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Defund Health Care!

By KIM BELLARD

In the wake of the protests related to George Floyd’s death, there have been many calls to “defund police.”  Those words come as a shock to many people, some of whom can’t imagine even reducing police budgets, much less abolishing entire police departments, as a few advocates do indeed call for.

If we’re talking about institutions that are supposed to protect us but too often cause us harm, maybe we should be talking about defunding health care as well.  

America loves the police.  They’re like mom and apple pie; not supporting them is essentially seen as being unpatriotic.  Until recent events, it’s been political suicide to try to attack police budgets.  It’s much easier for politicians to urge more police, with more hardware, even military grade, while searching for budget cuts that will attract less attention.  

It remains to be seen whether the current climate will actually lead to action, but there are faint signs of change.  The mayor of Los Angeles has promised to cut $150 million from its police budget, the New York City mayor vowed to cut some of its $6b police budget, and the Minneapolis City Council voted to “begin the process of ending the Minneapolis Police Department,” perhaps spurred by seeing the mayor do a “walk of shame” of jeers from protesters when he would not agree to even defunding it.  

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The Medical-Industrial Complex Pads Its Pockets As We Empty Ours

By MIKE MAGEE, MD

A report this month published in the British Medical Journal found that 80% of 293 physician leaders and board members of 10 of the most influential medical associations in the United States (including the American College of Physicians, American College of Cardiology, American Psychiatric Association, Infectious Disease Society of America, American College of Rheumatology, the American Society of Clinical Oncology, Endocrine Society, American Thoracic Society, and Orthopaedic Trauma Association) received financial payments of $130 million in total for “leadership” activities between 2017 and 2019.

In doing so, they were replicating the behavior established in 1939 by Vannevar Bush. Born March 11, 1890, in Everett, Massachusetts, the only son of a Universalist preacher and the grandson of a whaler, Bush earned a math degree from Tufts, followed by a PhD in engineering from MIT. From the beginning of his career he straddled the academic and the industrial in a way that anticipated the future of almost all scientific research.

In 1939, with the Second World War consuming both Europe and Asia, the father of the Medical-Industrial Complex met with the president of Harvard University and the president of Bell Labs, and mapped out a strategy for overcoming our lack of scientific preparedness. Out of that small meeting came a short, four-paragraph proposal for a centralized science operation—outside the control of the military—which he presented to President Roosevelt on June 12, 1940.

The president read the report, seized his pen, and scratched at the top, “OK-FDR.” With that stroke, the National Defense Research Committee (NDRC) was created, and with it, the fully codified and institutionalized era of academic-industrial partnerships in research.

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RWJF Emergency Response Challenge Apps Closing Soon: Apply Today!

SPONSORED POST

By CATALYST @ HEALTH 2.0

The deadline to apply for the RWJF Emergency Response for the Health Care System and General Public Challenges is approaching FAST! The Emergency Response for the Health Care System Challenge is seeking digital tools that can support the health care system during a large-scale health crisis (pandemic, natural disaster, or other public health emergency). Examples include but are not limited to tools that can support providers, government, and public health and community organizations. The Emergency Response for the General Public Challenge is looking for consumer-facing health technology tools to support the needs of individuals whose lives have been affected by a large-scale health crisis.

How It Works:

  • In Phase I, innovators submit their tech-enabled solutions addressing the challenge topic. Judges will evaluate the entries based on Impact, UX/UI, Innovation/Creativity, and Scalability. The top five teams will move onto Phase II.
  • In Phase II, five semi-finalists will be awarded $1,000 each to further develop their application or tool. Three finalists will be chosen at the end of Phase II to participate in a virtual pitch and present their solutions to an audience of investors, provider organizations, and more. The grand prize winner will be awarded $25,000 for first place.
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Health in 2 Point 00, Episode 126 | A triple-episode ft. Bigfoot, Tictrac, Lifestance & many more

Today on Health in 2 Point 00, there’s been so much movement in digital health funding this week that we have a triple-episode. Bigfoot Biomedical raised $55 million in a Series C, Tictrac raised $7.5 million for employee wellness, Lifestance Health raised a whopping $1.2 billion, Maven acquired Bright Parenting, Higi raised $30 million, Bright.md raised $16.7 million, Tia raises $24 million, Doktor.se raising €45 million, Orbita raised $9 million, Curatio’s undisclosed A, Siren raised $11.8 million, 100plus raised $15 million, Ubie raised $18.7 million, Change Healthcare acquired 2 different companies—PDX for $208 million and ERX for $213 million, and special funds by Andreessen Horowitz and Softbank supporting founders of color. —Matthew Holt

More Women Are Pursuing Majority-Male Specialties and Changing Patients’ Perceptions

By AMY E. KRAMBECK, MD

With the exceptions of pediatrics and obstetrics/gynecology, women make up fewer than half of all medical specialists. Representation is lowest in orthopedics (8%), followed by my own specialty, urology (12%). I can testify that the numbers are changing in urology – women are up from just 8% in 2015, and the breakdown in our residency program here at Indiana University is now about 20% of the 5-year program.

One reason for the increase is likely the growth of women in medicine – 60% of doctors under 35 are women, as are more than half of medical school enrollees. I also credit a generational shift in attitudes. The female residents I work with do not anticipate hostility from men in the profession and they expect male patients to give them a fair shake. They may be right – their male contemporaries are more egalitarian than mine – but challenges still exist in our field.

Urologists see both men and women, but the majority of patients are male. Urology focuses on many conditions that only affect men such as enlarged prostate, prostate cancer, and penile cancer.  Furthermore, stone disease is more common in men, as are many urologic cancers such as bladder cancer and kidney cancer. So the greatest challenge for young women in urology is to gain acceptance among older men who require examination of their genital region and often need surgery. I’m hopeful that women entering urology today can meet that challenge, largely because we have already made significant progress. For the barriers we still face, leading urologists have blazed a clear path to follow with these three guideposts.

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THCB Gang, Episode 12

Episode 12 of “The THCB Gang” was live-streamed on Friday, June 5th from 1PM PT to 4PM ET. If you didn’t have a chance to tune in, you can watch it below or on our YouTube Channel.

Editor-in-Chief, Zoya Khan (@zoyak1594), ran the show! She spoke to economist Jane Sarasohn-Kahn (@healthythinker), executive & mentor Andre Blackman (@mindofandre), writer Kim Bellard (@kimbbellard), MD-turned entrepreneur Jean-Luc Neptune (@jeanlucneptune), and patient advocate Grace Cordovano (@GraceCordovano). The conversation focused on health disparities seen in POC communities across the nation and ideas on how the system can make impactful changes across the industry, starting with executive leadership and new hires. It was an informative and action-oriented conversation packed with bursts of great facts and figures.

If you’d rather listen, the “audio only” version it is preserved as a weekly podcast available on our iTunes & Spotify channels a day or so after the episode — Matthew Holt

Escaping COVID-19

By RAGHAV GUPTA, MD

“In seeking absolute truth, we aim at the unattainable and must be content with broken portions.”

William Osler

A colleague shared an experience with me about testing one of his patients for the novel coronavirus and it left me a bit puzzled.  An elderly gentleman with past medical history of severe COPD (chronic obstructive pulmonary disease) and heart failure came to the ER with shortness of breath, edema and fatigue.  Chest x-day suggested pulmonary edema.  He wanted to test him for SARS-CoV2 but hesitated.  Eventually he was able to order it after discussions with various staff administrators.  Dialogue included sentences like “why do we need testing? He has Congestive Heart Failure (CHF), not COVID-19” and “it could create panic amongst staff taking care of him”. I applauded his persistence as eventually the test was done.  To not test is counter-intuitive and more like an escape from diagnosing the virus rather than escaping the virus itself. 

One – the mere fact that we might hesitate before testing for a virus which is a cause of a (ongoing) pandemic should ring all the bells of concern about lack of an optimal strategy.  Inadequate testing has remained the Achilles heel of our stand against COVID-19 because to have a lasting stand, we must know where to take the stand.  

Two – the concern of CHF raised above is clinical and valid, but it is of grave importance to understand that CHF and COVID-19 are not mutually exclusive.  We now know that even the infamous flu and COVID-19 are not mutually exclusive.  Common protocols from a few months ago to test for flu in sick outpatients and not test for COVID-19 if flu was positive was like the prey closing its eyes and hoping the predator does not see it.  It did defer the use of an already scarce resource at the time, testing.  SARS-CoV2 is a virus and the disease caused by it is called COVID-19.  Virus can be ubiquitous; disease does not have to be.  A patient with CHF exacerbation can be an asymptomatic carrier of SARS-CoV2 but may not phenotypically express the disease manifestations of COVID-19.  Or may be his COPD or CHF exacerbation has happened due to a milder COVID-19 inflammatory response?  What we know about COVID-19 is that we don’t know enough about it and therefore we cannot rule out its presence.  Especially while we are in the middle of a growing pandemic.  

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Call for Applications: Bayer G4A Partnerships 2020

SPONSORED POST

By BAYER G4A

Digital health is changing the world

From chronic disease management to prevention, G4A’s goal is to empower people with the tools and access they need to take control of their health. G4A does this through fostering a diverse and vibrant ecosystem of digital health partners to support their growth and impact.

On April 20th, G4A launched its 2020 Partnership Program with an open call for applications. The aim of the Partnerships Program is to work with companies across the globe on healthcare’s toughest challenges and innovate together towards a future of integrated care. This year G4A is seeking to collaborate with companies that are making an impact in the following areas:

  • Cardiometabolic and Renal DiseasesHeart health requires a 360-approach that encompasses lifestyle behaviors, remote monitoring, biomarker review, risk stratification, and more
  • OncologyUtilizing targeted therapies and patient performance technologies can identify patients efficiently and slow disease progression
  • Women’s Health Novel approaches are needed to manage gynecological conditions such as PCOS and Endometriosis, as well as Menopause, and provide answers to the unique needs of women’s health
  • PharmacovigilanceThe opportunity for innovation in drug safety is huge, specifically as it relates to adverse event detection
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We Can’t Breathe

By KIM BELLARD

I was wondering what might crowd COVID-19 off the news.  The historic economic devastation caused by it has been subsumed into it, just another casualty of the pandemic.  In better times, perhaps SpaceX’s efforts would inspire us.  But, no, it took the police killing of yet another person of color to take our attention away.  

Now, let me say right off that I am not the best person to discuss George Floyd’s death and the woeful pattern it is part of.  I have certainly been the beneficiary of white male privilege.  I’ve never been unjustly pulled over or arrested.  I haven’t taken part in the protests.  But people like me need to speak out.  Writing about anything else right now seems almost irresponsible.  

OK: you’ve seen the video. You’ve heard Mr. Floyd protest that he can’t breathe, that the officer was killing him.  You’ve seen other officers stand by and not do anything — some even assisting — even as bystanders pleaded for them to let Mr. Floyd breathe.  It’s disturbing, it’s distressing, and it’s nothing new.  

I saw a video from one of the resulting protests where another officer restrained a protester — a black man, of course — in exactly the same way, although in this case another officer eventually moved the officer’s knee off the protester’s neck.  He’d learned what that video looked like.

There now have been protests in over 140 U.S. cities, with the National Guard mobilized in almost half the states.  Most protests have been peaceful, but there has been looting and there have been shootings. It’s a level of civil unrest not seen since the 1960’s.

And we thought it was bad when we just wanted the grocery stores to have toilet paper again, when wearing a mask was considered a hardship.

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The Lack of Persuasion as a Failure Against COVID-19

By RAFAEL FONSECA, MD

Reopening safely out of the current pandemic ought to be done via persuasion, not coercion.

It has been more than five months since the world first learned about COVID-19. Models predicted a sharp increase in the number of cases, and a seemingly high likelihood the pandemic would overwhelm our hospitals. These models were often inaccurate, and we have all come to learn about the imprecision of epidemiological prediction.  Nevertheless, the infection is far worse than anyone initially accepted – becoming a staple of our generation. Fearing uncountable deaths and the possible need to prioritize resources for those affected, initial government measures were put in place to curtail the spread of the virus. Images of the Lombardic tragedy compelled all to stay in place and wait for the storm to pass, and with few exceptions most complied. Realizing the gravity of the situation, governments gradually implemented measures to prevent infections.  With some vacillation, we evolved from travel restrictions, to social distancing, shelter in place and universal mask use.

As the pandemic ensued, we watched the horror stories taking place in New York City and Boston. Even while we are in the midst of the so-called first wave, with thousands of deaths per day, many have started to wonder how long society will remain isolated and locked. Politicians look to experts for recommendations regarding policies that might save lives, and for the most part they have complied. However, as the weeks ensue, we see growing jobless claims, lines for food banks, and impatience.

This brewing impatience is a response to an unknown future dictated by the vagaries of nature and the lack of a coherent strategy to resume a life with a resemblance to normal. The public searches for guidance from federal agencies, state governments, and health authorities. A lack of clear direction from these institutions has heightened this anxious impatience. Additionally, the conversation is now ideological, with an almost Manichaean division between those wanting to save lives more so than the economy, and vice versa, creating cartoons of opposing perspectives.  Even for those recognized as  accomplished, dissenting from orthodoxy is punished severely. In the background, the public’s patience is running thinner.

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