false statements.Oct 20 2011: For you to take responsibility early before 40s, you would probably need more information when you are 6, so at the end the problem becomes more a shared responsibility with others: health policymakers maybe?!Oct 19 2011: Here are my thoughts on improving health care. At the moment insurance companies are driving the clinical decision making in health care and causing the sky rocketing costs. First we need to hand the clinical decsion making back to the clinicians- doctors, nurses and therapists who are the experts, not some business man or administrative assistants who sit at desks and authorizes or denies treatment. Insurance companies need to reimburse for preventative and maintenance practices for the major diagnosis posing the greatest burden on health care- things like heart disease, adult onset diabetes, obesity, tobacco, alcohol and substance abuse. Individuals/patients, not doctors should be held accountable for continued unhealthy practices such as
smoking and obesity.
Public policies making it mandatory to BUY health Insurance from a private for-profit business to me is unethical and gives these insurance companies a license to price gauge, deny claims, and provide inadequate coverage as they wish. We should just provide them with masks and guns to rob the American people.
A single party goverment PAYOR ( that does not mean the government provides the health care ) is the only way to arrive at a solution, as HUNDREDS of other countries have.
And just another thought...if all our healthcare dollars are ending up in the hands of insurance companies with the salaries of healthcare workers continueing to be so low...THERE WILL NOT BE ANYONE TO TAKE CARE OF YOU..NO DOCTORS, NO NURSES, NO NURSES ASSISTANTS, NO REHAB THERAPISTS...because when us baby boomers retire...there isn't going to be anyone in their right mind who will work in this broken medical system!!!
Oct 19 2011: Actually, single largest contributor to high cost of health care are costs of clinical trials and regulatory approval process. Inefficient FDA is why costs are high, not nearly as much due to insurance firms.
Oct 19 2011: i would have to disagree.
Oct 19 2011: I am really interested in your view and your argument. What is your own experience with insurance and regulatory costs that makes you disagree? I help design clinical trials and see the junction of costs in patient and investigator burden, molecule development, investigator grants, marketing, etc etc etc... Many of these costs arise from regulations which add highly superficial utility to the end-product, but are very costly. Many regulatory authorities require ALL questions answered in submissions, even mundane ones, which can take months to answer at $1-10 MILLION per day in lost pharma revenues due to limited age of patents for that time, which drives drug costs up to compensate. New submission process, new trial models, new data organization, AND NEW REGULATION STRUCTURE would be a huge headway to lower costs, even if you're right about insurance costs, and I'm somehow just not seeing them to be as much of a contributor to the bottom line as Reg.Oct 20 2011: I have 30 years experience in healthcare. I am first and foremost a compassionate clinician providing care to patients. I have also worked in discharge planning, utilization review, clinical research including clinical trials, marketing and and teaching. My experience with insurance companies , regulations and regulatory costs is so extensive I could not possibly present here the facts that support my opinion.
Gabriel Luft
Oct 19 2011: The core of the issue in the United States is incentives. The vast majority of our providers are paid based on a Fee for Service reimbursement model. This model incentivizes the quantity of care. Hence, physicians are not paid to manage the health of their patients, but rather were paid to place orders and do procedures (the more they do the more they make). There are a few models that take a different approach. For instance, the Kaiser system gets fixed prepaid amount per patient and are responsible for delivering the care required for that patient. Given this capitation, they are incentivized to manage the longer term health of the patient.
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This model was tried more broadly in the 90s by the HMOs, and failed due to perceived decline in access, versus a fee for service system. Health Reform is trying once again through the ACO and Patient Centered Medical Home initiatives, where a Provider organization takes responsibility for the health of the community at a fixed rate per person (depending on their conditions). Time will tell if this is successful.Oct 17 2011: The problem with the healthcare system in United States is simple. There is simply no prevention. Most efforts are focused on treatment more than prevention then again there's no money in wellness. The money is in keeping the population sick. Patients get on drugs like Lipitor or metformin and they never get off. This will have to change otherwise are going to create generation upon generation of sick people.
Albert Ip
Oct 17 2011: Christina,
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Your opening questions addressed a very important point which is missing in the discussion. Healthcare - caring of people in order to keep them healthy VS sickness treatment - remedies when health does not do its job. OK, there are diseases which attack healthy people too, but the bulk of the general practice is remedies to bad habits and poor health. Obesity related illnesses are an example of poor choices made by people - and I think it is the responsibility of health professionals to help people keep health.
This is just an early idea and there are many finer points to be considered to be qualified as a potential proposal. What if, just what if, doctors are paid on number of people they can keep healthy? Say a local doctor is paid a fixed sum to look after 1000 people in an area. If anyone is sick, the doctor has to treat the illness, no additional fee except in situation where the illness are preventable. But if all 1000 people are well and healthy, the doctor can have all his/her time doing "nothing" and yet still get paid.
The focus on treating sickness instead of keeping people healthy has missed the most important point in HEALTH CARE. It is about HEALTH, not illness nor its treatment! Yes, there are unlucky situations that we may have illnesses or diseases which are unrelated to the state of health. but If we are healthy, our immune system should protect us from a large number of avoidable illness. Sickness treatment is the complementary part (a smaller part) of health care.
Oct 18 2011: Your thoughts around health care and not sickness treatment resonate strongly. We take health for granted (in most cases) and as a result we are focused on restoring health when we lose it rather than making sure that we do not lose our heatlh in the first place. We definitely need the sickness treatment but the question is how can we can raise the importance of prevention, how can prevention become one of the key objectives of the healthcare system and then how can we get all participants to be aligned in the achivement of that objectives.
I think it is encouraging that more and more people are starting to think about prevention but more remains to be done.
Oct 18 2011: Christina,
When we are healthy, we take it for granted. Many do not pay particular attention to maintaining health. When illness strikes, it suddenly comes into focus the importance of health. The current problem of chronic disease is EXACTLY because the impact on our lives is in the "future" and there are always more "urgent" priority at hand.
The first thing that comes to mind is education. We need a public awareness that health is the most important asset anyone can have. Without health, there is no future.
The "health education" must include all the importance of nutrition, adequate exercise and mental health. Obviously it is easy said than done.
Money makes the world goes round. If there is money to be made in keeping people healthy, there will be people willing to find ways to earn that money. Look at the number of fitness companies, weight lost companies and the like. When the public understands health is an asset which needs maintaining, there will be people willing to pay for professional to help them keep healthy.
Calories in the supermarket are cheap, nutrition is expensive. In the time of economic crisis, I'm afraid the situation will get worse before getting better.Oct 19 2011: Most people focus on prevention by focusing on early detection. It is more important to actively develop a higher state of health. This is the definition of wellness.Oct 20 2011: Well said Christina.
There is a direct cause and effect regarding the alarming increase in cases of degenerative diseases directly attributed to lifestyle choices. The challenge is encouraging people to make healthy decisions today that have positive health outcomes many decades into the future.
Generally, humans are short-sighted: why forgo the instant ecstasy of that second or third serving of chocolate cake, or the joy of unprotected sex, when the rewards of restraint are so distant? We can't simply address the "demand" on our health care system without addressing the root cause of its "supply" issue.
Rewarding people today for health choices that have future positive outcomes is how "Behavioral Economics" is being leveraged with success around the world.
Jaime Lubin
Oct 16 2011: Christina...In Europe, specially in UK you have to think deeply in your own weeckness in health issues. Why? Let me explain you something about nature.....here in Mexico just in my state (Jalisco) we have more biodiversity than in all Europe, our plants and fruits are in the first place to be remedies for health care. Our full natural richness is a treasure that all countries want and came here to pick up plants to develop patents and transformed in pills and drugs. The health concept is very different in poor countries than in rich countries. And in that issue, we are a rich country.Nov 2 2011: The current "sickness treatment" model is clinician oriented. The technology has great potential to engage patients to their health management.
- +1
The mhealth technologies, smart homes, patient portals are not widely common yet. But they can support patients' decision making and help them monitor and record their daily livings.Oct 27 2011: The future of healthcare is integrated care. In integrated care systems, there's no 'wrong door' to care. If you visit your primary care doctor, she'll assess your mood, your mental health, your alcohol and drug use. If you go to a mental health or addictions professional, he will take your blood pressure, discuss your weight and eating habits. Healthcare providers aren't divided in integrated health systems, so they connect you with the help you need, and make sure each patient is receiving coordinated, quality care. Visit the SAMHSA-HRSA Center for Integrated Health Solutions for more information at www.integration.samhsa.gov.Oct 25 2011: in most countries the medical system is bankrupting. in the usa the medicaid/medicare system is bankrupting the system.
i would suggest that medical students who cannot pay for a medical school education be giving a free medical school education. instead of being burdened by student debt medical students upon inception of practice
would not be burdened with medical school debt.
participating medical students would be giving the option of a free medical education provided they are willing to provide a free percentage of medicare care for poor deemed eligible by government for a set period of time and set percentage of poor patients.
patients must be deemed eligible poor by the federal government. the time of obligated service and percentage of patients set by federal government. the government would soon recover their initial outlay of providing a free medical school education to students 5 fold, plus because of
the no billing proviso to medicare/medicaid . the federal government would recover much more than their initial financial outlay to students. students would not be burdened student loan obligations. this program would be for office visit only.
we can take this program one step ahead with a little vision and insight.if the doctor would be willing to have the
government pay their opening office costs the doctor would be obligated to provide free care according to their specialty for exp: lab tests, x-rays,
cat/mri and other special precedures etc.time and obligation of of free service set by governments. the no billing proviso to medicare/medicaid would apply. the government would really save large amounts of money.
in the long term the saving to governments could amount to trillions of dollars.
from what i understand in the usa for every 1% medicare saves over a 1 year period
over 15 years comes to a 1 trillion dollars saving?
joseph p.martinoOct 25 2011: What is the future of healthcare? It's not too hard to see. Exactly the way it's been going for decades.
How do you "redesign" something such as the health industry, or health care that is basically a criminal activity? Doesn't the "average American" want to "get rid of" crime and crime syndicates? Even if, or especially if, they have the appearance of being legitimate? All white-collar crime likes to appear legit.
Seven years ago the figures I found showed around 30 million Americans living in daily, acute pain, because they could not afford medical coverage and they could not afford medicine. Are they "average Americans" or is there something wrong with their morals? Today, the latest check I made showed the figure had risen to around 39 million Americans. I'm one of those.
It's taken me awhile but I get it now. People really do like inequality. That is how business thrives and profits are made. None of it has a thing to do with health care that is humane. Health care is not about being humane or serving humanity. What they serve you is a plate for you to place your money on. How do you fix that? How many times have we learned or heard about "previous existing conditions"? How many times have we learned or heard about, "that condition is not covered in your policy?"
How many times have we learned or heard or know about someone who is ill, unable to work, so they can't continue putting in the hours to keep their benefits alive?
And as time goes by, less can afford coverage that covers, and more become ill and uncoverable. Also, those few who are able to do so, maintain a distant and unfeeling attitude towards those who are in pain and suffering. I will keep saying it until I die, which is very near now, and I might add, extremely painful.
"Things don't, "get done because of money." Things "don't get done",.....because of money!"
That is the future of health care. A healthy economy needs more ill, diseased and dying people. It doesn't need or want healthy ones.Oct 23 2011: tnx for watching them, next April there will be 20+ more, great to see healthcare moving and shifting towards what we call participatory healthcare. great discussion here ! thank you for that, important.Oct 23 2011: Why allways we are worried by the future if that thing doesn't exist?
Why we dont doing something with the present.....? Our present time to be healthy.
Why we dont learn from the past?Oct 21 2011: I think Christina started by asking a question that didn't have much connection to politics in the health care department, so my opinion on that is that the role of technology and innovation would be to educate on prevention and result in better health, prevention is the key for me.
Now, for the second part of it... healthcare.. oh my! the endless debates on the subject, so political, so exhausting! I just always wonder, why do we expect the government to take care of everything? We complicate things so much... let the government take care of those who can't take care of themselves (I am aware that there are many that simply don't want to do it and rather have the gov do it for them) and those of us who are lucky enough to have a job accept our responsibilities and keep paying for our health care, and yes, our taxes will take care of those who don't work and don't get their own care... so what? am I happy about it? No, I am not, but you can't force people to work, you can't force people to do anything they don't want to do, it is the way of life. It is endless, we can go on an on about why people don't work, how they abuse all established systems, where our tax money goes, etc... unless we are in some position of power there isn't much we can do... of course we can all be activists and push for what we believe, sure.. lets work on that.Oct 21 2011: I am rather cynical about "health care" and medical technology, considering that many elderly people with medical insurance get extraordinary and expensive care at the end of their life to perhaps extend their life by three months for a charge to the insurance company of a large fraction of a million dollars! Hence, rather than being noble health care professionals, they are vultures.
While quality of life is important ones freedom of choice is also important.
Education is very important, for example, teaching healthy lifestyles cf. bad habits and risky habits like smoking tobacco, drinking alcohol, smokeless (spit) tobacco, injected illicit drugs, eating burnt meat from the BBQ grill, or getting sun burnt.
Unfortunately, some Public Service Announcements and public school educational programs tend to be propaganda.
Finally, the pharmaceutical cartel has an agenda, maximizing profit. Chronic illnesses are succored with palliatives. This cartel is necrophylic. It is hostile to dietary nutrients, vitamins, and herb supplements like garlic, ginger, Aloe Vera gel, oregano oil, manuka oil, manuka honey, cayenne pepper, (mega doses of intravenous) vitamin C, and the innovation of liposome encapsulation which delivers the nutrient or vitamin directly into the cell.Oct 21 2011: The majority of health problems are became from lifestyle factors so I think that the key is prevention.Humanity is always looking for the ''magical'' pill or treatment.Protect and care ourselves should be one of the greatest social values.In case of a disease that could not be prevented possible solutions could be volunteering offer of services(education), charity , exchange of services or (products), payment in installmentsOct 20 2011: I can't comment on US health policy, but I know the UK needs to acknowledge that evidence based practices need to be implmented correctly to be effective. We have NICE guidence (recommending best practice) and these focus on promoting cost-effective, evidence-based practice. However, implementation is a key part of health services. The best evidence-based programme in the world will not work if you have the wrong dosage or if offered in the wrong setting. This is particularily true of mental health, where good implementation is too often sidelined in favour of cost-savings.Oct 20 2011: In this debate, may I ask everyone to step back and ask the following question.
Should health be a person's right in a modern society?
If yes, then government has the responsibility to provide health care.
If no, then it is up to individual to maintain health, and if bad luck strikes, we will just fold our hands and see how this person can cope.
In our modern society (especially in developed countries), what is health care?
Oct 20 2011: no, health is not a right. neither healthcare is a right.
no, even if something is a right, it does not mean that the government should provide it.
no, if government does not provide healthcare, we still can finance it through private health insurance. we can have charity organizations. we can have crowd financing. there are infinite number of solutions.
i don't understand the last question.
Oct 20 2011: Krisztián,
I am sorry I did not make the contrast clear enough.
Let say free speech. Is that a right or not? Many western countries have free speech as a right (USA constitution makes it a right), but this is not universal.
Education - is that a right or not? Should every child get an education? Again, some countries provide education and to different levels. Some see education as a private matter to be determined by parents.
I can see argument on both sides whether health should or should not be seen as a right for citizens of a particular countries. Of course, if health is not a right, that does not imply there are no other means of providing health care - as you have adequately made clear.
If the social good of a healthy citizenship outweighs the burden on the government, then making health as a right makes sense. The eradication of small pots is a good example of collective action. Government is for collective actions which individual or corporations cannot or unwilling to do. If the social good of healthy citizenship is important (just as free speech is important for a democracy), why not makes it a citizen right?
Of course the flip side of the argument is to ask if government is the best agent to provide health or should health be provided by free market. Which is economically more efficient?
I guess the answer depends on one's the political view. As the population in developed countries are getting old and we generally have a smaller number of children, the burden of health care in the next 10 to 30 years is a big issue especially if the population is not healthy.
Oct 20 2011: free speech is a right, but it is tricky. the actual right is "not to be kept from saying whatever you want". speaking is an action, and nobody should be able to prevent you from doing that. neither by physical means nor by threats or fraud. this law does not imply anyone has to provide you the means of communicating your thoughts. it is your job to find the tools or forums you need.
education is not an action of the subject. education is not a right. learning is an action, and thus learning is a right. nobody should be able to prevent you from learning. teaching is a right. nobody should be able to prevent you from teaching something. it is also a right not to learn. not learning is an action. forcing people into learning something is unethical.
health is not an action, but a condition. healing is an action, but not an action of the subject. thus neither of them is a right. pursuing health is an action, and it is a right. nobody should be prevented from pursuing health. thus, the FDA for example is unethical.
having food is not a right. it is not an action. being able to pursue food is an action, and is a right. producing and selling food is an action, and is a right. buying food, provided that there is a seller, is a right. thus tariffs, quotas and regulations are unethical.Oct 20 2011: Thanks for the clarification. I have not thought about that.
Thanks again.
Edgar Munoz
Oct 21 2011: kicking is action so is a right... humm!?Oct 20 2011: Krisztián,
- +1
After thinking a little about this. I cannot agree with you.
"speech" is noun - "free speech" is a qualified noun. A special kind of natural ability of human.
"health" is a noun, but also a qualified noun (a well being living ). A special kind of living, again a natural ability of human.
If "free speech" can be a right, there is no reason why "well being" is not a right. Just like we have the right to live in a safe environment. If there is thief, e.g., police (a government agent) has the responsibility to make right for us. Health is the right to live healthy. To live healthy is an action and it is a right.
Oct 20 2011: speaking is an action. one can decide whether speak or not, and what to speak.
health is not an action, and being healthy is also not an action. it is not your decision whether you are healthy or not, and what illnesses you have.
safe environment is also not a right. having a safe environment is not an action. you cannot decide if you want to be safe or not, and if not, how.Oct 20 2011: I am still not convinced. But will leave this. Thanks anyway.Oct 20 2011: Totally for profit grain based chemical agriculture and our bloated pharmaceutical health care paradigm are the problem. These have become core beliefs and created a population of media zombies blinded by fake science.
A solution will never appear through the same illogic that brought us to this point of sickness, bankruptcy and delusion. Personal empowerment, real nutrition and an understanding of simple remedies will not be found in this ocean of ignorance.
Embellishing a system built on a crooked foundation and faulty thinking will only deliver more of the same.


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Ladybugs & Daisies Piggy BankLadybugs & Daisies Piggy Bank3
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Small $16.99Our ladybugs and daisies piggy bank is sure to please that little angel! With adorable ladybugs painted all over the piggy, it is cute and practical. It is available in three sizes. All have coin slots on top and rubber plugs on the bottom. We personalize with your choice of name. Birth information and full names on Jumbo Banks only. Up to two names on large bank, and first name only on small bank. All Paint Certified Lead Free!! Small 4 1/2" x 4 x 3 1/2"($16.99) Large 8" x 7¾" x 6"($28.99) Jumbo 10" x 9" x 7"($39.99). We also offer ceramic piggy banks in a Butterflies and Flowers design and a Rosie Posie design.
Large $28.99
Jumbo $39.99
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Ladybugs & Daisies Piggy Bank
This was the first time I purchased from My Bambino and we are really happy with Jumbo piggy bank. We chose Ladybugs & Daisies for out 9 year old who requested a piggy bank, it is a Beautifully painted bank and we made it even more special by personalizing it. Our grand-daughter was so happy and surprised and she loved it so much she went to everyone on Christmas day to show it off. They offer a huge selection. The package came on time as promised and it was well wrapped and placed in an inner box and also placed in a shipping box. Very Pleased customer.... I will be back.
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Ladybug bank08/19/2014
I purchased my second bank as a baby gift from My Bambino and had it shipped directly to the recipient who lived out of state. I made a couple of errors in my original order but followed it up immediately with an email to the My Bambino office. The staff were wonderful and made all necessary corrections. The family that received the bank raved about the Ladybug design that fit right in with their theme. Easy to order, prompt delivery and 2 satisfied customers! Thanks!
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Piggy Bank01/12/2014
very please with piggybank size and painting were great the name looked great also it was a Christmas gift for our new granddaughter I will add $ for birthdays, Christmas, etc

subset: commoncrawl


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I'm a fan since i was 9 years old that's from 1998 !!!!!
I play in a fairly well known underground alt. black metal band called Dekadent Aesthetix.
Check out my band here:
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I am also a freelance music journalist. I am running the Audio Cinic - Music Consumer Guide
Check out Audio Clinic here:
Also a medical school stundent.
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Investment Track
Interested in Investments?
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Moderators: Tonyblack, Jason, Toothy
Alanz wrote:I recon Sean Bean as Sam Vimes would be perfect
Dotsie wrote:I've just finished G!G! and Sybil seems to have started off really fat, then evolved into more of a strapping Amazonian type a the series went on. Nobby describes her as a "big fat party", and a "great big biddy". Miranda's probably right physically (ie strapping, not fat), and suitably posh, she just might be a bit young.
Dotsie wrote:She looks good for the part.
Miranda is 40? Bloody hell, being posh has it's advantages (well, obviously)
Jo of the Gates wrote:When I was reading Sybil for the first time, I pictured the actress Camryn Manheim, who is 51 but looks much younger.
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For the past few weeks, we've been playing around with the Pioneer 7.1-Channel VSX-1021-K AV Receiver: a home theater receiver designed with Apple products in mind. Below, we put the product through its paces in one of our famed AppAdvice product reviews – read on, and find out if the Pioneer 7.1-Channel VSX-1021-K AV Receiver really can be the perfect addition to your own hi-tech home.
The Pioneer VSX-1021-K 7.1 is a state-of-the-art home theater receiver. It's currently available in one color – glossy back, as you can see in the above image – and retails online via Pioneer's website for $549.99, though you can grab the receiver from Amazon for just under $400 (the price goes even lower if you're happy with a second-hand receiver). It's aesthetically pleasing and comes with its own remote control – though owners can also adopt a Pioneer remote iOS app (which is available for free in the App Store), and use their own iOS device to control the receiver, which is handy.
The home theater receiver ships with support for AirPlay – one of its best features – allowing users to "AirPlay" content from an iPhone, iPad or iPod touch to the receiver. You can connect the VSX-1021 to your home network either via an ethernet cable, or using Pioneer's AS-WL300 wireless adapter – however, this will set you back an additional $150.
It's also possible to connect an iOS device to the VSX-1021 using a USB cable: not only does this allow users to access content on their mobile device, but the receiver will also charge the product while connected.
Besides support for AirPlay and Apple's USB cable, the Pioneer VSX-1021 is also Bluetooth-compatible: this does require another adapter, which costs $100, but once connected the home theater receiver can interact with users' mobile devices – including laptops, Android and BlackBerry devices, besides iOS devices – via Bluetooth, which is an impressive feature. Furthermore, the free Pioneer Air Jam iOS app allows up to four iOS devices, paired via Bluetooth, to collaborate on an interactive playlist.
Because the Pioneer VSX-1021 is able to connect to the Internet, users can listen to Internet radio via the receiver or even stream music (MP3, AAC, WMA, WAV and FLAC files) from a desktop computer or laptop.
Furthermore, besides all of the above impressive features, the VSX-1021 also supports high-definition audio formats (Dolby TrueHD and DTS-HD Master Audio), meaning the music you listen to via the home theater receiver is going to be of excellent quality.
Alright, now we know what we're dealing with, let's take a look at the pros and cons of Pioneer's VSX-1021. First up, we're going to talk about the features we like.
The Good
The first thing we noticed when reviewing the VSX-1021 is that it's incredibly easy to use. This might not sound like a big deal, but there are a lot of home theater receivers out there that are overly-complicated, and impossible for anyone save the technically minded to get away with. Fortunately, we're pleased to report that this isn't the case with the VSX-1021: not only is it easy to set up, but its seamless support for Apple's iOS devices means you'll be listening to music through the receiver in no time at all. And if you do run into trouble, there's a copy of the owner's manual online.
However, the thing we liked most about Pioneer's VSX-1021 was its support for AirPlay. Since Apple launched the feature, we've seen countless receivers and speakers gain support for AirPlay – and the results haven't always been impressive. But we're pleased to report that Pioneer's receiver handles the feature perfectly: just connect your VSX-1021 to the Internet (either via a wired ethernet cable, or using the aforementioned wireless connector), and you'll be up and running in no time at all – inside the Music app, touching the AirPlay icon will reveal the receiver's name; select this, and music played from your iOS device will be streamed, via AirPlay, to your Pioneer receiver.
The receiver also ships with a microphone, which monitors the conditions of the user's room and adjusts the volume of played music accordingly – ensuring that users always enjoy the perfect level of volume. This is another feature we absolutely loved – we were also happy to see that we didn't have to pay extra for the microphone, too.
As Apple fans, the support for AirPlay – as mentioned – is definitely something we love, but Pioneer's two iOS applications (ControlApp and Air Jam) are also brilliant. ControlApp is rather like Apple's own Remote app, allowing users to control the receiver from an iOS device. However, AirJam – though it does require a Bluetooth adapter – is a very impressive service, and is something which would suit any party perfectly. Just download the app and connect to the receiver via Bluetooth, and up to four users can start creating and collaborating on playlists via their iOS device.
The VSX-1021 ships with lots of inputs, which we were glad to see, and the quality of audio played through the receiver is brilliant. However, for us, it's the Pioneer VSX-1021′s support for Apple's iOS devices that truly sets it aside from other receivers on the market.
But, as with any product review, we're not just going to tell you about the good …
The Bad
Yes, we did run into a few problems while reviewing Pioneer's receiver – we'll outline them for you here.
Though AirPlay is our favorite feature, it does have its fair share of flaws: first, though we might be asking for a little too much here, it would be nice to have wireless support without having to drop an additional $150 on an adapter. However, as the price of the VSX-1021 isn't astronomical, spending a little extra on accessories is doable. Unfortunately, though, connecting to a wireless network proved to be quite problematic – it's incredibly easy to set up the receiver, and even to configure a wired connection, but when we attempted to get the VSX-1021 connected to a wireless network using the adapter, we ran into a few issues. Perhaps our advice to potential customers would be to reserve a space near an ethernet access point for the receiver, though this isn't always possible.
Once the receiver was connected to the Internet and we were ready to AirPlay, tracks did stream over to the receiver without any issue. However, after the AirPlay-ed track had finished, we were disappointed to see that the VSX-1021 didn't resume playing the track our AirPlaying had interrupted. Instead, there was silence. It would have been nice for the receiver to fall back on whatever track, artist or album was being played before users AirPlay a song, though this is only a minor qualm.
The Verdict
The Pioneer VSX-1021, as you can see, is a fully featured receiver and is indeed a very impressive device. Its support for AirPlay, Bluetooth and its iOS applications are all things we love – and the issues we encountered with the receiver are, after all, only minor. If you're an iOS device fan, we're sure you'll appreciate the VSX-1021 as it is made with Apple fans in mind.
For more information, head over to Pioneer's website or view the product's webpage at Amazon. Below, we've included some more images of the Pioneer VSX-1021 for you to check out. If you already own the receiver, feel free to share your thoughts in the comments!


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For once, maybe we should cut the Blue Oval loyalist some slack. Sure, many of them would rather swallow their pride and bolt a venerable GM automatic behind their motors instead of taking their chances with a junk C6 or AOD, but who can blame them for exercising common sense? Even ego-stroking marques such as Ferrari, Bentley, Rolls Royce, and Jaguar have all relied on GM transmissions to reliably shuttle along their pretentiously ignorant clientele at some point in time.
The truth of the matter is that there are so many bulletproof GM trannies, it can be tough to choose the best unit for your application. Good problem to have, isn't it? Within the GM's camp of torque-transferring studs, there are proven dragstrip heroes such as the Powerglide, TH350, and TH400. Then there are cheap-and-easy early overdrives like the 700-R4 and 200-4R. Likewise, evolution is constant. The plethora of recently updated electronic overdrive units includes the 4L60, 4L65, 4L70, 4L80, and 4L85.
Naturally, this diverse lineup of all-stars requires doing your homework before investing in a performance transmission. Zack Farah of Gearstar is here to help with your studies. He's been in the transmission business for nearly 30 years, and his hoards of happy customers are a testament to his innovative and exhaustive approach to rebuilding and testing GM automatics. In addition to helping you through the selection, we had Zack differentiate between various GM trannies, explain the basics of how they work, give tips on how to swap in an overdrive, walk you through the rebuild, and lend some tips on promoting parts longevity.
Gearstar owner Zack Farah got his start in the transmission industry 28 years ago at Tri Star International, a company that built over 100 transmissions and 300 torque converters every day. While the bulk of production at Tri Star was as an OEM supplier, high performance transmissions were Farah's true calling. "The high performance or racing transmission customer is building his pride and joy, and the demands placed on these machines are very different from those placed on passenger vehicles," he explains. Realizing that no company was offering anything other than off-the-shelf transmissions, Farah split from Tri Star and started Gearstar with the goal of manufacturing the finest performance automatic transmissions and converters available. "Each one of our transmissions is custom-manufactured to a car's specifications and application, taking into account horsepower and torque output, cam specs, rearend gear ratio, rear tire diameter, speedo type, vehicle weight, and vehicle use. Gearstar utilizes the most experienced technicians in the industry."
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Due to the complex nature of automatic transmissions, few DIYers will ever attempt to tackle a rebuild. According to Farah, that's not necessarily a bad thing. "A high performance transmission like the ones Gearstar manufactures simply cannot be built by DIYers". The master builders at Gearstar each have an average of 25-30 years of experience. "Our builders have the latest diagnostic and testing equipment, which enables us to calibrate shift points, set redline, tune shift quality, check pressures and temperatures, and track down vibrations, noises, and leaks. Additionally, if one of our builders has a question, he can draw on the experience of other seasoned technicians. What Gearstar offers is unequalled in the industry, let alone something built in someone's backyard."


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A 10 micron filter pad for fine sediment removal.
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1.3 oz of cation exchange resin.
Another layer of protection against heavy metals such as lead, and mercury.
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3.5 oz. ultra fine G.A.C. This has long been accepted by the E.P.A. and others as the premier cost effective way to remove chlorine, bad odor and color from drinking water. G.A.C also removes organic contaminants such as pesticides, herbicides and Trihalomethanes, a cancer causing organic pollutant.
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2 ounces of calcite. This raises the water's pH to neutral, thereby lowering acidity and increasing alkalinity, which many nutritionists recommend.
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30 micron polishing filter for sparkling clarity.
This filter cartridge will deliver eleven 8 oz. glasses of 10*stage water a day all year for each member of a household of six!
And, it will do it for about 5 cents a gallon. That's about 1/4th the cost of the all the other quality national brands.
Although this powerful cartridge is specifically designed for the Enviro 10*Stage filter system, it will adapt to any system with a standard 10 in. housing.
For use on tap municipal tap water only.
Do not use on water that is microbiologically unsafe or where water is not of known source or quality.


text:
Pennsport neighborhood in Philadelphia, Pennsylvania (PA), 19147, 19148 detailed profile
Discuss Pennsport neighborhood (subdivision, block, or community) on our hugely popular Pennsylvania forum.
Back to: Philadelphia, PA, Pennsylvania, Pennsylvania smaller cities, Pennsylvania small towns, All cities.
City-data.com does not guarantee the accuracy or timeliness of any information on this site. Use at your own risk.


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Moderators: Tonyblack, Jason, Toothy
adult cover
Tonyblack wrote:Erm... Paul Kidby didn't do the cover for Nation.
Tonyblack wrote:Erm... Paul Kidby didn't do the cover for Nation.
Here's the so-called 'black cover' which I think is rather nice actually.
I think it's great and just recently reread it. Some people didn't like it, but I thought it was well worth getting.Bouncy Castle wrote:I've not actually read Nation.
Is it funny? Is it worth getting?
Or borrow a bogey-free copy from the library.Tina a.k.a.SusanSto.Helit wrote:Nation is good. It does have "funny" parts if you like satire and take the time to appreciate it. It is Not a Discworld book, but it has a lot of silly outlooks about nature and the relations of people.
If you are not really sure, then buy a used copy on the cheap. Tis hard to lose that way.
Users browsing this forum: Google [Bot] and 2 guests


text:
Corneal Disease Center - Caldwell, ID
Caldwell Eye Doctor Doctors for Corneal Disease
Type of Physician: Eye Doctor
What is a Eye Doctor?
A certification by the Board of Ophthalmology; practitioners provide comprehensive eye and vision care. They are trained to diagnose, monitor and medically or surgically treat all eyelid and orbital problems affecting the eye and visual pathways, and to diagnose, monitor and treat all eye and visual disorders. They often prescribe vision services (glasses and contact lenses) as well as serve as a consultant to physicians and other professionals.
Specialty: Ophthalmology
Common Name: Eye Doctor
Ophthalmologist Doctors in Caldwell *
St Lukes Saltzer
Eye Associates
St Lukes Saltzer
Eye Associates
Jensen Eye Associates
Jensen Eye Associates
Jorge A Martinez MD
Intermountain Eye Centers
Intermountain Eye Centers
Vision Quest Medical Center
Intermountain Eye Laser Center
Eagle Eye Surgery & Laser Ctr
Millennium Surgery Center
Treasure Valley Eye Center
Retina Specialists of Idaho
Retina Consultants of Idaho
Restore Vision Centers
Maple Grove Eye Clinic
Intermountain Eye Laser Center
Intermountain Eye Laser Center
Pacific Cataract & Laser Inst
Pacific Cataract & Laser Inst
Northwest Eye & Laser Center
Veteran Affairs Medical Center
Veteran Affairs Medical Center
Idaho Retina
Hollingshead Eye Center
Caldwell, Idaho
Corneal Disease
What is the cornea?
The cornea is the clear tissue at the front and center of the eye. Its clarity (translucence) permits light to pass into the eye, through the pupil and on to the retina at the back of the eye. ...!--*ICCChunk-1833*-->
Other Related Corneal Disease Articles
Emergency Contact for Caldwell
Nearby Caldwell Hospitals *
West Valley Medical Center
Southwest Idaho Treatment Ctr
Saint Alphonsus Medical Center
St Luke's Meridian Med Ctr
Complex Care Hospital Of Idaho
Walter Knox Memorial Hospital
Treasure Valley Hospital
Boise Behavioral Hlth Hosp
Intermountain Hospital
Saint Alphonsus Reg Med Ctr
VA Medical Center-Boise
Idaho Elks Rehabilitation Hosp
St Luke's Boise Medical Center
Saint Alphonsus Medical Center
*Provider Directory Terms of Use:
The WebMD 'Provider Directory' is provided by WebMD for use by the general public as a quick reference of information about Providers. The Provider Directory is not intended as a tool for verifying the credentials, qualifications, or abilities of any Provider contained therein. Inclusion in the Provider Directory does not imply recommendation or endorsement nor does omission in the Provider Directory imply WebMD disapproval.
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Care Center Data
The Foundation also trains care centers in QI and provides tools to improve care and build stronger partnerships between people with CF, families and their care center team.
The CF quality improvement work is based on seven goals to improve CF care. They are:
For More Information
Please remember that numbers tell only part of the story. Data alone cannot tell you where you will feel most comfortable or which care team is the best fit for you or your child.
Information from the patient registry is provided to inform and inspire quality improvement, not to rate or judge care centers against one another.
We encourage you to use this data to work together and find ways to make your or your child's health and the quality of your care the best it can be.
These data were reported to the CF Foundation's Patient Registry for the period of January 1, 2012 through December 31, 2012.
Access Care Center Data
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Updated: 3/19/2014


text:
VeinSolutions is now part of St.Vincent Medical Group. Their
board-certified vascular surgeons have created an innovative approach to
vein care. They use the latest technologies in the diagnosis and
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VeinSolutions is located in the St.Vincent Carmel on the
first floor, near entrance 3 in Suite 160. Call 317-582-7676 or
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---------------------- FIAT LUX Changelog ---------------------- 11 Septembet, 2012 - v1.3 - Changed YouTube video background for Self-Hosted video background. 14 June, 2012 - v1.2.1 - Update to WordPress 3.4 (admin/options.php, admin/options-framework.php). 14 May, 2012 - v1.2 - Changed jQuery Tubular plugin to jQuery mb.YTPlayer for YouTube video background. 13 December, 2011 - v1.1.1 - Fixed enqueue scripts on Twitter and Flickr widgets for WordPress 3.3 (functions/widget-flickr.php, functions/widget-twitter.php). 16 August, 2011 - Version 1.1 - Added lightbox to portfolio/blog post galleries. 15 August, 2011 - Version 1.0.3 - Fixed social icons style bug (style.css). - Fixed slider play/pause bug (js/libs/supersized.shutter.js.php). - Fixed pictures grid bug (includes/loop-pictures.php). 13 August, 2011 - Version 1.0.2 - Changed TimThumb max file size from 1.5MB to 10MB (includes/timthumb.php). 12 August, 2011 - Version 1.0.1 - Fixed widget areas bug (functions/widget_areas.php). 10 August, 2011 - v1.0 - First Release.
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Picasa video troubleshooting
If you're having trouble playing your video in Picasa, use the troubleshooter below to resolve your issue.Step 1: Make sure your file type is supported by Picasa and that you have the correct software to play it back.
Visit your camera manufacturer's website to see what type of video file your camera uses. Use this table to view a complete list of video file types supported in Picasa, and to make sure you have the software necessary to for playback.
Make sure your video file type is enabled in Picasa.
An outdated version of Quicktime or Windows Media Player may result in video playback issues in Picasa. Download the most recent version:
- Windows Media Player: http://www.microsoft.com/windows/windowsmedia/player/
- Quicktime: http://www.apple.com/quicktime/download
Outdated hardware can cause playback difficulties. Visit the website of your video card manufacturer to check for updated drivers for your card.
If your video file is corrupt, it won't play properly in any application. If other like video files play properly in Windows Media Player or Quicktime, your original video file may be corrupt.
You may be missing a required video codec. A 'codec' is basically a program that compresses your video and allows for playback. You'll need different codecs depending on the type of video file you want to play. Visit http://www.filehippo.com/download_klite_codec_pack/ to download and install the proper file.
Uninstalling and reinstalling Picasa can remedy many common video playback difficulties. Learn more about how to uninstall Picasa.
Please visit our help forum to get additional support for your issue. You can post a question or find answers from Google guides and our most knowledgeable users.


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Quit Smoking Now! Series LC760-834-3798; call for information. Read MoreWomen and Heart Disease ACTU, Nov 26, 5:30 to 6:30 p.m.Sunny Vendiola, MD, Family Medicine760-568-1234 Read More
Living with Cancer…How to Cope LCStress Management for Cancer Patients and Loved Ones2nd W each month, 2 to 3 p.m.Kathleen Lubanski, RN, NP760-834-3798 Read MoreOsteoporosis: Dietary Concerns ACM, Dec 2, 11 a.m. to noonMaureen McCarthy, RD, Clinical Dietitian760-568-1234; reservations by Nov 29. Read More
Top 10 Myths About Heart DiseaseGo Red for Women REDucate SeriesTU, Dec 3, 11:45 a.m. to 1:30 p.m.Philip Shaver, MD, CardiologyAmerican Heart Association's Tasty Topics luncheon is held at The Bellatrix at the Classic Club, Palm Desert. 11:15 a.m. registration.760-346-8109. Reservation required; $30 fee for heart-healthy luncheon and lecture. Read More
Great Living Starts Here Series LQW, 2 to 3 p.m.Dec 4: Party Planning for the Holidays, Eisenhower Chef demonstration Read MoreDec 11: Trimming Your Waistline While Trimming the Tree, Eisenhower Clinical Dietitian760-610-7205 Read More
Heart Disease and the Inflammation Connection LQArgyros Health and Wellness Lecture SeriesW, Dec 11, 5:30 to 7 p.m.K. Douglas Thrasher, DO, Family Medicine760-610-7205 Read MoreVertigo! ACHealthy Night OutW, Dec 18, 4:30 to 6:30 p.m.Stuart Barton, MD, Otolaryngology760-568-1234. Includes heart hearty dinner; $8 payable by Dec 13. Read More
CALENDAR KEYMost classes and lectures are free and early registration is recommended. For a full listing of lectures, events, programs and support groups, visit emc.org/calendar. Online registration is available for most events.AC Annenberg Center for Health Sciences at EisenhowerLC Eisenhower Lucy Curci Cancer CenterLQ Eisenhower George and Julia Argyros Health Center, La Quinta
Would you like to have someone from Eisenhower Medical Center speak to your organization on a health-related topic? Please contact Vanessa Shanks at 760-834-7956 for more information.
By: Maggie Downs
An easy, hour-long drive from Palm Springs, Oak Glen is a 15 square-mile hamlet of soft hills, orchards and farms. Because Oak Glen is 10 to 15 degrees cooler than the desert, the air is as crisp and cool as a green apple, often laced with the scent of a cozy fire. This is where trees try on the new fall fashions, displaying brilliant leaves of blazing orange, crimson and gold.
Along this scenic loop of more than 30 ranches, farms and businesses, Oak Glen is ripe for visitors who have a penchant for produce, particularly apple lovers. The first Oak Glen apple orchards were planted in 1876, followed by dozens more. Many of the original ranches are still in operation today, even if ownership has changed hands over the years. More than 100 varieties grow on these hills, including favorites like Pink Lady and Roxbury Russet, and the more exotic Mutsu.
Labor Day ushers in apple season, which lasts until Thanksgiving. Visitors can pick their own apples or pumpkins. If fresh fruit isn't your thing, make fresh cider your main squeeze. A local favorite is Moms Country Orchards, where the produce is plentiful and pesticide-free. Moms has also claimed the title of the widest selection of jams, jellies and preserves in the country. Other goodies include spicy peanut butter, homemade mustards and vine-ripened heirloom tomatoes.
"You know the saying — an apple a day keeps the doctor away? I really believe there's something to that," says Alison Law-Mathisen,
HOURS: Most Oak Glen ranches are open daily. The Wildlands Conservancy is open daily from 8 a.m. to 5 p.m.
DRIVING DIRECTIONS: From Palm Springs, take I-10 West . Take the CA-79/Beaumont Avenue exit, Exit 94. Turn right onto Beaumont Avenue, which becomes Oak Glen Road. Estimated driving time is 55 minutes.
TIPS: Before hiking the trails at the Wildlands Conservancy in Oak Glen, stop by the office to pick up one of their charming hand-drawn maps. Also, check their calendars for upcoming activites, events and guided walks. Remember to wear sturdy walking shoes, sunscreen and a hat, and carry plenty of water and snacks. Bring a light jacket for cooler weather.


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Welsh raid yields treasure for Barrow
Last updated at 14:23, Monday, 07 May 2012
South Wales Scorpions 24 Barrow Raiders 42
BARROW Raiders claimed a crucial three points in their quest for promotion with a hard-fought victory over South Wales.
Against opponents who had failed to score a single point in their last outing, Barrow found the going tough at the Gnoll.They were behind for much of the first half, but produced a strong display after 20 minutes had gone and in the end claimed a comfortable victory, key to their chances of going up.
With promotion rivals Oldham slipping up at home to North Wales Crusaders, it was crucial Raiders did the business in Neath.
The game was delayed for an hour – putting a dampener on plans for a night of celebration when the players arrived back in Furness – as the match doctor failed to turn up and it took some time to find a replacement.
It looked as though the delay did no good at all for the visitors, as Ruairi McGoff gave away a needless penalty for an illegal tackle and then Andy Bracek knocked-on 30 metres from his own sticks.
It was from this second error that the Scorpions went ahead, as former Raider Nathan Mossop started a move that saw Steve Parry exchange passes with Tom Morgan and go over through a huge hole in the Barrow line out wide.
Barrow were getting nowhere fast and full-back Andy Ballard was forced back over his line to concede a drop-out when a straight run would have cleared the danger.
Raiders were made to pay as the South Wales pressure came again, with full-back Jamie Murphy dropping a shoulder and creating a hole to go through and make it 10-0.
Things went from bad to worse as a fine Martin Ostler break was well-supported by Aaron Low, only for the centre to fall awkwardly in a tackle from Murphy and Dalton Grant, lose the ball and come off injured with his left arm hanging limply by his side.
Barrow needed something to give them a boost and a penalty did just that as they were able to mount a sustained attack on the Welsh line for the first time, the result being Darren Holt's pass picking out a rampaging James Gordon, who charged over by the posts.
Another penalty almost paid dividends as skipper Liam Harrison went for the line, but he was too ambitious in trying to ground and lost the ball in the process, relieving the pressure.
The same thing happened the next time Barrow were handed a penalty near the South Wales line, this time Ballard trying to go round the posts and losing possession as he came to the attention of the home defence.
Finally, Raiders were able to find their scoring touch as Harrison made a fine breakaway and Jack Pedley used his first touch to collect the ball and send Liam Campbell in to give them a 12-10 lead.
Liam Finch went close to scoring as he was dragged down a foot short and Barrow kept on pushing, only for their own haste to score to cost them and the gap to stay at two at the interval.
A forward pass from Campbell to Harrison – ruled by the touch judge – denied he captain a try at the start of the second period as he looked home free through a well-carved gap, with Barrow keeping the ball in the opposition half.
They eventually extended their advantage as Holt passed to Chris Larkin on the last tackle and the centre offloaded to his wingman James Nixon, who had a poacher's finish in the corner.
Nixon was soon doubling up as Harrison and Larkin broke from halfway down the left and Larkin fed the Dalton speedster and watched as he cut back inside and ran rings round the defence from 20 yards out for his second.
Ballard was quickly in on the scoring act as he weaved his way through from 20 yards out and everything looked rosy in the Barrow garden.
But a brief blip saw a Holt kick go straight to Grant, who broke and sent Parry past Ballard for 30-16.
It was only brief though as some slick handling saw Finch send Ostler in over on the right, the second-rower going close to a second soon after but losing the ball as he went to ground. That missed chance allowed Scorpions to strike back once again, with Tom Morgan on the end of a fast passing move started by Nathan Mossop to score on his debut and make it 36-20.
Again, though, Barrow did not let their hosts build any momentum, with Ballard sending Nixon away on the right and the winger going inside to his old centre partner Harrison.
The skipper was brilliantly stopped by an Ashley Bateman tackle, but the next play saw Ballard again flummox the hosts as he swept in for his second try.
Morgan too had a brace for the hosts, a penalty for lifting in the tackle creating the chance and some slack defending aiding the debutant's cause as he sliced through.
That was the last score though as Barrow headed back across the Welsh border with three points in the bag.
First published at 14:14, Sunday, 06 May 2012
Published by http://www.nwemail.co.uk
Have your say
The Beer was a bit steep,get in the real world its proper beer not that Northern rubbish.
Really great set of fans from Barrow. The man in the Santa suit was a hoot! A really good team as well. Liam Harrison never stopped all match and Darren Holt was a great lynchpin. Nixon has some speed as well.
Glad everyone enjoyed themselves and look forward to seeing you again - maybe next year but not if you get promoted .. lol
View all 3 comments on this article


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