Severe rhinovirus nothing to sneeze at


Let no assumption go unchallenged in this new era of healthcare, including the one that says rhinovirus is 'just' the common cold

Either way, saying "bless you" is considered the polite thing to do today, even though it's a dramatically out-of-date custom that is based in what amounts to superstition. And yet, it's a gut reaction to always respond when someone sneezes.

As the United States continues to monitor flu season, patients and doctors are resorting to gut reaction, assuming those coughs and sneezes are probably the H1N1 virus. Because it is logistically impossible to test everyone with flu symptoms, the default is to diagnose (or self-diagnose) swine flu.

Although it's "just" the common cold, this severe outbreak seems to be causing more lower-respiratory-tract infections and pneumonia than normal, according to the hospital. It will be impossible to track the outbreak because there is no national reporting mechanism for rhinovirus-like there is for the H1N1 pandemic-and few providers routinely test for it.

Prevention amounts to covering coughs and sneezes as well as frequent hand washing, and there is no cure. Tamiflu, which shows some effect on H1N1, does nothing for rhinovirus, which is the leading cause of respiratory illness worldwide.

What we can learn from this bit of data is that it's never too late to challenge our assumptions and question our gut reactions. Maybe it's time to view rhinovirus just as seriously as we view H1N1.


Speaking of challenging assumptions, a 73-year-old University of Pennsylvania medical school professor recently took a shot at the venerated Dartmouth Atlas of Health Care. You know the one: the ground-breaking research report that first uncovered the dramatic variation in care delivery across the country. It's cited as gospel by nearly every politician.

Richard Cooper dismisses the atlas, saying its research is flawed. He believes variation in care actually is a function of poverty. More poverty results in greater health needs, and, therefore, more spending, he says.

His wholesale rejection of the atlas lacks credibility, however, he makes a valid point about measuring poverty in relation to healthcare. Care in the emergency room is costly, and the impoverished frequently show up in emergency rooms for routine care. The Medicare Payment Advisory Commission has started its own study of variation, and it promises to take socioeconomic issues into account.

It's a new era in healthcare overall. Let no assumption go unchallenged.

To all our readers, the team at MANAGED HEALTHCARE EXECUTIVE wishes you the blessing of healthiness in the new year.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be REACHED AT

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