Indoor seated dining is a conceit that the US can’t afford.

Photo by Pablo Merchán Montes on Unsplash

The data are in. They were never in doubt.

  • A tent that’s ventilated enough to keep COVID at bay and affordable for restauranteurs, generally won’t be warm enough for comfortable seated dining this winter. Even when households eat together, they are entering an enclosure in which others have eaten, staff will enter, etc.
  • Indoor filtration systems don’t have time to intercept droplets between diners at the same or adjacent tables, nor interactions between kitchen staff, wait/host staff, or between staff and customers.

For now, we need…


By Laurie Gelb, MPH, BCPA

Studies of a potential link between smoking status and the clinical course of COVID-19 infection have yielded contradictory results. A recent meta-analysis [3] sought to address the question more completely.

COVID-19 targets lung epithelial cells, causing, in part, viral pneumonia and atypical acute respiratory distress syndrome (ARDS). The CDC has reported pre-existing respiratory disease as 9.2% in patients diagnosed with a severe COVID-19 course [2], likely an underestimation.

The researchers scanned Embase, Google Scholar, PubMed, Scopus and Web of Science databases to identify appropriate clinical studies [3]. Studies that included smoking status and characterized disease…


By Laurie Gelb, MPH, BCPA

Current Covid-19 tests are reverse transcription–quantitative polymerase chain reaction (RT-qPCR) assays that first extract RNA from patient swab samples, then detect viral RNA through RT-qPCR amplification of the extracted RNA.

These tests detect the presence of an antigen, rather than antibodies as do serological tests. Thus, they are highly sensitive, but not as specific; false negatives are common (up to 30% in some studies) [2] and have led to the conflicting results, even over a few days, experienced by some patients. …


The ability to help a patient answer, “How likely is it?” can reduce the likelihood for all.

By Laurie Gelb, MPH, BCPA

Data relative to the pandemic’s impact are not difficult to obtain. With a click of the mouse, patients with Internet access can see new and cumulative Co-V cases and deaths in numeric and linear form, and by zip code, town, county, and state.

The ready availability of epidemiological information notwithstanding, patients are still gathering unsafely, from dinner parties to large rallies. Many are refusing to wear masks as a matter of misguided principle. …


Why do women continue hormones that could cause them harm?

By Laurie Gelb, MPH, BCPA

Using systemic female hormone therapy for more than five years carries documented relative risk in terms of cardiovascular disease, cancer, dementia, incontinence and gallbladder disease, among others. Clinicians counsel their patients accordingly.

However, in 2015, more than one-third of US HT prescriptions were written for women over age 60. In the same year, based on claims data, prevalence of systemic HT use among US women with commercial health insurance was estimated at 6.8% in women 60–64, and 1.6% in women over 74.[2] Clearly, there is a gap between the evidence and patient decision-making.

Qualitative Perspectives…


By Laurie Gelb, April 18, 2012

Photo by Bret Kavanaugh on Unsplash

What’s a “convenience item?”

For most plans, it’s anything from the elevation feature of a wheelchair seat to a motorized patient lift to a track to move a shower chair into a traditional stall. In other words, it’s features, equipment or supplies that you don’t want to reimburse.

The rationale for non-reimbursable DME is most often that in and of itself, the “convenient” add-on or gadget doesn’t treat a disorder or isn’t essential for ADLs. A power wheelchair’s tilt and recline functions, for example, are reimbursed because without them a chair-bound patient is more…


By Laurie Gelb, October 17, 2011

Photo by Berkeley Communications on Unsplash

If you thought the 80’s were “the Me Decade,” consider these the “Me, Myself & I” years. Introspection is in, singly or in groups (witness the Occupy Wall St. Movement).

What does this have to do with managed care? Depends on who’s doing the managing (or thinks they are).

A top tier disease management vendor’s intake form currently includes the following question:

Do you currently have any of the following conditions:

[list of 12]

where the list includes cancer, pregnancy, poor circulation, heart attack and stroke, among others, in seemingly random order.

So just…


By Laurie Gelb, December 10, 2012

Photo by Håkon Sataøen on Unsplash

You wake up one morning and decide gasoline costs are just too high. You want to begin filling your car’s gas tank with water, which is, of course, much cheaper. You call your mechanic to find out if this is a good idea. He sadly tells you that it will not work. Chastened, you text your broker to invest in some alternative energy stocks.

What is unlikely about this scenario? Well, first and foremost, you have already internalized the fact that water will not run your car. You don’t blame car manufacturers or your…


By Laurie Gelb, July 7, 2011

Photo by Tbel Abuseridze on Unsplash

Recently I became aware that my husband’s national pharmacy record contains not only his own data, but that of another patient.

The root cause: the other patient, in another state, with a different payor, was never asked to confirm his address when he picked up his meds. He has the same DOB, first and last name as my husband, though their middle initials, and, of course addresses, are different. Naturally, a “boomer” generation yields birth date clusters. Had anyone ever asked him one simple question at each pickup, “What is your address?” …


By Laurie Gelb, June 7, 2011

Actual hypochondria, by definition, entails inappropriate self-dx and/or care-seeking (fueled by what Microsoft’s paper calls “the escalation of medical concerns”).

So what escalates concerns, whether you’re buying a car or selecting a health plan? Feeling like you’re being played by self-interested advisors. Being unable to get “a straight answer.” Reading legal disclaimers instead of declarative sentences that apply to your situation. Looking at your organization’s health content, can you honestly deny any reasons for user frustration?

What we can foster via the social Web is appropriate self-dx and care-seeking. …

Laurie Gelb

MPH. Research → strategy → content. MDACC, Anthem, Sanofi vet. Open the windows, get outside, and get vaxed. The life you save in minutes may be your own.

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