10 Reasons You Can’t Sleep & How to Fix Them

by David DiSalvo, contributor

Having trouble sleeping?
Below are 10 of the most common reasons why with suggestions on how to correct them.

1. Your room isn’t dark enough.

Ideally, your bedroom shouldn’t have any lights on, especially light emitted from a TV or any electronic device. When your eyes are exposed to light during the night, your brain is tricked into thinking it’s time to wake up and reduces the production of melatonin, a hormone released by your pineal gland that causes sleepiness and lowers body temperature. Light emitted by electronic devices is especially troublesome because it mimics sunlight.


2. Exercising too late.

If you exercise within three hours of trying to sleep, you’ll overstimulate your metabolism and raise your heart rate causing restlessness and frequent awakenings throughout the night. Try to exercise in the morning or no later than mid to late afternoon, which will result in sounder sleep.

3. Drinking alcohol too late.

We tend to think of alcohol as a sleep inducer, but it actually interferes with REM sleep, causing you to feel more tired the next morning. Granted, you may feel sleepy after you drink it, but that’s a short-term effect. Here’s a great video at WebMD about alcohol and sleep.


4. Room temperature too warm.

Your body and brain wants to cool down when you sleep, but if your room is too warm you’ll thwart the cool-down process. Having a fan in your room is a good idea because it will keep you cool and produce a consistent level of white noise that will help you fall asleep. Just don’t get too cold, because that will disrupt sleep as well. (You can also try cooling your brain.)


5. Caffeine still in your system.

The average half-life of caffeine is 5 hours, which means that you still have three-quarters of the first dose of caffeine rolling around in your system 10 hours after you drink it. Most of us drink more than one cup of coffee, and many of us drink it late in the day. If you’re going to drink coffee, drink it early.


6. Clockwatching.

Though it’s hard not to do, don’t look at your clock when you wake up during the night. In fact, it’s best to turn it around so it’s not facing you. When you habitually clockwatch, you’re training your circadian rhythms the wrong way, and before long you’ll find yourself waking up at exactly 3:15 every night.


7. Getting up to watch TV until you’re sleepy.

This is a bad idea for a few reasons. First, watching TV stimulates brain activity, which is the exact opposite of what you want to happen if your goal is to sleep soundly. Second, the light emitted from the TV is telling your brain to wake up (see #1 above).


8. Trying to problem-solve in the middle of the night.

All of us wake up at times during the night, and the first thing that pops into our heads is a big problem we’re worried about. The best thing you can do is stop yourself from going there and redirect your thoughts to something less stressful. If you get caught up on the worry treadmill, you’ll stay awake much longer.


9. Eating protein too close to bedtime.

Protein requires a lot of energy to digest, and that keeps your digestive system churning away while you’re trying to sleep — bad combination. Better to have a light carbohydrate snack.


10. Smoking before bedtime.

Smokers equate smoking with relaxing, but that’s a neurochemical trick. In truth, nicotine is a stimulant. When you smoke before trying to sleep, you can expect to wake up several times throughout the night; much as you would if you drank a cup of coffee.




(contributor_data.name)!?html   David DiSalvo is a science, technology and culture writer who contributes to Forbes, Scientific American Mind, The Wall Street Journal, Psychology Today, Esquire, Mental Floss and a smattering of other publications. His first nonfiction book, “What Makes Your Brain Happy and Why You Should Do the Opposite” (Prometheus, 2011) is available in paperback and Kindle, and his second book, “The Brain in Your Kitchen” is now available for Kindle. More at his website: www.daviddisalvo.org. The opinions expressed are those of the writer.





Related Information to Why You Can’t Sleep:


Top 10 Foods Containing Protein:  (avoid these foods too close to bedtime)

1. Turkey

2. Fish (tuna, salmon, halibut)

3. Cheese

4. Pork Loin Chops

5. Tofu

6.  Beans

7.  Eggs

8.  Yogurt, Milk

9.  Soymilk

10. Nuts, Seeds



Drinking Alcohol late at night not only causess insomnia.  Check this out:

alcohol1 alcohol2 alcohol3


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Sleep well, everyone. 


5 Ways To Help Teens & Kids Cope Post Trauma

Today’s teens and kids are exposed to unpredictable adult-like stressors. 


I spoke with Kate E. Eshleman, Psy.D., | Pediatric Psychologist| Pediatric Behavioral Health| Children’s Hospital, at Cleveland Clinic and contributing expert to MEDCRUNCH.



She offers advice on how to help children and teens cope post trauma. 


1. How can parents help children and teens after a traumatic event  , albeit a natural disaster or death?

There are many ways parents can help their children and teens cope. It is important for parents to make themselves available to their children, such that the kids can approach their parents if they are having any difficulties. It is appropriate for parents to check in and ask how their children are doing, but it is also important to be aware that not all children will want to talk or ask questions, and parents can take cues from their kids.


If parents are observing that their children seem upset but are not wanting to discuss, they can try and engage them in distracting activities such as a family movie night, going on an outing (i.e., dinner or a fun activity), or every day errands such as to the grocery, anything to assist in getting the children’s minds off of what is bothering them.



2. Does maintaining daily routines help, such as sitting down to dinner nightly?

Maintaining a routine is definitely important, as it assists in keeping some normalcy, even if things do not seem “normal.” Continuing to have the same expectation of the children’s behavior and activity is important, though if there are significant things going on, it may be okay to have a little more flexibility around those routines. Nightly, or at least regular, dinners are always important. This is a great opportunity to ask your children questions and/ or allow them to discuss their day. This will also be a good time for parents to observe/ assess for any changes in their children’s mood or behavior.


3. What questions should parents ask children who seem withdrawn or anxious?

There are not necessarily specific questions that should be asked, but rather very general questions such as “how was your day?” or “anything on your mind?” More important than the specific question, is parents’ inquiring into how the child is doing, showing that they care and are interested in what the child is thinking/ feeling, and providing the opportunity for the child to discuss if (s)he is interested.


 4. What healthy habits help? Should anything be increased/decreased during highly stressful times?

Healthy habits include eating well, getting rest, and being physically active. While these are relatively simple concepts, they are not always easy to implement, and can often be the first to go when times become busy and stressful. It may be helpful to prioritize what needs to be done and by when, and making sure to schedule in the healthy activities (i.e., finding a time to go to the grocery so there is food in the house, avoiding the need to stop and grab fast food on the way home, or planning to start a homework project on the weekend, so a child is not up late the night(s) before it is due). It is also important to maintain fun and enjoyable activities during stressful time, to provide a break from the stressors and an opportunity to relax and enjoy one’s self.


5. Should parents share their own fears with kids or not?

 This one probably depends on several things. As a general rule of thumb, children should not have to worry about adult issues, as they are plenty busy worrying about kids’ issues. If it can be avoided, it is recommended that parents not openly discuss their concerns with or in front of the children. It is also important to note that children, beginning from an early age, take their cues from their parents, so even if parents are not verbalizing their thoughts and concerns, the children may be aware of what is going on, thus it is important for parents to monitor their own behavior and reactions. This being said, it is important for parents to tell their children the truth in a developmentally appropriate way, so if there is something happening that is directly affecting the children, it will be important for children to have some awareness of those things.




Our heartfelt thoughts and prayers go out to those who lost loved ones in Oklahoma.


Stay healthy & safe, everyone.



Cleveland Clinic is ranked one of the top hospitals in America by U.S.News & World Report (2012). Visit them online at http://www.clevelandclinic.org for a complete listing of services, staff and locations.


Lack of Sleep Dangerous for Young Drivers


NPR recently reported that 4 in 10 teens admit to texting while driving.  And texting while driving replaced drunk driving as the number one cause of death among U.S. teens.


Now, a new Australian study ties lack of sleep to higher risks of crashes among young drivers.


Distracted AND Drowsy?  OH.  MY.


Researchers at the George Institute for Global Health in Sydney surveyed more that 19,000 people between the ages of 17 and 24.


They found those who were getting 6 or fewer hours  of sleep per night increased their risk for a crash compared to those getting MORE THAN 6 hours per night.


But those who did not catch-up on the weekend increased their risk and were more likely to be involved in “run-off-road” crashes.




Researchers want to make young drivers aware of the importance of sleep and its affect when they’re behind the wheel.




CG: Dr. Harneet Walia/Cleveland Clinic
“Because the sleepiness can lead to attention lapses, impairment in concentration, impairment in judgment, slowed reaction time.“ 


WALIA ADDS, “There has been a lot of data out there that reports people who sleep less are more likely to be involved with drowsy driving and drowsy driving is one of the top most causes of being involved in an accident.”



 [VT/VO on Pathfire #9141]


Teens and Sleep from National Sleep Foundation

Sleep is food for the brain. During sleep, important body functions and brain activity occur. Skipping sleep can be harmful — even deadly, particularly if you are behind the wheel. You can look bad, you may feel moody, and you perform poorly. Sleepiness can make it hard to get along with your family and friends and hurt your scores on school exams, on the court or on the field. Remember: A brain that is hungry for sleep will get it, even when you don’t expect it. For example, drowsiness and falling asleep at the wheel cause more than 100,000 car crashes every year. When you do not get enough sleep, you are more likely to have an accident, injury and/or illness.






According to the Insurance Institute for Highway Safety:

  • In 2010, the latest year for which data are available, motor vehicle crashes were the leading cause of death among 13-19 year-old males and females in the United States.

A total of 3,115 teenagers ages 13-19 died in motor vehicle crashes in 2010. This is 64 percent fewer than in 1975 and 10 percent fewer than in 2009.

  • Thirty-three percent of deaths among 13-19-year-olds occurred in motor vehicle crashes, 39 percent among females and 31 percent among males.
  • 16-year-olds have higher crash rates than drivers of any other age.
  • The crash rate per mile driven is twice as high for 16-year-olds as it is for 18- and 19-year-olds.
  • About 2 out of every 3 teenagers killed in motor vehicle crashes in 2010 were males.
  • In 2010, 58 percent of deaths among passenger vehicle occupants ages 16-19 were drivers.
  • Fifty-nine percent of teenage passenger deaths in 2010 occurred in vehicles driven by another teenager. Among deaths of passengers of all ages, 17 percent occurred when a teenager was driving.
  • Statistics show that 16- and 17-year-old driver death rates increase with each additional passenger.
  • Eighty-one percent of teenage motor vehicle crash deaths in 2010 were passenger vehicle occupants. The others were pedestrians (9 percent), motorcyclists (4 percent), bicyclists (2 percent), riders of all-terrain vehicles (2 percent), and people in other kinds of vehicles (2 percent).
  • Fifty-five percent of motor vehicle crash deaths among teenagers in 2010 occurred on Friday, Saturday, or Sunday.
  • In states with GDL programs that include at least five of the most important elements, there was a 20% reduction in fatal crashes involving 16-year-old drivers.
  • In 2006 (latest data available) crashes involving 15- to 17-year-olds cost more than $34 billion nationwide in medical treatment, property damage and other costs, according to an AAA analysis.
  • Teenage drivers and passengers are among those least likely to wear their seat belts.
  • In 2009, 11 percent of the people who died in distracted driving crashes were teens 15 to 19 years old. Out of all the teens who died in crashes in 2009, 18 percent died in crashes that involved distracted driving. Fifteen percent of teen drivers who were involved in fatal crashes were distracted at the time of the crash.
  • In 2008, 37 percent of male drivers ages 15-20 who were involved in fatal crashes were speeding at the time.
  • In 2010, 54 percent, or 1,532, of the 2,814 occupants of passenger vehicles age 16 to 20 who were killed in crashes were not buckled up.
  • Among fatally injured passenger vehicle drivers ages 16-17, 16 percent of males and 13 percent of females in 2010 had BACs at or above 0.08 percent. Among fatally injured drivers ages 18-19, 31 percent of males and 22 percent of females had BACs at or above 0.08 percent.


Bottom Line for Young AND Old:

Be Well-Rested When You Get Behind-the-Wheel and Don’t Text & Drive!


5 Hot Health Tips for Recent Grads by Maria Dorfner


Tomorrow, my niece and Godchild, Lauren graduates from college. I am SO proud of her.


 It seems like only yesterday I was holding her in my arms.  As she graduates with Honors from Saint John’s University and embarks into the real world, I’d like to share a few hot health tips. 


  • Remember the most important word in the English language is no
  • No to drugs, violence, breaking the law, cheating, lying
  • No to racism, chauvenism, discrimination, unhealthy behaviors
  • No to too much alcohol, abuse or bullying
  • Values include Heath, Honesty/Truth, Integrity, Loyalty, Commitment/Followthrough
  • Values include Family, Spouse, Friends, Helping Others, Giving 100% at every job you do
  • Values like Excellence, Accountability (the list goes on). Your core values are who you are
  • You can’t control the world around you, but you can control how you react to it
  • When you are healthy, centered and balanced you will remain calm and make better decisions
  • When you feel angry or anxious, step away and breathe instead of reacting
  • Healthy coping mechanisms: Make yourself a cup of tea, go for a walk, or call a friend
  • Stand up for what you believe in because one person CAN make a difference
  • If someone is ever mean to you do not take it personal
  • Do not judge as they may be going through something that has nothing to do with you
  • Be patient, kind and do not react. Treat others as you wish  to be treated


  • Keep learning.  “Today a reader. Tomorrow a leader.”
  • Read Biographies of people you admire (you will learn how they overcame obstacles)
  • Read history, self-improvement and inspirational books
  • Read the news instead of watching it
  • Read healthy magazines instead of celebrity gossip or glamour mags
  • Snack on brain foods to keep your mind sharp (walnuts, almonds, veggies, fruits)  
  • Eating nutritious foods daily will keep your mind and body healthy, energetic and fit


  • Get outdoors in nature daily
  • Turn off the TV and all your gadgets to quiet your mind and the information overload
  • Surround yourself with healthy, positive people who motivate and inspire you
  • Close your eyes and meditate daily, even if it’s only 10 minutes
  • Avoid gossip or negative and toxic environments
  • Remember you are beautiful just the way you are
  • Laugh every single day; builds your immune system
  • Believe in yourself: You can do anything you set your mind to


  • Walk at least 30 minutes  a day
  • Stretch upon rising each morning and before turning in each night
  • Stay hydrated with lots of water daily
  • Find a sport you enjoy that doesn’t feel like exercise (soccer, bowling, tennis, swimming)
  • Turn up the music to make the time pass quicker when you exercise
  • Strive to be healthy longterm instead of thin
  • Make rest a part of your daily healthy  habits; strive for 8 hours a night


  • Don’t ever compare yourself to others
  • Be the best version of you that you can be
  • Remember, no one else in the world is exactly like you; you ARE unique
  • Develop your unique skills by doing; if you don’t know what you’re good at –ask friends
  • Take your job seriously, but never yourself. Everyone makes mistakes, so learn to laugh
  • Don’t ever be afraid to talk to someone if you have questions about something
  • Appreciate and see all the goodness and beauty in life, even during bad times
  • Find mentors you admire.  You can learn a lot from people you respect


Congrats to all 2013 Graduates & my wonderful, intelligent niece Lauren,  future ace accountant. 


Remember, health is your greatest wealth. Make a deposit EVERY DAY!!!  🙂






New Health Study: Barefoot Running by Maria Dorfner


Today, the Cleveland Clinic News Service (which yours truly helped create and launch) talks about barefoot running vs. shoes.

In 2011, I predicted barefoot running would take off.   Today, more and more runners are leaving their shoes behind.

But a recent study out of Taiwan found that with or without shoes, it’s HOW your foot strikes the ground that increases your chance of injury.   Dr. Susan Joy did not take part in the study, but treats patients at Cleveland Clinic SPORTS HEALTH.


Runner's World magazine, published by Rodale s...
Runner’s World magazine, published by Rodale since 1971 (Photo credit: Wikipedia)

CG: Dr. Susan Joy/Cleveland Clinic Sports Health

Joy says, “The problem is that if you hit the ground really hard with your heel, that bone to bone contact there is not making use of all of the natural shock absorbers in the foot and the lower leg transmitting a lot of force up through the body and that can lead to injuries.“ [:12]








 CG: Dr. Susan Joy/Cleveland Clinic Sports Health

Joy says, “If you’re thinking either a barefoot technology or a minimalist or a lighter weight shoe you just have to make sure you’re paying extra attention to your gait. Because you can’t take a less-efficient gait and just put those on and expect the shoe to make the changes. What the shoe does is it makes you concentrate more on how you’re hitting the ground, which then, slowly over time allows you to adapt better to a new gait pattern.“ [:21]


[VT of Dr. Susan Joy’s soundbites/VO on Pathfire #9139 from Cleveland Clinic News Service]



“Many runners believe shoes have magical properties that they probably lack,” says Amby Burfoot, an executive editor at Runner’s World Magazine.

“Mainly we run in shoes for comfort and safety, reasons that are compelling enough for me.” -excerpt from The Barefoot Root by Zoie Clift www.marathonandbeyond.com/choices/htm

Two years ago, I wrote the following article about barefoot running shoes. It was inspired by my seeing someone wearing them at the gym. Her name was Vena Cook-Clark.  It was the first time I had seen them, and they looked so odd. I asked lots of questions, and thought readers could benefit from what I learned.
Barefoot running shoes have gained popularity since then, since I spotted a lot of them used in the Boston Marathon.  I spotted them in Boston Magazine’s cover photo with runner’s sneakers in the shape of a heart.  I posted the beautiful cover on my Facebook wall, and later that evening Anderson Cooper ended his program with a full-screen shot of it.


Here’s a glimpse back:
 photo:  Vena Cook-Clark on the treadmill in her barefoot running shoes
Running the Distance by Maria Dorfner

Following a good workout, my head was lowered as I sat in the sauna sweating like a turkey on Thanksgiving Eve. My lowered eyes couldn’t help but notice and follow what was the oddest footwear that I’d ever seen at the gym. They sauntered into the sauna like an alien entering a spaceship.

At first, I thought sweat was clouding my vision. As I wiped the dripping water from my weary eyeballs, I realized I wasn’t seeing things. These toes were webbed into a bright royal blue, ribbed, rubber-like material.

English: Vibram FiveFingers Bikila shoes, top ...
English: Vibram FiveFingers Bikila shoes, top view. (Photo credit: Wikipedia)

I instantly recalled a pair of socks fitted for all five toes, which I had seen in stores around the holidays in bright Christmas colors of red, green and white.

I’ve never tried those type of socks on, as I figured it’d take too long to wiggle my fat toes into them. Ideally, when my feet are cold, I like to pull my socks on like a fireman reaching for gear at a four-alarm-fire. No time for messing around. I want my gloves and socks without complications.

But these weren’t socks. Before me were half socks, half water shoes.

When I raised my eyes, sitting beside me was a woman listening to music on her iPod. She probably didn’t want to be disturbed. But my curiosity got the best of me. So, I tapped her on her shoulder to inquire about her odd footwear. What on earth were they? She laughed, and said they were her new running shoes.

Running shoes? Did I hear her right? Were my ears waterlogged from swimming? Apparently not, as she went on to say she absolutely loved them because they made her run faster and they were healthier for her feet.

Healthier? As someone who specializes in health, my interest was peaked even more now. I asked more questions. Her name was Vena Cook-Clark, age 27, and she’d been running as a hobby for 6 years.

Originally, the unusual look and lightness of the shoes grabbed her attention. She read that barefoot running was better for her alignment, and it was enough to make her plunk down the asking price of $100.00 to give them a try.

When she brought them home, her husband joked they looked like she had “alien toes,” but now, she exclaims he wants a pair too. I asked if they were difficult to put on. She said it gets easier after the first few times, and it’s worth the trouble. She added, “It was awkward running with them initially, but after about 2 weeks I got used to them and now want another pair for hiking.”

A woman wears Vibram "Five Fingers" ...
A woman wears Vibram “Five Fingers” shoes. (Photo credit: Wikipedia)

She boasted about how easy it is to toss them in the wash with the rest of her running or working out clothing. She told me they were manufactured by a company named Vibram and told me I could find them on the internet by Googling “Vibram Five Fingers.”

When I got home that evening, I did just that. I instantly found what was called a “Barefoot Movement.” Purists preferred the term, “Minimalist Movement,” since you’re not really barefoot while wearing them. First, I wanted to find out if there really were health benefits to wearing them.

Turns out, a 2010 study from India says children who wore shoes before the age of 6 were more likely to develop flat feet than kids who ran around barefoot. They also had better developed longitudinal arches. Statistically, 8.2% of kids who wore shoes regularly suffered from flat feet compared to 2.8% of barefoot kids. The study was published in The Times of India.

I also learned I’m not the first person to discover this study. In 2009, Christopher McDougall wrote a New York Time’s bestseller called, “Born to Run: A Hidden Tribe, Super Athletes, and the Greatest Race the World Has Never Seen”. It offered an in-depth look at the Tarahumara Indians in Mexico’s Copper Canyons. They ran hundreds of miles over rugged terrain in bare feet, and they ran into their 70’s without any sign of injury. Die-hard runners took note, and made the switch.

English: Bare feet running
English: Bare feet running (Photo credit: Wikipedia)

I wondered what physicians thought about them.

Last year, Harvard scientists, demonstrated that people who run barefoot or with minimal shoes – as people have done for millions of years – often land on their feet in a way that avoids a jarring impact. Less pounding equates to less stress and injury on the foot.

PBS has a video that visually demonstrates what your feet look like when they are running with regular sneaker vs. what they look like when you’re running barefoot or with minimalist sneakers. It’s interesting to note how your feet land on the ground differently. Minimalist shoes have you land on the ball of your foot instead of the heel.

The majority of physicians claim they are indeed better for your feet and “may” prevent injury. There’s that word “may” instead of can, which doctors say when they want to cover themselves. Non-committal, yet they state anyone with plantar fasciitis or any type of foot injury from running may benefit from them.

Physicians offer the following advice if you switch from your regular running sneakers to minimalist sneakers. Start slowly. They recommend you start by using them on trails and grassy surfaces before hitting cement or pavement.

If you’re interested in gaining the benefits of running barefoot, experts say that you need to prepare your feet before you make the switch. You can do so by:

1. fanning your toes, holding for 10 seconds, 10 times a day per foot.
2. Flex your feet for 5 seconds, then release.
3. Trace letters in the alphabet with your feet in mid-air each day.
4. Stand on your tippy-toes, and
5. Side walk.

The above seems like a lot of fancy footwork, but wearers like Vena Cook-Clark rave about them, and won’t be going back to regular running shoes anytime soon. Clark says, “I look at my old running shoes and can’t believe I used to lug those heavy things around in my gym bag. I love these and I run so much faster now and my feet feel so much better afterwards.”

English: Vibram FiveFingers KSO
English: Vibram FiveFingers KSO (Photo credit: Wikipedia)

They were founded by Dan Lieberman and Peter Von Conta. Fitness experts have since made the switch and word-of-mouth about them is rapidly spreading because the footwear causes curious people, like myself, to inquire about them.

Stephen Meade, founder of BigBamboo, LLC says he’s seen a guy wear them to meetings under a suit. He said you can’t help but notice and inquire about them. He did and says the guy who wears them is a marathoner and swears by them. Meade can’t wait to get a pair himself.

Although, Brian Cuban, an avid runner who has run 8 marathons with his best time being 3:27 in the Marine Corps. Marathon says he’d never use them.

Cuban, who in addition to running marathons, is also an attorney, writer, blogger and speaker, believes they will always be a niche item for high distance runners. He doesn’t see them ever catching on mainstream.

Cuban said, “I have too many existing foot and knee issues to make them viable. I need to decrease my strike force, not increase it.”

U.S. Navy Lieutenant Commander Andrew Baldwin, M.D. who is also an avid marathon runner agrees.

Baldwin is not a big fan of minimalist shoes. He says, “They’re correct in theory, but with our overweight society with bone structure accustomed to heavy lifting, it can be dangerous and lead to injury.”

Andy Baldwin, M.D. knows a bit about health and fitness, both professionally and personally. He’s been running since he was a kid, and has completed 35 marathons and 8 iron mans.

Baldwin is a triathlete, humanitarian, U.S. Navy diver and media personality currently serving as a family medicine resident at the Naval Hospital Camp Pendleton in Southern California. He has also served at the Navy’s Bureau of Medicine and Surgery in Washington, D.C. as a spokesman and advocate for Navy medicine.

While in D.C. he assisted the U.S. Surgeon General with a program called Healthy Youth for a Healthy Future and currently serves as an advocate for the Let’s Move Campaign headed by First Lady Michelle Obama. Both of these programs target childhood overweight and obesity.

On a side note, he was also the star of the ABC hit show, “The Bachelor: An Officer and a Gentleman.”

Yet, despite low opinions, sales are on the rise.

Sales for the Vibram Five Finger shoes have tripled every year since their launch in 2006. And sales continue to grow. So these rubber-soled, light as air running shoes may be more than a passing fad within the fitness industry.

The biggest complaint from consumers to date has been that the seams tear after 90-days. Consequently, the warranty on them is you guessed it, 90-days. But, the upside about that is the manufacturer, Vibram, will promptly replace them at no cost if that happens. So far, the customer service has been excellent, and they’ve been around since 2006. The second complaint is blisters. But traditional running shoes can give you blisters too.

The webbed running shoes may look dorky and weird, but they’re super comfortable, like being barefoot, only your feet are completely protected from sharp objects and stones. They also keep your feet warm. If you’re renovating your home and have nails on the floor, they could be a benefit or if you have small children who leave all sorts of things lying around, they could also be a smart substitute for wearing socks around your home.

I also bumped into Vena Cook-Clark at the gym again, and she ran up to me in her Vibrams to tell me she was thrilled to announce she had gotten a second pair for hiking, and that her husband was now sporting a pair, loving them.

Skeptics who may not want to use them for running, are using them for comfort and grip during weight lifting, yoga, bike-riding or plain old walking.

I recently walked through a mall, and couldn’t help but spot them in all the footwear stores. They come in a variety of attractive, vibrant colors for both men and women. When you lift them it’s exciting to feel how light and flexible they are and there is a buzz in stores with people talking about them.

Last month, runners wore them in a 5K race in the Oshkosh Half Marathon. And you can’t walk into an athletic footwear store without seeing them on the shelves. Top brands are starting to get into the race. Nike and New Balance just introduced “Minimalist Sneakers” this week.

Current Top 5 Brands for “Minimalist Sneakers” which cost approx. $100. are:

1. Vibram
2. Nike
3. New Balance
4. Reebok
5. Brooks

As for me, I still want my gloves, socks and sneakers without complications. But I’m willing to give these a try, if only for the light weight for carrying them around. I’m also thinking they’d be great for walking on the beach in the sand. I love the feel of sand of my toes, but there’s always a chance of stepping on something sharp. I like to walk/run by the ocean and these seem like a good alternative to bulky traditional shoes. I also like the non-webbed toe version, which are even lighter in weight than the Vibrams. They’re easier to toss into a beach bag than traditional running shoes. I recently tried Stand-Up Paddle boarding and I could see using them for that as well.

Vibrams weight is 5.7 ounces. The Mizuno Universe 3 (price $119.99) weighs 3.6 ounces and has a closed toe as you’d see on a traditional sneaker, so no alien toes.

As summer approaches, you may see more and more of these minimalist running shoes, and do a double-take as I did. If they are durable and people like them, I believe word-of-mouth will have these minimalist shoes going the distance like a Tarahumara Indian in Mexico’s Copper Canyons.


English: Vibram FiveFingers Bikila shoes, inne...
English: Vibram FiveFingers Bikila shoes, inner side (facing other foot). (Photo credit: Wikipedia)

I also enjoyed The Boston Globe Magazine article, “The Great Running Experiment” by Shira Spring.  Check that out if this is a topic that interests you.

“The human foot is a work of art and a masterpiece of engineering.” – Leonardo Da Vinci


Here’s a link to my original article, “Running the Distance” by Maria Dorfner



Hottest Health Career of the Future by Maria Dorfner


If your kids are graduating from college wondering what to do with the rest of their lives, and they’re interested in the health field, but avoid it to make more money elsewhere, keep reading.  If not, keep reading anyway!  Thank you.

Today, “kids” are encouraged to be entrepreneurs. Start a company at the age of 3!

All before they EVEN know what to do with money (reminds me of a blog Brian Cuban wrote about why sports figures or celebs  end up broke). I think the future is going to include founders. How many “founders” are there today and where will they be in 20 years?

I understand why it’s happening.  You get fired up every time you read about a dumb idea getting millions of dollars in funding. It’s frustrating because you think your ideas are FAR BETTER.

Those articles encourage kids to quit their jobs or not attend college at all.   The unhealthy message they get is just come up with the next great thing, get funded and you’ll be fine.


Let’s peak behind-the-scenes. Some crappy idea getting millions in investments may be one college buddy who is now a VC helping another college buddy. No intention to “save the world” which a lot use as their mission statement. That buddy VC attracts others, who have no idea they are going to lose money because it was just a gift to a friend, and not a real investment in anything real. The Nancy Drew in me can spot scams before they become public.   We need a delete/block in life for folks who try to take advantage or exploit others.  Lots of snake oil salesmen out there feeding off of hungry entrepreneurs.

There’s also other little factors you can’t control. So, your idea being better means nothing.


Additionally, even if it’s legitimate, the majority of those companies will fail. Proven fact. Even if you get funding, expect to work your you know what off for one VERY expensive lesson.

I digress.  Back to HOTTEST HEALTH CAREER of the FUTURE.


If you REALLY want to change the world and have an interest in health –take a look at the future and where there will be ACTUAL demand.

HERE’S A GLIMPSE through my eyes.  My parents always say, “Maria has a big heart.” So, if eyes are the windows of the soul…my green peeps would be shaped like this. 


They’re not, but thanks to the San Diego Eye Institute my vision is 20/20 to see the future:


20% of all U.S. physicians are 55 or older, including more than HALF of the 5,000 active board-certified thoracic surgeons. Approximately 70% are expected to retire in the next 13 years, dramatically shrinking the provider pool leading to a critical work shortage JUST when aging baby boomers are sick and tired of stomping on grapes.   


Most of these sick baby boomers will suffer from heart disease creating quite a demand for well-trained heart surgeons, even if that surgeon is in another room or at home while doing this robotic or digital surgery.  In real estate they say, Location, Location, Location.   When it comes to a career in health, I say it’s



By 2025, some experts predict the number will be almost 2,000 short of what’s needed in the U.S. The demand for heart surgeons will explode. They battle both heart disease AND lung cancer –another baby boomer problemo. 

Average starting salary for a heart /lung surgeon? 350K


That’s right. Your kid makes 350K right out of college.  CA-CHING!

How long do they need to study? Residency required is 5 years followed by 2 fellowship years. You may work 50 hours a week, but you’ll do that if you’re entrepreneur too. Only you’re creating crazy things in the HOPES of creating demand.

Even if there IS a demand, you HAVE to convince friends, family or PWM (People. With. Money) you haven’t lost your marbles.  Does the product or service create the demand or vice versa?  I say when people need something it’s subconscious. When it shows up, they recognize it because the need (demand) was already there. It does NOT exist first.  I aced marketing in college with one other person. That tells me 2 out 10 people in a room understand.  The other 8 wait to “see” something first.   They lack vision.


Now, let’s look at a man with all his marbles AND vision in tact. He is one of the best cardiothoracic surgeons in the world.   I say THE best.  His name is Delos “Toby” M. Cosgrove. I am honored to call Mr. and Mrs. Cosgrove friends. When I first met them in 2001, Toby was Chief Cardiothoracic Surgeon at the Cleveland Clinic.

Today, he is Chairman. Under his leadership, the Cleveland Clinic’s heart program is consistently ranked NUMERO UNO. He presides over the $6B healthcare system that is The Cleveland Clinic. Calling him an innovator is also an understatement. He holds 30 patents and is absolutely brilliant.


I spoke with Toby about what it takes to be a resident at the #1 heart program and will share that later.

I followed him and went behind-the-scenes as he interviewed the best and brightest students to be selected for a residency at The Cleveland Clinic. Since it’s ranked #1, it attracts the smartest students from around the world. Interestingly enough, there was only one woman in the group. In general, 66% of physicians are male. Only 29% are female. Another shortage and demand for the future.

Tie this with the current obesity epidemic, a leading cause of heart disease.


Most recently, Cosgrove warned people about the link between heart disease connected to the foods you eat. You know when a man who would profit from your heart disease issues a warning –it’s time to listen.


May 2, 2013 How Our Guts – and What We Eat – Contribute to Heart Disease, Stroke and the National Debt

by Delos M. Cosgrove

We’re gorging ourselves into an epidemic of chronic disease, the costs of which will soon overwhelm our ability to pay and continue to be a contributing factor to the ever-increasing national debt. More proof of this has emerged with two studies that have uncovered new links between common foods and heart disease, stroke and death.

The culprit is a little-known substance called TMAO, or trimethylamine-N-oxide. It’s created when bacteria in the gut interact with two specific dietary nutrients – carnitine (found in red meat and dairy products) and lecithin (found in egg yolks, liver, beef, pork and wheat germ).

We now know that TMAO helps fatty substances in the blood to accumulate in the walls of the coronary arteries. These accumulations, called plaques, are the frequent cause of chest pains and heart attacks.

These findings were made in two recent studies by researchers in the Cleveland Clinic Lerner Research Institute and reported in the New England Journal of Medicine and Nature Medicine. It’s interesting to note the usual bad guy in heart disease, dietary fat, is not the person of interest here. Carnitine, the substance that gut bacteria convert into TMAO, is not in the fatty part of the meat. It’s in the red, meaty part. So it doesn’t matter if you cut the fat off your steak, or if you buy lean cuts.

So there’s no getting away from it. We have to be more careful about what we put in our mouths. We need to be aware of the foods that contain high amounts of carnitine and lecithin. But the real message of this research is broader – each person’s unique gut flora has a tremendous impact in how our bodies react to these nutrients. Those with TMAO levels among the top 25 percent had 2.5 times the risk of a heart attack or stroke compared to people in the bottom 25 percent.

Such a finding could change the way we prevent and treat heart disease, by using TMAO blood levels as a marker of cardiovascular risk and possibly a treatment target.

No one is suggesting the complete elimination of red meat and egg yolk from your diet. Like so much in life, moderation is key. You can continue to enjoy a good steak, but you may want to limit it to about 4 to 6 ounces every other week.

We’re facing an avalanche of chronic disease in the coming years. Anything we can do to mitigate this avalanche of heart disease — and other chronic conditions like cancer and diabetes — will not only give us longer and happier lives, it will improve the economic outlook for our children and grandchildren who will ultimately have to pay for our poor lifestyle choices.


Here is another interesting finding:

According to the U.S. Census Bureau, as of 2010, there were over 850K licensed physicians in the United States. In the United States, there are approximately 24,000 physicians for every 10,000 people.

I wanted to find out how many physicians per people there were in the healthiest countries. Turns out, the average is 34.9 physicians for every 10,000 people.

So, the shortage isn’t just in the field of cardiovascular surgery. I am a HUGE fan of preventing disease instead of treating it. Will we no longer need physicians or surgeons if we are able to prevent disease?

Too late. Even if you are healthy today, you still exposed an inordinate amount of toxins in the environment AND stress caused by factors you can’t control. Staying healthy involves continually being educated on what toxins to avoid AND learning and relearning healthy strategies and HOW to remain calm in the face of adversity.

There is A LOT of adversity in the world.   Enough to make you sick.

So, any disease that exists now or in the future has already been created and needs to either be REVERSED or TREATED. It will take as long as it did to create this disease to rid it from the existing population in the world. The only people who can completely benefit from PREVENTION are those who are A) already healthy or B) newborns.

And these two groups still need to be consistently educated on prevention from people like Delos M. Cosgrove.

So, if you’re smart and want to help change the world, it’s a field that will have an opening for you when you graduate with a good starting salary.

Of course, I know everyone isn’t “cut” out to be a heart surgeon or can be.  All I’m saying is if you CAN, do it.  The only question is do you have the academic grades for it? If yes, you can find financial resources.  If you don’t have the grades for it or it’s too late to select this field –then encourage a smart kid to explore it as a career.

I know recent college grads who make between $7 to $15 an hour or $20K, which was the starting salary THIRTY years ago AND the economy was thriving then. So, if you or your kid is smart –think longterm.

You need patience to be an entrepreneur OR a heart surgeon.  The latter guarantees success & innovation as dexterity is now a criterion as robotics and computers enter operating rooms. Think of it as fun playing video games while saving lives.


More importantly, it’s a career with HEART that won’t have you screaming, “I can’t take it anymore!” at the end.


p.s.  I was a founder before it was cool or part of a herd mentality.


Speaking of leaders, be sure to FOLLOW DELOS M. COSGROVE as a THOUGHT LEADER on Linked In.

Cleveland Clinic: http://my.clevelandclinic.org/staff_directory/default.aspx


Click FOLLOW button on upper-right-hand corner of this blog to be alerted by email when there’s a new post, thanks.

Meet Roland Harris, Chairman & CEO, Medida Metrics


Today, I’m speaking to Roland Harris. That’s not him in the hair-raising photograph. That’s what people look like when they receive their hospital bill. Harris wants to fix that.

Roland is Chairman and CEO of Medida Metrics, a Healthcare Performance Company.  He is currently working on the implementation of activity based costing/management software that is quick for hospitals to install within 60 to 90 days, and it forces rapid change that can ultimately make figuring out where costs are highest or unnecessary. 


Unneccessary costs that get passed on to you, the healthcare consumer.  That’s when you go to a hospital for a procedure and end up floored when you get your bill. Figuring it out can be daunting. 


 A closer look reveals charges you never imagined.


“Transformation needs to take place within the entire industry, with policies, just as it did over a decade ago in the automobile industry,” says Harris. .       


Harris adds, “Today a hospital has to challenge its basic assumptions. are its management policies what they need to be, do their supporting systems provide the insight required to prevail and grow in an increasingly competitive environment. Hospital’s already employ many of the Six Sigma tools that the automobile industry utilized but without the hard data to support their decision making. The ExactCost software solution allows them to extract such data in a readily usable manner so that their decision making is fact based not intuitionally driven.”


He adds, ” It really is transformational in the same sense that the automobile industry had to discover all the bad things about itself in order to discover how it could go about putting itself on a more efficient, effective track.” 


Ultimately, in the case of automobiles, as you know, the price came down, the availability went up, and the cost to the institution went down, and profits have since recovered and are growing.”


If the hospital was interested in the same kind of impact, in improved product meaning better patient care, a reduced cost to themselves that they could pass along to the patient as part of that improved care, a more effective and efficient institution that would use, in some cases, similar techniques. They’re IT-based.



They started early on trying to produce new types of vehicles using the same approaches, and you’re trying to fill in gaps in the market and all that kind of stuff, so the resistance, the desire to deny that there was a problem was part of what I would consider to be a 25-year period; and then there was a gulp where they realized they had to cut their costs by cutting 10% across the board, which is what you’re beginning to see hospitals and others do in trying to deal with the notion of Obamacare, etc.


They’re just cutting across the board, but they’re not really looking at: What is the impact of all these different cuts, and am I cutting in the right areas? Because they really haven’t developed an approach, a way of thinking about what their problems are to really be able to nail it down in a very specific way to make changes that will have the greatest positive impact.”


Harris says, “I think because, to some extent, of the regulation and having to come to grips with it, they’re being forced along the path faster than, I would argue, the automobile industry. So to go back to the notion that this company was established in 1999 with the notion that what they saw in automobiles was going to be carried over to hospitals. I would say that in 1999, hospitals could care less.  There were a few Israeli hospitals that were trying it out, largely because, in Israel, the whole notion of entrepreneurship is encouraged, so there were a few that were trying it out.”


Hospitals didn’t think they had to care about what their costs really were. Ultimately, insurance companies and governments covered most of the costs. There was the casual user who might have to pay out of pocket, but they work with them to try to come up with a good best price.


In 1999, let’s argue, to give us a timeline, they could care less. I would say probably until about a year … so maybe three years ago … they cared a little bit, not necessarily about the technology that I’m suggesting, but they cared a little bit about it. There was enough noise in the system that said they were going to have to change.


There was enough pressure on institutions that weren’t performing very well and were having to consider what their options were, so I’d say, basically from 1999 until literally three years ago, so let’s say 2008/2009 there was a growing in interest in doing something, but they weren’t quite sure what it was.


Right around 2009 what they decided they were going to do is they were going to invest in data-warehousing technologies as IT. That was the improvement because it would give them better financial information.


They all started … the hospital industry tends to follow each other, so when one of them decided to invest in data-warehousing technology, everybody invested in data-warehousing technology.


If you talk to consultants who understand what it is they’re doing, they will tell you that the implementation of data warehousing does nothing to really solve the problem that they have … right? … because their problem … right now a typical hospital has somewhere between 25 and 40 different IT-based systems that are operating.


Many of them are disconnected. Some of them are attuned from a standpoint of billing and other kinds of financials. Many of them are built around the notion of reimbursement. None of that really allows you to really understand what it costs you when Roland Harris comes into your admitting room, goes through all of your processes, is administered to, and ultimately released by the hospital.


I can’t capture that with the standard systems that they have in place today, so what I do is I figure out what my gross costs are, every aspirin I have in the place, every pill I’ve dispensed, all of my doctor’s time that I have to account for, and then with a hatchet I basically chop it up.


That’s how you get a $12,000 expense to somebody like Richard’s son who’s in the hospital for four hours. They just grossly estimate what must have been associated with taking care of him. They then basically allocate that, and the system then disposes of it.


In the case of an insurance company, insurance companies have negotiated rates, so the insurance company says, “Ha! $12,000 … that’s not really $12,000 it’s really $6000 of which I’m going to dispute, so I’m going to pay you $4000, and so it’s kind of understood. The bill is still $12,000, the bill is still made up of a series of things that people don’t completely understand or come to grips with.


Same thing with the Federal Government. The government says, “Ha! I don’t pay for certain things; I’m going to take those out.”


Few are really dealing with: What was the real cost to administering to Roland’s stay at that hospital. They’re all working of these gross calculations, regional calculations, and things like that, to come up with approximations that they all agree kind of work, and then they work it out.


 If you’re the poor person that shows up without any insurance or some kind of government support, you literally could walk away with a bill for $12,000, and if you’re sitting here with that $12,000 bill in your hand and you were to turn to anybody in that institution from the CEO all the way down to the administrator and ask them,  “How can you account for the fact that you just charged me $12,000?” only in very gross language could they ever give you any sense whatsoever for how what they did for you is associated with $12,000. 


Hospitals will understand where they are competitive and where they are not. This will enable them to improve their operations or outsource that with which they cannot compete.

My 36 years of experience with IT would suggest that the implementation of a software system serves as a guide to change. Software has inherent rules which in order to utilize it requires that you ‘buy in’ to what it is attempting to do. ERP system in the automobile industry had the same effect.”

billing18 If you wanted to encourage rapid change, which I would argue healthcare needs to, one of the ways to do it is to, in fact, implement a system of some sort that forces a set of rules that you think you roughly can agree to.


If you go back to the data warehousing notion, data warehousing doesn’t do it for you. All data warehousing does is, in the back room somewhere, where people are not forced to really interface with it, it basically takes information coming in and accounts for some of it in general ways, and stores it so that it is more available to those who already know that information exists.


What my system does is actually put in a position where you can ask questions about yourself that you literally didn’t know the answers to, hadn’t preprescribed that you were going to have to store information related to it, you literally could ask a question from almost any perspective into the institution to understand what the real cost, what the time was associated with it, and what the outcome was associated with whatever that particular procedure might have been. Right?  It’s iterative. It gets smarter with you.


Today what happens is: you walk in and somebody decides, “Okay, it’s Roland Harris. He has insurance/he doesn’t have insurance. Please sit over there.” Eventually somebody comes for you which is a nurse. The nurse spends some amount of time, who knows how much real time they spend with you. You’re then put in a procedure room; some things happen/don’t happen. You’re either admitted to the hospital or a procedure is performed. It goes through that whole process.


 That process is kind of made up every time somebody walks in through the front door. You can’t really account for how expensive it is. You can’t account for whether there are any missed steps in what you do. You can’t account for whether you could have done it in a better way. You can’t decide that, in some cases, you might not even want to perform certain kinds of procedures because your hospital really isn’t structured to be able to do it effectively.


 What I can do is say: How many knee surgeries have been performed in this institution over the last month and have the system automatically call up all the knee surgeries. Then I can take a look at what doctors were associated with those knee surgeries, and then I could now take a look at the doctors associated with knee surgeries and determine what the general outcome was for each one of the doctors. Then I can ask myself, “How much did it cost me to actually have that doctor do whatever they did,” and I can go and take another cut at it.


 Finally I can say, “I can’t figure out ” … because my routines are the same … “why is it that one doctors is costing $12,000 and another is $2000?” and it may be that … I asked at another one … which was “What device was actually deployed by the doctor as part of the procedure?” and it turns out they used a different kind of knee because they used the runner’s knee and this doctor seems to prefer the runner knee. Well, it turns out he’s putting runner’s knees in 60-year-old nonathletic people.


 Now the question for the institution is: Is that really a best practice? Is that really what we want to do? Would we prefer to be in or out of the knee replacement? Would we prefer to use the device that is less expensive in this particular case? Is there a reason why the doctors are doing what they’re doing? We generate those kinds of questions, and then we can tie it back to what it actually cost you to do it.


An institution might be benefited by the $12,000 knee, or it turns out that, in this case … this was a real situation … they didn’t actually benefit from it. It turns out that the infection rate around the runner’s knee was actually much greater, and so, therefore, the people being readmitted into the hospital actually drove up the cost to the hospital.


In a world like Obamacare where, effectively, the second time a person comes around you can’t charge full boat for it, that puts you in an awkward situation. In today’s world, let’s argue, up until today, I can charge twice. Who cares? Now my care … because I care about my patient … but if I just cared about revenues coming into the hospital, the fact that I have to perform Dr. A’s procedure two times more often than I do Dr. B’s is actually okay because he generates more revenue. I select my doctors on the basis of their ability to generate revenue for the hospital.


In the future, I want to know that there’s a difference in regards to the way they do what they do because I may not be able to afford the doctor that has to redo his surgery this often because of the devices he chooses, so the option might be either not to have that doctor perform at my hospital or to convince that doctor to use the device that is more likely to produce a better outcome. That’s what we do.


There’s something like 150 different types of surgical gloves that an average hospital will have in inventory, and it’s just because doctors have preferences.


 If you were running your own store, would you really allow 150 different … you might allow some for people with sensitive skin or certain kinds of procedures, but the notion that literally you’re going to inventory … and it’s not really 150, it’s many times more than that, but let’s just use 150 because it’s big enough, but it’s small at the time.


Think of every choice that any individual in an institution could potentially make that might affect: 1) just the overall quality of care, so even if you’re not driven to try to drive up your numbers, wouldn’t it be nice to be able to provide better care because the 60-year-old is getting the knee that’s going to last 20 years and not the knee that’s designed to last ten for certain kinds of situations.

Some of them are driven by where they set numbers and targets for themselves, and the more profit-oriented ones, the ones more specialized, would tend toward that. Its the notion that, at the end of the day, they don’t know where they are. They don’t know why those choices are made, and therefore they can’t act of them.

They can’t make themselves a more efficient institution, and they can’t change their policies and practices when, literally, those policies and practices exists differently in the heads of every physician, every nurse, every administrator, every staff person that exists within that institution.

It’s not for the patients. This is generally for the hospital, itself. There’s no reason why, at some point, you couldn’t, in fact, be able to have a discussion around what the bill was with better detail because of the reports, so maybe one of the reports that a hospital selects is one that would better explain, ultimately, the bill that is in the person’s hand; but this is more internal.

 The question is, from a legal standpoint: how much information do they really want to provide? But yes, they could nail down at a patient level, they could do it at a doctor level, they could do it at a department level, they could do it over a month’s time, they could do it over a year’s time. They can cut it any way they want, so they could produce a report that literally took a particular visit and broke it down, and you would, therefore, be able to explain why the aspirin costs what the aspirin costs.


 What I am more interested in, even that that, though, is the notion that they only charge $25.00 or 10,000% for an aspirin because they have because they really don’t understand what the cost of the aspirin was involved in the particular procedure that ended up in the $12,000 bill.


They ought to at least know why they have to charge that much money for an aspirin, and today they couldn’t tell you even close to why the aspirin has to cost so muchbilling19There’s no way that their aspirin is better inspected or anything else that would cause that aspirin to be worth so much more when administered at a hospital versus buying it at your doctor’s office or a local pharmacy.

So, why is it so difficult for hospitals to collect useful reports up to now to show actual cost of care?

Harris says it’s because their systems aren’t oriented to do that. Before, when he talked about the fact that somewhere between 25 and 40 different hospital systems exist, they all exist for their own purposes. They don’t exist to render information that can be pulled together to create the kind of report that ties out how who touched Roland for how long, and what did they do with Roland when they had him, and what procedure rooms were used, and what equipment was used. All of that stuff is available in a hospital today, but it’s not available in a way that they can pull it together to explain to Roland why it cost what it cost for Roland, or any patient.


To take you to the other side of it, just as an example of what could be done if it was at the nth level: Years and years ago, when I was working for IBM, I used to do outsourcing, and I had a hospital that I ran out on the West Coast. It was actually … because this story is a good one, I’ll tell you it was El Camino Hospital. It was small hospital.


I went out one day and they were obviously doing some work to add a wing to the hospital, and so I asked … because I knew a lot of the doctors and things like that. I asked them, “Why are you adding a wing to the hospital.” They said, “Well, somebody did a piece of homework, Roland, and it was just an amazing thing. We noticed that we were getting more women in here to have babies than makes any sense given the population that generally exists in our area.”

I said, “Why is that?” and they said, “Well, we don’t really know because we only did some marginal marketing analysis, but we think it’s because the women want their kids to be born, basically, at Silicon Valley. We think they literally want their kids born in a place which would be noteworthy, so they come here to have their babies. So we’re now beginning to administer to that by adding a wing where more births occur at this hospital.”


If a hospital really got to that point, Maria, where it really started thinking to itself, “Do I have perform every single procedure? Should I do everything that could be done by a hospital or are there some things that I’m actually better at?”


I’ll give you another example. Right now a lot of hospitals make a lot of money off of radiology, but there’s a lot of stand-alone radiology centers. As the Accountable Care Act begins to push on the notion that you have to prove that you are actually operating in the most effective, efficient manner, more people with the option are going to choose to go these stand-alone radiology centers, and the hospitals are going to be forced to take the results coming out of those centers versus rerunning them themselves, and a lot of those really expensive radiology centers are going to be almost half empty because they’re not going to be able to charge the same kind of rates, based upon the $12,000 story, as they have historically. They make a fortune off those things.


Hospital will understand where they are competitive and where they are not. This will enable them to improve their operations or outsource that with which they cannot compete.

They don’t like that, that’s where they make their money, but again, I did outsourcing for years for IBM and I worked through the pharmaceutical industry where they told me, “Why would ever outsource because we put sugar in little capsules and sell it for exorbitant sums?” That’s a quote.

They ended up outsourcing like fiends when they finally got pushed up against the wall and people started inspecting the cost of their business.

I did the same thing in insurance companies. When insurance companies said, “Why do we care? IT is a rounding error cost to us? It’s our manufacturing site, Roland, why would I ever give that to you?” By the time I finished, they were backing up trucks trying to give me their equipment.

I think hospitals are in the same position. You can, right now today, say, “We do it all because that’s what people expect us to do,” but in the future you may not be the best at all those things. You may not be able to run it at the right cost. You may have to get out of some of those businesses.

The question is: How do you know what businesses you should be in and what businesses you shouldn’t be in, what you do well and what you don’t do well, if you can’t even tell me the cost of an aspirin?

We’ve installed it in a small hospital in Florida. I won’t say it’s fully operational at this point; and we’ve got a couple of other deals in the wings that have gone through the pilot and the pilots have been … so we’ve gone from where they didn’t want to do a pilot to now they’re doing pilots, but not only are they doing the pilots, Maria, but they’re coming out of the pilots and going, “Wow! This really matters.”

I give you, again without the hospital just because of the nature of these discussions, but in one case this hospital had installed a new radiology upgrade. They thought that it was actually a benefit to them based upon the way it had been sold to them. Our system all of a sudden identified that their costs substantially rose over a period of time. They had no clue why their costs went up.


We got up underneath it and found out that they had added this pilot by adding to this particular set of radiology devices and that the pilot was driving additional man power requirements.

Nurses were spending more time, doctors were spending more time. The redo rate ended up being higher. The amount of time it took to do the procedure was longer.

So they were able to cut something off that, otherwise, they may have never found. It would have just added to the cost of everything.

It would have been another one of those costs that would have to have been ratcheted out and handed off to somebody that makes up the $12,000 hit, and instead, they’re not fully aware of it, and based upon that, they’re now moving very quickly through their process … which hospital process is slow … but very quickly through their process to actually get approval to install this across their radiology division and ultimately, I would hope, the entire hospital, because they found that they saved millions of dollars just in one identification from our system.

<a href=”http://mariadorfbilling5ner.files.wordpress.com/2013/03/billing12.png”>billing12

And there’s one other hospital I don’t have permission to use the name of that is installing it for heart procedures. Then there’s a major lab, one of the top labs in the world, we’re probably a few weeks away from getting an agreement to go forward with them because the pilot was so successful.

The pilot was so successful, Maria, that … it was funny because, again it challenges the system. The internal people had been studying the area, basically on paper to the best of their ability internally for years, and had come to the conclusion that some of the mapping of costs that they were trying to do artificially within their organization really wasn’t revealing the real cost. They had estimated what they thought the real cost was, but the operations side of it refused to believe that it actually cost what the finance people were arguing it cost.


We went in, and in less than … we installed in 30 days, they ran it for 60 days afterwards. We came up with an analysis, a deep analysis of their real costs.

They were able to, therefore, immediately agree that a substantial number of the things that we’d identified were absolutely accurate. They got down to four things that they thought, “Well, maybe it’s not as accurate.” They got up underneath that and found out that was also accurate.

So the argument is a political one internally which is, “Oh, if that’s really what it appears to be, then we’re making choices in our business that are wrong.” That’s how fundamental this thing is.

Hopefully I can announce that soon, but a substantial worldwide laboratory that literally may change the way it chooses its products in the future and how it prices them on the basis of the analysis that they were able to do using our system, just in a pilot.


If I go from 2009 or so to the Accountable Care Act being actually put into law, the tension now going from, “We’ll survive it. We’ll work around it,” to being real. You’re seeing epic implementations.

Around meaningful use you’re seeing lots of data warehousing stuff going on. These guys are spending millions of dollars on data warehouses that will, in some cases, take five years to deploy, that at the end of the day, will just give them better information in narrowest places and not the kind of information I’ve just described.

I can install my system in a department in a less than 90 days. It can be up and running and available to them. We steal the information from their system by understanding what those systems are and how they produce information. We draw that information from them and create our own reports, so we don’t have to change anything they’re doing to do what we want to do.


 It’s really quick to implement, relatively inexpensive, and it provides insight.

The piece that, on top of that, ultimately … back to the transformation discussion … is really necessary is: ultimately doctors have to think … like when I worked for IBM and IBM was going right down the drain, and Gershner came onboard, what he had to do was he to change the way management thought about its jobs and its responsibilities and make us feel more responsible for the choices we make. 

Ultimately, in hospitals, that has to happen, too, and then they have to have a tool that allows them to understand the impact of the choices they make. We provide the tool. The hospital still has to work on how they’re going to go about having that impact so that people begin to think different around what their real responsibilities are.

I’m seeing that in places where we’re working, but that political/cultural aspect is difficult.

The question is whether it’s installed across … I would recommend that people install it generally in radiology and lab first. They’re easiest to implement. We can generally get them done in 60-90 days. Again, hospitals have their own procedures and things like that, so it can be longer, but we can install generally in that period of time.

What does this system cost to implement?

Harris says it really varies. The cost per year is basically $375,000 per department, and if you run it across an entire institution, a hospital or hospital system, it’s basically a million and a half dollars. Those are rough numbers because it changes. Some of these organizations we’re working with right now are so substantial that the price would be much higher than that, but as an opening gambit for an average hospital, that’s roughly what you’d be talking about.

Do employees have to be trained to use it as well, because that’s a consideration?

Harris says employees actually take quite naturally to it because it makes their job actually easier.

He says, “The first thing is: do they fight it because they think that’s it’s going to cause a downsizing in their department, so you’ve got to have discussions around that, but for those who either are told, ‘Don’t be afraid, we’re not planning on downsizing,’ is part of it, or are more excited by the advancement.”

 What we’ve actually found is … we call them superusers. We general draw into our early implementation, or the pilot, we will draw in a selected handful of thought leaders that other people will follow, and we given then superior skills in using our product.

Then we let them loose so that they can play with it, and those superusers have been driving a lot of the cultural change. It’s not a very expensive thing. You don’t need a whole lot of people.

There’s two different changes: One is the change culturally to an institution in regards to how it thinks about itself; that’s difficult. I’m not attempting to argue; I do all of that with my product. I put some pressure on that to have that happen sooner because of my product.

Then the other side of it, which is implementation and getting people trained on it, that’s really easy to do. Generally within a few days somebody can be apt enough.

What it also does is … if you remember back. You may not old enough to remember. Basically, the original VisiCalc spreadsheet kind of thing where you install this application with great delight because you thought it was going to solve all your problems, and then you realize, after you installed it, it’s just sitting there blinking at you and you actually had to learn how to put information in and yada, yada, yada.

What happens, I would argue, is the system allows you to be much more intuitive. The more you use it, the smarter you get. The smarter you get, the deeper it allows you to go until you can ask questions you never would have even thought of before.

On the surface level, to get the information around the radiology example I gave you, that we’ve done as part of the 90-day implementation program. It was probably less than two or three day’s worth of class in there, and then we allowed access to the system for the superusers.

That’s how simple it can be at the easiest level. Hopefully one day there will be a CFO who is sitting there who wants to have that kind of insight, wants to understand how one department impacts another.

For example, in the case of radiology, when radiologists buy certain kinds of equipment, it may actually had an impact on the lab; or when the lab changes its procedures, it might have an impact on radiology because one is depending upon the other to do certain kinds of research and things associated with whatever the procedures happen to be.

Is the type of savings that trickles down that ultimately trickles down to the patient?

If you could imagine that a hospital would incur a couple of million dollars of additional cost and not know where it was from, and have that happen 10 to 100 times a day, and then ultimately with a hatchet, somebody has to hand it out to the different people being billed, it absolutely has a huge impact on the patient.

The other thing is that the Affordable Care Act basically also puts another pressure on it, and that is … and again I know you know healthcare so I’m just giving you the shorthand view … basically, it’s like a limbo cane.

Initially the hospitals get together and develop a certain set of relationships in order to get their costs under control. They predict a certain cost for a procedure based upon those relationships, and all they have to do is get up under the high limbo bar in order to take some of those savings as part of their profits based upon the Affordable Care Act.

But every year what’s going to happen is that bar is going to get lowered lower and lower to the ground until it’s evident on opening day how to go about saving money with this new consortium; but when you’re halfway down that bar and you’re really bending way over backwards, so you really know what your real costs are, what your choices are? Have been you been making them religiously? Have you been partnering adequately? That stuff they don’t know how to do.


Obamacare basically drives down the costs by artificially lowering the bar on a regular basis, but when they need to do is be able to get up underneath the bar because, eventually, what they’re going to find is they can’t go low enough unless they’re really sophisticated in regard to what their costs are.

Opening day it will seem simple. Somewhere in the not-too-distant future it will be almost impossible for some of those hospitals to get under that bar because have the wrong relationships, because they don’t really understand their costs, because they do procedures where they’re in conflict with other institutions that have better cost structures, on and on and on.

An insurance company could actually decide to be at the center of it, go out and develop relationships with specific hospitals, with specific radiology centers, on and on and on, create kind of a cost structure, go to the government and say, “We are going to do knee replacement surgeries and right now you pay $1000 for a knee replacement surgery. I can do it for 800 bucks. If I can do it for 800 bucks, I want to share in the difference between the 800 and the 1000. That’s what the Accountable Care Act would do.

You don’t have to be hard-wired as if you’re all becoming a single company in order to get that advantage. You can actually apply as, in effect, a created organization that exists only for purposes of government payment.

That’s my argument for why the hospitals are going to have to care, because you take that kind of group … so it’d be interesting to know, and if you don’t mind I might reach out myself, but if you know and could just let me know, I ‘d appreciate the answer. If they’re just getting together in a loosely-coupled, where effectively what they want to do is they want to share what they think are the best practices of each institution. They want to share what they think are the lowest-cost approaches to doing things, and then, in effect, they’re going to bid on certain capabilities in through the government programs so that they can get some of this … again, they share in the excess. They get to keep some of the excess the government will give back to that kind of consortium.

That’s what’s going to happen as the Obamacare stuff rolls out.

Again, there are two different ways. One is they’re just becoming a more complex organization, and then they have to make choices. I an absolutely do that. But the other is, if they’re going to be buying … they’re, in effect, partnering with each other for purposes of government payments and they’re, in effect, establishing routines and procedures together that they think they can do under the price limit, then the whole notion of cost becomes an imperative.

That’s the stuff you don’t hear people talking about when you hear them talk about Obamacare on TV and the newspapers, etc., is that … in my estimation, if done correctly and all things remain, because it’s a very complex law, it basically will drive an average hospital to its knees because, year after year, that limbo bar will be lower and lower and lower, and if you really don’t have your act together, you’re still “doctor driven” where you’re not really trying to tie together, “Are we in the right places? Are we doing the right things? Are we partnered with the right people? Have we outsourced things that we shouldn’t be doing ourselves to smaller institutions like radiology centers because they can do it more efficiently? Have we figured all this stuff out?” If they don’t, they’ll crack.

Will the patient care diminish under Obamacare because they want to bring their things in at a lower cost?

Harris says if the argument is that doctors always do the right, which arguably is what the act depends upon, then the answer would be no because a doctor would have to admit at some point that they couldn’t do that particular procedure at a particular hospital and would select the hospital that actually is more apt, and so, effectively, some hospitals would just go out of business.


In reality, are there some people that will be affected because their hospital will die painful, slow deaths? Maria:             There are so many … recently I was reading about the closings of so many hospitals in poor neighborhoods has been … I think there were 42 closures … that there’s a lot of that going on, and I don’t know if they would have even had the money to implement software like this to see … I mean, maybe they were bleeding money in areas that they didn’t know, that they could’ve been saved had they had software like this to keep track of expenses, but I don’t know.

What we’ve stopped doing, Maria, is we’ve stopped selling to institutions that are on the verge of going out of business or are in real trouble because they’re so afraid that, if anything, they do more of the bad things that got them into trouble, not less; and so we just find we get lost in it. They get excited by it, they want to do it, but they can’t do it today because they’re got a meeting and … you’re right.

Literally, in a couple of cases, I went in. I started with calls at the CEO level, was basically almost thrown out of the office because “We don’t need this, yada, yada, yada,” ended up catching a meeting with a CFO since I happened in the building. The CFO lights up like a bulb and says, “Man, this is great. Do you know where I’m going next?” He says, “I’m going to a meeting where they’re going to tell me I’ve got to cut $50 million out of my budget this year and I don’t have … at this point, let’s say, it’s June, so $50 million is over six months. He says, “And I don’t know where I’m going to get it.”

I know he doesn’t like the notion that, “I might need something like what you’ve got,” but Roland, “I need something like what you’ve got.”

Ultimately … again, I won’t name names … but that CFO ended up losing his job. Did he lose his job because he started pushing back on the fact that these guys weren’t smart enough about this stuff? Who knows. He ended up losing his job.

It’s not a simple act to have people who are drowning understand that, if they take two strokes, there’s a life preserver.


We’ve stopped going to institutions that are really in desperate immediate trouble because they can’t keep themselves focused enough to realize we’re part of the solution.

We are working through different consulting organizations that may already have an interest in working with those kinds of firms, to maybe use this as a tool, but what we’ve found is: we need institutions that either believe they’re going to be thought leaders under the new Affordable Care Act, or that they are going to be survivors through acquisitions and, therefore, will be powerful enough and have enough money orientation to be able to get through it.

That’s where we start. Again, our process has been a painful process because the way that hospitals consider new things is to … it’s such a lengthy process. What you get is you get ultimate buy-in when you finally get through the process, but the process, itself, is extremely painful.

I would suggest one of the things they need to do is think about how they think about things because even the best of them will not survive.


The smarter the institution, the more they’re convinced they do most things right, and so then you start from there.

That’s a long path to go on, and if you’re dealing with those who are dying and basically are on their last gasp, they can’t think straight to be able to realize what we actually can do for them. Somebody would have to have a level enough head to install it in the department most likely to be immediately benefited from it, and then to have the wisdom to sit there and go at it until they get it, until you finally get that first spreadsheet up on a green screen and it all adds up, and you think to yourself, “Man, that’s pretty good.”

I’ve now got my household budget in this thing, so now I’m going to figure out, “Is golf really killing me or is it the weekend visits to the bar?” or something.


 Is there a way for these institutions to use your software on, say, a 30-day test?

We’ve actually got it. It’s reasonably inexpensive. For $80,000, which most institutions don’t even blink at, we will install the system. Let’s say it take 30 days or so, or 60 days to install, depending upon what the application is and what they want to connect to it, and then we give them another 60-90 days as part of the same $80,000 where they can play with it. We’ve gotten past that, and so far nobody who’s actually played doesn’t believe it actually has a benefit.  I do think that people will start lining up because, again, the industry tends to follow industry leaders.”



What I do know now … before it was more theory because, again, you go all the back to our birth, it was a bunch of guys who didn’t really necessarily know healthcare who decided healthcare needed it. We’re now at the point where, what we do, we know it works.

It’s not a matter of somebody built something, it really isn’t required, and so it’s getting treated the way it could … where people, including Mayo … where really sophisticated people put their hands on it, they like it.

Nobody has said, “This doesn’t work. This is crazy. The answers are wrong.” Where they’ve thought they think some of the answers might be wrong, they go off and they do the homework, and they come back and they go, “No, you were right.”



We’re not having the problem of those who are willing to actually put their hands on it. It still, for whatever reason, Maria, hasn’t shortened the process of approval.



If you had this amalgamation of all the hospitals and everyone was using this software, and then you say, “You know what? At the end of the year, we’re going to generate this report that actually tells the public trends of costs in hospitals,” if they were open to that, because transparency is important today, and if this is a product that could make things more transparent for the public, for the patients, as well as the hospitals?

I don’t know if they’d be open to that, but it seems like the ability to generate a report both internally … maybe the first year you want to analyze it yourself to see where you can lower costs and then strive toward showing off.



Basically, that’s what we would like to be able to do, but on opening day, because it feeds off the hospital’s own information, so therefore, the more hospitals you have attached yourself to it, the more we’re able to draw insights from those hospitals and, in effect, create exactly the report that you’re talking about, which would be a much more insightful, thoughtful report than anything anybody else has been able to generate because they do it off of data that is so rounded, so general, it really doesn’t help you much.


The more people that use our system, Maria, the more we are able to produce those kinds of reports with that kind of insight.




The more hospital I get online, the more I can generate exactly what you’ve just described and do it in such specificity that others would have a difficult time keeping up with me; so that is one of the things I’m trying to do.