Wednesday, November 14, 2018
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A Conversation About the Dangers of Overhydration with Professor Timothy Noakes

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By SAURABH JHA MD

Professor Timothy Noakes, a South African exercise scientist and emeritus professor at the University of Cape Town who has run over 70 ultramarathons, speaks to me about the dangers of overhydration in endurance sports.

Listen to our conversation at Radiology Firing Line Podcast.

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partner

The Internet of Medical Things Gold Rush (And My Grandfather’s Wooden Leg)

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By MICHAEL MILLENSON 

The most intriguing aspect of the recent Connected Health Conference was the eclectic mix of corporations claiming cutting-edge expertise in the Internet of Medical Things (IoMT).

HP, a legend in computer hardware, was touting a service that scoops data from Web-enabled home devices such as bathroom scales up into the cloud and then manages the information on behalf of your doctor. This presumably fulfills their corporate vow to “engineer experiences that amaze.”

Verizon, not content with deploying its cable TV clout to “deliver the promise of the digital world,” is connecting to a chip on the lid of your pill container that can monitor whether you’re taking your medications.

Even Deloitte, rooted in corporate auditing, has translated its anodyne assertion that “we are continuously evolving how we work” into a partnership with Google. DeloitteASSIST uses machine learning to translate verbal requests from hospital patients into triaged messages for nurses.

Looking Back at the RWJF Challenges

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SPONSORED POST

By JOHN EL-MARAGHY

Catalyst @ Health 2.0 is proud to have worked with the Robert Wood Johnson Foundation to address issues in substance misuse and artificial intelligence through two exciting innovation challenges. Following the finalists’ live pitches at the Health 2.0 Annual Conference, Matthew Holt and Indu Subaiya had the pleasure to interview leaders from the six companies that placed in the top spots across both competitions.

First Place Winners

RWJF Opioid Challenge: the Grand Prize award went to Sober Grid, a social network designed to support, assist, and educate those suffering from addiction and substance misuse. The Sober Grid platform incorporates a suite of geolocated support, a “burning desire” distress beacon, and coaching tools. For those looking to get help and support, the Sober Grid platform is a fantastic free utility.

RWJF AI Challenge: the Grand Prize award went to Buoy, a virtual triage chatbot designed to work on any browser. All too often we rely on quick online searches for health information and sometimes receive inaccurate or unreliable results. The Buoy system takes a more conversational approach and emulates similar techniques a doctor would use when diagnosing symptoms and speaking with a patient.

Second and Third place prizes were also awarded to the following organizations:

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Last Month in Oncology with Dr. Bishal Gyawali

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By BISHAL GYAWALI MD

Me-too deja vu

I read the report of a phase 3 RCT of a “new” breast cancer drug but I had the feeling that I had already read this before. Later I realized that this was indeed a new trial of a new drug, but that I had read a very similar report of a very similar drug with very similar results and conclusions. This new drug is a PARP inhibitor called talazoparib and the deja vu was related to another PARP inhibitor drug called olaparib tested in the same patient population of advanced breast cancer patients with a BRCA mutation. The control arms were the same: physician choice of drug, except that physicians couldn’t choose the one drug that is probably most effective in this patient population (carboplatin). The results were nearly the same: these drugs improved progression-free survival, but didn’t improve overall survival. In another commentary, I had raised some questions on the choice of control arm, endpoint and quality of data about the olaparib trial when it was published last year. This current talazoparib trial is so similar to the olaparib trial that you can literally replace the word “olaparib” with “talazoparib” in that commentary and all statements will stay valid.

The oncology version of half-full, half-empty glass

The PARP inhibitors olaparib and niraparib are also approved in ovarian cancer based on improvement in progression-free survival (PFS), without improving overall survival (OS). If a drug doesn’t improve OS but improves only PFS, it should also improve quality of life to justify its use. According to two new reports, these drugs do not appear to improve quality of life. The niraparibtrial reported that the patients were able to “maintain” their quality of life during treatment while the olaparib trial reported that olaparib did not have a “significant detrimental effect” on quality of life. I find it remarkable that a drug that isn’t proven to improve survival is lauded for not significantly worsening quality of life … at $10,000 a month!

It is also important to recognize that these drugs were tested as maintenance therapy against placebos. For “maintenance therapies,” as explained in this paper, improving PFS alone is not an important endpoint. That’s why I am also not excited about this new trial of sorafenib maintenance in ovarian cancer. A drug has to be very ineffective to fail to improve even PFS as a maintenance therapy against placebo.

Health in 2 Point 00 Episode 57

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On Episode 57 of Health in 2 Point 00, Jess and I report from Exponential Medicine. In this episode, Jess and I talk about digital surgery and how Shafi Ahmed and Stefano Bini are transforming surgical training. She also asks me about my favorite session, one by Anita Ravi on health care for those who have been sex trafficked. Other highlights include ePatient Dave’s talk about access to data for patients and letting patients help, and Leerom Segal’s overview of why voice matters- Matthew Holt

The IPCC Confirms Life As We Know It Will Soon Cease to Exist

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By DAVID INTROCASO PhD

THCB readers may recall last year in early June when the Trump administration announced it would withdraw from the 2015 Paris climate accord and earlier this January when the World Economic Forum met to discuss its global risk report that included the chapter, “Our Planet on the Brink,” I discussed in part (here and here) the health care industry’s indifference to global warming (See also my related 3 Quarks Daily essay.) Now comes the United Nation’s Intergovernmental Panel on Climate and Change’s (IPCC’s ) latest report. Once again overwhelming scientific evidence that confirms life as we know it on this planet will soon cease to exist is received with apathetic insouciance.

Created in 1988 the IPCC is considered the world’s definitive scientific body on climate change and co-winner with Al Gore of the 2007 Nobel Peace Prize, finalized in early October its report, “Global Warming of 1.5°C.”  The 2015 Paris accord called for the report.  It was prepared by nearly one hundred scientists who analyzed thousands of the most recent scientific evidence.  The report’s summary was accepted by over 180 countries including the American and Saudi Arabia delegation during the IPCC’s meeting recently concluded in South Korea. 

What is newsworthy about the IPCC report is its conclusion that keeping or holding temperature increases below 2°C, the goal of the Paris agreement, would not avoid the catastrophic effects of global warming. At 1.5°C life on this planet would suffer serious or dire harm, at 2°C catastrophic harm.  Specifically, the report compared the impact between a 1.5°C (2.7°F) increase in temperature with a 2°C (3.6°F) increase (The earth has already warmed by 1°C since the pre-industrial era). Among numerous other findings, should temperatures increase to 1.5°C, the report found of 105,000 species studied, four percent of vertebrates (that include us), eight percent of plants and six percent of insects would lose half of their climatically-determined geographic range. At 2°C, the percents double to triple. Global crop yields will decline significantly. At 1.5°C we will lose 70 to 90 percent of coral reefs, at 2°C there will be a 99 percent loss. At 1.5°C Marine fishery losses or the global annual catch loss would be 1.5 million tons, at 2°C they double.

2018 Midterms: The Year of the Female Physician

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By NIRAN AL-AGBA MD 

While women make up more than half of the U.S. population, an imbalance remains between who we are as a nation and who represents us in Congress. The gender disparity is no different for physicians: more than one third of doctors in the U.S. are women, yet 100 percent of physicians in Congress are men. To date, there have only been two female physicians elected to Congress.

However, in the coming midterm election, there are six races with a chance at making history. It’s these battles which could make 2018 “The Year of the Female Physician.”

I remember being a first-time voter in 1992, labeled at the time “The Year of the Woman.” I was a sophomore at Michigan State University and turned 18 just three days before the election. Following the contentious Supreme Court hearings involving Clarence Thomas and Anita Hill, an unprecedented number of female candidates were vying for office that election year.

President George H. W. Bush was vilified for an appalling answer to the question of when his party might nominate a woman for President. “This is supposed to be the year of the women in the Senate,” he quipped. “Let’s see how they do. I hope a lot of them lose.” Frustrated about the state of gender inequality in politics, a little-known “mom in tennis shoes,” Patty Murray, decided to run for the U.S. Senate to represent Washington. She won, paving the way for an unprecedented number of women to enter national politics over the next 30 years. Still, very few of them have come with a background in medicine.

The Case for Open Innovation in Health | Sara Holoubek of Luminary Labs

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“Most large healthcare companies will have numerous teams – innovation teams, maybe a venture fund, business units – all doing different things,” says Sara Holoubek, CEO of Luminary Labs, a consultancy known in healthcare for its expertise staging open innovation challenges. “How much more powerful would it be if everyone agreed on a common investment thesis? ‘We know our business model is changing and, therefore, where is our big bet?’”

The ‘big bet’ is not always easy for stakeholders in healthcare companies to agree on. Hence, Sara’s advocacy for open innovation, a methodology built for collaboration both internal and external to the organization. She’s been masterminding challenges, hackathons, participatory design sessions, and the like in healthcare for years, helping pharma companies, health plans, health systems and government organizations gain access to new ideas from external problem solvers and startups.

Open innovation not only brings much-needed agility to the way these big companies develop products, build partnerships, or pivot into new markets, but it also helps clarify which business problems the organization is actually trying to solve.

Large organization or small, how do you know when it’s time to take your innovation efforts outside? How do you make sure that your open innovation attempt is truly a ‘challenge’ and not just a splashy brainstorming session or hackathon to nothing?

A few weeks back, Luminary Labs published ‘The State of Open Innovation Report’ in effort to help benchmark the practice and build its business case as a worthwhile methodology for business innovation. Seeds of the report can be found in this interview. Listen in as Sara defines the practice and shares her tips and best practices.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health

Exponential Medicine

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By MATTHEW HOLT

After only maybe 5 years when I’ve been away running a conflicting conference in some other part of the world I finally get to go to Exponential Medicine the next 4 days. I met Daniel Kraft way back before he was famous, and his conference grew from being a week long academic session in an airline hangar in Mountain View to being a mega 4 day bash at the Hotel Del Coronado in San Diego (partly aided by TEDMED abandoning the venue and heading off in its own strange direction post billionaire buyout–well done Mark Hodash despite the lawsuit and yes I am jealous!).

Anyway, it’s going to be lots of fun. There’s plenty of people from my Health 2.0 world presenting. Lonnie Rae Kurlander, ePatient Dave, heck even John Halamka has been tempted off the farm — although I suspect Dave will have him in a headlock about access to his BIDMC data pretty quick).

Then there’s the surgeons and the weirdos. I leave Shafi Ahmed & Stefano Bini to decide which category they’re in, although whatever John Brownstein says I do owe him a nice bottle of scotch. Anyway, check out the program and if you haven’t bought yourself a ticket or bribed your way in, don’t worry it’s all being live streamed and Jessica DaMassa from WTF Health will as ever be interviewing anyone who doesn’t get out of the way quick enough.

So if you’re there I’ll be milling around not doing much, so say hi. And otherwise follow along here and @boltyboy