Lee Kirksey, MD  
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Healthcare system is missing the mark and failing with American Women

Jun 01, 2013 - 0 comments

lee kirksey md




Heart Disease


Cleveland Clinic


glenna crooks


disruptive women








vascular surgeon


healthcare reform

My good friend Glenna Crooks (see www.glennacrooks.com) is a well known health policy advisor and former member of the health policy team in the Reagan administration. Glenna actively blogs for disruptive women in healthcare at (disruptivewomen.net). Our careers intersect with our mutual interest in the rising impact of health disparities for American women.

Recents studies verify the women, especially those women in lower socioeconomic conditions with less education, have experienced an alarming decline in life expectancy since the early 1990's. This despite the fact that the medical community continues to make historic progress in medical treatments for problems such as heart disease, stroke and cancer.



The findings have been attributed to several issues including the recent economic downturn in the US which resulted in higher levels of unemployment and loss of health insurance as well as higher rates of smoking in American women. Or as former President Bill Clinton said in a speech that he delivers for his Clinton Global Initiative on Healthcare, some Americans people are dying of a "broken heart" from lack of access and opportunity.

One of the factors that may also play a role is the ongoing neglect and lack of understanding that the male dominated medical industry continues to display for women. Frankly we just have not done a good job in meeting women's healthcare needs in the public or private sector

1) Women represent more than 50% of the U.S. population and thus, companies have the potentially to as much as double their target market just by paying attention here.  No doubt virtually all healthcare companies have women in their customer base, but it is worth investigating what percentage that customer demographic represents.  If it is less than 50% and you sell a product that is not limited to use by men, then you have some obvious growth opportunities.

2) Women control the checkbook. If one actually believed the stereotypes that have perpetuated about women and our national economy, one would readily overlook these interesting facts:

■The average U.S. woman is expected to earn more than the average U.S. male by 2028
■51% of U.S. Private wealth is controlled by women
■Women account for over 50% of all stock ownership in the U.S.
■Women control more than 60% of all personal wealth in the U.S.
■Women control more than 80% of all U.S. spending
If those figures don’t make you want to figure out how to invest in sales and marketing programs to actively attract the attention of the female marketplace, you are not a very good CEO.

3) Women also influence or control much of how the other 50% purchase healthcare.  It is pretty obvious that women decide when and how their children will utilize healthcare services most of the time.  I am not saying that fathers never have a say or participate in that decision, but let’s get real.  It’s the moms that generally drag the kids to the pediatrician and buy them anti-colic drops at Whole Foods.  The global pediatric market is estimated at around $81 Billion by at least one group.  With expanded insurance coverage of children courtesy of the PPACA, that market is expanding markedly.  Appealing to the moms that control the bulk of that $81 billion is a good way to get your hands on it.  On a more global basis, it is estimated that moms represent a $2.4 trillion market.

Women also control or at least heavily influence much of the healthcare purchasing behavior related to the men in their lives.  For instance, Kaiser Permanente did a study a few years back that showed that, on average, 75% of health plan choices were made by women and that, overall, 80% of all family healthcare decisions were made by women.

4) Women live about 10 years longer than men.  As a result, they represent 10 more years of customer purchasing power than their male counterparts.  If the lifetime value of a customer is important to your product line because you have a recurring revenue model (and assuming your product is relevant to the over-50 market), understanding how to serve the female marketplace enables you to create about 10 more years of same store value than you can get out of your male customers.

5) Women are willing to spend money, and lots of it, on health and wellness and related verticals.  It is essential to recognize that women’s health does not equal medicine that is directed to areas covered only by a bikini.  Yes, women care about gynecology and breast cancer, but in the scheme of things the healthcare issues associated with those two categories are small potatoes.  Heart disease, lung cancer, diabetes, orthopedic problems, health insurance, choosing what provider/hospital to go to…those are the bread and butter of human healthcare purchases.   It is time to redefine women’s health as healthcare that happens to be for women.  When you open your mind to that definition, the market potential rises exponentially.  In fact, look at it this way:  the U.S. healthcare market is estimated at about $2.8 trillion in 2012.  If 80% of all that money is being influenced in some way by women, you should be paying better attention to your mom.  Of course this is not exactly the right way to look at it since so much of medicine is based on what physicians (majority: men) recommend to their patients, but no matter how you slice it, the number is large.  And women are the ones picking the family doctors, so marketing to doctors who appeal to women is a key part of the value creation chain.

6.    Women have the kind of customer loyalty that transmits real value in healthcare. It used to be believed that women are “more loyal” customers than men.  That theory has largely been altered to recognize that women and men exhibit different kinds of customer loyalty.  Whereas female customers are relatively more loyal than male customers to individuals such as individual service providers, males are relatively more loyal than females to groups and group-like entities such as companies.  When you are talking about an industry, such as healthcare, where purchases are extremely personal and largely made as the result of person-to-person, one-on-one relationships (e.g., through physician or pharmacist recommendation, broker sale, etc), attracting a female customer base can be a significant advantage in establishing long-term customer loyalty.    In fact, while it is often conventional wisdom that advertising should promote loyalty to company brand names (something we see a lot of in pharmaceutical marketing, hospital marketing, insurance plan marketing, etc.), it would seem that the smart money would be on promoting the personal experience/relationships between individuals (doctors, pharmacists, brokers, etc.) and consumers if women control 80% of healthcare spending.  Kaiser has been particularly sensitive to this, I note, in the development of advertising that emphasizes the individual physicians in their employ vs. the corporate brand itself.  These guys know where their bread is buttered.

Women use word-of-mouth marketing
7) Women communicate about their experiences.  Yeah, everyone knows women talk a lot.  But if you are the purveyor of a product or service and you want to proliferate its use, you want them to keep talking.  This is particularly so in the brave new world of social media, which the healthcare industry is desperately trying to figure out how to utilize to its advantage.  Women tend to do far more research and ask for referrals and advice than men when making a significant purchase decision, including a decision around service providers.  Research also shows that women tend to shop around longer and make more “wholistic” decisions about purchases, taking into account more lifestyle factors than do men.  It is worth noting that 78% of women in the U.S. use the Internet for product information before making a purchase and account for 58% of all total online spending; 22% shop online at least once a day.  Notably 92% of women pass along information about deals or finds to others.  When it comes to moms, the primary healthcare purchaser in our country, note that 63% read blogs online and that the average moms mention brands an average of 73 times/week vs. 57 times/week among males.  64% of moms ask other moms for advice before making purchases.  Women spend 2 more hours per week on social networking sites.  When you combine that statistic with the fact that people over age 55 represent the fastest growing segment of social media users, you know healthcare is going to be a major topic of their social communications.

Overall these statistics have significant ramifications for how marketing should be conducted in this age of social media.  If you fail to appeal to women in your efforts to market your healthcare product or service in this day and age, you are missing out on a true advantage of the medium:  free advertising through customer testimonial.    And perhaps more importantly, if you provide healthcare products and services to women that are not well-received, the blogosphere and everyone else in the world is going to know about it and fast.

In summary, healthcare may be a mans’ world, but it’s a woman’s marketplace.  If men want truly to maximize their market success while they still run the world, the way to do it is through walking a mile in our very attractive and uncomfortable shoes.  As for the women who aspire to leadership in the healthcare field, keep on keepin’ on and never give up.  At a minimum you will get your shot during those 10 years when you outlive your male colleagues.

Think your having a heart attack? Do you know what to do?

Sep 03, 2012 - 1 comments

Heart Attack


Ghost Stories


atrial fibrillation

The first minutes after the onset of chest pain or stroke are the most critical. Decisions made during this period can great influence that liklihood of success and the degree of recovery following a stroke or heart attack. From NY Times. Anahad OConnor


Anahad O’Connor tackles health myths.
Last week the entertainer Rosie O’Donnell surprised fans when she announced that she recently had a heart attack.

Ms. O’Donnell wrote on her blog that she felt an ache in her chest and soreness in her arms, followed by nausea and a “clammy” feeling. She took an aspirin, she said, but decided against calling 911. The next day she went to a hospital, where she learned one of her coronary arteries was 99 percent blocked, requiring a stent.

“I am lucky to be here,” she wrote. “Know the symptoms, ladies.”

Studies show that for men and women, the symptoms can differ. Men are more likely to experience the classic signs, like chest pain, shortness of breath and radiating pain in the neck and arms. Women are more likely to experience severe fatigue, indigestion and cold sweats.

Despite the differences, the response should be the same: Immediately call 911, then chew an aspirin, said Dr. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Heart Institute in Los Angeles.

Some people may suspect that chewing an aspirin, which inhibits platelet activity that could block arteries during an attack, makes little difference. But a study in The American Journal of Cardiology highlighted its importance. In a group of 12 subjects tested in a laboratory, chewing an aspirin tablet for 30 seconds before swallowing on an empty stomach prompted a 50 percent reduction in platelet activity in five minutes. It took 12 minutes to achieve the same effect when the aspirin was swallowed whole.

Dr. Merz said people who suspect they are having an attack should chew one full-strength tablet, which is 325 milligrams. But most important, she added, is to “get to an emergency room.”


If you experience symptoms of a heart attack, dial 911 first, then chew on an aspirin.

Think your too young to have a strok, Think again

Sep 03, 2012 - 2 comments



Heart Attack


atrial fibrillation


irregular heart beat

Recently, I read a great article in NY Times that precisely describes the mentality of many unfortunate patients I see who have suffered a stroke at a younger than expected age. A disbelieft that sometimes still exists even after the stroke has visited and left its physical ravages. "I'm too young to have a stroke"

Six years ago, Todd McGee was a lean, athletic 34-year-old working in construction and living with his wife and toddler daughter on Martha’s Vineyard, where he spent summer weekends surfing. A stroke changed his life forever.

Today, with one arm useless and difficulty speaking, Mr. McGee, now 40, cannot work. He devotes most of his time to keeping as healthy as possible. Though he is able to drive and care for his daughter, now 7, everything takes longer, and he has trouble concentrating even on routine activities that others take in stride, like grocery shopping.

“I definitely wish I had my old life back, building houses and boats and surfing in my spare time,” he said.

His experience, complicated by a serious delay in diagnosis, is a powerful reminder that strokes can and do happen to young people. The sooner the correct diagnosis is made, the less likely the result will be lifelong impairment.

Although a vast majority of strokes occur in people over age 65 (the risk is 30 to 50 per 1,000 in this age group), 10 percent to 15 percent affect people age 45 and younger (a risk of 1 in 1,000). A study by doctors at the Wayne State University-Detroit Medical Center Stroke Program found that among 57 young stroke victims, one in seven were given a misdiagnosis of vertigo, migraine, alcohol intoxication, seizure, inner ear disorder or other problems — and sent home without proper treatment.

“Although young stroke victims benefit the most from early treatment, it must be administered within four and a half hours,” said Dr. Seemant Chaturvedi, a neurologist at Wayne State who directs the program and led the study. “After 48 to 72 hours, there are no major interventions available to improve stroke outcome.”

“Symptoms that appear suddenly, even if they seem trivial, warrant a meticulous work-up,” he added.

Follow-up analyses of the Detroit study showed that patients seen by a neurologist in the emergency room, as well as those who were given an M.R.I. as part of the initial work-up, were less likely to receive a misdiagnosis.

“Patients, too, should be aware of the risk of stroke regardless of their age,” Dr. Chaturvedi said in an interview.

The Centers for Disease Control and Prevention have reported a steep increase in strokes among people in their 30s and 40s. A rise in risk factors — obesity, diabetes, high blood pressure and sleep apnea — and improved diagnosis account for this upturn.

But younger patients are no better today at recognizing the symptoms of stroke. “Only 20 to 30 percent of patients get to the emergency room within three hours of symptom onset,” Dr. Chaturvedi said. “They tend to wait to see if the symptoms will go away spontaneously, and they show up in the E.R. 12 to 24 hours later.”

A Cautionary Tale

After an intense workout in the surf the day before, Mr. McGee awoke one morning with a headache and feeling out of sorts. He went to work but came home nauseated and chilled. He assumed he’d come down with the flu his family had just had.

Then in the middle of the night, a headache he described as “the worst pain of my life” prompted a trip to the emergency room. The attending doctor thought Mr. McGee had a muscle tension headache, treated him with intravenous pain medication, handed him some pain pills and sent him home.

Embarrassed that he’d gone to the hospital “for just a headache,” Mr. McGee took the pills when the pain returned the next afternoon. Soon after, he suffered what he thought were side effects from the medicine. Now he knows what it really was: a transient ischemic attack, a mini-stroke, that left him briefly unable to speak and numb on one side.

from NY times
Jane E Brody
Sept 3, 2012

Why health insurance mandates are Necessary...Pro

Jul 04, 2011 - 10 comments

health insurance reform


insurance mandate




International affair



There is no true way to reform healthcare in a meaningful way that does not involve insurance mandate, ie a system that requires everyone to buy into and be covered by some basic level of health insurance.  Universal coverage, as this is known, is agreed upon by all who seriously advocate for programs which can solve the sustainability problem of our current system
Why is mandatory healthcare necessary? In healthcare, where an individual can impose costs on society, the need for mandatory insurance is just common sense.  The explanation is similar to that offered for automobile insurance. Everyone who drives an automobile is required to have liability insurance in case they have an accident, they will not inflict costs upon others.  This means that one must carry insurance all the time, not just periodically when they feel it is convenient. When everyone contributes, the average price of insurance premiums should be lower. (Unless as we found out, health insurers are not passing on the savings to consumers which is one of the requirements of health reform.
The rationale for requiring health insurance is similar and if anything more compelling. Conceivably, you might own a car but elect to never get in it and drive-perhaps owning it only in case of emergency.  However, medical illness is totally unpredictable and entirely outside of one’s control.  The cost of treating uninsured individuals is huge and the onset of illness may be followed by years of costly treatment.  For example, the costs of treating uninsured individuals in emergency departments are passed onto insured individuals in the form of higher costs. Either in the form of higher health insurance premiums, free care pools organized by the hospital requiring them to bill insured individuals higher rates or higher taxes for state funded plans like Medicaid.
Although, there is an assumption that all people who are insured do so because of low incomes.  Research out of Massachusetts shows that over 38% of uninsured  have annual incomes over 58K.
Uninsured individuals are more likely to forego preventive health services like mammogram, colonoscopy etc, they are less likely to have early disease management for treatable problems like diabetes, hypertension high cholesterol and obesity and therefore more likely to prevent with severe costly conditions that otherwise could have been prevented and certainly treated.
Health insurance mandates do require the creation of fair and equitable subsidies for those who cannot afford health insurance.  Sliding scale systems based on accurately reported income is the most commonly described.  However, everyone must be required to pay into the system. It is important that mandatory coverage requirements be enacted at the same time as subsidies otherwise, people would be encouraged to drop their private coverage. Mandatory coverage should be instituted nationally, otherwise people would be incentivized to relocate or shift jobs because of state to state variation.