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Showing posts with label Health Insurance. Show all posts
Showing posts with label Health Insurance. Show all posts

Saturday, February 11, 2017

Pushing Drugs - American Style: Watching the news makes people sick.

This is a post from the blog of Professor emeritus Dr. Richard Hayes, who taught Buddhism and Sanskrit at McGill University, and is now back home in the 4 corners area of the United States. Dayamati Hayes is also a Quaker, peace activist, vegan, and a conscientious objector from the Viet Nam war. As a friend who I have known on internet lists and now on social media for more than several decades, Dr. Hayes is well known and respected for his wit, wisdom, and insight into our human condition. In fact, there are too many excellent posts one could share from Richard, but this one is only a sample, and one that has some relevance to digital health:

http://dayamati.blogspot.ca/2017/02/pushing-drugs-american-style.html

Watching the news makes people sick

At the outset I must confess to being addicted to watching the news on television. Although my favorite televised news sources are on PBS, on most nights I supplement the PBS News Hour with the news on one of the traditional network stations or a cable news channel. Something that has repeatedly struck me in watching the evening news on traditional network stations is that advertisers have obviously learned that the vast majority of people who watch the evening news are suffering from indigestion, irritable bowel syndrome, erectile dysfunction, atrial fibrillation not caused by a heart-valve problem, moderate to severe psoriasis, rheumatoid arthritis, osteoporosis, depression, insomnia, restless leg syndrome or dry eye disease. If not afflicted by one of those conditions, they are being assaulted by meatballs or chicken wings.

Not all the commercials are pushing drugs, of course. Interspersed with all the pharmaceutical products are commercials featuring lawyers who are prepared to sue pharmaceutical companies for offering products that have life-changing side effects, and health insurance plans that complement Medicare to provide coverage to pay for all those pharmaceuticals that TV viewers are urged to ask their doctors about. Given the evidence of television commercials, remarkably few of the people who watch the televised news are under the age of sixty-five and have sound minds in sound bodies.
An often-heard claim of those who are convinced that the Affordable Care and Patient Protection Act has all but destroyed the health-care system in the United States is that the ACA (which they persist in calling Obamacare) has driven insurance premiums through the ceiling, thus bringing financial ruin to small businesses and confronting hard-working Americans with having to choose between health insurance and sending their children to overpriced universities. What is missed in this analysis, of course, is that health insurance is expensive because medical care and pharmaceuticals are expensive. Also left out of consideration is that almost every pharmaceutical product sold in the United States is available in Canada for a fraction of the cost.

Why don’t Canadians pay their share of the cost of drugs?

A claim I have heard many American make, clearly a claim that they have learned from the pharmaceutical companies themselves, is that the prices of pharmaceutical products are so high in the United States because it costs pharmaceutical companies a great deal of money to do the research necessary to develop new products. Some American friends have even showed indignation that Americans are subsidizing Canadians, who derive all the benefits of expensive medical research but pay none of the cost. Once, when I was still living in Canada, I received an email from a (former) friend in the United States who accused me, in language unsuitable for anyone not in either the navy or a motorcycle gang, of being a freeloader who was enjoying good health at the expense of poor Americans. That claim was false for two reasons. First, I have almost never been prescribed a pharmaceutical product and tend to avoid over-the-counter medical products. Second, there are better explanations for why pharmaceutical prices are outrageously high in the United States. So the answer to the question “Why don’t Canadians pay their share of the cost of drugs?” is that they in fact do pay their fair share. Americans pay more, not because they are subsidizing freeloading Canadians, but because Americans pay far more for products than it costs to develop and manufacture those products.

Why do Americans pay for overpriced pharmaceuticals?

The pharmaceutical companies typically claim that they must charge high prices for their products because of the high cost of developing them. It cannot be denied that running controlled tests on new products and making sure the products meet safety standards is costly. It should also be pointed out, however, that advertising the products once they are developed is also costly. To that can be added that pharmaceutical companies also tend to pay shareholders rather high dividends. When health care products are manufactured by for-profit corporations that have investors to reward with high dividends, then costs naturally rise. While the claim of many advocates of free-market capitalism is that competition keeps costs down, the opposite is often the case. If two companies are competing for a share of the market, the cost of the competition—the advertising of products to potential consumers of the products and to potential prescribers of those products—can be quite high.

Neither of those kinds of advertising is necessary. There is no justification whatsoever for running expensive advertisements on television that end with the line “As you doctor whether…is right for you.” There is no need to make the patient into a sales representative for a product that the patient may end up buying. If someone has, say, osteoporosis, then it should be sufficient for the physician to suggest a range of possible treatments, and to tell the patient the desired effects and the likely side effects of each of the possible treatments. And that information should be given directly to the physician in the form of the results of clinical trials, not in the form of slick presentations delivered in the context of work-vacations at expensive resorts. The cost of disseminating objective information is relatively low, whereas the cost of trying to persuade a physician to prescribe product A rather than the almost-identical product B is much higher.

One way to bring medical costs down is to make advertising of medical products illegal, as it is in some countries that have lower costs for pharmaceuticals and hands-on medical care. Another way is to have government-imposed limits on the amount of profit a company can make on a product, as is also the case in some countries that have reasonable consumer-costs for health-related products. A third way is to have a government-run insurance plan that negotiates prices with pharmaceutical companies and imposes a cap on how much a pharmaceutical company can receive for its products. There is no need for a government-run plan to be managed by the central government. In Canada each province has its own plan, and no two provinces have exactly the same setup.

Health care is far too important to be left to the vagaries of markets in a for-profit corporate scheme. The good health of the entire citizenry is far more important than the bank accounts of capitalist shareholders. There are plenty of other markets in which investors can make or lose their money. Pharmaceutical companies, manufacturers of medical devices, clinics, hospitals and retirement homes for the elderly should not be in the private investment sector of the economy. (Neither should correctional facilities, but that is a matter for another day.)

Americans desiring affordable health insurance should first advocate for more affordable treatments, and that is best achieved by a not-for-profit health-care system. They should be asking for, in fact demanding, more government involvement and less private-sector investment in products designed for health. Such a change in outlook would, however, require that Americans first seek a cure for their addiction to free-market capitalism and the delusion that the best way to keep costs down is to let the market determine prices. That strategy has been tried again and again, and it has failed again and again. It is time for Americans to considered an alternative system (not to be confused with “alternative facts”).

Next time you see a television commercial for an expensive treatment that you have seen a hundred times before, instead of simply reaching for the mute button on the remote control, ask your doctor whether socialized medicine is right for you. If you doctor says No, then consider seeking a second opinion. 

Wednesday, November 23, 2016

eHealth Medical Fiction - "Cell" by Robin Cook

I just finished a page turner by Robin Cook called "Cell". I knew from the beginning that it was an eHealth type of medical fiction. It features a smartphone app called iDoc that promises almost to take over the role of the personal physician. I suspected while reading the influence by Eric Topol, who must be one of the greatest champions for spearheading the medical smartphone revolution.

I was not too surprised to find that Robin Cook does acknowledge Topol at the end of the book. For a while I was concurrently reading Topols' "The Patient Will See You Now" and "Cell".  Robin Cook wrote "Cell" in 2014 and he credited Topols' "The Creative Destruction of Medicine".  Reading the medical fiction is  just a diversion. If you really want to learn about how the smartphone will revolutionize medicine - read Topol.

Medicare should be a major department for all Americans, just like Education and Defense. The author appears to argue like this in the book as he alludes often to the Affordable Care Act and Obamacare. The villain is a Health Insurance Company bent on making billions with the miracle app. The iDoc app is wonderful as the algorithms on the smartphone help to prevent illness and conditions. Health advice is immediate and always accessible.

Unfortunately, the app takes a turn for the worse and the "heuristics" start killing off patients in the alpha testing.  That involves what I think is the only science fiction element in the story - a nano-chip implanted in diabetes patients that is remote controlled by wireless radio signals releasing doses of insulin.  In real life the FDA has approved an "artificial pancreas" of sorts - a network of devices - that automagically monitors and controls blood sugar levels - it just doesn't work on the nano scale.

Just saw over at the Geek Doctor blogspot there is a guest blog by Seth Berkowitz, MD about  Apple’s CareKit and ResearchKit frameworks and the HealthKit API being used at BIDMC. Engaging patients in their health like that is a step towards a kind of iDoc.
  


Thursday, July 12, 2012

The Health and Wellness Companion Personal Health Record

I just found out through my online life insurance company (employer's benefits) that I can access a Practice Solution Personal Health Record.  I am about to apply for online access but I found the user agreement quite interesting, so I am posting it here:




End User Terms of Use (last revised September 15, 2009)
The following Terms of Use constitute an agreement between you and MD Physician Services, a Canadian Medical Association company ("we" or "us" or "MD Physician Services") with respect to your use of the Health & Wellness Companion (the "Service"). By using the Service you agree to the following Terms of Use. If you do not agree to these Terms of Use, please do not use the Service. We may revise this document from time to time. If you disagree with the changes discontinue your use of the Service. Your ongoing use of the Service after the changes take effect signifies your agreement to the new terms. We encourage you to review these terms and conditions regularly.

  1. About The Service
    The Health & Wellness Companion is a web-based interactive health information service comprised of a number of tools and content sources provided by MD Physician Services to you through your employer and/or corporate insurance provider ("Provider") to help you better manage your health:

    1. Assessments are interactive questionnaires that evaluate your family history and lifestyle habits, identify areas of risk, and recommend personalized action plans. The Questionnaires provide an assessment of risk and suggestions for behavioral change. There is no guarantee that following the recommendations will prevent the onset of disease.
    2. Personal Health Record (PHR) is a confidential, secure online location where you can store important medical data such as family and individual health information. You are solely responsible for the accuracy and completeness of the health information that you enter into your PHR.
    3. Health Library is a comprehensive library of accurate, quality-assured health information on medical conditions and/or diseases (causes, symptoms and treatments) as well as a searchable database of information about prescription drugs. The content is provided for information purposes only and is not intended for diagnostic purposes. If you have specific health concerns we recommend that you see the advice of a physician.

    While we have made every effort to provide a reliable and accurate information source you understand that the Service is provided AS IS and without warranties.

    We may from time to time add new features to the Service, substitute a new feature for an existing feature, or discontinue an existing feature. Information about new features will be provided to you by your Provider. The use of any new features will be governed by these Terms of Use.


  2. Ownership
    We own the Service and it is made available to you by your Provider under a contractual arrangement. All content and materials available on the Service is owned by us, our suppliers or your Provider as the case may be and is protected by copyright, trade-mark, service mark, patent, trade secret, or other proprietary rights and laws. You may not copy, modify, alter, revise, paraphrase, omit, change, display, store, timeshare, rent, lease, sublicense, publish, distribute, transmit, transfer, assign, sell, or commercially exploit in any manner the Service, or any software or content contained on the Service. You may however, print or download one copy of the materials or content on this site on any single computer for your personal non-commercial use, provided you keep intact all copyright and other proprietary notices. Use of content or materials for any purpose not expressly permitted in these Terms of Use is prohibited. No part of any content, form or document may be reproduced in any form or incorporated into any information retrieval system, electronic or mechanical, other than for your personal use (but not for resale or redistribution).


  3. Disclaimer of Warranty of Text
    The medical information, consultation features and other resources contained in this Service are for informational purposes only and in no way are intended to substitute for professional medical care or attention by a qualified practitioner. No representations or warranties of any kind whatsoever regarding any treatment, action or medication or preparation by any person with respect to the information, consultation features, possibilities or conclusions, or other resources offered or provided within or through the Service are made by MD Physician Services, its suppliers or your Provider. You agree that MD Physician Services, its suppliers and your Provider are not responsible for the results of your decisions resulting from the use of any content or software on the Service including, but not limited to, your choosing to seek or not to seek professional medical care, or your choosing or not choosing specific treatment based on the text.

    Note to users accessing the Health & Wellness Companion from outside Canada
    The assessments and the content of the Health Library have been developed in accordance with relevant Canadian clinical guidelines. If you require advice for your specific circumstances, please contact a health professional in your country of residence.

    Links to various other Web sites from the Service are provided for your convenience only and do not constitute or imply endorsement by MD Physician Services, its suppliers or your Provider of these sites, or any benefits, products or services described on these sites, or of any other material contained on them. Practices Solutions, its suppliers and your Provider disclaim any responsibility for their content and accuracy.


  4. Disclaimer of Warranty of Software
    You agree that use of the Service is at your sole risk. The Service and the software are licensed "As Is". MD Physician Services, its suppliers and your Provider disclaim all warranties, expressed or implied, including, without limitation, any implied warranties of merchantability of fitness for a particular purpose. No warranty is provided that the functions contained in the Service will meet your requirements or that the operation of the Service will be uninterrupted or error-free, or that defects in the Service will be corrected. To the extent possible, MD Physician Services has provided a reliable and accurate information source however we cannot guarantee that information contained in the Service will always include the most recent developments with respect to a particular item. Unless otherwise agreed to in writing, MD Physician Services and its suppliers do not warrant or make any representations regarding the use or the results of using the Service including, but not limited to its correctness, accuracy or reliability.


  5. Limitation of Liability
    We and our suppliers are not responsible in any manner for direct, indirect, special or consequential damages howsoever caused arising out of the use of this Service, even if advised of the possibility of same. This disclaimer of liability applies to any damages or injury caused by any failure of performance, error, omission, interruption, delay in operation or transmission, communication line failure, alteration of information on the Service, or inability to gain access to or use your Personal Health Record. We disclaim all responsibility or liability for any damages caused by viruses contained within any electronic file containing a form or document. Your sole and exclusive remedy for any dispute with us or our suppliers is the cancellation of your registration for the Service.


  6. Your responsibilities
    You are responsible for keeping your password confidential and for notifying us if you suspect that your password has been hacked or stolen. Please contact us at support@wellnesscompanion.com. You are solely responsible for the accuracy and completeness of health or health-related information that you enter (for example in response to a HRA questionnaire or in the PHR).


  7. No Endorsement
    We do not endorse any information, products or services unless such information, product or service is clearly marked as endorsed.


  8. Content Providers
    Content on the Service is provided by third party suppliers, Clinemetrica, Healthwise Inc. and MediResource®.
    About Clinemetrica

    Founded in 1989 by faculty and research staff from the Division of Clinical Epidemiology, the Montreal General Hospital and McGill University, Clinemetrica is a fully bilingual Contract Research and Corporate Health Organization applying the highest academic standards. Members of the Clinemetrica editorial board also have clinical positions with the McGill Cardiovascular Health Improvement Program. Clinemetrica editorial board includes:
    • Steven Grover, MD, MPA, FRCPC
      Dr. Steven A. Grover is the Director for the Analysis of Cost-Effective Care and the Division of Clinical Epidemiology at The Montreal General Hospital and a Professor in the Departments of Medicine and of Epidemiology and Biostatistics at McGill University. After graduating with a medical degree at McGill University, he completed his post-graduate education at the University of California at Los Angeles, McGill University, and Harvard Medical School. He then received his research training at the Brigham & Women's Hospital while completing a Master's of Public Administration at the Kennedy School of Government, Harvard University. Dr. Grover's research team developed the validated and published disease simulation models that are used on the Practice Solution's website.
    • Ilka Lowensteyn, PhD
      Dr. Ilka Lowensteyn is a Medical Scientist at the Centre for Cardiovascular Risk Assessment at the McGill University Health Centre and an adjust assistant professor in the department of Medicine at McGill University Health Centre. She is also the Director of Clinical Research for the Cardiovascular Health Improvement Program (CHIP), which is a cardiac rehabilitation program for the McGill teaching hospitals. After graduating with a doctoral degree in Exercise Physiology from the University of Miami, she completed an NHRDP post-doctoral fellowship at McGill University.
    • Sylvie Marchand, RN
      Sylvie Marchand is a registered nurse with 25 years of clinical and research experience. Her main areas of practice are cardio-metabolic disease and lifestyle change.
    About First DataBank

    Each First DataBank product module is supported by a comprehensive editorial policy that has been internally peer-reviewed. In the execution of those policies and the development of the NDDF Plus database, First DataBank’s staff of more than sixty pharmacists and research associates use a variety of reference sources including, but not limited to, primary medical literature (e.g., published journal articles), medical reference texts, published expert treatment guidelines, and manufacturer product package inserts. To ensure the quality of this data, First DataBank employs the following procedures:
    • The development of detailed process map sets for core processes to enhance their consistency and accuracy. These process map sets include box diagrams that identify all steps in a work flow, responsibility matrices that designate the parties responsible for performing tasks, control plans that serve to manage risk, and precise work instructions.
    • The application to modules of data audits designed to prevent patient safety issues. Data is regularly reviewed to ensure that it is in accordance with editorial policies in material respects. These audits run prior to delivery to customers and are designed to identify problem issues in advance. Six Sigma statistics are also calculated for each First DataBank module.
    • Data validation at the point of entry to optimize quality and performance. Data validations are incorporated into maintenance system forms to reduce issues at the point of entry.
    • Maintenance system quality checks to support data integrity. Second quality checks are performed for many data elements by a pharmacist or research associate who did not participate in the original entry of the data, and who is required to check the data against original reference sources.
    • Formal methodology for testing that begins at design and extends through delivery. First DataBank clinical pharmacists use automated software tools to test output information across multiple platforms and databases. Dedicated teams execute both clinical and functional tests to ensure that database, software and forms return correct results. Suites of test cases have been developed for every module and requirements traceability and cross reference test cases are performed to ensure compliance with requirements.
    • Root cause analysis to ensure problem understanding and prompt resolution. When issue do occur event investigation are conducted so that problems are diagnosed and corrective actions implemented to prevent their reoccurrence.
    About Healthwise

    The Medical Review Board is directed by our chief medical officer, Dr. Steven L. Schneider, and our medical directors, Dr. Adam C. Husney and Dr. Martin J. Gabica; all three are board-certified family medicine physicians. Dr. Catherine Serio provides leadership on behavioral health issues for all Healthwise products. There are nine board-certified associate medical directors. Together, these thirteen physicians conduct initial and final reviews of all Healthwise® Knowledgebase topics written by Healthwise, and they are involved in the planning and updating of all Healthwise publications and products.
    • Chief Medical Officer - Steven L. Schneider, MD, Family Medicine, Boise, ID
    • Medical Director - Adam C. Husney, MD, Family Medicine; Physician, Boise Minor Emergency Center, PA, Boise, ID
    • Medical Director - Martin J. Gabica, MD, Family Medicine; Boise, ID
    • Behavioral Health Specialist - Catherine Serio, PhD, Psychology, Boise, ID
    • Associate Medical Directors
      • Patrice Burgess, MD, Family Medicine; Assistant Clinical Professor, University of Washington, Family Practice Residency of Idaho, and Medical Director of Physician Relations at Saint Alphonsus Regional Medical Center, Boise, ID
      • William M. Green, MD, Emergency Medicine; Medical Director, Sexual Assault Forensic Evaluation Team and Clinical Professor, Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
      • Sarah Marshall, MD, Family Medicine; Assistant Clinical Professor, Department of Family and Community Medicine, University of California, Davis, Sacramento, CA
      • Joy Melnikow, MD, MPH, Family Medicine; Professor, Department of Family Practice, University of California, Davis, Sacramento, CA
      • Anne C. Poinier, MD, Internal Medicine; Physician, St. Luke's Internal Medicine, Boise, ID
      • Caroline S. Rhoads, MD, Internal Medicine; Associate Professor of Medicine, University of Washington, Seattle, WA
      • Kathleen Romito, MD, Family Medicine; Physician, Primary Health Wellness Center, Boise, ID
      • Michael J. Sexton, MD, Pediatrics; Medical Director, CARES Program, St. Luke's Children's Hospital, Boise, ID; Associate Clinical Professor, Family Medicine, University of Washington, Seattle, WA
      • E. Gregory Thompson, MD, Internal Medicine; Physician, St. Luke's Internal Medicine, Boise, ID
    Other members of the Medical Review Board review Knowledgebase topics from the specialist's point of view. With the input of these specialists, Healthwise medical writers develop topics based on scientific evidence and current clinical practice.
    Members of the Medical Review Board are experts in their specialty area. Their credentials include board certification, academic appointments at the nation's leading medical schools, active involvement in research, and publication in peer-reviewed journals and medical textbooks. Most important, they share the Healthwise commitment to empowering patients with reliable health information and building strong patient-provider relationships; this encourages partnerships in the decision-making process.
    About Mediresource
    The MediResource Clinical Team includes a dedicated staff of in-house health care professionals, editors, and medical writers, along with a team of medical advisors and freelance medical writers. All have extensive experience in their medical specialty and in producing medical information for the public that is relevant, timely and accurate.
    All MediResource health content is clinically reviewed by a health care professional. Authors of health content are always qualified medical writers. Clinical reviewers are health care professionals selected for their experience and expertise in the topic. All articles are edited by two medical editors experienced in the production of medical information for the public.
    • Medical editors
      • James Harbeck, PhD
      • Nicolette Blase
      • Joanne Lee, BSc
      • Angela L. McOrmond
    • Healthcare professional consultants
      • Pharmacist consultants
        • Ruth Ackerman, BScPhm, RPh, MBA
        • Jennifer Ahn, BScPhm, RPh
        • Daniella Gallo, BScPhm, PharmD
        • Andrea Hudson, BA Psych, BScPhm, PharmD, RPh
        • Daniel Kim, Hon. BSc (Tox), BScPhm, RPh
        • Samantha Moe, BSc Phm, ACPR, PharmD
        • Cathy Nguyen, BScPhm, RPh
        • Trish Rawn, BScPhm, PharmD, RPh
        • Tom Smiley, BScPhm, PharmD
        • Kathy Tam, BScPhm, RPh
        • Amanda Ung, Hon. BSc, BScPhm, RPh, ACPR
      • Medical writers
        • Sharon Aschaiek, Hon. BA
        • Lisa Bendall, Hon. BSc (Psychology)
        • Gisèle Grant, BSc
        • Jaclyn Law, Hon. BA (English)
        • Amy Toffelmire, BA
        • Marijke Vroomen-Durning, RN
      • Medical advisors
        • Emergency medicine - Ernie Murakami, MD, Alan Kaplan, MD
        • Gastroenterology - Paul Moayyedi, MB, ChB, PhD, MPH, FRCP (London) FRCPC
        • Hematology - Darrell J. White, MD, MSc, FRCPC
        • Infectious diseases - Lorne A. Babiuk, OC, SOM, PhD, DSc, FRSC, R. Reynolds, MD
        • Internal medicine - R. Reynolds, MD
        • Neurology -Jack Schneiderman, MD, FRCPC
        • Otolaryngology -Robert Irvine, MD
        • Pediatrics -Jeremy Friedman, MB ChB, FRCPC, Sanjay Mehta, MD, MEd, FRCPC, FAAP, FACEP, Dennis Scolnik, MSc, MB, ChB, DCH, FRCP
        • Psychiatry -Ronald A Remick, MD, FRCPC
        • Rheumatology -Katherine Siminovitch, MD
        • Sports medicine - E. Laura Cruz, MSc, MD, CCFP, Dip Sport Med
      Note about content suppliers
      Each content supplier has its own terms and conditions and licence agreement which are incorporated by reference into these Terms of Use. By accessing and using this material you agree to comply with these additional terms and conditions. For more information please read Healthwise Knowledgebase Licensing Agreement and Terms and Conditions.
      You are required to acknowledge the MediResource Conditions of Use each time you access their service.
  9. Advertising policy
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  10. Privacy
    In order to provide you the Service we need to collect certain information from you. Please read about our information handling practices in our privacy policy
  11. Transparency
    The Health and Wellness Companion is certified by the Health on the Net Foundation as compliant with the HONcode. As part of the certification process MD Physician Services must disclose its sources of funding as well as any conflicts of interest. The provision of the Health and Wellness Companion and the development of enhancements are financed in part by fees paid to MD Physician Services by employers and/or corporate insurance providers. There are no conflicts of interest to be declared. Health information found on the Health and Wellness Companion is provided by independent third party content providers.
  12. Termination of Access
    We reserve the right, in its sole discretion, to terminate your access to the Service. In the event of such termination we will notify you and you are advised to transfer any medical records or other information stored on the Service. If the Service is terminated by your Provider, your Provider may arrange for a replacement service to be made available to you. You consent to the transfer of any personal health information you have supplied to us when using this Service to such replacement supplier. Any such transfer will occur only on the instructions of your Provider. In the event that we do not receive instructions to transfer your information, we will retain your information for a minimum of 60 days after the date of termination after which time it will be destroyed.
  13. Governing Law
    This Agreement is governed by and shall be construed in accordance with the laws of the jurisdiction in which the end user resides and the laws of Canada applicable in that jurisdiction without regard to their conflict of law provisions.