The First Vaccine Ever Invented: Smallpox Vaccine

Many people think of vaccination as a modern invention, but the actual concept of vaccination originates in 1798 when the smallpox vaccine was developed.  The virus which combats smallpox was discovered a few years later, is still the exact virus we use in our current vaccine. Other vaccines developed in the early 1900's include vaccines for the Plague, Diphtheria, Pertussis (whooping cough), TB and Tetanus.  Over the years many more vaccines have been developed. There are currently two vaccines (Hep B and HPV) which have the power to combat cancer.

Vaccination is the best, most cost effective, and easiest mode of disease prevention in the entire world!

Today I wanted to write about the history and miraculous outcome of the very first vaccination ever created, THE SMALLPOX VACCINE.

CURRENTLY SMALLPOX IS COMPLETELY ERADICATED WORLD-WIDE; THIS IS DUE TO VACCINATIONS

In the early 1900's 13 million people died from smallpox and it has mortality as high as 80% in children.

                                                                    smallpox 1912
The smallpox virus is one of the largest, most complicated viruses in nature. Smallpox virus has the longest genome of any virus in the world,187 genes, in comparison HIV/AIDS virus only has 10 genes! 

The earliest account of  smallpox"virulation" (i.e. vaccination)  is from as early as 1000 BC in India physicians would take a scab from a smallpox sore and grind it to powder.  The ground powder would then be blown into patients noses. Perhaps of more significance is,  Lady Mary Wortley Montagu was the wife of a Brittish Commissioner serving in the Ottamin Empire of Turkey, when she learned about the ancient practice of virulation, she "vaccinated" her children, then brought the vaccination/concept to her country of origin, Brittian. The "vaccination" was used in the royal family which fueled support from the European public.

The problem with this powder "vaccination" was that 2-3% ended up contracting smallpox from it, and ultimately dying as a result of the illness.  Despite this 2-3%, the use of this "vaccine" reduced contraction of smallpox and therefore the death rate ten fold and determined worth-the-cost.

Edward Anthony Jenner was the creator and inventor of the current vaccine.  He discovered that you could use "cow-pox" instead of "human-pox" (i.e. smallpox), without the 2-3% mortality rate.  This was discovered by following a patient of his whom was a milk maid.  Milk maids, were known to have very beautiful skin.  Their beautiful skin was because these maids never contracted smallpox, therefore they never developed the insidious scarring which results from smallpox.   Jenner found that milk maids  contracted "cow-pox," as a few lesions, only on their hands.  It became apparent to him that exposure to the "cow-pox" created a type of immunity against smallpox.  So Jenner made a vaccine from the cow-pox, eliminating that 2-3% mortality, and vaccinated his own son to prove it's efficacy.

Even though Jenner's smallpox vaccine was developed in the 1790's,  smallpox still raged on, because of production and transportation limitations.

In 1855 the US government mandated that all school age children get vaccinated for small pox, this legislation promoted mass production and access nationwide.

                                     D.A. Henderson with his Presidential Medal of Freedom in July 2002

For a while the last cases of US small pox were in 1949, of 8 people and two died. That was until we utilized mass air-travel.  This travel gave the US access to India and Brazil which had raging epidemics of smallpox.  The CDC calculated how quickly smallpox could spread via air travel,  only 14-21 days to a raging epidemic.  This air-travel dilemma fueled the desire to eliminate the epidemic entirely.  In 1967 Dr. Donald Henderson led a team with the goal to completely eliminate smallpox epidemics worldwide.  WHO workers vaccinated 25 million people but, there were still many un-vaccinated persons.  With a disease that's as infectious as smallpox, you MUST HAVE 98% of the population vaccinated in order to prevent spread.  The next mass vaccination of smallpox was started soon after in Sierra Leone, which had the highest levels of smallpox world wide. Within 9 months small pox was eradicated entirely in Sierra Leone.

WHO officially certified smallpox elimination,  December 1979. This declaration occurred 2 years after the last case of recorded smallpox in a 23 year old man named Ali Maow Maalin from Somalia.   

This eradication included the use 

of over 100 million vaccines worldwide

After many, many years presently the smallpox vaccine is no longer needed or used (except for the Commander in Chief and possibly the militia).  Three vials of the smallpox virus exist, they are held in three, level four, high security facilities and are carefully guarded.

In some states routine vaccinations are not mandatory.  But, please it is my personal opinion which is also shared by the medical community at large, THAT YOU PLEASE VACCINATE, I hope this story proves to be an excellent example of vaccination miracles!

As always remember I am a Physician Assistant student, I am not certified (yet!) and I am not a physician.  The comments on my blog come from lectures I attend in school, personal thoughts and opinions on the subject and other sources.  Before making any health care changes, please talk with your doctor first! Kim :)

Food Friday: Onions

 Arcimboldo's oil painting: Summer

So I have always been interested in onions, because #1 I LOVE them, #2 so many people HATE them, #3 a few women in my ward boil onion skins in water and drink the water when they have a cold and they say the cold goes away within the day, #4 Shreck describes himself as being an onion, and who doesn't want to be more like shreck right (or avoid it???) :)

So as usually I get a lot of my information from one of my favorite books:

Did you know... the thickness of an onion's skin has been used o predict how bad the next winter will be?  Thin skin means a mild winter and thick indicates a rough winter. .... so my fellow Utah friends, grow a few onions in your garden and get a heads up on the winter before it happens and tell all your friends how bad it's going to be and they will think you are so smart!

Onions are members of the lily family... and there are two types: 1. bulb-forming, 2. perennial

The origin of the onion is believed to be in Asia where 5,000 year old onion gardens have been excavated. Pharaohs were buried with onions as a sign of eternity.  The Romans believed the onion could cure any ailment.  During the middle ages onions could be used as currency, and even a FANTASTIC WEDDING GIFT! (wow, hasn't life changed... could imagine getting an onion for your wedding???).

Onions contain a compound called QUERCETINE, A POWERFUL FLAVINOID ANTIOXIDANT. Onions are also an excellent source of fiber, vitamin C & folate.  Phyotochemicals found in onions have shown to reduce the risk of some cancers!

Onions can be used for:

1. CANCER: yellow onions were the fourth highest in anticancer-growth activity.  Onions display moderate levels of cancer-protective activity.
2. LUNG CANCER: Quercetin has been show to have beneficial affects vs. lung cancer.
3. COLON AND LIVER CANCER: strong-tasting (yellow & shallots) do a better job of inhibiting the growth of liver and colon cancer.
4. PROSTATE CANCER: the strongest risk reduction factors for prostate cancer were onions, cereals and grains, beans, fruits and vegetables.
5. HEART HEALTH: (my favorite reason for eating onions, and probably most applicable to you!).  sulfides found in onions decreases blood clotting, and significantly LOWERS YOUR LDL CHOLESTEROL LEVEL. When you decrease the clotting properties of your blood it REDUCES YOUR RISK OF ATHEROSCLEROSIS (narrowing of the arteries by fatty plaque buildup!!), HEAR DISEASE, HEART ATTACK AND STROKE.

A couple months ago I came across an old 1900's custom, which said that onions have the ability to attract germs and sickness from the air.  It went on to say that as far back as 1900 someone with a flu or cold, would put an onion by their bed, and when they wake up the onion would be black. It also relates, that the sickness would be gone or decreased.  In the early 1900's hospitals and homeowners used to put onions in bowls next to patients beds to help absorb bacteria. This long-standing belief, is discredited by many scientists, because they say that virus and bacterial are transmitted via contact, not as much via air particles and that an onion wouldn't have the abilities to, in essence, be a magnet for these air-bound germs.  However, there have been no scientific studies regarding cut onions but it is highly discredited by scientists (http://www.snopes.com/medical/swineflu/onion.asp). 

My cute, Philipino friend in my ward told me that in her culture they boil onion skins in water and drink it when they are sick and she said she is never sick for long. Given what we know about onions, the boiling does not rely on the traveling through the air, it is soaked into the water.

Many high end restaurants never used previously chopped onions.  They always use fresh ones and throw away any left overs, because, not only the smell that fills the fridge, and the proposed belief that they attract a lot of bacteria. This could be a good reason why onions have such thick skin and so many layers, so air does not have access to it!

TIPS FOR NOT CRYING WHILE CUTTING ONIONS:  all methods for reducing the volatility of the sulfide that causes the irritation.

1. Peeling and cutting under running water, 
2. Chopping near a gas flame,
3. Refrigerating onions before chopping, 

Thanks for reading, hope this was helpful.  I am a Physician Assistant Student, I am not certified yet, and I am not a doctor.  Please talk with your doctor before making any lifestyle changes or medication changes.  My blog is often a conglomeration of my opinions, ideas, views, classroom lectures, past knowledge and resources from books, websites and research; not all of it is solid fact or everyone's beliefs and opinions.

The Common Cold

THE COMMON COLD - A.K.A. UPPER RESPIRATORY INFECTION (URI).  The common cold is CAUSED BY A VIRUS.  They are the MOST FREQUENT human illness.  25 million seeks care for colds/year in the USA and SADLY 30% RESULT IN ANTIBIOTIC PRESCRIPTIONS!!!

The CC is actually a HUGE economic burden because it is the most common cause of missing work and school, totaling 500 million per/yr.

CHILDREN UNDER 6 YEARS OF AGE, WILL USUALLY GET 6-8 COLDS PER YEAR. 

CHILDREN WILL OFTEN HAVE ONE COLD PER MONTH SEPT-APRIL

ADULTS WILL USUALLY GET 2-3 COLDS PER YEAR.

......and you may ask..... Why start in September.... Is this because that is when the COLD WEATHER sets in???? Actually... it is scientifically proven that cold weather does not cause or affect a cold, .... IT IS MORE LIKELY DUE TO ATTENDING SCHOOL WITH MANY OTHER LITTLE KIDS, AND WE ALL STAY INSIDE WITH EACH OTHER AND OUR BEST BUDDIES GERMS! But, to give the "weather" hypothesis some credit, it has been shown that more viruses survive LONGER in winter when the indoor humidity is actually quite low.

The ways that URI's are spread, in order are:

1. HAND CONTACT
2. Small Air droplets (coughing, sneezing)
3. Large Air Droplets (this occurs when you get the virus directly on your mucus membranes -i.e. eyes, nasal passages, mouth) 

IT is important to remember two things:  

1. HAND WASHING IS THE MOST EFFECTIVE WAY TO PREVENT COLDS, this is because of #2..
2. >90% of people have NO VIRUS IN THEIR SALIVA therefore air droplets are less virulent (think of how snot is not saliva and little kids are touching their snotty noses and touching your hands etc....)

it is NORMAL for your snot to start clear and turn white then yellowish-green later.  It can still be a common cold even with green snot.  In fact colored snot (i.e. green) is a NORMAL self-limited phase of the common cold.

THERE IS NO CURE FOR THE COMMON COLD.  ANTIBIOTICS PLAY NO ROLE (note anti -bacterial NOT anti-viral and the CC is VIRAL).

THERE IS A 1 IN 4,000 CHANCE THAT AN ANTIBIOTIC WILL HELP THE COMMON COLD. if you take antibiotics for a cold they will eventually lead to increased resistance and lead to more serious resistance infections.

The best way to PREVENT a common cold is:

1. FREQUENT HAND WASHING (good old soap and water)
2. Do not touch eyes or your nose
3. COUGH OR SNEEZE INTO CROOK OF ARM, OR INTO SHIRT, not hands!!!
4. Vitamin C (200-500 mg daily)

 

Many over the counter medications advertised for colds are good, they mostly just help with the symptoms of the cold, not to cure the cold.  BUT PARENTS USE MEASURING SPOONS WHEN DOSING THE MEDICATIONS, because a basic kitchen T-SPOON from the store is around 2-10 mL, whereas a MEDICAL dosage is based off of a BAKING MEASURING T-SPOON IS, WHICH IS 5 ML. Be careful not to use the "large" spoons, because they are about 15 mL.  The thing to remember is your basic kitchen spoon is extermely variable and you could easily overdose your child by not using BAKING MEASURING SPOONS.

Does Your Child Get EAR INFECTIONS???? The #1 reason children 6 mo. -3 years old!!!

EAR INFECTIONS - I.E. OTITIS MEDIA (AOM) IS THE #1 DIAGNOSIS FOR SICK CHILDREN BETWEEN AGES OF 6 MO'S - 3 YEARS OLD!!! 

by the age of 1, 60-80% of kids will have had at least 1 episode of AOM; 80-90% BY AGE 2-3 YEARS!!!  AND 75% of kids will have RECURRENT AOM!!! (I want to BOLD everything in this post and put tonz of !!!! everywhere)!

AOM is the #1 reason that antibiotics are prescribed to kids.  

30% of ALL antibiotic prescriptions are for KIDS. 

INFANTS SPEND APPROX 42 DAYS ON ANTIBIOTICS FOR AOM IN THE FIRST YEAR OF LIFE AND 49 DAYS IN THEIR 2ND YEAR OF LIFE!

The annual cost of these antibiotics total $5 billion per year, and of that $5 billion 40% OF IS SPENT ON KIDS 1-3 YEARS OLD!!!  AOM has increased markedly from the 70's to the 90's there are many hypotheses as to why this is. The leading explanation is because there are more children in daycare, due to women moving into the workforce vs. staying home. 

A big reason why AOM occurs mostly in children and not adults is because the anatomy of their Eustachian tubes (the tubes that connect the ear to the nose for drainage) are immature and their immune response is immature too!

Because the Childs tubes are more FLAT vs. the adults which are DOWNWARD SLOPING this causes a decrease in drainage and fluid to get stuck.

Some major Risk factors for getting AOM:

1. BOTTLE FEEDING WHILE LAYING DOWN, DO NOT PUT THE CHILD TO BED WITH A BOTTLE.  the reason is because the E.Tubes function in a Pressure-equalizer-type-role, and when you lay down the pressure in your head changes and can actually suck fluid inside the tube.  Also the fluid can travel in that direction more easily because gravity is no longer helping the milk to go into the stomach. Try to always feed with a bottle while at least sitting up, or laying partially (not flat) how about 30-45 degree angle!
2. RESPIRATORY VIRUSES & BACTERIA this will often occur because of the fluid in the E.Tubes, because V&B love moist environments - the perfect home for infection.
3. DAYCARE- increases exposure to virus's and bacteria, at a younger and more vulnerable age vs. home care. Often daycare cannot be eliminated, but try and look for smaller daycares with less children vs. large classes.
4. PACIFIER USE (unsure exactly why, probably has to do with the eustachian tube location)
5. FAMILY HISTORY
6. THE SEASON (i.e. winter...)
7. MALES are more likely to get it than females
8. SMOKING

BREASTFEEDING IS PROTECTIVE VS. AOM! This is partially because mother's milk has inherent antibodies that she provides to the child for their immunity while their immunity is still developing.

Look for my installment #2 next week on Ear Infections with some really interesting new research regarding how ear infections are linked to skin irritation and asthma!  And what you can do to try and stop the Ear infection BEFORE it even begins.

Food Friday: Honey "One of the few non-perishable foods in the world"

So I have always been interested in honey, because a long time ago I heard that HONEY has ANTIBACTERIAL PROPERTIES and is a traditional topical treatment for infected wounds. According to Dr. Charles Molan It can be effective on antibiotic-resistant strains of bacteria.  It is one of the only things on this earth that DOES NOT support bacterial life.  It is important to note that different types of honey have varying amounts of antibacterial activity. It has been determined that Manuka Honey from New Zealand has the highest amount of antibacterial properties than any other type of honey.

so a little info: bees travel an average of 55,000 miles and need to tap over two million flowers just to bring one pound of honey!!!  Bees have been producing honey for over 100 million years.  The color and flavor of the honey depends on the bees' nectar source (blossoms).

The benefits of honey have been documented as far back as  Babylonian writings.  Queen Cleopatra used to take milk and honey baths to maintain her youthful skin.

Honey has been shown to help the following disease conditions:

1. decrease CHOLESTEROL
2. Aided in protection against COLITIS (which is an intestinal infection/inflammation)
3. CANCER: significantly decreased tumor growth in mice when fed honey. 
4. WOUND-HEALING: in a children's hospital in Germany for three years researchers used a special preparation of honey called Medihoney, and as a result significant reduction in even the most resistant wound infections were observed.

DO NOT GIVE HONEY TO CHILDREN UNDER THE AGE OF ONE YEAR, BECAUSE THEY DO NOT HAVE THE ABILITY TO KILL BOTULISM SPORES THAT LIE WITHIN

http://www.cartoonstock.com/newscartoons/cartoonists/cga/lowres/cgan711l.jpg

Whooping Cough Vaccine - DTaP

So in my class yesterday the topic was WHOOPING COUGH.  It is of importance for California because we have started to see a re-surgance of it lately, it has been labeled an epidemic.  It is important to understand that most of us consider an epidemic as a huge massive outbreak of disease and often we have a hard time treating that disease or the sheer number of people who have the disease.  But, another type of epidemic is in the case of whooping cough.  Whooping Cough used to be nearly extinct due to vaccines and so therefore even if a couple hundred persons get it (50,000 since 2005), it is considered an epidemic due to how serious it is, lack of treatments and the fact that it is avoidable. 

The reason an outbreak has been seen in WHOOPING COUGH is due to LACK OF VACCINATION, and even more important LACK OF BOOSTER VACCINES CONTAINING THE DTaP VACCINE (you get these when 11 or 12).  Over 50,000 cases have been documented since 2005!!!

When you are 12ish you are supposed to get a "booster" shot which keeps your childhood vaccines active and keeping them working.  But, the booster does not often contain the DTaP vaccine which is the booster for whooping cough.  So that booster must be obtained separate from the booster.  The second piece of the puzzle is due to a decrease in vaccination of children, and then these children contract the cough (previously extinct) and then pass it to the other "non-boosted"  youth AND adults.

Now when it comes to vaccination, I like to look at the benefits in particular; the SERIOUSNESS of the illnesses they prevent.

To illustrate this example, is one of the most contractible and serious preventable-diseases is whooping cough.

If you were standing in a large room speaking to 150 people, and you were infected with whooping cough approx 142 (95%) of those people would contract Whooping Cough.  Whooping Cough is spread via "aerosol," which means it spreads VERY, VERY, RAPIDLY through the air and your breath.

Whooping cough once contracted lasts 1 1/2 months to 3 months.  The cough starts as a regular upper respiratory failure, but after a couple weeks, it changes and the cough becomes so intense that it actually causes CONVULSIONS of the body, to the point where you have almost no control of yourself (almost seizure-like), this stage lasts approximately 2-4 weeks.  One of the biggest problems with whooping cough is not just the convulsions, but because it decreases your respiratory immunity it turns your lungs and body into a very susceptible breeding ground for other secondary infections.

So how is it YOU AND YOUR CHILDREN can avoid getting this disease? MAKE SURE TO OBTAIN THE BOOSTER SHOT CALLED "DTaP," AROUND THE AGE OF 14ish or if you never had had one at 14, This is because the whooping Cough Vaccine given for your kindergarten shots only lasts approximately 10 years, so once it wears off, if you come in contact with anyone who has it, YOU WILL GET IT and YOU WILL GIVE IT TO OTHERS AROUND YOU.

hope this was helpful and I didn't completely loose anyone, as I sometimes am unsure how to explain this stuff.

Medicine Highlight: ASPIRIN

 ASPIRIN A MODERN MEDICAL MIRACLE

Aspirin really is ONE OF THE MOST FABULOUS DRUGS on the market FOR CERTAIN CONDITIONS!

The father of modern medicine was Hippocrates, who lived sometime between 460 B.C and 377 B.C. Hippocrates was left historical records of pain relief treatments, including the use of powder made from the bark and leaves of the willow tree to help heal headaches, pains and fevers.

By 1829, scientists discovered that it was the compound called SALICIN in willow plants which HAD PAIN RELIEVING PROPERTIES!
Because Salicin was tough on stomachs, a means of 'buffering' (i.e. decreasing stomach effects) was searched for. In 1853, Charles Frederic Gerhardt, neutralized salicin by buffering it with sodium and acetyl chloride, creating acetylsalicylic acid- what we currently call ASPIRIN. Gerhardt never sold or marketed his medical miracle.  So along came a man called, Felix Hoffmann who convinced his employer, Bayer to market the new wonder drug. Aspirin was patented on February 27, 1900.

File:Bayer Aspirin ad, NYT, February 19, 1917

Some uses for aspirin include: 

1. Stroke, 
2. PREVENTION of blood clots
3. Painful periods
4. Fever, 
5. Headache Disorder, 
6. HEART ATTACK and HEART ATTACK PREVENTION
7. Pain, 
8. various forms of arthritis

Do not use aspirin if:

1. pregnant, and especially if you are in your 3rd trimester of pregnancy
2. You are breast feeding
3. YOU ARE A CHILD!!!
4. you are allergic to "salicylates"
5. if you have an ulcer
6. If you have a "bleeding disorder" such as anemia or decrease in clotting factors

To highlight aspirins amazing properties, it truly is very effective at managing pain.  But, according to many of my professors, one of the best preventative measure you can take regarding avoiding a heart attack is to keep an aspirin in your wallet or purse.  When you feel chest pain or feel a heart attack beginning, one of the best ways to decrease the extent of the heart damage is to CHEW AN ASPIRIN. This has been proven to be one of the best MEASURES YOU CAN TAKE TO TREAT A HEART ATTACK, YOURSELF BEFORE THE AMBULANCE ARRIVES.  IT HAS THE POTENTIAL TO SAVE YOUR LIFE! So You, yourself must keep an aspirin in your wallet at all times, an tell your parents, grandparents and spouses to do the same.

It is important to understand HOW aspirin is able to accomplish this miracle.  The reason is because of it's mode of action and how it is absorbed in the body.  THERE ARE ONLY TWO SUBSTANCES THAT ARE ABSORBED IN THE STOMACH: ALCOHOL AND ASPIRIN, versus other drugs and substances have to run their course through your intestines before absorbed and therefore take a much longer time to take effect in the body. Once absorbed, Aspirin works in three functions: anti-inflammatory (i.e. decreases pain), anti-pyretic (i.e. decreases fever) and a POTENT ANTI-COAGULANT (i.e. stops blood from clotting). It is the clotting blood that is causing a heart attack, you can stop FURTHER clotting.

Also, according to pharmacology one of the best ways to PREVENT A FIRST-TIME HEART ATTACK, is to take a "BABY ASPIRIN" (I.E. 81 MG) Because the dosage is soooo small, there are virtually no side effects associated with it (unless you are allergic to aspirin). One "baby aspirin" can affect and alter the clotting properties of your blood for many days (in a good way!).  So I would ADVISE ANYONE WITH A STRONG FAMILY HISTORY OF HEART ATTACK, to start taking a "baby 81 mg aspirin" every day or every other day.  Because the potential this little dosage has to stop a FIRST HEART ATTACK is very high!!!

The most significant side effects associated with aspirin include:

1. Abdominal Pain with Cramps, 
2. Stomach Irritation, 
3. Heartburn,
4. Nausea, 
5. Vomiting

Hope this was helpful for all my fellow blogging friends!

Kim

Sources include: www.emedicine.com, www.cartoonstock.com, and 

http://inventors.about.com/library/inventors/blaspirin.htm

Old Habits Can and Should Often be Changed When it Comes to Health Care!

So I don't know if many of you know that because I am completely not realistic about life sometimes, I was crazy enough to choose the ONLY PA program in the country which is a dual degree with Masters in Public Health.  Now, the truth is that I absolutely love public health topics because the are so relevent to EVERYONE.  So I thought I would enlighten your minds with a recent topic from one of my classes and the one of the sources comes from a NY Times article. 

http://www.nytimes.com/2010/06/22/business/22geisinger.html?_r=2&pagewanted=1&emc=eta1

So when it comes to health care costs MANY OF US KNOW, medicine is not cheap, so this obviously affects you and I.  If I could describe the way most PRIMARY CARE offices work (this is your regular physician you see often), because the physician is payed per procedure or per patient, in order to cover costs of not only the physicians salary, but of the staff, and personell running the "business." it is in the offices best interest to see as many patients as will be allowed.  which turns out being about a 15 minute appointment per patient. 

So right now the way the reimbursement system works is, practitioners are paid based on sheer quantity of visits, NOT BASED ON QUALITY.  At this point a practitioner is not compensated for any instruction, life-style modifications (i.e. exercise instruction etc...) and the current medical system does not support PREVENTATIVE MEDICINE, it really supports TREATMENT OF EXISTING CONDITIONS.

So in this article it highlights an Eastern insurance company who is experimenting with novel reimbursement ideas.  This company pays for multiple nurses for each doctor, and their entire role is to manage and keep up with chronically ill patients.  They are available for phone calls every day of the week, and often end of conversating with these chronically ill patients (i.e. diabetic patients) up to once a week.  This has shown to drastically decrease ER visits and further progression of these chronic diseases to extremely expensive and very sick people.  The doctor is also compensated for PT EDUCATION REGARDING PREVENTATIVE MEASURES, and it also available for for appointments.  When the insurance company saves money based on patients not being so sick and decreases in hospital visits, the saved money is given to practitioners as incentives to continue practicing more preventative medicine. 

It really is quite novel, and it is important to understand that there are many problems with the health-care system as is.  It will take major change on the part of not only practitioners, but insurance companies too.  BUT THE GOOD THING IN ALL OF THIS CHANGE, IS THAT IT IS CREATED IN ORDER TO BENEFIT THE PATIENT AND CREATE MORE PATIENT CENTERED CARE, not insurance dominated and quantity dominated. 

Anyways I am always interested in improving the health of communities and individuals and making care much more quality and prevention driven.