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Feed Informer Michael Millenson Michael Millenson Respective post owners and feed distributors 2012-09-17T09:43:04Z Feed Informer http://feed.informer.com/ http://app.feed.informer.com/widgets/AVCPVACLJO Ben Franklin Blitz: To Keep Profits Healthy, Insurers Want You Wealthy And Wise The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z Your health plan is on a Ben Franklin blitz. They want to make you healthy and wise -- and, as payment incentives change, themselves wealthy. So get ready for help in living a purpose-driven life...and getting enough sleep.
Facing a possible meltdown of Obamacare membership and cranked-up competition from provider-run plans, health insurers are adapting the advice of Ben Franklin: by making you healthy and wise, they can make themselves wealthy.

And that "early to bed, early to rise" part? Your insurer may connect you to a sleep tracker app, too.

With private and government payers increasingly placing insurers financially at risk for controlling costs, not just playing claims, "we're on a journey…to managing health," said former UnitedHealth Group executive vice president Dr. Reed Tuckson, now an independent consultant. "Value-based reimbursement is the driver of change."

Speaking at the Consumer Experience & Digital Health Forum, sponsored by America's Health Insurance Plans (AHIP), Tuckson rattled off a list of digital data that will facilitate that change, including clinical information and data on claims, socio-demographic status and care management.

In practical terms, that information may result in United, a $157 billion behemoth that is the nation's largest health insurer, sending a taxi to take an elderly woman to her mammogram after repeated automated reminders are ignored. Or, in the future, paying to clean out a family's air conditioning ducts to prevent a child's asthma attacks.

That's the "healthy" part. As for making customers "wise," health plans are acutely aware of the confusion their product causes. In October, AHIP teamed with the National Consumers League to launch MyHealthPlan.guide, described as "a sort-of health insurance Wikipedia for consumers." Some individual plans are pouncing on customer calls, even it's just for a new identification card, to help them "navigate the minefield," as Tom Meier, vice president for market solutions at Health Care Service Corp. (HCSC), put it.

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HCSC is the parent of a group of Blue Cross and Blue Shield plans, whose 15 million members make it the nation's fourth-largest health insurer. Its phone reps try to make customers wiser (my word, not Meier's) by talking about wellness, finding a doctor and the cost of care–"things you don't even know you're calling for."
 2016-12-11T16:51:00Z urn:uuid:390aa5d2-724a-d4b8-b601-82abb2d88e10 When The American Medical Association Cheered Hillary The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z What I remember most was how quickly she won over a crowd that had good reason to be suspicious; how fluently she spoke...and, most of all, the standing ovation some 2,000 doctors and their spouses gave her....Let's hope the hard lessons Hillary Clinton learned in the 1990s-era health reform debacle imprint themselves in her actions as well as in her words.
As Hillary Clinton's motorcade sped toward the Chicago hotel hosting the American Medical Association's annual meeting in June 1993, the clergyman giving the invocation made a jarring request of God: that the audience not boo the speaker.

Those weren't his exact words, of course, but the prayer pointedly included reminders about the obligation to be polite to guests, particularly when a national TV audience was watching. An AMA official made a similar plea without involving the Deity.

In the current presidential campaign, Hillary Clinton has faced repeated questions about her likability, speaking skills and overall political agility. As a Chicago Tribune reporter covering that 1993 speech, what I remember most was how quickly she won over a crowd that had good reason to be suspicious; how fluently she spoke for some 50 minutes without either text or teleprompter; and, most of all, the standing ovation some 2,000 doctors and their spouses gave her when she finished.

If God smiled on Hillary before the AMA, who knows what He (She?) might do for her when she debates Republican presidential candidate Donald Trump?

Bill Clinton listened to Hillary Rodham Clinton on health care reform in 1993. Will today's partnership turn out better for them and the nation? (Photo: Eduardo Munoz Alvarez/Getty Images)

The headline on my June 14, 1993 Trib story read, "Mrs. Clinton Tries to Soothe Wary MDs." It was a well-deserved wariness. Hillary, who held no official title other than First Lady, had been placed in charge of the White House Health Care Task Force by her husband, Pres. Bill Clinton. Their plan's specifics would not be unveiled until the president gave a primetime televised address to a joint session of Congress on Sept. 22, but the broad outline was already clear.

Clintonian reform was based on "managed competition," an idea championed by Stanford economist Alain Enthoven and colleagues that had substantial support from conservative Democrats and moderate Republicans (back when there was such a thing). The basic idea, though modified by the administration, mandated a standardized benefits package and then incented health plans to compete based on price and quality.

Doctors worried they'd end up as cogs in giant insurance company networks. Those concerns were undoubtedly heightened when a group of five companies insuring more than 60 million Americans formed the Alliance for Managed Competition.

Yet the same Hillary Clinton who'd earlier in the year railed against fee-for-service physicians who "ripped off" the system spoke earnestly and directly is this venue to issues close to her audience's heart. She mentioned her gratitude to the doctors who'd treated her father as he lay dying in Little Rock earlier in the year. She lashed out at the "excessive oversight" of insurance company reviewers and government bureaucrats who second-guessed medical decisions. She endorsed malpractice reform and, responding to an AMA wish list, seemed sympathetic to amending antitrust laws to allow medical professional societies to discipline poor-quality doctors. Her speech was repeatedly interrupted with applause.
 2016-07-30T11:00:00Z urn:uuid:30d02143-9492-b50a-0615-85d9648911b5 Echoes Of Trump, Sanders At 'Right Care' Meeting The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z If Lown wants to change the "culture" that prompts those [unnecessary CT] scan orders….I suggest finding some moms willing to publicly agree that not treating their child's "intracranial bleeds and skull fractures" (as the research phrased it) was perfectly fine.
The annual Lown Institute Conference advocates for the "right" kind of patient care, as in "the correct course of action." But the political meanings of "right" and "left" also echo, sounding like a healthcare version of the recover-lost-glory demands of Donald Trump and the moral crusade of Bernie Sanders.

The program for this year's meeting, held in Chicago, urged attendees to "take back health [care];" you could almost hear a Trumpian, "Make medicine great again!" In an opening address, the institute's senior vice president, Shannon Brownlee, proclaimed, "We are gathered out of a shared sense of moral purpose and a shared sense of outrage at the state of American healthcare." The targets of that outrage that "we" need to take back healthcare from comprised a Sanders-type litany of the "pharma, biotech and device companies…[who] have illegally marketed products."

There was one more villain, very carefully defined. That would be "a culture of overtesting and overtreatment…[that] harms patients, clinicians and communities." Got that? While Brownlee's acclaimed 2007 book, Overtreated, repeatedly highlights the abuses of fee-for-service medicine, the Lown Institute's namesake founder and its president are academic physicians. And so, the doctors and hospitals responsible for and often profiting from overtreatment magically become just one more set of victims of the "culture."

Ideological blinders notwithstanding, the institute's work celebrates and highlights an impressive array of individuals working diligently for every conceivable kind of "right care." There was Dr. Jeffrey Brenner, a Camden, NJ family physician whose description of his dogged, data-driven efforts on behalf of the poor and sick brought a standing ovation. And Dr. Joanne Lynn, a long-time advocate for the frail elderly, explaining why a MediCaring community model that mixed medical and social services was what the vulnerable old and their families really needed.

For the policy wonks, there was Lauren Taylor, co-author of The American Health Care Paradox: Why Spending More is Getting Us Less, showing how the billions of dollars spent on unnecessary and ineffective medical care "crowd out" desperately needed money for education, housing and other social services. And for those focusing (literally) at the bedside, a University of California-San Francisco physician described an effort to reduce the frequency with which hospital patients are poked and prodded for blood work. The program was dubbed, "Think twice, stick once."

True to its grassroots ambitions, the institute has established "right care" programs with chief residents at 32 academic institutions. Lown will keep contact with those individuals as they progress in their careers, while also working with the chief residents who take their place. Lown also maintains friendly relations with Choosing Wisely, a parallel initiative against overuse that 70 specialty societies. In addition, a fledgling Right Care Alliance has set up separate councils focused on issues, such as science and evidence, and medical specialties, such as cardiology.

I've followed the institute's work since its inception, and this is the second conference I've attended. As much as I find Lown informative and inspirational, whether it can be influential remains a big question mark. An Institute of Medicine analysis of U.S. healthcare expenditures found $210 billion in unnecessary services in 2009. If you want to wrest away that magnitude of money, yo need to demonstrate some "might" to go with "right."

So, for instance, though "Think twice, stick once," was launched last year as a national initiative, at its home institution it hasn't even spread beyond the Department of Medicine that birthed it. In political terms, this as if Bernie Sanders couldn't win the Vermont primary.
 2016-04-20T09:59:00Z urn:uuid:d1791c63-37ff-4186-bf3a-3410d2c4f0c9 The Profitability (Or Not) Of Harming Patients The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z A quiet effort has been going on for years to persuade hospitals they can make more money preventing patient harm than by allowing it to occur. When the government announced last week that a patient safety partnership with hospitals had saved 87,000 lives and nearly $20 billion over four years, that may have been evidence that the effort is paying off.

Seb Oliver/Getty Images

When the government announced last week that a patient safety partnership with hospitals had saved 87,000 lives and nearly $20 billion over four years, there was an oblique reference to the role played by "financial incentives."

Left unsaid was that a quiet effort has been going on for years to persuade hospitals they can make more money preventing harm than by allowing it to occur. In recent years, that's included articles in the medical literature looking at the profitability of preventing serious bloodstream infections in critically ill infants in the neonatal intensive care unit (NICU) and in kids with leukemia.

For adults, there have been analyses of the financial impact of serious infections and surgical complications. In a presentation I heard earlier this year, a vendor mentioned the return on investment (ROI) of a technology that more rapidly detects when a post-surgical patient unexpectedly stops breathing.

These appeals to the bottom line (coupled with mention of the moral imperative, of course) stand out even more when one considers the context. It was back in 1999 that the Institute of Medicine issued its landmark To Err Is Human report estimating that up to 98,000 Americans died each year from preventable errors in hospitals. The IOM set a ten-year goal of reducing that number by half.

Yet by 2010, a New England Journal of Medicine study that merited page one New York Times attention found no substantial progress. I attributed the decade's dearth of death reduction to a combination of the invisibility of error (it's often not egregious), clinical inertia and income. Since then, preventable death estimates have gone as high as 400,000 a year; about 100,000 deaths and more than 1 million injuries is a conservative figure. A study published just two months ago found medication errors in half of all surgical procedures.

To be clear: no one is accusing hospitals ever deliberately ignoring imminent hazards. But most patient harm isn't precipitated by loose-hanging wires or loosely qualified doctors and nurses. It results from a series of small, "less-than-best-practice" problems that ineluctably add up to avoidable patient injuries and deaths. Fixing them requires time, money and consistent clinical and management commitment.

As recently as 2006 the Society for Healthcare Epidemiology of America (SHEA) felt that to obtain that kind of support it had to teach its members to make the business case for infection control. "While society would benefit from a reduced incidence of nosocomial [treatment-caused] infections," the society noted, "there is currently no direct reimbursement to hospitals…funding infection control activities."

"No direct reimbursement" was a euphemism. As another physician noted in a journal article that same year, "a tacit but potentially significant barrier" to hospital management support was "a widespread but unsubstantiated belief" that serious infections substantially raised reimbursement.
 2015-12-07T02:30:00Z urn:uuid:7a332973-a3c7-de1a-372d-9a3056c43c23 Key for Health IT Entrepreneurs: Don't Disrupt the Wrong Thing The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z The crucial advice from two of the savviest digerati doctors in Silicon Valley can be summed up this way: disrupt medicine without disrupting the lives of those who practice it.
Among the 200 demos, 60 exhibitors and more than 100 speakers at the annual Health 2.0 conference on digital health, a critical insight for succeeding in this burgeoning market might have gotten lost in the noise.

The crucial advice came on separate days from two of the savviest digerati doctors in Silicon Valley. Not coincidentally, both Dr. Robert Wachter and Dr. Michael Blum practice at the University of California, San Francisco (UCSF) Medical Center.

Wachter, an internist, was an early and eloquent advocate of the potential of electronic health records (EHRs) to improve the safety and quality of care. Actual EHR implementation, however, brought not nirvana, but a jarring number of "side effects." Not least was the way the technology often distracts, confuses and complicates the lives of clinicians, endangering patients in the process.

The centerpiece of Wachter's latest book is the story of a vulnerable 16-year-old boy who goes to UCSF for a colonoscopy and is supposed to get one antibiotic pill. Instead, for a variety of reasons linked to computerized drug ordering, robots and human dependence upon both, the patient ends up with 38-1/2 pills and suffers life-threatening seizures. Wachter's book is entitled, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age.

"We're on the cusp of a revolution" that is much more than a technological change, Wachter pointed out. He added, "We will get it right if we figure out not only the technology, but the adaptive change" needed for doctors and nurses on the front lines of care.

That same blunt message of "don't hype, don't harm" was reinforced the next day by Blum in regard to digital health apps. Blum, also an internist, is Director of the Center for Digital Health Innovation at UCSF. Like Wachter, he's a health IT leader, not a Luddite.

Blum's innovation title (he's also associate vice chancellor for informatics) makes him for a magnet for entrepreneurs wanting UCSF to help them demonstrate the digital health fix for health care.

Too many entrepreneurs, said Blum, come to him with "a fairy tale. There's a new sensor, Bluetooth-enabled, and it zips right to your doctor, who's waiting for this."

 Added Blum, "Someone's delusional…. You can't just dump data in the medical record. It needs to be in the care process."

What Wachter and Blum were both warning about, albeit from different perspectives, is the danger of disruptive technology that disrupts the wrong things: upsets checks and balances that keep patients safe, makes working conditions more stressful and simply doesn't play well with others.

"Technologies don't fix things," noted Blum, standing in front of a slide showing a frustrated user tearing out his hair. "At best, they're an enabler."

A promise of some objective assessment of those enabling capabilities came from two exhibitors, the Care Innovations Validation Institute, a joint Intel–GE company, and Social Wellth. The Validation Institute bestows a "certificate of validation," along with a money-back guarantee, on vendor offerings in population health whose claims are found to be credible. Social Wellth, meanwhile, describes itself as a curation expert, providing verification that individual mobile apps are safe, credible, functional and effective.

So far in 2015, $3.4 billion in venture funding has been poured into digital health companies, according to Health 2.0 co-chairs Matthew Holt and Indu Subaiya. That doesn't count the millions being invested internally by corporations like IBM, which has made the health care marketplace a centerpiece of its Watson artificial intelligence platform.

As I noted in a joint keynote with Matthew, being a doctor without Health 2.0 tools will soon be like being a doctor without a telephone: Information Age medicine is medicine.

The key to business success, however, will be to disrupt medicine without disrupting the lives of those who practice it.
 2015-10-11T16:00:00Z urn:uuid:8ff226c2-9f0c-fafa-4ebc-212d45cc3313 Health Datapalooza: A Shot of Whiskey, A "Data Hippie" And Capitalism The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z Health Datapalooza is dedicated to transforming American medicine. But despite talk of "data liberation" and "health data hippies," the success of the open data movement is a direct result of a synergistic relationship between government and capitalism. Which is truly the American Way.
Shortly after the close of last week's Health Datapalooza 2015, an attendee in the hotel lobby pulled out a bottle of Tin Cup whiskey and some paper cups for an impromptu celebration. A colleague responded by brandishing a bottle of Jack Daniels, while another man whipped out a libation whose label I didn't catch because I was too busy enjoying a generous pour of Tin Cup.

I immediately had much warmer feelings about the U.S. health care system.

Health Datapalooza evokes early-20th-century-slang via a 1990s-era alternative music festival. However, it's rooted within the Beltway in a visionary Health Data Initiative launched early in the Obama administration by an amalgam of bureaucrats, policy wonks, academics and entrepreneurs.

That effort was supercharged when Todd Park joined the Department of Health and Human Services (HHS) in the newly created posts of Chief Technology Officer (CTO) and Entrepreneur-in-Residence. Park popularized the catchphrase, "data liberación," thereby bestowing a pinch of Ché Guevara-style panache on digitized data release.

Park said the goal was unleashing "the power of open data and open innovation to improve health and health care in America." That meant releasing a steady stream of data from HHS, making it machine readable for APIs and publicizing its availability to innovators. The free flow of new information was expected to shake up the $3 trillion health care sector through community health initiatives, public health innovation and new businesses.

The evidence that Park's prediction is coming to pass can be seen in the exhibits, sessions and demos of Health Datapalooza. Larger policy issues haven't disappeared, however, and concerns with the breadth of data available, its timeliness and its accuracy are now under the aegis of the non-profit Health Data Consortium.

Celebrating the free flow of health information at Health Datapalooza 2015

The most important function of the annual "datapalooza," which the consortium oversees, is to serve as "a focal point and convenor for the community," as Bryan Sivak, Park's successor as HHS CTO, put it. (Sivak left in March; Pew veteran and Datapalooza regular Susannah Fox just took office.) Nearly 2,000 people came to this year's gathering. Here are a few impressions:

 The unique mix of attendees remains. Those sitting at my lunch table one day included officials from the Office of the National Coordinator for Health Information Technology (ONC); an American entrepreneur with a web-based disease management service he set up in China; a New York-based consultant to West Coast venture capitalists; health services researchers; and a corporate middle manager.

A scientist at Oak Ridge National Laboratory, famous for its nuclear weapons research, chatted with me about a project with the National Library of Medicine. There were military officers in their uniforms and Silicon Valley-types in theirs. Exhibitors ranged from corporate giants like Verizon to start-ups like RowdMap to data use enablers such as the National Center for Health Statistics.

Payment change plus data equals opportunity. HHS Secretary Sylvia Burwell reiterated that the nation's largest health care payer will continue to push for value-based payment to replace fee-for-service. Since data doesn't change anything little unless it's acted upon, the payment changes by HHS and private insurers have created a surge of interest in information that might enable more effective and efficient care.

As former ONC head Farzad Mostashari put it, payment changes "and the digital infrastructure to do what we couldn't do before" mean "there's no better time to be an entrepreneur." Mostashari's new company, Aledade, uses predictive analytics to help primary care physicians keep patients healthy.

"Patient-generated health data" piques interest. What the patient knows is just as important as "engagement" and "activation." For instance, patients can "know something isn't quite right well before sensors figure it out," said Bob Kocher, a physician, Venrock partner and former White House health care adviser. Patients then "tell their doctors and that triggers a conversation: it could be text, video call or push a button [and answer questions]."

Oh, and those sensors? They've got to improve, too. "Guess what? Doctors don't care about your Fitbit data," declared Dell's Mandi Bishop, an analytics expert and self-proclaimed fitness freak. Turns out doctors are loathe to rely on a plastic band that people sometimes forget to wear or maybe has a weird blip in data because the user spent three days sitting around a meeting talking about health.

In one session, ONC and the British National Health Service to discussed their collaboration on evaluating patient-generated health data (PGHD) collected through validated questionnaires.

People Want a Price Tag. Whether it was Steven Brill recounting the personal experiences that led to his Time cover story, "Bitter Pill: Why Medical Bills Are Killing Us," and subsequent book, or former New York Times reporter Jeanne Pinder describing her company, Clear Health Costs, the wildly varying prices for the same medical services remains a hot issue. Medicare data release on that topic made front-page news during the meeting.

Interoperability is In. Everyone says they're in favor, so let's all just ignore those accusations about "data blocking" by technology vendors and hospital execs. We can even expand the definition to include "a seamless user experience," as suggested by DJ Patil, the new U.S. Chief Data Scientist.

As for technical barriers, Todd Park switched from "liberation theology" to language more appropriate to someone working with U.S. Department of Defense (DoD). Park and colleagues face the unenviable task of trying to forge interoperability between medical records at DoD and Veterans Health Administration. There is "no silver bullet," Park warned, but he promised "massive air cover" to colleagues as they "go to [any] barrier and blow it up…[and] get us to victory." (Perhaps like this?)

The Power of the Press. Those guys who stand in front of a camera with the White House or Capitol in the background? They weren't here. Instead, you had the kind of journalists who dive into a data dump to develop stories that will demand attention in the White House and Capitol: ProPublica, Kaiser Health News, Vox, U.S. News & World Report, The New York Times and the Wall Street Journal. In the past, I've written how the press pushed the profession to improve quality and safety. With the release of more and more useful data, press power continues to grow.

Your Friend, the Insurance Company. To health insurers, detailed provider data represents a cudgel to be wielded in negotiations with doctors and hospitals…No, wait! What I meant to say is that data is a tool health plans carefully deploy to ensure you get the best care at the lowest possible price.

As I listened to Humana CEO Bruce Broussard, I realized that the shift to value-based reimbursement is giving us kinder and gentler insurance companies. "The conversation is [now] about health," Broussard said. "Someone cares about me, as opposed to me looking like a number. There's more empathy in the system." (Alas, Broussard lacked the proper musical accompaniment.)

The Hippie Who Isn't. You could be forgiven for mistaking Nick Adkins for a modern-day hippie, what with the hat, earrings, tattoos, kilt and pink high-socks. However, Adkins, who holds an MBA from Belmont University, is actually the co-founder of a firm that links doctors and patients through HIPAA-compliant asynchronous video telemedicine. (Look it up.) The guy whose Twitter handle is @datahippie is Christopher Boone, PhD, the chief executive officer of the Health Data Consortium, and a man whose look and style much more closely resemble Don Draper than Abbie Hoffman.

Boone claims to be a "data hippie" because he wants to start a social movement and "raise awareness" about patients getting full access to their health information. As it happens, Boone already is a leader of a social movement; it just happens to be fueled by a synergistic relationship between government and capitalism rather than the counter-culture. Which is truly the American Way.

Nonetheless, if Boone truly wants to raise everyone's consciousness about health data by drawing on the hippie tradition, I suggest next year's meeting be convened in the mountains of Colorado. As this classic film suggests, the social lubricant will not be Tin Cup.

Feelin' groovy, I stand ready to be liberated.
 2015-06-08T22:52:00Z urn:uuid:7eef91eb-6020-9190-8cd0-f127cb09032c Parsing Patient Engagement: Better Compliance Or Better Decisions? The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z "Better compliance" and "better patient decisions" can certainly co-exist in health IT, but there's also an implicit tension: What happens if the shared decision making bucks what the doctor thinks best?
Two modest kiosks far in the back of a cavernous HIMSS 2015 exhibit hall symbolized two separate streams of the patient engagement effort as filtered through health information technology (IT).

One featured a Bluetooth-enabled toothbrush paired with a personalized videogame to teach kids to properly care for their teeth. Call that approach, "Enabling compliance." Nearby, another kiosk showcased a computerized questionnaire to help patients understand their treatment goals and true feelings about risks and benefits of a proposed surgery. Call that, "Better decisions."

The two approaches can certainly co-exist. Dominating "Brush Up: The Toothbrush Training Game" doesn't say anything about how you'd prefer to treat a toothache. Nonetheless, there's an implicit tension between the two strategies. When Wiser Care, the company with the computerized decision support, promises to bring "clarity to health care decisions," a question lingers in the air: what happens if the shared decision making bucks what the doctor thinks best?

Is patient engagement about better compliance or better decisions? (AP Photo/Kevin Wolf)

Given the relative newness of these products, vendors prefer the all-encompassing promise to improve the "patient experience." In the part of exhibit floor where the two kiosks were found, an area sponsored by the health technology accelerator HX360, a host of eager entrepreneurs offered their wares.

Employers who've raised workers' insurance deductibles can provide them with doctor-shopping direction through Grand Rounds. The company promises to connect patients with medical experts who are the top 0.1 percent of doctors and provide "a guided experience that gives you clarity on your condition." Along the way, patients might get text messages from CareWire, checking up on their condition after surgery, or use CareSync to coordinate among patient, caregivers and clinicians. The patient might also be wearing a Fitbit provided by CipherHealth to manage their exercise and diet – while CipherHealth enables the hospital to monitor that management.

Elsewhere in the exhibit hall, Conversa displayed a clever way to get patient-generated data from digital devices directly into the electronic health record. Meanwhile, as my friend and colleague Jane Sarasohn-Kahn has written, one of the largest exhibits was the Connected Patient Gallery, sponsored by Walgreens. I was struck by participants as diverse as a newly updated, online Merck Manual from the old-line drug company and a kiosk from PatientsLikeMe, the innovative social network that has grown to serve more than 350,000 patients.

Although the evidence is still not in on the effectiveness of these new services, they fill a clear need. Studies cited by HX360 show that just 36 percent of patients describe themselves as "very well-informed" about conditions and treatments and a third leave the hospital unsure who is supposed to coordinate their care.

 Patient satisfaction as measured through CAHPS scores is increasingly linked to compensation in the inpatient and outpatient environment alike. More importantly, motivating and enabling patients with chronic disease to consistently make the lifestyle changes needed to keep them healthy has gained new importance as payment moves from fee-for-service to fee-for-value. The latter includes bundled payment and payment linked to outcomes. The patient-as-partner has become both a business and clinical imperative.

As a 2013 Institute of Medicine workshop put it, "Prepared, engaged patients are a fundamental precursor to high-quality care, lower costs and better health."

Not surprisingly, patient engagement products tailor their pitch to the paying customer – not typically the patient. CareWire promises to "improve adherence throughout the management of care" and thereby "enhance" the bottom line. GrandRounds tells potential provider customers, "We preferentially guide our commercially insured patients to your top physicians." Even Wiser Care reassures providers that shared decision making leads to higher patient and provider satisfaction and even helps workflow by starting the treatment conversation from a more advanced place.

Certainly, aligning financial incentives to reward patient-centered practices is a positive change. Moreover, patient compliance with clinical directives is critical when the course of care is appropriate. However, patients can't take that for granted.

Was the doctor's decision evidence-based? Tools as diverse as computerized clinical decision support and Choosing Wisely materials for both doctor and patient can help ensure that it was. But simply listening closely also matters. A colleague recently told me of the "non-compliant" diabetic who instantly began taking her insulin once it was switched to an oral dosage that didn't involve needles. The patient experience is enhanced the most when technological innovation includes a cultural transformation that emphasizes the voice of the patient.

Jan Oldenburg, a recognized patient engagement expert now at Ernst & Young, advised health systems to integrate patients and caregivers into every process. That means proactively using patient and family advisory councils and social media. Most important of all: "Do you take action on what you hear?"

As I've previously written, transformation in the doctor-patient relationship must recognize the importance of the medical evidence, the patient's preferences and values and the doctor's clinical experience. A striking example of how that might look was provided in a breakout session featuring The Dartmouth Institute's Dr. Carolyn Kerrigan. Kerrigan, who has worked to integrate patient-generated health data and self-reported outcome assessment into the medical center's normal workflow, told the story of a patient who had been scheduled months in advance for back surgery to relieve spinal pain.

As the date approached, the spine surgeon realized that he didn't have a recent self-reported pain assessment. When those results arrived, he called the patient for a candid discussion. Her score on a disability index had declined from a 32 to a 26; the typical surgery patient scored 50+ pre-operatively and in the 30+ range afterwards.

"Together they decided [surgery] didn't make sense, and her surgery was cancelled," said Kerrigan, herself a surgeon, adding, "This story remains an inspiration to us."

Surgeons and a medical center celebrating an expensive operation that never happened? Technology can reinforce that kind of transformation, but clinicians – with a persistent nudge from patients and payers – will have to lead the transformation themselves.
 2015-04-24T17:09:00Z urn:uuid:258a835c-e12e-c397-6ba1-a22761bbe903 Profits, A Prophet And World Peace Through Health IT (Maybe) The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z The makers of missiles and of farm products, of attack planes and baby strollers all want a part of the health IT action. Profits, not a prophet, as motivation -- but maybe "world peace," anyway.
I had a HIMSS 2015 hallucination.

Walking through the crowded exhibit halls of the premier health information technology trade show, the Prophet Isaiah's vision of beating swords into plowshares and the lion lying down with the lamb suddenly unfolded before my eyes. Even if we were in McCormick Place in Chicago, not the Temple Mount in Jerusalem. (Although we were on an upper level.)

There ahead of me, the maker of the A-10 Thunderbolt "tank buster" dwelled in a booth a few steps from a maker of fasteners for tractor engines: sword and plowshare. Elsewhere, the PAC-3 missile manufacturer contentedly cohabitated with a company that sells baby strollers: lion and lamb.

However, what prompted this copacetic condition was not a prophet, but profits. As tens of billions of dollars pour into digital technology to improve the efficiency and effectiveness of U.S. health care, companies large and small all want a cut.

The attack plane manufacturer and the missile maker? Lockheed Martin and Northrop Grumman respectively, both of which also sell electronic health records and health information management systems.

The tractor engine fastener? Made by the Spiralock division of Stanley Black & Decker, whose Stanley Healthcare unit sells a "solution set" for clinical operations and workflow.

Baby strollers? They're from the Graco unit of Newell Rubbermaid, whose Rubbermaid Healthcare division advertises mobile computing solutions and "providing caregiver workflow advantage."

"Swords into plowshares" at HIMSS 2015?

Total U.S. spending on health care is closing in on a staggering $3 trillion. Entrepreneurs from everywhere in the economy are making a pilgrimage to this sector. Venture capital funding in health IT roared to $4.7 billion in 2014, according to the Mercom Capital Group, more than double the $2.2 billion in 2013. Small wonder that more than 42,000 attendees flocked to HIMSS this year, a jump of some 10,000 from as recently as 2011.

Here's where we come to the part about world peace. The U.S. health care system is by no means the only one needing modernization and rationalization. Several years ago, HIMSS issued a white paper examining electronic health records from a global perspective. The group now boasts regional offices and puts on events in Europe and Asia. As global capital markets recognize the potential of health IT, it's not too much to hope that individuals of all religions, races and nationalities can come together in search of the "new, new thing," the next big deal and the large pot of cash that comes with both.

Ideology is one thing, but, as the saying goes, business is business. Co-existence fostered by capitalism.

Admittedly, this isn't quite what Isaiah had in mind. Still, if a prominent Middle Eastern country decides to switch from centrifuges to Software As a Service, I'll be looking for the Iranian booth at HIMSS next year.

 2015-04-19T14:13:00Z urn:uuid:5cd3e2f9-3460-9304-a39b-2cbd091ea535 The Fate Of The MD In The $12 Million Patient Safety Scandal The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z Dr. Charles Denham, a physician-turned-entrepreneur-and-activist, has agreed to pay $1 million to settle government charges of taking a $12 million kickback to influence a national patient safety standard in favor of one company's product. Though the legal case seems closed, many questions remain open.
At the beginning of 2014 the patient safety movement was shaken by Justice Department allegations that a high-profile physician, Dr. Charles Denham, took nearly $12 million in kickbacks to influence a national guideline for a product used to prevent surgical infections.

The case has just been settled, but plenty of questions remain.

As I wrote last year, Denham was different from his peers. A radiation oncologist-turned-activist-and-entrepreneur, Denham had his own Wikipedia page, a speaking contract with Celebrity Talent International and a waterfront homein Laguna Beach, California. He worked with organizations ranging from the Clinton Global Health Initiative and the Discovery Channel to prominent individuals such as actor Dennis Quaid (whose newborn twins were nearly killed by a medication mistake) and Capt. Sully Sullenberger, famous for safely landing a crippled US Airways jetliner.

Then, the government accused Denham of accepting $11.6 million from CareFusion Corp.for software development contracts inflated by kickbacks. The alleged purpose was to influence a national standard that could affect sales of CareFusion's ChloraPrep antiseptic skin wipes. In a statement, Denham termed allegations of impropriety "blatantly false" and said the contracts were signed before either a positive study of ChloraPrep appeared or the standards group on which he served, the National Quality Forum (NQF), had published its recommendation.

On March 2, the government announced Denham had agreed to pay $1 million "to settle allegations that he violated the False Claims Acts by soliciting and accepting kickbacks." The settlement includes Denham's consulting company, Health Care Concepts, Inc., and his non-profit research group, Texas Medical Institute of Technology (TMIT). Denham was never formally charged with any wrongdoing, however, and the announcement carefully states: "The claims resolved by the settlement are allegations only; there has been no determination of liability."

I've known Chuck since 2000, and I believe his commitment to patient safety is genuine. Still, when I delved last year into what Chuck has said that he and his companies have accomplished, I discovered a lot of what I called "fuzzy edges" surrounding the facts.

The government's press release doesn't clear up much. One million dollars isn't a lot of money compared to the $40.1 million settlement with CareFusion or, I'm guessing, the legal bills on both sides. The size of the settlement and the language about "no determination of liability" suggest everyone was ready to move on. When I contacted Chuck, he referred questions to his legal counsel.

Legal and ethical culpability, however, are very different standards. The NQF distanced itself from Denham, as have others. Moreover, serious questions were raised about his work as editor-in-chief of the Journal of Patient Safety, where he served from February, 2011 until he resigned because of the pending ChloraPrep controversy. After scrutiny of 10 articles in which Denham was a first author or co-author, "potential conflicts" were identified in nine.

 An editorial published in the December, 2014 issue of the journal concluded, "In the absence of a convincing alternative explanation from Dr. Denham, it appears that he was induced by payments from CareFusion to recommend and promote NQF policies that were favorable to CareFusion." (I couldn't find any public response by Denham.) The journal then announced a number of changes to protect against future conflicts of interest, real or perceived.

What did Denham really do, and why? Unfortunately, the lawyers will likely keep Chuck from any candid conversation with colleagues who feel disappointed, confused and betrayed. (I'd guess lawyers are also the reason Chuck's celebrity speaker's bureau page and his Wikipedia entry have been emptied of information. For now, a different speaker's bureau bio can be found here.)

So what was Chuck thinking? Last year, I suggested ego could easily have entered in. Chuck is very smart and knows it; he may have justified the outsized contract CareFusion gave him by convincing himself it "was tribute to the brilliance of his work," I wrote. Perhaps he also believed his advocacy was justified by ChloraPrep's performance. But the absence of appropriate financial disclosure has no obvious answer. Perhaps Chuck thought everyone has conflicts and his didn't require extra airing. Perhaps.

Be that as it may, it is your actions that define you. Or, at least, that's how Chuck's non-profit, TMIT, sees it: "Our core values drive our behaviors and, in turn, our culture." In that spirit, TMIT continues to put on webinars devoted to patient safety and systemic quality improvement. A webinar late last year was entitled, "Leading Through Crisis: From the Fog of War to the Triumph of Leadership."

Chuck Denham may still be trying to lead. Nonetheless, his values and his behaviors remain, for many of us, far closer to foggy than triumphant.

 2015-03-08T11:00:00Z urn:uuid:47671ce5-e00c-bfff-71cc-1953f1acb792 How Mayo's "Dr. Google" Deal Disrupts Medicine The Examining Table http://blogs.forbes.com/michaelmillenson 2015-12-17T12:13:18Z The deal to produce clinical summaries under the Mayo Clinic name for Google searches symbolizes the medical priesthood's acceptance that information technology has reshaped the doctor-patient relationship. More disruptions are already on the way.
"Dr. Google" has joined the Mayo Clinic, quietly signaling a powerful disruption for all of medicine.

Back in 1997 I wrote: "The information age is to medicine as the Protestant Reformation was to the Catholic Church." The Church didn't disappear when information once held tightly by the priesthood became widely available, but religion changed forever.

My search engine, the doctor

In that context, Mayo's agreement to produce clinical summaries under its name for common Google medical searches is like a medieval pope happily handing out Bible translations. The mission of the most-used search engine on the planet is to make the world's information "universally accessible and useful." Mayo, in contrast, has for decades been a global symbol of doctor-knows-best. Recommending a Google search "as the first stop for those needing health information," in the words of a Mayo physician executive, represents a true paradigm change.

But there's much more going on here than search. From the Fitbit to medicine's front lines, information technology is forcing a new doctor-patient relationship with new rules for new roles.

If information is power, digitized information is distributed power. While "patient-centered care" has been directed by professionals towards patients, collaborative health – what some call "participatory medicine" or "person-centric care" – shifts the perspective from the patient outwards.

Collaboration means sharing. At places like Mayo and Houston's MD Anderson Cancer Center, the doctor's detailed notes, long seen only by other clinicians, are available through a mobile app for patients to see when they choose and share how they wish. mHealth makes the process mundane, while the content makes it an utterly radical act.

About 5 million patients nationwide currently have electronic access to open notes. Boston's Beth Israel Deaconess Medical Center and a few other institutions are planning to allow patients to make additions and corrections to what they call "OurNotes." Not surprisingly, many doctors remain mortified by this medical sacrilege.

 Even more threatening is an imminent deluge of patient-generated health data churned out by a growing list of products from major consumer companies. Sensors are being incorporated into wearables, watches, smartphones and (in a Ford prototype) even a "car that cares" with biometric sensors in the seat and steering wheel. Sitting in your suddenly becomes telemedicine.

To be sure, traditional information channels remain. For example, a doctor-prescribed, Food and Drug Administration-approved app uses sensors and personalized analytics to prevent severe asthma attacks. Increasingly common, though, is digitized data that doesn't need a doctor at all. For example, a Microsoft fitness band not only provides constant heart rate monitoring, according to a New York Times review, but is part of a health "platform" employing algorithms to deliver "actionable information" and contextual analysis. By comparison, "Dr. Google" belongs in a Norman Rockwell painting.

These participative technologies have helped supercharge online patient communities, which by one estimate include about one in five Americans with a common chronic condition. "Peer-to-Peer health care," as Pew calls it, has helped turn self-reported symptoms and therapeutic responses into crowd-sourced data points. Peers can also point the way to tools such as a consumer version of a sophisticated symptom checker or a medical-grade calculator of surgical risk. The aging of "digital natives" will only accelerate this trend.

While the old doctor-patient relationship is dissolving, its replacement isn't yet clear. An Institute of Medicine reportdeclared, "Prepared, engaged patients are a fundamental precursor to high-quality care, lower costs and better health." However, public policy is struggling to keep up.

In California, Stanford Health Care recently connected Apple's HealthKit data aggregator to its electronic health record. Back in Washington, the Office of the National Coordinator for Health Information Technology is plodding through a patient-generated health data policy process.

Important questions about data ownership, privacy and disparities in access to technology all loom. In addition, while apps may be empowering, but content is not always neutral, whether in what's included, in the order in which it's presented or the presence of ads. Just days ago, the Federal Trade Commission cracked down on what it called "deceptive" dermatology apps. Medical groups, hospitals, insurers, pharma companies and entrepreneuers are all vying for a role as person-centric partner.

Nonetheless, while technology is disrupting the traditional doctor-patient relationship, the importance of traits such as compassion and careful listening will always remain. Collaborative health works best as a dynamic relationship. Doctors completely ceding control can sabotage care as much as hoarding all control does. Apple co-founder Steve Jobs famously declined his doctors' initial advice on how to treat his pancreatic cancer and followed his own instincts, a decision that may have hastened his death.

Physicians still like to quote Dr. Will Mayo's advice, "The best interest of the patient is the only interest to be considered." A century later, activists prefer, "Nothing about me without me." Genuine collaborative health will require incorporating information technology into relationships that harmonize both those views.

Also on Forbes…

[gallery ids="819,820,821,822,823,824″]
 2015-02-25T13:46:00Z urn:uuid:99d73071-b6b0-e106-4171-b93cc0cbc2c6


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Jesus continued teaching on the mountain (38):
The spirit that God wants reflected to the world by your life is revealed in the law of Moses and the teachings of the prophets.
Take these things seriously. Consider carefully their relevance for your life.
Live in obedience to them.
Don't just give them lip-service, like the teachers of the law and the Pharisees.
In order to live as God's child, you must be faithful to the essential spirit of God's word as recorded in the inspired scriptures.
(38) Matthew 5:17-20


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Friday, August 31, 2012
SOTC--Fall Swap Card
This is a card that I made for our monthly SOTC—Sisterhood of the Traveling Cards--Swap on SCS. Fay was our hostess for August. Here is her challenge: For the month of August we're going to have a FALL theme. Please make a card inspired by the Fall colors of brown, gold, orange, red, etc. and or Autumn images/themes. Whatever you love about Fall and are inspired by.
I love when the leaves change colors in the fall—we can see a woods from our deck. With all of the hot weather and lack of rain, I am not sure what the colors will be like this year.
Image/Sentiment—Inkadinkadoo Fall Colors
Cardstock—Gina K Ivory, Pumpkin Spice, Fresh Asparagus, Chocolate Brown; Imaginisce Patterned Paper
Accessories—Black Embossing Powder; Quickutz Leaves Embossing Folder; Orange leaf brad and Orange Round Brads; Brown Ribbon; Copic Markers
I have entered this card in the following challenges:
Delightful Sketches--Fall Days
Ruby's Rainbow--No Image, Just Words
Perfect Sentiment
11 comments:
- Darlene
Love the beautiful Fall colors! I also like how you colored in the sentiment - very effective!
- August 31, 2012 at 5:39 AM
- kadie
This is lovely, Barb!
- August 31, 2012 at 3:37 PM
- :: BlueInks ::
You have every perfect Fall element on this card......BRADS included! ♥
- September 1, 2012 at 3:02 AM
- Basslady
wow! i love the earthy autumn-colours and the saying is so true!
wonderful card!
thanks so much for playing along with us at Ruby's Rainbow Challenges!
hugs and kisses from germany,
silvi xoxo
- September 1, 2012 at 6:00 AM
- Athina
Beautiful fall colors! Love the embossing on the background!
- September 1, 2012 at 7:16 AM
- MiamiKel
Ohhhhhh *Fab-u-lous!*
- September 1, 2012 at 10:23 AM
- Debbie
What a lovely card.Great sentiment and fab papers and embossing.Thanks for joining in with Ruby's Rainbow ' No images just words challenge'.Good luck.Hugs Debbie x
- September 1, 2012 at 2:38 PM
- happyscrapper
g the rich fall colors , and the embossing on you card. The little extras are perfect. Thanks for joining us at Delightful Challenges, and hope to see you back.
- September 1, 2012 at 6:16 PM
- Judith
What beautiful autumn colours and a lovely sentiment thanks for playing along at delightful challenges this week hugs Judith x
- September 2, 2012 at 9:16 PM
- * Shaz *
A beautiful card!
Thank you for joining in the fun at Ruby's Rainbows this time
Shaz x
- September 3, 2012 at 1:49 AM
- Patty Gorka
Fantastic! Love the leaf paper and leaf brad.
- September 3, 2012 at 4:07 PM


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The Board of Governors for St Leonards are known as 'Council'. The Council is responsible for setting the overall policy for the School, determining its strategic direction and maintaining its financial strength. Together with the Headmaster and academic staff, Council determine the course in which the school operates, thus ensuring that pupils can achieve their full potential.
Council is directly responsible for the Headmaster and Bursar appointees, who report to Council on School performance on a quarterly basis.
Council members are selected for their individual skills and expertise, to preside on the Board and relevant sub-committees that deal with finance, property, marketing, appointments, school liaison, IT and the Junior School.
Our current Council members are as follows.
Chairman: Mr James Murray MA LLB DL
Mrs Victoria Collison Owen MA
Mr Martin Passmore MA GCGI FRSA
Mrs Rosaleen Rentoul BSc (Hons), Dip Ed, PGCE, PGCE
Mr Graeme Simmers CBE CA
Mrs Clare Wade
Neil Donaldson
Neil was educated at Merchiston Castle School and went on to be a Governor of the school for 12 years and Deputy Chairman for four. His family timber business, based in Fife, is now 157 years old and Neil has extensive business experience. Neil is currently Chairman of the Investment Trust, Baillie Gifford Shin Nippon PLC. He is also Deputy Chairman of the R&A and a Director of the British Golf Museum . Neil previously filled the position of Chairman of Crieff Hydro Ltd as well as the Securities Trust of Scotland, and currently holds many senior positions within the UK timber industry as well as being involved with a number of charities.
Neil has been a member of Council since 2014, his sits on the Audit Committee and his family connections with St Leonards go back four generations.
Mrs Heidi Purvis BA PGCE
Heidi has been a parent at St Leonards for twelve years since moving to St Andrews with her husband Rob and family. Her five children have been educated from the Junior School through to the Sixth Form, with three still enrolled at the school. She was on the Junior School Advisory Board for three years and has been on the Council since 2015, sitting on the Marketing Sub-Committee. She also draws on the experience she has had as a teacher herself, having taught Modern Languages for several years at secondary level.
Sandy Richardson
Sandy Richardson has been a member of the Governing Council since 2015. He has a professional background in fundraising in the education and cultural sectors. Formerly at Heriot-Watt University and National Museums Scotland, he is Development Director for V&A Museum of Design Dundee, which opens in 2018.
Sandy is a former pupil of New Park School, which, in 2005 was amalgamated with St Leonard's. He particularly takes an interest in the school's development plans and is keen to help fulfil them through engaging broader philanthropic support.


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Cupcakes in Gourmet Traveller
Gourmet Traveller is arguably the best food magazine I've ever subscribed. I'm not sure if you have this magazine sold in your country, though. For over a year I've been reading this magazine and finally in this month issue... CUPCAKES ON THE FRONT PAGE!!!
And finally the plum cakes.
I swear there are more cupcakes and recipes in Gourmet Traveller this month. Cupcakers grab this month issue and frame it up. They are so pretty you'll feel like licking the pages of the magazine. Mark my words, this is the best food magazine ever!


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Welcome to the website of The Healing Light Spiritual Centre
The Healing Light Spiritual Centre offers demonstrations and workshops on psychic, mediumistic, healing, personal development and other related subjects. They are run by experienced teachers who passionately believe in providing the individual student with a safe, friendly environment in which to nurture their gifts.
Over the years we have hosted some wonderful demonstrations of clairvoyance (or mediumship as we would prefer to call it) given by the countries leading mediums. Our Free Sunday Demonstrations continue to grow in popularity, feature local mediums and usually conclude with Spiritual Healing for those in need. Even if you do not personally receive a message at one of our demonstrations, our hope is that you will leave uplifted and inspired by what you have seen. We also run development groups and a very successful annual Residential Mediumship Seminar in Worthing.
Looking for a psychic or mediumistic development group in the Brighton or Sussex area? Drop us a line through the web site, not only do we run an annual residential seminar, but several of our members run 'home development circles' for complete beginners to working mediums and even personal mentoring by top quality tutors. If we cannot help you, there is a good chance that we can put you in touch with someone who can through our network of contacts throughout the country. Want to stay in touch with what we have on offer, why not join our online mailing list? You can also follow Cherry and our tutors and mediums on FaceBook.
Our Ethos
The founding principle of the Healing Light Spiritual Centre has been as a non-profit concern whose purpose is to provide facilities and a harmonious environment for like minded individuals to work together in ways that bring benefit, understanding, healing and joy to others.
Contact with the Spirit World through the practice of Mediumship is part of our spiritual belief and religious freedom.
Above & Beyond 2018 Seminar
FRIDAY 23rd to SUNDAY 25th of FEBRUARY 2018
At the luxurious three star Windsor Hotel in Worthing, West Sussex
With Tutors to be announced
The Windsor is the ideal choice for our Seminar as it is situated in a quiet location and provides all our students with some of the most comfortable and relaxing rooms in Worthing which have been designed and decorated for your comfort. The Windsor also provides excellent and flexible conference facilities. Unwind and recharge before our busy programme with a relaxing drink in the licensed bar and dine in the excellent restaurant.
Included in the seminar package are;
Programme of classes with our tutors open to all levels
Meals; Breakfast, buffet lunch, evening meal and light refreshments during breaks.
Same price bedrooms for our seminar, all of which are double sized air-conditioned and en-suite with access to the hotels complimentary Wifi network. They are also double glazed and all the rooms have LCD TV's* with the full range of freeview TV and radio channels. A welcome tray, safe, hair dryer and ironing centre are standard features in all rooms. Rooms will be allocated according to occupancy.
Car parking as available and complimentary on street parking vouchers.
The price for the seminar package is £310. However, if you share a room, this comes down to a very reasonable £249 which is what most people did for our 2016 seminar.
Non resident package at £180. (See booking Terms & Conditions).
We are sure this will to be a great weekend at a quality hotel, with highly motivated and inspirational tutors.
Full details can be found on our Workshop and Tutors pages
Demonstrations and Events
The following demonstrations of mediumship will be held at Milward Court Day Centre, Wilmot Road, Shoreham, Sussex BN43 6BU (near Southlands Hospital area). (Go to www.streetmap.co.uk to pull up a map.)
Milward Court has excellent facilities for the less able.
Entry is usually £5.00 on the door. However some events will be individually priced and / or ticket entry only, so please check programme. Further information can be obtained by telephoning Cherry on 01273-422892 (No later than 9pm and due to high phone charges, please only leave land line numbers on answer machine.)
email email@example.com
All at 7.30pm unless otherwise stated
We reserve the right to change the advertised programme without prior notice
2017 - FRIDAY unless stated
Jan 17th TUESDAY,-----Tony Stockwell TICKETS ONLY
Feb 10th-----Lyn Probert
March 17th----Vicky Diprose
April 7th----Now ADI TOWNSEND
May 12th-----Marlene Woolgar
June 9th----Iain Mason
July 7th----Sue Smith/Cherry
Aug11th-----Declan FYLNN
Sept 15th-----Michael Kingscote
Oct13th-----Adi Townsend
Nov 10th ------Becks Sawyer
Dec 1st------Darren Brittain - TICKETS ONLY
We hold a meeting on the first Sunday of every month at 11am which consists of a 40 minute demonstration by one of our local mediums . All are welcome to attend and there is no entry fee for these demonstartion, although a freewill donation is always gratefully received to help cover the cost of venure hire. There is usually a raffle and all are very welcome to join us for tea, coffee and biscuits after the meeting.
Spiritual Healing is available after the meeting and is offered by registered healers.
The venue is Milward Court Day Centre, Wilmot Road, Shoreham, West Sussex BN43 6BU.
Need more information? Phone Cherry on 01273 422892.
Date and Demonstrating Medium
DEC 4th---TERRI SPAIN
Jan 8th---------Wendy Carr,
Feb 5th------ Carol-Ann COX
March 5th-----Sue Smith
April 2nd-----Sue Burtonshaw
May7th ----- Teri Spain
June 4th---- Mandie King
July 2nd---- Elliot
Aug 6th----Katherine Thacker
Sept 3rd....Gina Hammett
Oct1st-------Louise Eaton
Nov 5th------Law3rence Ramsay
DEC 3rd----Malcolm Putland /Lesley Badgeary


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Category Archives: Writing
Tainted Writing
I must admit I was a bit disappointed with the way the second season of The Flash ending. One of the reasons I have kept up with this show while letting so many of the other "superhero" shows go was its focus on light rather than dark.
However, the millennial way of doing things seems to be get a viewer invested in a "good guy" then show he's been bad all along.
Sorry, good writing doesn't work that way.
It is easy for a good man to pretend to be bad, but it is impossible for a bad man to pretend to be good. (see Mirror, Mirror, STOS) Even his efforts at "good" are tainted by darkness, and one instinctively doesn't completely trust him even at his most charming.
This tendency to trick the viewer or reader into believing someone is good, knowing deep down he is bad is just poor writing. To be truly effective, one must show the villain in all his evilness, while presenting a "charming" appearance to the hero; leaving the audience breathlessly moaning, 'no, no, no, don't trust him!." An excellent example is David Copperfield's Uriah Heep, a mousy little man with sufficient power to wreak havoc in the lives of the main characters all the while pretending to be humble servant. The reader suffers intensely wondering when, or if, David and the others will ever figure out this desperately wicked person and be free of his machinations.
Understandably, it is harder to portray that in film, but the best cinematographers excel at it. Maybe through a glance, a gesture, an aside, or just the attitude of the hero. Take Frank Capra's portrayal of Mr. Potter in It's a Wonderful Life. We see the evil things he does, but when he is his most charming, offering George a great job, it is George's reaction to the handshake that reveals the depth of Potter's treachery. A certain look in his eyes, then rubbing his hand against his trousers. Iconic.
I'll keep watching Flash, but it's lost a bit of the wonder for me. Plot twists simply for the sake of "rebooting" are simply childish.
The Golden Age of Science Fiction
Back when I was growing up in rural America, I didn't realize what a remarkable time period I lived in. My dreams always leapt to the future in far flung galaxies or excavated in the past amid ancient or fantastical civilizations. I practically lived in the library where I had free access to these worlds through the pages of books. Yet I always longed for the days when I could afford to buy my own copies, when books would be as free and plentiful and accessible as the air I breathed.
Fast forward to the 21st century when all my dreams seemed to come true: books are plentiful and accessible thanks to e-readers and publishing platforms like Createspace; however, the writers have changed. Back in the Golden Age of science fiction, writers wrote series of books, not books of series. They created marvelous worlds and characters and spun countless episodes of adventures like an ongoing television series.
Today, however, writers take one story, pump it up with useless backstory, bland dialogue and wasted pages of description in order to stretch the one story over a dozen books. And I am left back in the exact same desert as before—unable to satisfy my thirst for imaginary worlds and larger than life characters.
But back to the Golden Age of Science Fiction. In the decades leading up to the 1970s, science fiction had a positive outlook—even the most thought-provoking stories left the reader with a gleam of hope at the end, a chance that humanity could learn from their mistakes and move forward into a glorious age of space exploration. Even the cautionary tales, the woeful predictions of gloom and doom were offset with stories detailing the best humanity had to offer. There was also a slew of juvie lit (not necessarily about high school kids), but written for high schoolers that showed we could overcome our base nature and rise to join the vast and glorious civilizations that spanned the galaxies. It was a time for encouragement and enthusiasm to explore the cosmos and every kid wanted to be a huge part of it.
At least, those of us who read science fiction.
I miss those stories. Even going to the library today finds precious little on the shelves worth my time and investment. Oh, I know Tom Corbett, Andre Norton, Ray Bradbury, and the Heinlein juvie novels were formulaic – that's what made them so great! In spite of the peril and danger we knew our heroes would succeed. In a world fraught with real dangers and problems, losing myself in an uplifting story was a sorely needed form of escapism.
I think we've lost something vital with today's version of science fiction. We are breeding a generation that has no imagination, that expects aliens to plot the destruction of humanity (and thus expects humanity to plot its own demise), that hasn't the gumption to reach outward to the stars because of all the obstacles that must first be overcome. Today's science fiction does far more to defeat the exploration of space than to entice young people to boldly go where no one has gone before.
With our passion for "realistic" stories we have lost not only a piece of our history, but a piece of ourselves. And a society that lacks imagination, can never prepare for the future.
Radio Cat
My friend Jim Baum owns a local radio station. We met several years ago when I was a wet-behind-the-ears editor and he was mayor. With a long history of radio broadcasting behind him, Jim became my mentor, teaching me how to manoeuvre my way through small town politics, to become comfortable conversing with movers and shakers, and to ask good, investigative questions.
However, this blog isn't about my journalist friend….it's about his cat. Squeak has been taking care of the radio station for as long as Jim has been there. Whether Squeak came with the station or moved in right along with Jim is something I've never learned. Squeak is there at 5:30 a.m. every morning to greet Jim and "open up" shop. She seldom ventures outside, preferring to prowl the small three to four room station 24-7. She greets visitors with feline elegance and graciousness and during most of Jim's interviews at the station she supervises from his desk in a prominent position between interviewer and interviewee. To a lucky few, she extends the honor of a personal "cat bath".
As any cat person knows, cats tend to make their presence known and felt without saying a word. The last time I was in the station, Squeak sat quietly on the floor at my feet letting me know in no uncertain terms I had usurped her chair. I quickly shared and was reward with the privilege of scratching her chin and ears.
Cats are highly intelligent creatures and every so often one seems to enjoy being intimately involved in the writing process. Squeak supervises Jim's creative process, adding a comment now and again when he pays more attention to writing than to her.
It's been awhile since I've had a cat that shared my love of writing. Long, long ago in a town far, far away, we had a Siamese cat who felt I couldn't write anything unless she was perched on my shoulders or the back of the desk chair. I have author friends who sometimes moan about their cats hijacking their stories by walking across the keyboard or getting between them and the computer screen. But let's face it, where would we be without our furry muses? There is something soothing and creative about a purring cat, and even when they are not purring, the simple act of stroking their silky fur has often jumpstarted a story or idea.
Here's to long life to all radio and writing cats…wherever they may be.
Men in Dresses
Scrolling through the list of offerings on Netflix and Kindle often leaves me frustrated and longing for something good to read/watch. Not that there aren't great sounding titles out there, but I get really tired of the glut of "strong female leads" inundating society right now. Although I much prefer watching something with a "strong hero lead," I don't mind a strong female if she's well-written; however, most "strong female leads" aren't females, but merely "men in dresses."
Let me explain. Hollywood's version of a strong female is someone who has dumped her femininity in exchange for being foul mouthed, pushy, control-freak, and beating the stuffing out of every villain around; i.e. just another guy in a dress. Not only is this insulting to me, it also denigrates females. We are strong warriors, but we go about it in a totally different way. Take Captain Janeway, for example. She tamed a Borg, took on Q and made mush of him, managed to make friends of alien cultures without "kirking" their planets or culture, all without having to punch out her opponent.
Strong women harness the power of words rather than profanity to make their point. Aside from the whole morality issue, profanity is just lazy writing and lazy speaking. Truly talented folks know the power of words, and women have the most experience in whittling down their opposition with a few well-chosen words. Take Princess Leia for example. "Governor Tarkin. I should have expected to see you holding Vader's leash. I recognized your foul stench when I was brought on board." No wimpy captive this. She skillfully puts Vader in his place while expressing disdain for her captor, all the while giving up nothing of her femininity.
Strong women, like strong heroes, allow the strength of their convictions to make the right decision. While Hollywood has stripped women of their femininity as if it's something bad, Hollywood seems to delight in making their heroes all wimps. Under pressure the hero caves, gives up, hopes the tough guy heroine can save the day by beating up the villain. True strength comes from an internal belief regardless of personal cost. Tarkin figures he can use Leia's femininity against her by threatening her home planet of Alderaan. Leia, on the other hand, horrified by what he plans, actually uses her femininity to trick Tarkin. She feigns giving in and gives him a false answer. Of course the story writer doesn't allow it to work, but still she doesn't trade a whole planet for the rebellion. Earlier, she uses her strength of character to stare down Vader even under torture. She may look helpless, but she never gives in.
Strong women know how to use wit and timing to take out the bad guy. While I love a good fight scene, there is no way I'm going to believe some 100 pound girl can beat up several 200 pound guys, no matter how many martial art techniques she knows. Women just don't have the body structure and strength to do that. Besides, why should we resort to brute strength when we can easily use our brains to find a less strenuous solution? Leia waits for the right moment, then strangles Jabba the Hut with a chain, not her bare hands.
Part of a woman's mystique is that she is different from men. A truly great writer knows how to incorporate femininity into a heroine and allow her to be a warrior and a woman at the same time. Lazy writers simply put men in dresses and call them heroines.
Convoluted mind of a writer
I have a Pinterest account, not a Facebook account. While that might not seem like a terribly important confession, my tendency is to use the Pinterest account as a sort of digital notebook. It's much tidier than trying to find bits and scraps of ideas amid the flotsam of crumpled notepads and torn napkins, since I'm an inveterate jotter. I scribble down all sorts of random information wherever I can find a clean space.
So imagine my delight in finding Pinterest: a veritable wealth of ideas for the aspiring writer and nifty little categories to keep all that information organized. I think my favorites are the writing prompts. The ideas come from other writers to encourage one another to actually write or as exercises to spark the creative juices. I screen shot and use various prompts that pop up on Pinterest for my AVID classes as quick writes. I'm a firm believer in using imagination to build better writers, so prefer the flamboyance of "A talking wolf is the least of your problems," he said to the humdrum write about a life experience or choose whether bubble gum should come in balls or sticks. Wait, that last has possibilities….
Still, there are those off the wall prompts that magically appear on my screen and tickle my skewed sense of humor. Prompts I find amusing and delightful, but will never use in a story or novel simple because it's not my style, such as:
"That has got to be the lamest pick-up line in existence."
"Don't worry. That's just Plan A."
"So what's Plan B?"
"To take you hostage."
Nope, I can't go to Hell.
Satan still has a restraining order against me.
"No, sir. I am not underestimating the kidnappers. YOU are underestimating my grandmother."
"I need to talk to a human," he demanded.
"And why do we have to bring a twelve-year-old to a crime scene?"
The boy smiled faintly and replied, "Detective, I am here for your protection."
Such fun little prompts that stir my soul, yet will never find life on the printed page. So why do I collect them? For the same reason I collected bits of broken pottery or green rocks at the beach—they fascinate me; cases of what ifs, never weres, might have beens which satisfy some primal, deep seated urge to let my imagination run wild and fill up my creative tank. The bits and piece simmer and stew in the back of my brain and somewhere along the way metamorphose into brave new worlds of my own creation. They become the building blocks of my universe as essential and powerful as DNA.
And if not, they function as wonderful money wrenches to mess with my students' minds.
Plot Twists
"Life is a book and there are a thousand pages I have not yet read." Will Herondale
I don't know who Will Herondale is, but he is quite right. Anyone who thinks life is boring or humdrum or not worth living simply isn't living. When I was in high school I had my life all mapped out. Go to college, get a degree in journalism, and serve on the mission field writing news stories.
Like well-written books, a well-lived life has plot twists; although, I missed the first one in the midst of language school, cultural adaptation, and family life. I did graduate and did wind up on the mission field; however, no one seemed to want my services as a writer covering the various stories and events happening on the mission field. I wrote those stories in our letters home to family and friends. In spite of the curve in the road, I found a way to pursue my passion.
The curve turned into a plot twist where the "career girl" became a stay at home mom, and I still found time to write in the midst of bottles, diapers, meal planning and laundry. The unexpected direction filled my life with its share of troubles and unspeakable joys.
The next plot twist was equally unexpected, but more overt as we left the mission field to return stateside. We assumed we would always be on the mission field until we retired. Now we were no longer missionaries, but also right back where we started—in the same rural area serving the same small church. Ironic, but satisfying, and we had a wealth of experience and wisdom we would have missed out on.
Fast forward a few years to a time our last two children are in high school and the chance of a lifetime drops in my life. After 20 something years I finally get to use my journalism degree as editor of a small town newspaper. My ultimate dream job ended after four years as a new plot twist emerged.
Today I find myself teaching at a local high school. Back when I was in college I had no illusions about being a teacher. I wasn't cut out for it; my personality didn't fit in with being cooped up in a small room teaching the same thing over and over. Routine wasn't for me. Yet I find myself strangely satisfied with this new chapter in my life even though the challenges some days leaving me feeling like I've gone a few rounds with a rancor. What will be in the next chapter? I don't know, but I'm looking forward to finding out.
Life's plot twists are a good lesson for writers, who might mistake the humdrum and ordinary for extraneous material. It's within those bits and pieces of ordinary life that one's characters develop the strength and fortitude for handling the extraordinary times. Not all plot twists have to be earth shattering or life altering; they merely need to develop a new layer to one's character and move the character forward on their journey.
Enjoy the detours.
On Hiatus
It's been awhile since I've posted; even though I have a blog written and ready to go, I've got too much on my plate in my personal life right now between school, family, and other issues, so I've really not been in a mood to write upbeat, positive blogs.
So until further notice (and I can get my life and muse back on target), I'll be taking a break from the writing game…at least from my blogs. I have a novel 2/3 of the way finished and would really like to have energy and creativity to finish it. I do hope to start the blog back up some time next year, but not promising that it will be anytime soon.
Take care, my friends, and keep on writing!
Shouting into the Wind
Sometimes writing a blog feels like shouting into the wind—tossing words out into emptiness without listeners. But I knew when I started this blog it was apt to be like that. As an introvert, I'm less likely to engage with large numbers of people, and with my busy school schedule, I have little time and energy left over on the weekend to keep up with the massive chat campaign necessary for successful blogging.
So why do it? Why blog and throw out my opinions and ideas on a vacuous sea of cyberspace?
The challenge. Writing a blog challenges me as a writer and as a person. It takes work to come up with an interesting article that doesn't bore me or potential readers. I like the thrill of crafting words that might touch a reader or stick in someone's mind long after they've forgotten who wrote it.
The interaction. Okay, I know that sounds weird since I just said I'm an introvert, but I really do like meeting people one on one. So exchanging ideas with a reader or fellow blogger is a good thing, and something I enjoy, just not a whole bunch and all at once.
The potential. This connects back to the reason my novels on Kindle are always priced at 99 cents. If even one person reads my blog (or book) and gets something out of it, even if only a mild entertainment, I've succeeded. I've forged a link in time and space with another individual. Doesn't matter if it's only for a moment. In the vastness of time and space I crossed paths with another human being, exchanged thoughts, and we both are better for it. Even if the reader never responds, that connection is important to me.
Shouting into the wind is primal. It's an innate part of being human, a deep seated need to impact our world, to make our thoughts and worlds last forever, to shout them to the four corners of the world. It's cathartic. Shouting releases tension, purges toxins, promotes healing and health.
Shouting into the wind strengthens us, frees us, remakes us, empowers us, and gives us the courage and purpose to seek new horizons and explore new countries. So even if no one is listening, even if you think no one is listening, keep writing, keep struggling, keep creating, keep shouting into the wind.
Shameless Self Promotion
In case you didn't catch it from the title, I'll warn you again: I will be talking specifically and in detail about my books. I figure after 70 something blogs, I can relax a bit and talk about a subject near and dear to my heart….my own creations.
So what sets my novels apart from the ocean of books out there? Probably not much. Such a question is as pointless as debating whether apples are better than passion fruit. Or whether a Ferrari out "oomphs" a Lexus. The delight is in the eye of the beholder…in this case, the reader.
What you will find in all my novels is a predilection for the light side of storytelling rather than the dark side. Not sorry for the Star Wars reference…I grew up with the original trilogy before it went dark side. So swashbuckling, fantasy, and space opera like Star Trek fueled my imagination from a young and impressionable age. And I've had over 30 years to perfect it. I like a fun read, one that leaves me feeling happy at the end, which is what I write because ultimately I do believe in happy endings, even in real life.
You'll find my stories have a familiar feel to them, bits and pieces of other authors and genres you've read, all blended together into a unique, yet comfortable universe. Thanks to a fan who took the time to review one of my stories, I now know what makes my stories special isn't the scientists or royalty or upper echelons, but the ordinary folk dealing with what life throws at them in a rather unique setting. And sometimes the ordinary folk don't get to solve the problem; the answer comes from outside their socio-economic group simply because they don't have the resources or answers or power—much like real life, although we don't want to admit it to ourselves.
While Amazon tries to please readers with specific information about books through genres and age groups, my stories really don't fall in those categories. How do you categorize a book that both teenagers and college professors enjoy? Amazon doesn't have an All Ages button. Unfortunately.
Merely saying my books are "science fiction" isn't enough since the various sublevels are as plenteous as the asteroid belt on the other side of Mars. My stories recombine the types of science fiction and fantasy the way Snapple flips juice: Japanese western on Mars? Ninja fantasy? Space opera without a fleet of ships? I take an idea and find a home for it without stressing about what "genre" it falls under.
Then there's the whole price thing. Ninety-nine cents. On Kindle. Every day. Always. Not because I don't think my books are worth it, but because I grew up a poor kid making 50 cents an hour babysitting to buy $3.50 paperbacks. No wonder I got most of my books at the library. So I remember what it's like to be a reader with a voracious appetite for books and unable to buy them. I wish I could keep the paperback price down, but it's a necessary evil to make the books available to library databases. Yet another reason to keep the Kindle price as low as it will go.
See it's not about money for me. It's about readers. I'd rather give a reader a couple hours of pleasure than get a royalty. Don't get me wrong. If ever I build a large enough reader base that my books take off and I make several thousand dollars, I'll be whooping and hollering. But I'd rather have the readers.
As an added bonus, I finally figured out how to promo my books as FREE Kindle books, so for the next few days until Aug 5, Redline is free on Kindle. Go grab a copy and enjoy.
So I challenge you. Take a look at my book list, pick one out, and take a gamble. If you like it, pick up another one, or write a review. If you don't like it, drop me an email. I'd love to visit with you. No strings attached and I won't get mad. Promise.


text:
By Arthur C. Clarke
One of the 35 publication (digital-only) 2012 RosettaBooks releases comprising the entire Arthur C. Clarke Collection.
Originally released in 1983, this assortment represents a few of the maximum brief fiction from one of many genre's most famed authors. those accumulated works have been written all through Clarke's occupation, from 1946 to 1981—originally showing in technological know-how fiction magazines resembling Thrilling ask yourself Stories, Famous marvelous Mysteries, and OMNI.
Between those pages you'll locate a few of Clarke's such a lot groundbreaking early stories—many of which motivated later vintage novel-length paintings. The name tale, "The Sentinel," shaped the root for what might later turn into the Space Odyssey series—perhaps Clarke's most famed paintings. You'll additionally locate "Guardian Angel," a not often reproduced tale that was once the muse for Childhood's End.
Preview of Collected Stories, Volume 2: The Sentinel PDF
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As soon as it was once the best planet in all technology fiction. Fourteen darkish visions of the long run, edited through Brian Aldiss
The ambition, greed, and wanderlust of guy have introduced him to the horizon of time, the place the starlit street of the universe forks—utopia a technique, oblivion the darkish dead-end. Earth has been slashed through an atomic knife. A father and son stare upon the pearl-white crescent that's the final reminiscence of Earth. on the penultimate second of an atomic battle, the last word god appears—pure mutant-human and 24-karat gold. Amid nice excellent towns and flawless machines. guy is a misplaced soul—no cause to dwell and no solution to die.
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From the forgotten annals of technology fiction magazines of 3 a long time come fourteen dynamic tales of time-travelers, mutant, golden gods, robotic fanatics, earth-exiles, and mind-stunning visions of earth's future—and celestial past.
Heresies of the massive God - Brian Aldiss
Night - John W. Campbell
Film of dying - J. S. Campbell
"If I Forgot Thee, Oh Earth. .. " - Arthur C. Clarke
The Golden guy - Philip ok. Dick
The Wound - Howard Fast
The Time capture - Henry Kuttner
Among the bushy Earthmen - R. A. Lafferty
Guest specialist - Allen okay. Lang
Later Than you're thinking that - Fritz Leiber
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The Valley - Richard Stockham
Down one of the useless males - William Tenn
The males go back - Jack Vance
A witty and wide-ranging anthology of snubs of each variety--from literature and from life--most actual, a number of apocryphal, all memorable. incorporated during this assortment are a few selection put-downs through such celebrated previous masters as William Shakespeare, Woodrow Wilson, Groucho Marx, Mark Twain, Dorothy Parker, and Winston Chruchill.
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Additional resources for Collected Stories, Volume 2: The Sentinel
These are very impolite phrases during this position. Don't say you have been answerable for that unspeakable garbage! ' 'Now boys! ' installed Harry in his top oil-on-troubled-waters voice. 'Don't be too harsh. We can't follow our personal excessive criteria of feedback to every thing. and folks ought to make money. along with, thousands of children like Captain Zoom. definitely you wouldn't are looking to holiday their little hearts—and so close to yuletide, too! ' 'If they honestly cherished Captain Zoom, I'd fairly holiday their little necks. ' 'Such unseasonable sentiments! i actually needs to apologise for a few of my compatriots, Solly. Let's see, what was once the identify of the 1st serial? ' '"Captain Zoom and the threat from Mars"' 'Ah sure, that's correct. by the way, i'm wondering why we continuously are menaced via Mars? i guess that guy Welles all started it. in the future we can have an immense interplanetary libel motion on our hands—unless we will turn out that the Martians were both impolite approximately us. 'I'm very completely satisfied to claim that I by no means observed "Menace from Mars". ' ('I did,' moaned a person within the history. 'I'm nonetheless attempting to disregard it. ') 'But we're not fascinated about the tale, resembling it was once. That used to be written by way of 3 males in a bar on Wilshire side road. nobody is bound no matter if the risk got here out how it did as the script-writers have been inebriated, or whether or not they needed to preserve under the influence of alcohol so that it will face the threat. If that's complicated, don't hassle. All that Solly was once concerned about have been the lighting tricks that the director demanded. 'First of all, he needed to construct Mars. to do that he spent part an hour with The Conquest of area, after which emerged with a comic strip which the carpenters changed into an overripe orange floating in nothingness, with an incredible variety of stars round it. That used to be effortless. The Martian towns weren't so basic. you are attempting and consider thoroughly alien structure that also is sensible. I doubt if it's possible—if it's going to paintings in any respect, someone's already used it right here in the world. What the studio eventually outfitted used to be vaguely Byzantine with touches of Frank Lloyd Wright. the truth that not one of the doorways led wherever didn't really count, so long as there has been sufficient room at the units for the swordplay and normal acrobatics that the script demanded. 'Yes—swordplay. the following used to be a civilisation which had atomic energy, dying rays, spaceships, tv and suchlike smooth conveniences, but if it got here to a struggle among Captain Zoom and the evil Emperor Klugg, the clock went again a few centuries. loads of infantrymen stood around maintaining lethal having a look ray weapons, yet they by no means did whatever with them. good, infrequently. occasionally a bath of sparks might chase Captain Zoom and singe his pants, yet that was once all. i assume that because the rays couldn't rather well circulation quicker than gentle, he may possibly constantly outrun them. 'Still, these decorative ray weapons gave every body a number of complications. It's humorous how Hollywood will spend unending hassle on a few minute aspect in a movie that is whole garbage. The director of Captain Zoom had something approximately ray weapons. Solly designed the Mark I, which gave the look of a move among a bazooka and a blunderbuss.