While our focus on the pandemic has now subsided, our health data quality problems remain. We’re swimming in health data—by some estimates, one-third of all data generated in the world is related to health and health care, and that amount increases more than 30{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} every year.
With all that data, then, why can’t we answer our most pressing heath questions? Which of the five top diabetes drugs (if any) will be best for me? Will back surgery be more effective than physical therapy for my spine? What are the chances that I will need chemotherapy in addition to radiation to make my tumor go away?
EHRs have become ubiquitous
Electronic health records (EHRs) have become pervasive in the U.S., largely thanks to a multi-billion-dollar federal initiative that made interoperable EHRs a national goal. The 2009 HITECH Act provided incentives for healthcare providers who computerized and penalties for those who did not. In addition to the improved patient care this would enable, the millions of digitized health records would create opportunities to transform medical research.
“Prior to EHRs, clinical research was all on paper,” says Dale Sanders, chief strategy officer at Intelligent Medical Objects (IMO), a healthcare data enablement company that offers clinical terminology and tooling to improve the quality of medical data. “You would transfer that paper-based data to spreadsheets and do your own data analysis in a very small local environment. It didn’t give a broader view of a patient’s life, and it certainly didn’t enable any kind of broader population analysis.”
Theoretically, EHRs should make it possible to aggregate, analyze, and search through information collected from millions of patients to discover patterns that aren’t evident on a smaller scale—as well as to track a single patient’s health status methodically over time. Imagine being able to quickly compare and analyze the cases of the few thousand people who have a particular rare condition or to follow users of a certain drug over a set period of time to observe long-term side effects that weren’t obvious in trials.
Of course, it’s not that easy. “There’s a lot of raw data [in EHRs] and it’s very, very dirty,” explains John Lee, MD, an emergency physician and clinical informaticist who has served as chief medical information officer for several health systems. “Some of it isn’t accurate, and the stuff that is accurate isn’t packaged up in a way that’s usable and scalable. There is an opportunity tantalizingly at our fingertips if we could get out of our own way.”
Sanders concurs. “Covid made us all realize that the data that we’re collecting with EHRs is not very good for clinical research, or for reacting to pandemics and public health challenges. It’s time to evolve the way we’re using them.”
Massachusetts’s COVID-19 public health emergency runs out on May 11, ending state masking requirements in health care facilities.
Public health advocates are urging Massachusetts health officials to keep universal masking in place at health care facilities. John Tlumacki / The Boston Globe, File
A coalition of public health advocates is urging Massachusetts to keep masking requirements in place in health care settings, even after the state’s COVID-19 emergency declaration runs out in early May.
“Without universal masking precautions in healthcare, vulnerable people face substantial risk of being exposed in waiting rooms or clinical settings against their will, violating their autonomy, and deterring many from seeking much-needed care,” the Massachusetts Coalition for Health Equity wrote in an open letter last week.
Coalition co-founder Dr. Lara Jirmanus, a family physician and Harvard Medical School instructor, explained in a virtual press conference Wednesday that removing masking requirements from health care settings will be especially risky for babies and children who can’t mask.
“People can bring these infections home to their loved ones and hurt them,” Jirmanus said. “And I will say personally, as a parent of a 16-month-old baby, this is part of my calculation.”
In September, the Centers for Disease Control and Prevention revised its guidelines to relax masking requirements for health care facilities in parts of the country with lower levels of community transmission. (In Massachusetts, state masking requirements remained in health care settings even after the CDC change.)
Relying on community transmission data to dictate masking is flawed, Jirmanus asserted, citing underreported cases.
According to the coalition’s letter, “far fewer people are testing for COVID-19 as much required routine testing has ended, federal funding for COVID-19 testing has diminished, and most rapid tests are not reported. Further, most low-wage workers don’t have paid sick time, and many are incentivized or compelled to go to work with COVID-19, or to avoid testing.”
Even when transmission rates are low, clinics and hospitals will still be an epicenter for COVID-19 patient care, creating opportunities for the virus to spread, according to the coalition’s letter. Removing masks from health care settings also puts providers at risk at a time when the health care system is overrun with staffing shortages, the group argued.
A spokesperson for the state’s Executive Office of Health and Human Services told The Boston Globe that the state health department will continue to track COVID-19 cases and make adjustments as circumstances change.
The spokesperson also told the Globe that infection control leaders at several of the largest hospital systems in Massachusetts have repeatedly asked state health officials to end the mask mandate.
The Massachusetts Coalition for Health Equity remains unconvinced.
“We are wondering, when we take a look at that Globe article, why have hospital administrators been lobbying to remove masks? Is this about the money?” Jirmanus asked. “It doesn’t make sense. Removing masks in health care … is going to cause health worker outbreaks and it’s going to exacerbate existing staffing shortages and thereby exacerbate the budget crisis.”
She added: “We all have a loved one in our lives who could be hurt by a COVID infection. … and we could all be harmed by long COVID. So let’s be safer together.”
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It’s already been a busy year for Ben Jacobs, co-founder of Tocabe: An American Indian Eatery. Early in 2023, he helped launch a direct-to-tribe ready meal program in partnership with Spirit Lakes Nation in North Dakota; and now Jacobs has been appointed to President Joe Biden’s Council on Sports, Fitness & Nutrition (PCSFN).
“I am still in so much shock, and I am trying to understand what they want to see out of the mission,” Jacobs says. “I can say, on a surface level, I want to help support getting Native foods from Native producers and make those ingredients accessible to our members.”
Bringing nutritious and Native foods to American Indian tribes has long been a goal for Jacobs, an Osage Nation member, who started the fast-casual Native American eatery Tocabe in 2008 with his partner, Matt Chandra. Not only are the nutrient-rich ingredients on the menu such as bison, tepary beans, wild rice and Indian blue corn sourced from Native American farmers, but Tocabe also hosts an online marketplace, selling the foods to those who can’t get to the restaurant’s locations in the Berkeley neighborhood and in Greenwood Village.
As for this latest move, Jacobs says the PCSFN advisory position came down through the grapevine thanks to Daron Carreiro, a citizen of the Chicksaw Nation serving as the Senior Policy Advisor for Native Affairs on the White House Policy Council.
The buffalo at Tocabe comes from Native American farmers.
Rachel Greiman
“I looked at the names and thought it was fun to have my name thrown in, because it’s all professional athletes and coaches,” notes Jacobs, who shares the job with former MLB player Ryan Howard, Olympian gold medalist Chloe Kim, basketball player Stephen Curry and his wife, actress Ayesha Curry. “I thought it was neat they were bringing people in from the culinary world, too, not just sports and fitness, so we are hearing the voices not just of professional athletes, but those on a more grassroots outlook too.”
Overall, Jacobs says the process happened pretty quickly, explaining that he’d almost forgotten he was a contender before getting an email asking for more information about himself. Two days later, on March 24, he learned that he’d made the team. He’s still filling out paperwork and waiting to find out more information on what he can do and what’s expected of him in the role, which officially starts sometime in May or June, according to Jacobs.
“‘Excited’ isn’t the term, but I think, just because it feels like there are so many things I want to see, I have to figure out where I should start in order to make this [position] genuinely impactful and not just an image-based position for myself,” says Jacobs. “I am excited to expand the network of opportunity to make significant change.”
The President’s Council on Sports, Fitness & Nutrition is a federal advisory committee aimed at promoting healthy eating and physical activity for all Americans, regardless of background or ability. The first iteration of the program started in 1956 under President Dwight Eisenhower, when it was called the President’s Council on Youth Fitness.
“The fact that my name was thrown in the mix shows the work we try to do at Tocabe is impactful,” adds Jacobs. “It doesn’t go unnoticed, even if we don’t see [the outcome] every day.”
Tocabe is located at 3536 West 44th Avenue and 8181 East Arapahoe Road in Greenwood Village. For more information, visit tocabe.com.
On March 27, 2023, the U.S. Food & Drug Administration (FDA) released two final guidance documents to assist with transitioning medical devices: (i) that were subject to certain enforcement policies issued during the COVID-19 Public Health Emergency (PHE), and (ii) that were issued emergency use authorizations (EUAs). These guidance documents finalize the corresponding draft guidance documents that were issued on December 23, 2021. In a previous post, we discussed several key takeaways from the draft versions of these transition guidance documents.
“Transition Plan for Medical Devices That Fall Within Enforcement Policies Issued During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency” Final Guidance
In the “Transition Plan for Medical Devices That Fall Within Enforcement Policies Issued During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency” final guidance, the FDA discusses the transition plan for medical devices that were subject to certain enforcement policies issued during the PHE. FDA confirms that the policies listed in the guidance, which are set forth in List 1 thereto, will remain in effect until 180 days after the end of the PHE. The PHE declaration is scheduled to expire on May 11, 2023. Therefore, the enforcement policies identified in List 1 will no longer be in effect after November 7, 2023.
In the guidance, the FDA provides recommendations for a “phased transition process” with respect to devices that fall within the expiring COVID-19 PHE enforcement policies. The FDA summarizes the three phases of the 180-day transition plan as follows:
Phase 1 (May 11, 2023): Manufacturers should follow adverse event reporting requirements as described in 21 C.F.R. § 803.
Phase 2 (August 9, 2023): If planning to continue to distribute their devices after Phase 2, manufacturers need to adhere to registration and listing requirements (21 C.F.R. § 807 Subparts B-D) and should adhere to requirements associated with reports of corrections and removals (21 C.F.R § 806).
Phase 3 (November 7, 2023): In Phase 3 the enforcement policies identified in List 1 will no longer be in effect. FDA states it does not intend to object to continued distribution of devices where a required marketing submission has been submitted and accepted by FDA before the start of Phase 3, and FDA has not taken a final action on the marketing submission. FDA further indicates that it does not intend to object to the devices not complying with certain unique device identification (UDI) systems requirements and other applicable labeling requirements described in 21 C.F.R. § 801.
FDA recommends manufacturers submit a “Transition Implementation Plan” with their marketing submissions (if needed) that addresses the manufacturer’s plans for addressing devices already distributed, which plans need to include actions to be taken in the event either a positive or negative decision by the FDA on the marketing submission. Furthermore, FDA strongly encourages manufacturers to complete and submit these submissions well in advance of the start of Phase 3. This is recommended to avoid potential delays created by a large influx of new submissions.
“Transition Plan for Medical Devices Issued Emergency Use Authorizations (EUAs) Related to Coronavirus Disease 2019 (COVID-19)” Final Guidance
The EUA Guidance includes recommendations for certain reusable life-supporting or life-sustaining devices, devices distributed after the EUA termination date, laboratory developed tests, and EUA-authorized in vitro diagnostics subject to Clinical Laboratory Improvement Amendments of 1988 categorization and waivers. With respect to certain reusable life-supporting or life-sustaining devices, FDA requests manufacturers of such devices to submit information regarding whether or not they intend to submit marketing submissions to continue distributing the device(s) after the applicable EUA termination date.
Furthermore, FDA states in the EUA Guidance that it will not object to the continued distribution of devices after the device’s applicable EUA termination date if (1) the manufacturer has submitted a marketing submission that is accepted by FDA prior to the EUA termination date, and (2) FDA has not taken final action on the marketing submission. Therefore, it is recommended that manufacturers of these devices submit marketing submissions well in advance of the EUA termination date.
Foley is here to help you address the short- and long-term impacts in the wake of regulatory changes. We have the resources to help you navigate these and other important legal considerations related to business operations and industry-specific issues. Please reach out to the authors, your Foley relationship partner, or to our Health Care Practice Group with any questions.
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Wouldn’t it be nice if there were some undiscovered ingredient, and one bite of it would cure all our health concerns?
There isn’t one, sadly.
But scientists do know the recipe to better health, and it is a long-term practice of good habits when it comes to sleep, eating, exercise, socialization and stress.
In honor of the 75th anniversary of the World Health Organization, here are the factors that add up to better health and what you can do today to improve in these areas.
Ask your doctor if you have specific concerns in any of these areas.
A bad night’s rest doesn’t just mess with your concentration during the day. So far this year, CNN has reported that not getting enough sleep can increase your risk of mood problems, asthma, stroke and longevity.
Sleep is kind of a big deal.
The US Centers for Disease Control and Prevention recommends that adults get at least seven hours of sleep a night — but quality is important as well.
To get more good sleep, research shows it’s important to set a schedule for going to bed and waking up, follow a nighttime routine to tell your brain it’s time to go to bed, keep your bedroom dark and cool, turn away from the screens early, and don’t lay in bed if you are having trouble sleeping.
People’s individual bodies need different things, but is there a best way to guide your nutrition?
According to many scientific studies and U.S. News & World Report’s annual rankings, it’s the Mediterranean diet.
Don’t let the word diet fool you — this isn’t a restrictive philosophy to manipulate your body weight. The Mediterranean diet is a way of eating that features simple, plant-based cooking, with the majority of each meal focused on fruits and vegetables, whole grains, beans and seeds, with a few nuts and a heavy emphasis on extra-virgin olive oil. Fats other than olive oil, such as butter, are consumed rarely, if at all, and sugar and refined foods are reserved for special occasions.
Numerous studies have found the Mediterranean diet can reduce the risk for diabetes, high cholesterol, dementia, memory loss, depression and breast cancer.
Scientists have long known that exercise is good for a healthy body, but research has shown it’s also important for a healthy mind.
The US Department of Health and Human Services recommends that people between the ages of 18 and 64 engage in at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity each week, as well as muscle-strengthening activities at least twice a week.
The good news is even if you can’t get there right now, adding even a little bit will help.
Research published earlier this year showed that even 11 minutes of exercise a day can lower your risk of cancer, cardiovascular disease or premature death.
Many people place a lot of importance on some of the health behaviors often thought of as more physical, but social and emotional factors deserve our attention as well.
And good, strong friendships are key to not just alleviatingour stress and improvingemotional well-being, but also boosting markers of our physical health, according to the latest research.
People should grow this area of health by investing more in a feeling of community, experts have suggested.
They also stressed the importance of making friendship a priority in your schedule: Text a friend that you haven’t talked to in a long time, commit to meeting one new person a month, host a dinner party or join a class.
Strong bonds won’t happen overnight, but starting small and prioritizing friendships as an important part of your life can bring more happiness, less stress and more support, workplace belonging expert Adam Smiley Poswolskytold CNN earlier this year.
“Even when — especially when — their friend is struggling or going through something hard,” said Poswolsky who is also author of “Friendship in the Age of Loneliness: An Optimist’s Guide to Connection.” “You know someone is a true friend when they have your back when you’re sick, when you lose your job, when you make a mistake, when you’re going through a break-up, when you’re stressed, when you’re sad.”
I know I’ve heard it every time I go to the doctor for any concern: Whatever it is, it gets worse with stress.
Sure enough, stress can send a body into fight or fligh, which raises cortisol. Higher levels of cortisol can exacerbate health conditions such as cardiovascular disease, diabetes and chronic gastrointestinal problems, according to the Cleveland Clinic.
Stress can also cause or contribute to anxiety, irritability, poor sleep, substance abuse, chronic distrust or worry, and more.
Fortunately, a balanced diet, good sleep, exercise and social support can help with stress reduction. It can also help to explore breathing and meditation techniques.
You may be thinking, I am already stretched thin in my day — adding in all these health behaviors will cause stress by itself.
The good news is that these habits are best added with small, manageable changes over a period of time.
Approach your goals one bite at a time and with a plan, flexibility, fun and support, and you may soon find you’ve made the changes you are looking for, said Katy Milkman, the James G. Dinan Professor at the Wharton School of the University of Pennsylvania, author of “How to Change: The Science of Getting From Where You Are to Where You Want to Be.”
Sign up for CNN’s Stress, But Less newsletter. Our six-part mindfulness guide will inform and inspire you to reduce stress while learning how to harness it.
Most food items at the supermarket these days, including bread, eggs, and milk are considerably more expensive than they were in the recent past. And you can expect to continue to feel pain at the checkout container. As the USDA notes, food prices for bread, meats, and much more are predicted to increase anywhere between 3 percent and more than 11 percent in 2023. Makes you want to get in the habit of cutting coupons, huh?
Compounding the problem for cyclists and other athletes is the need to go bigger on calories to support training and racing needs. This can make for a very expensive grocery cart.
Though it can be more challenging than ever to eat well on a budget, the great news is that you can still find several nutrient-dense, performance-benefiting foods in the supermarket aisles that have a less demanding price tag.
More From Bicycling
When you want to save a few bucks, adding these cheap healthy foods to your grocery list will go a long way in keeping your food budget from spilling over.
The Best Cheap and Healthy Foods to Add to Your Cart
1. Mussels
Carlo A//Getty Images
As the costs of fresh seafood rise, it appears that fewer Americans are spending time shopping at the fish counter. But among the cuts of pricey salmon and sea bass, mussels remain a cost-conscious choice, yet one few people think about for a weeknight dinner. Ringing in at only about $3 a pound (costs can fluctuate a bit depending on the time of year and where you purchase them), these shellfish offer a fantastic amount of briny-tasting nutrition for your dollar.
For starters, mussels are a great source of protein, with every 3 ounces of the fish supplying about 20 grams of protein to support muscle recovery and building, both key to being a stronger cyclist. Mussels also provide very high amounts of vitamin B12—a serving has more than 3 times the daily need—which the National Institutes of Health says is required for a healthy central nervous system, healthy red blood cells, and the production of DNA.
Other nutritional highlights include notable amounts of selenium, iron, phosphorus and even vitamin C. As a bonus, farmed mussels are widely considered one of the most environmentally sensitive seafood buys you can make.
Fresh mussels have a limited shelf life, and you should consume them within 24 to 48 hours of purchase. Most retailers are going to sell them to you in a two-pound bag, which is enough to serve two people.
→How to add it to your plate: To prepare, place about 1 cup of liquid such as water, broth, beer, wine, or coconut milk in a large saucepan, bring to a boil, add mussels, reduce heat to medium-low and simmer covered until they open up. Do not overcook the mussels because they will become tough and shrink; it will only take a few minutes to cook them. Discard any mussels that have not popped open. You can season the cooking liquid with everything from chopped shallots to fresh herbs to pesto to curry paste. Cooked mussels can also be removed from their shells and added to soups, pasta dishes and salads.
You can also find bags of fully cooked mussels in the frozen seafood section of many grocers which are even more convenient.
2. Dry Lentils
Enrique Díaz / 7cero//Getty Images
Eating plant-based foods, like lentils, more often is certainly easier on your bank account. A study in The Lancet Planetary Health that analyzed feeding patterns from 150 countries found that for wealthier countries, like the U.S., eating a diet higher in plant-based foods may be from 22 percent to 34 percent less costly when compared with other types of diets that are higher in animal-based foods.
With a benevolent price tag of $2 or less a pound, a bag of dry lentils delivers a huge nutritional bang for your buck. On top of protein (18 grams in a 1-cup cooked serving), the legumes provide huge amounts of fiber—about 16 grams in a cup of cooked lentils. That’s worth noting when you consider that most people struggle to meet their daily fiber requirements, which is at least 25 grams of fiber per day for women and 38 grams for men, or 14 grams for every 1,000 calories consumed.
Lentils also provide a laundry list of essential micronutrients including iron, phosphorus, thiamine, and folate. A recent investigation published in the journal Diabetes Care suggests that greater dietary folate intake is associated with a lower risk of developing diabetes.
→How to add it to your plate: A bag of dry lentils will last you several meals. And unlike dried beans, lentils do not require a pre-soak before cooking. Simply simmer dried green or brown lentils in a pot of water until tender, about 20 minutes. Don’t overcook or they will turn mushy. Use them in soups, salads, chili, curries and veggie burgers. Lentils can also stand in for ground meat when making a Bolognese-style sauce for pasta night.
3. Millet
Iuliia Bondar//Getty Images
While other grains, like quinoa and farro, get all the press, inexpensive millet still largely flies under the culinary radar in America. But you can stock your pantry with this nutritious whole grain for a budget-friendly price: A 28-ounce bag will set you back only about $5. It might be even cheaper if purchased from bulk bins.
Long a staple grain in Asia and Africa, millet has a great corny flavor along with a range of useful nutrients for active bodies, including B vitamins and magnesium. One study in the journal Hypertension suggests that a greater intake of magnesium could have a positive effect on blood pressure numbers.
Not to be overlooked is that the grains supply the complex carbohydrates (20 grams in each ½-cup cooked) that cyclists need to power their rides. Millet is gluten-free, which makes it a good whole-grain carb option for those who need to steer clear of gluten.
→How to add them to your plate: To prepare, simply simmer 1 cup millet in 2 cups water or vegetable broth and a couple of pinches salt until tender and the water has been absorbed, about 20 minutes. Remove from heat, let stand covered for 5 minutes, and then fluff with a fork. Try mixing the cooked grains with chopped vegetables and a dressing for a healthy salad. Toss in cooked lentils for a more substantial main dish. Google “millet tabouleh” for a switch-up to using bulgur. Millet can also be made into porridge similar to oats.
4. Raisins
lacaosa//Getty Images
If you are looking for a way to trim the cost of how you fuel your time on the saddle, consider low-cost raisins as a solid option. Calorie for calorie, they are certainly less expensive than packaged gels and chews. One study (albeit small) in the Journal of the International Society of Sports Nutrition found that raisins were just as effective as chews at helping people keep up their endurance without any noticeable differences in gastrointestinal issues.
Another investigation in the Journal of Strength and Conditioning Research showed that when male and female athletes were fed 1 gram carbohydrate per kilogram body weight from either raisins or sports gel 45 minutes before a one-hour cycling test, there were no differences in performance. Raisins contain fast-acting carbs in the form of glucose and fructose that, like more expensive sport nutrition products including gels, can supply working muscles with a rapid energy source.
As additional food for thought: Raisins are a source of potassium, which is important for regulating water balance in the body and improving muscular contraction.
→How to add them to your plate: If using raisins as your fuel source during rides you’ll want to eat about ½ cup for each hour of your ride to take in enough carbs. You can also use the parched grapes in homemade energy bars, balls, and trail mix. You can sprinkle them on yogurt, oatmeal, and salads, and also mix them into muffin batter to help meet overall carb needs. Finally, you can also toss raisins into salads, roasted vegetable sides, stews, and grain dishes.
5. Red Cabbage
dulezidar//Getty Images
We all know the pain of swinging open the fridge door only to find a container of tender salad greens that have turned into expensive mush. Thankfully, a hearty head of less costly cabbage can go a long, long way. Not only will it last for weeks in the fridge before going rotten, but red cabbage has an impressive nutritional resume, including good amounts of dietary fiber, vitamin K, and vitamin C. It’s also a source of the same class of antioxidants you’ll find in blueberries called anthocyanins.
In fact, a 2023 study in the Journal of Agricultural and Food Chemistry showed that the type of anthocyanins found in red cabbage are particularly effective at helping lower inflammation in the body and improving the gut microbiome. By acting as an antioxidant in the body, some research literature suggests that anthocyanins could help athletes better recover from workouts by lowering the degree of muscle damage.
→How to add them to your plate: Thinly sliced raw red cabbage is a good addition to salads, slaws, stir-fries, burgers, and lunch sandwiches. Braised or grilled red cabbage is a great low-cost side dish. Also, try using whole cabbage leaves as a fresh alternative to tortillas when making tacos. Red cabbage is also worthy option for making inexpensive homemade sauerkraut.
Other Cheap, Healthy Foods
Add these other budget-friendly foods to your grocery cart to help get the nutrition you need while keeping your food bill from exploding.
