Well, you might not have noticed that my blogs were missing for the last three months but anyways, its good to be back. I was having a little time off blogs and social media as I was transitioning in my career but now I am back. Sometimes, it is very difficult to manage time for things that you must do versus things you enjoy doing, especially when these two don’t intersect. For me, these last few months the things I had to do were all bureaucratic while I couldn’t find the time for things I enjoy doing like writing these blogs. But now that we are back, let’s recap what has happened in the oncology world in the year 2019 so far. I can’t cover all of them, but will try to summarise the major events in oncology.
Hundred Foxes’ Howl versus One LION’s Roar
In my country, there is a saying that goes somewhat like the roar of one lion will scare hundreds of howling foxes away. In medicine, I guess, it translates as one good RCT trumps the results from hundreds of observational studies. For patients with advanced ovarian cancer, primary surgery to achieve complete resection is the most important treatment and prognostic factor. However, what to do with the lymph nodes is a question that has troubled the oncology community for a long time. Logically, it makes sense to remove the lymph nodes too because they are the sanctuary sites for cancer cells. However, lymph node dissection carries high morbidity. Although multiple observational studies suggested a survival benefit with lymph node dissection, the LION trial, now published in the NEJM, shows that for women with macroscopic complete resection of primary tumour, lymph node dissection increases morbidity (postoperative complications) and post-operative mortality rates but doesn’t improve survival. I am glad that this trial was carried out and these results will now save many women with ovarian cancer worldwide from unnecessary harmful procedures, but I am also sad that we didn’t answer this question until now and thus, many patients suffered unnecessarily. I hope this LION’s roar scares us from jumping to conclusions based on logic or observational data alone and without RCT evidence in future. Another lesson here is the importance of public funds in supporting RCTs like these.
I’m a physician, born in McAllen, Texas. In June 2018, I returned home to demand that immigrant children who had been torn from their families as a result of the Trump Administration’s zero-tolerance policy, be safely and immediately reunited. I demonstrated at a federal detention center in McAllen at the Free the Children Protest. I marched alongside other concerned citizens, and we confronted a bus carrying the children.
With my palms pressed against the bus, I demanded that the government free them. I could not have imagined that just a few months later, I’d demand that the government find them.
Back then, the Office and Refugee and Resettlement had just certified that over 2,600 children had been separated from their families.
The Office of Inspector General (OIG) of the Department of Health and Human Services recently released an updated account. They actually weren’t sure how many children were separated. Turns out they didn’t count them. According to the report, HHS doesn’t know exactly if, when, or how they’ll find the lost children.
I grew up right there, along the south-Texas border, and I know that cattle are better accounted for than these infants and children.
So whose fault is it? In my opinion, the blame falls on Health and Human Services Secretary Alex Azar and Homeland Security Secretary Kristjen Nielsen, both of whom are ultimately responsible for executing the President’s policy agenda through their respective departments. The Department of Homeland Security (DHS) systematically separated families. The Department of Health and Human Services failed to identify the children who were separated.
Today on Health in 2 Point 00, Jess and I are standing on a roof answering health tech questions from the Digital Health Commercialization Panel event in San Francisco. In this episode, Jess asks me about all the money that is being raised or spent in the health tech worlds of Europe and the US. DoctoLib, a company that is like ZocDoc in the US, raised 150 million Euro, which is probably the largest raise for a European company involved in health tech. Meanwhile, in the US, Teledoc also stretches its way into Europe, buying MédecinDirect, which is a telehealth company in France. We also see health tech companies in the employer health space taking home large piles of cash. Cleo, which is a platform entirely run by women serving women’s’ health postpartum, raises 27 million. UniteUs, which is a company focused on improving people’s social determinants of health, raises 30 million, but I still worry about this type of initiative and want to see if there is a market for this type of care and if hospitals are willing to pay for it–Matthew Holt
Every year at this time, you hear warnings that flu season has arrived. New data from the CDC indicates the season is far from over. So, you are urged by health authorities to get a flu shot. What you may not realize is how the flu can affect the hospitals you and your loved ones rely on for care.
In January, the large urban hospital where I am an intern faced the worst flu outbreak it has ever seen. Nearly 100 staff members tested positive for the flu. Residents assigned to back-up coverage were called to work daily to supplement the dwindling ranks of the sick. Every hospital visitor was required to wear a mask upon entry. At one point, every patient in the medical ICU had the flu and the whole unit had to be quarantined. Because of this, the hospital was put on diversion – no new patients could be admitted.
Why was this flu outbreak so bad? Doctors are still trying to understand all the causes, but one likely reason is that hospital staff with symptoms came to work and became a reservoir for the virus. A majority of visitors and patients don’t get their flu shots, making matters even worse.
Once administrators caught on to the mess this year’s flu was creating, they took some new and aggressive measures. In addition to the free vaccines provided to employees every year, they performed daily symptom check-ins, encouraged sick days, and held an influenza town hall. After discussion with the State Department of Health, medical residents were provided free Tamiflu and urged to take it as prophylaxis. Only 40% picked it up. Residency directors asked symptomatic house staff to stay home. A positive flu swab meant a mandated five days off work. One month later, we are still required to check in daily and confirm that we are symptom-free via a text messaging system or a checklist circulated to each hospital floor. These responses were effective, and the wave of flu appears to have passed. We must now plan ahead to prevent the next outbreak.
Google’s Verily has a $1Billion dollar investment fund and a nearly limitless talent pool of data scientists and engineers at the ready. So, how are they planning to invest in a better future for health?
Luba Greenwood, Strategic Business Development & Corporate Ventures
for Verily told me how the tech giant is thinking about the big data
opportunity in healthcare – and, more importantly, what they see as their role
in helping scale it in unprecedented ways.
So, where should other health tech investors place their bets, then?
Luba’s previous successes investing in digital health and health technology
while at Roche (FlatIron, MySugr, etc.) give her a unique perspective on the
‘state-of-play’ in healthcare investment…but has the game changed now that she’s
in another league at Verily? Listen in to find out.
Filmed at the Together.Health Spring Summit at HIMSS 2019 in Orlando,
Florida, February 2019.
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.
I’m going to show you the Match rate and mean Step 1 score for three groups of residency applicants. These are real data, compiled from the National Resident Matching Program’s (NRMP) Charting Outcomes in the Match reports.
U.S. Allopathic Seniors: 92% match rate; Step 1 232.3
U.S. Osteopathic Seniors: 83% match rate; Step 1 225.8
International Medical Graduates, or IMGs (both U.S. and non-U.S. citizen: 53% match rate; Step 1 223.6
Now. What do you conclude when you look at these numbers?
In the debate over the U.S. Medical Licensing Examination’s (USMLE) score reporting policy, there’s one objection that comes up time and time again: that graduates from less-prestigious medical schools (especially IMGs) need a scored USMLE Step 1 to compete in the match with applicants from “top tier” medical schools.
In fact, this concern was recently expressed by the president of the National Board of Medical Examiners (NBME) in an article inAcademic Medicine (quoted here, with my emphasis added).
“Students and U.S. medical graduates (USMGs) from elite medical schools may feel that their school’s reputation assures their successful competition in the residency application process, and thus may perceive no benefit from USMLE scores. However, USMGs from the newest medical schools or schools that do not rank highly across various indices may feel that they cannot rely upon their school’s reputation, and have expressed concern in various settings that they could be disadvantaged if forced to compete without a quantitative Step 1 score. This concern may apply even more for graduates of international medical schools (IMGs) that are lesser known, regardless of any quality indicator.”
The funny thing is, when I look at the data above, I’m not sure why we would conclude that IMGs are gaining advantage from a scored Step 1. In fact, we might conclude just the opposite – that a scored Step 1 is a key reason why IMGs have a lower match rate.
A class action legal ruling this month, on a case originally filed in 2014, found that UnitedHealthCare’s (UHC) mental health subsidiary, United Behavioral Health (UBH), established internal policies that discriminated against patients with behavioral health or substance abuse conditions. While an appeal is expected, patients with legitimate claims were systematically denied coverage, and employer/union purchasers who had paid for coverage for their employees and their family members received diminished or no value for their investments.
Central to the plaintiff’s argument was the fact that UBH developed its own clinical guidelines and ignored generally accepted standards of care. In the 106 page ruling, Judge Joseph C. Spero of the US District Court in Northern California wrote, “In every version of the Guidelines in the class period, and at every level of care that is at issue in this case, there is an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions.” He concluded that the emphasis was “pervasive and result[ed] in a significantly narrower scope of coverage than is consistent with generally accepted standards of care.” Judge Spero found that UBH’s cost-cutting focus “tainted the process, causing UBH to make decisions about Guidelines based as much or more on its own bottom line as on the interests of the plan members, to whom it owes a fiduciary duty.”
In a statement to FierceHealthcare, UnitedHealth said it “looks forward to demonstrating in the next phase of this case how our members received appropriate care…We remain committed to providing our members with access to the right care for the treatment of mental health conditions and substance use disorders.”
It is important to be clear about what transpired here. Based on evidence, a subsidiary of UnitedHealthCare, America’s second-largest health care firm, has been found in a court of law to have intentionally denied the coverage of thousands of patients filing claims. The organization justified the restrictions in coverage using internal guidelines tilted to favor financial performance rather than accepted standards of care. In other words, UBH’s leaders (as well as those at UHC) knowingly defrauded their customers and devised a mechanism to rationalize their scheme. In his ruling, Judge Spero described testimony by UHC representatives as “evasive — and even deceptive.”
Welcome back–and thank you for bearing with us while we figured out all the technical stuff transitioning the old THCB site to the new one! Hopefully this all looks familiar, but while the content is the same, under the hood everything is actually brand new.
We’ve made some simplifications, particularly having the “big 4” categories listed at the top of the page: Health Tech, Health Policy, Medical Practice & Health Care Business. The left margin has Videos (THCB Spotlight, WTF Health and Health in 2 Point 00), and our latest tweets from @THCBstaff below them. The right margin has room for our soon-to-come podcast “HardCore Health”, as well as 15 years worth of Archives and a place to sign up for our email newsletter, the THCB Reader.
If you want to comment and were previously registered, your registration should have carried over — login is on the top right. Of course you can still register in the same place (and yes, to stop spammers, you do need to do so in order to comment).
We will be adding new features and changing stuff around a little as we stretch our new technical legs! I hope you enjoy the new and improved THCB site — Matthew Holt
Health coaches are playing an ever-more important role in healthcare,
but there’s no one single authority when it comes to finding one — or vetting
them for that matter — until now.
Marina Borukhovich, CEO of startup YourCoach, talks about how she hopes to disrupt health coaching after she learned the value of having a ‘squad’ of experts help her through her breast cancer journey.
In fact, ‘Squads’ are the value-add that YourCoach is hoping will set
them apart. The app’s signature feature is that it lets you build-your-own team
of experts who can work together to tackle any aspect of health and wellness.
“We’re connecting coaches from around the world
who are going to lead the client holistically,” explains Marina. “So, it could be
diabetes support, it could be pull[ing] somebody in who does meditation, they
could bring in a business coach. It just really depends on the person…and what you
need as a person.”
“We’re building ‘Team YOU.”
Joining in on the fun in this interview is Eugene Borukhovich, who some
of you will recognize as the face of Bayer’s G4A program.
Eugene serves as an advisor to YourCoach and is also Marina’s husband —
possibly making them the “Beyonce & Jay-Z” power couple of
digital health. Is this a blessing or a curse? Apparently, there are 3am pitch
practices that sound like the solid foundation of any marriage.
Listen in to meet them both.
Filmed at JP Morgan Healthcare Conference, January 2019.