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THCB Gang Episode 17, LIVE 7/9 1PM PT/4PM ET

Episode 17 of “The THCB Gang” will be live-streamed on Thursday, July 9th! Tune in below!

Joining me tomorrow are some of our regulars: patient advocate Grace Cordovano (@GraceCordovano), health economist Jane Sarasohn-Kahn (@healthythinker), WTF Health Host Jessica DaMassa (@jessdamassa) and a few guests! We will be speaking about the rise in cases, the current trends in health care, and what the future of care looks like.

If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

Equipoise and Its Problems

By MICHEL ACCAD, MD

I recently participated in a debate opposing me to Professor Adam Cifu on the topic of “Evidence-based medicine in the age of COVID.” The debate took place on an episode of Dr. Chadi Nabhan’s Outspoken Oncology podcast. Dr. Saurabh Jha was the moderator and he did a great job keeping us on point and asking for important clarifications when needed. It was a fun and cordial moment and I found it intellectually fruitful. You can listen to it here or on any podcast platform. The discussion strengthened my conviction that the central issue about EBM is the conflation of the role of the physician with that of the clinical scientist.

That conflation was quite apparent in a recent online editorial published by Robert Yeh and colleagues on the topic of equipoise during the COVID-19 pandemic. Yeh at al. are accomplished academic cardiologists and outcomes researchers (Yeh was a guest on The Accad and Koka Report a couple of years ago).

I’ll get to their editorial in a moment, but equipoise is a term that I became aware of only in the last few years, mainly from mentions on MedTwitter. From those mentions I developed an intuitive sense of what equipoise must mean: a mental state of uncertainty about a treatment that prompts the medical community to seek a more definitive answer by way of a randomized controlled trial. For example, one might say “I’m not sure if hydroxychloroquine works to prevent or treat COVID-19.  Based on the existing collective experience, there is equipoise about it.  We need a clinical trial.”

That seems reasonably straightforward, but the editorial by Yeh et al. piqued my curiosity so I decided to look into the origin of the term and its introduction in the medical literature.

Continue reading…

Health in 2 Point 00, Episode 133 | PBMs galore, Genome Medical, & the FCC’s Rural Health Program

Episode 133 of Health in 2 Point 00 is brought to you by the letter P — that’s P for PBMs, of course. In this episode, Jess and I talk about Genome Medical extending their series B and getting another $14 million on top of the $23 million they already raised for their remote genetic counseling services, the FCC adding another $198 million to their rural health program, bringing the funding to a whopping total of $802 million, Anthem’s PBM IngenioRx acquiring pharmacy startup Zipdrug, and Capital Rx, a startup PBM, announced a deal with Walmart. —Matthew Holt

Goodbye Glasses, Hello Smartglasses

By KIM BELLARD

It’s been a few months since I last wrote about augmented reality (AR), and, if anything, AR activity has only picked up since then — particularly in regard to smartglasses.  I pointed out then how Apple’s Tim Cook and Facebook’s Mark Zuckerberg were extremely bullish on the field. and Alphabet (Google Glasses) and Snap (Spectacles) have never, despite a few apparent setbacks, lost their faith.   

I can’t do justice to all that is going on in the field, but I want to try to hit some of the highlights, including not just what we see but how we see.  

Let’s start with Google acquiring smartglass innovator North, for some $180m, saying: 

We’re building towards a future where helpfulness is all around you, where all your devices just work together and technology fades into the background. We call this ambient computing. 

North’s founders explained that, from the start, their vision had been: “Technology seamlessly blended into your world: immediately accessible when you want it, but hidden away when you don’t,” which is a pretty good vision.

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Health in 2 Point 00, Episode 132 | Accolade IPO, Somatus, NexHealth, Tatch & more

Today on Health in 2 Point 00, Jess and I cover some big news! Accolade has filed its IPO, so on Episode 132 I give my take on this health care navigation service. We also cover Somatus getting $64 million for chronic kidney disease care, NexHealth raising $15 million, Tatch raising $4.25 million for sleep apnea diagnosis, Simply Speak raising a $1.1 million seed round, and optimize.health raising $3.5 million for its remote monitoring platform. —Matthew Holt

Telehealth’s Missing Link: In the Rush to Implement Virtual Care, What Did CMS Leave Out?

By RAY COSTANTINI, MD

Imagine three months from now when the predicted ‘second wave’ of COVID-19 is expected to resurge and we’re still without a vaccine. Telehealth has become the entry-point to care, widely adopted by patients both young and old. Now, when an elderly diabetic patient wakes up in the middle of the night with a dull ache on her left side and back, she doesn’t ignore the symptom, like she may have during the first COVID outbreak. Instead, she logs online to her local hospital’s website from a cell phone and accesses a simple questionnaire to report her health history and presenting symptoms. The whole process takes just a couple of minutes and she immediately hears back from her health provider with the suggestion to schedule an in-person appointment for further testing to rule out any kidney issues. 

This patient doesn’t become one of the nearly 50% of Americans who delayed care during the initial COVID pandemic. She was able to access care without having to download an application or wait to schedule a virtual appointment during normal business hours. She receives virtual asynchronous care on-demand, coordinated to sync with her electronic health record. The next day, she receives a follow-up call from her primary care doctor to ensure her symptoms were alleviated with the over-the-counter pain medication she was prescribed. 

I applaud the article written by Paul Grundy, MD, and Ken Terry, “Primary Care Practices Need Help to Survive the COVID-19 Pandemic,” in which they called on Congress to make health policy decisions that will provide immediate financial relief for primary care practices. We must mitigate the real risk we face: the highly possible shutdown of our healthcare system. Amid the coronavirus pandemic, the U.S. healthcare system has taken an enormous financial hit and primary care practices have been especially affected and are struggling to survive. As the authors point out, telehealth has taken the spotlight to fill the acute need for an influx of patients needing to access care under social distancing practices. Telehealth can increase access to care, relieve provider burden, reduce costs to systems, and improve patient outcomes. However, this is only possible with on-demand telehealth, or asynchronous care. 

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“When Blood Breaks Down”: It Can Break Your Heart

By CHADI NABHAN, MD, MBA, FACP

The goal for me and for my clinical and research colleagues is to put ourselves out of a job as quickly as possible”. This is how Mikkael Sekeres ends his book “When Blood Breaks Down” based on true stories of patients with leukemia. I share Mikkael’s sentiments and have always stated that I’d be happy if I am out of a job caring for patients with cancer. To his and my disappointment, this wish is unlikely to ever come true, especially when dealing with leukemia.

With almost 15 years of experience, Sekeres possesses a wealth of knowledge and patient stories making him the ultimate storyteller taking us along an emotional journey that spanned hospital rooms, outpatient clinics, and even his car. We get to know Mikkael the person and the doctor and immediately recognize how difficult it is to separate these two from each other. With hundreds of patients he has cared for, Mikkael could choose which stories to share. He decides on 3 patients, each with a unique type of leukemia and a set of circumstances that makes their story distinct. While I don’t know for certain, his selection likely reflected his ultimate goal of writing this book. It was about sharing life lessons he had learned from his patients–lessons that we could similarly learn—but it was also about giving us a glimpse of history in medicine and the progress that has been made in treating leukemia.

We get to know the three main characters of the book very well. David is an older man with acute myeloid leukemia (AML), Joan is surgical nurse who suddenly finds herself diagnosed with acute promyelocytic leukemia (APL), and Mrs Badway is a pregnant woman who was in her 2nd trimester when she was diagnosed with chronic myeloid leukemia (CML). While learning about their illnesses and family dynamics, Sekeres educates us about the various types of leukemia and enlightens his readers about so much history that I found fascinating. I did not know that the Jamshidi needle that I have used on so many patients to aspirate their bone marrows was invented by an Iranian scientist. Maybe I should have known, but I didn’t, that FISH was developed at Yale in 1980 and the first description of leukemia has been attributed to a French surgical anatomist, Dr. Alfred Velpeau in 1827. Somehow, I always thought that Janet Rowley discovered the Philadelphia chromosome, but Sekeres corrects me when he pictured Peter Nowell and David Hungerford who discovered that chromosome in 1961. As a reader, you might be more drawn to the actual patient stories, but the geek in me enjoyed the history lessons, especially the ones I was unaware of. Sekeres inserts these pearls effortlessly and with perfect timing. He does that so seamlessly and naturally that you learn without realizing you are being taught.

Continue reading…

THCB Gang Episode 16

Episode 16 of “The THCB Gang” was on Thursday, July 2nd! You can see the video below!

Joining Matthew Holt were some of our regulars: patient safety expert Michael Millenson (MLMillenson), MD & hospital system exec Rajesh Aggarwal (@docaggarwal), health care consultant Daniel O’Neill (@dp_oneill), and our guest Marcus Whitney (@MarcusWhitney), CEO of Health Further & author of the new book Create and Orchestrate (You can email Matthew for a free signed copy, or get it on Kindle for 99 cents) We talked about the current rise in cases, how we get changes around race (and a lot more) moving in health care and what the future of care will potentially look like if we do.

If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

Health in 2 Point 00, Episode 131 | Tele-everything! Oscar, Evidation, Lululemon, Calibrate, & more

Today on Health in 2 Point 00, Jess and I talk about Oscar raising $225 million, Evidation Health raising $45 million doing digital clinical trials, Lululemon buying fitness startup Mirror for $500 million, Calibrate raising a $5.1 million seed round bringing telehealth to weight loss and metabolic health, at-home urine analysis startup Healthy.io buying Inui Health for $9 million, and Airvet raising $14 million for veterinary telemedicine. —Matthew Holt

COVID-19 & Fertility Care: Remote Monitoring Meets Fertility Benefits for Better At-Home Option

By JESSICA DaMASSA, WTF HEALTH

Trying to achieve pregnancy with fertility treatments can be challenging, stressful, and expensive in the best of times — let alone a global pandemic. Since the COVID-19 outbreak in the U.S., fertility care has been basically “paused,” and women attempting to conceive have been left with a very different set of decisions and options for care than were available pre-pandemic. So, how does fertility care shift from the clinic to the home? Tammy Sun, co-founder & CEO of fertility benefits startup Carrot Fertility, and Lea Von Bidder, co-founder & CEO of Ava, a women’s health tech startup best-known for its ovulation tracking bracelet, stop by to talk about how they are redefining the how, when, and where of fertility care for greater success outside the doctor’s office.

What’s smart about this partnership? How the two companies are working together to build off the biometric data collected by Ava’s tracker, basically adopting a remote monitoring approach to collecting and analyzing data in the home in effort to either help optimize the chances of getting pregnant naturally, or better inform the IVF or other medically-assisted procedures that will return as options as the pandemic wanes. From the impact on would-be-parents and their employers to the sentiment of women’s health investors, we talk through the opportunities and challenges of expanding fertility care in the home.

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