Year: 2017

The High Cost of Public Reporting

Sep 18, 2017• 31

ANISH KOKA MD

In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe.

Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear. He loved guitar playing, and camp horror movies. Those who knew him well said he had a kind heart, a quick wit and loved cats.

I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon. I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack. Not able to make sense of the story on the phone, I was in to try to sort it out. Joe was gruff, short with his answers – but clearly something just wasn’t right. He was only 54 but had more problems than the average 50 year old. Progressive calcification of his aortic valve some years ago had caused intolerable shortness of breath resulting in replacement with an artificial valve. Longstanding diabetes had resulted in kidney failure and dialysis, and most recently abnormal liver tests had revealed the presence of the early stages of cirrhosis from hepatitis C. Yet Joe continued to live an active life – with only a tight circle of family and friends aware of the illnesses beneath the surface.Continue reading…

DACA Repeal is Bad for Medical Students, Healthcare, and the Public

Sep 16, 2017• 5

BY SUHAS GONDI

The Trump administration’s recent announcement to end the Deferred Action for Childhood Arrivals (DACA) program instilled fear and outrage in communities across the country. As a medical student with friends and classmates with DACA status, I am particularly disappointed in the poor and compassionless judgment of our nation’s leader. I fear for my peers who have worked incredibly hard and overcome the most daunting of obstacles to get where they are today, and who now could see it all taken away from them. Their now tenuous situation is unimaginable to me. But I also fear the impact of this decision on my non-DACA classmates, on our training, and on our futures. There is certainly a moral case to keep DACA alive, but the effects of its repeal on the healthcare system writ large make apparent that it’s also a bad idea for all Americans.

The American Medical Association (AMA) letter to Congress spells out many of the reasons why. Study after study has shown that, due to multiple demographic changes, physician demand will far outpace supply over the next decade. By 2030, the US will face an estimated shortfall of up to 104,900 physicians. Even now, we are witnessing how a lack of doctors in rural and other federally designated Health Professional Shortage areas results in inadequate access to care for too many, and directly contributes to worse health. As AMA CEO James Madara wrote in the letter, “the DACA initiative could help introduce 5,400 previously ineligible physicians into the U.S. health care system in the coming decades,” and work towards alleviating this persisting issue.

Why a Silicon Valley Approach Can’t Work for Health Tech

Sep 15, 2017• 4

By AMELIA EDWARDS

Imagine if I told you that there was a pool of close to 600,000 individuals in New York City who were ripe for innovative health technology integration. You probably wouldn’t believe me and say that it sounded too good to be true. This said pool does in fact exist and can be found concentrated within the city’s public housing.

While entrepreneurs, governmental leaders, and healthcare officials constantly speak of innovation and disruption, there seems to be a major disconnect between these words and actual creativity. This large, untapped pool of individuals who fall under the New York City Housing Authority’s (NYCHA) umbrella is one example of the lack of creative, and truly disruptive practices, that I see in today’s early stage ecosystem.

In health tech, we have all too readily accepted the Silicon Valley model of startups and attempted to force healthcare to fit within this mold. Startup mythology has encouraged us to look at disruption as a four step model:

Develop a pitch deck and product
Raise Money
Experience success, a TechCrunch article, and wealth
Exit out with acclaim and glamour

7 Ways We’re Screwing Up AI in Healthcare

Sep 14, 2017• 8

BY LEONARD D’AVOLIO

The healthcare AI space is frothy. Billions in venture capital are flowing, nearly every writer on the healthcare beat has at least an article or two on the topic, and there isn’t a medical conference that doesn’t at least have a panel if not a dedicated day to discuss. The promise and potential is very real.

And yet, we seem to be blowing it.

The latest example is an investigation in STAT News pointing out the stumbles of IBM Watson followed inevitably by the ‘is AI ready for prime time’ debate. If course, IBM isn’t the only one making things hard on itself. Their marketing budget and approach makes them a convenient target. Many of us – from vendors to journalists to consumers – are unintentionally adding degrees to an already uphill climb.

If our mistakes led to only to financial loss, no big deal. But the stakes are higher. Medical error is blamed for killing between 210,000 and 400,000 annually. These technologies are important because they help us learn from our data – something healthcare is notoriously bad at. Finally using our data to improve really is a matter of life and death.

Which of These 10 New Companies Will Change the Face of Health care?

Sep 13, 2017

BY HEALTH 2.0

The Health 2.0 Fall Conference is the perfect place for new and young companies to get a foot in the door – to generate industry buzz, obtain critical funding and pitch new partners.

Our lineup includes:

Our exclusive Launch! event – 10 companies will debut their solutions and have them voted on by the audience.

Henk Jan Scholten, a co-founder of last year’s winner – Siren Care – said, “Launch! was the ideal platform for our product because it’s not only laser-focused on digital health but also has a stellar industry reputation and strong following of innovators and thought leaders. Showcasing our product with a live patient demo on stage gave us instant credibility that is hard to achieve.”

Be sure to also attend Traction, which puts Series A-ready companies center stage as they compete to be recognized as the most fundable start-up from venture capitalists and corporate investors.

Why Doctors (And Everybody Else) Should Read Books by Nassim Taleb

Sep 12, 2017• 5

By SAURABH JHA, MD

“There are some enterprises in which a careful disorderliness is the true method” – Herman Melville, Moby Dick

Asymmetry of Error

During the Ebola epidemic calls to ban flights from Africa from some quarters were met by accusations of racism from other quarters. Experts claimed that Americans were at greater risk of dying from cancer than Ebola, and if they must fret they should fret more about cancer than Ebola. One expert, with a straight Gaussian face, went as far as saying that even hospitals were more dangerous than Ebola. Pop science reached an unprecedented fizz.

Trader and mathematician, Nassim Taleb scoffed at these claims. Comparing the risk of dying from cancer to Ebola was flawed, he said, because the numerator and denominator of cancer don’t change dramatically moment to moment. But if you make an error estimating the risk of Ebola, the error will be exponential, not arithmetic, because once Ebola gets going, the changing numerator and denominator of risk makes a mockery of the original calculations.

The fear of Ebola, claimed Taleb, far from being irrational, was reasonable and it was its comparison to death from cancer and vending machines which was irrational and simplistic. Skepticism of Ebola’s impact in the U.S. was grounded in naïve empiricism – one which pretends that the risk of tail events is computable.

Dear Republicans, There Are Second Acts In Washington

Sep 12, 2017• 1

By STEVEN FINDLAY

Nazis and white supremacists. Charlottesville. Immigration policy and DACA. Climate change. In the context of these issues, there’s been much discussion of late about moral and ethical principles and American values.

There is, of course, no moral equivalency between white supremacists and those who oppose and protest them. People who advocate white supremacy are just plain wrong, on moral grounds.

And the Trump administration is clearly pursuing a path on immigration policy and climate change that is contrary to the ethical standards and values of the vast majority of Americans. I would add to this list the expansion of health insurance coverage. If anything is clear after this summer’s failed attempt by Republicans to repeal the ACA it’s that almost all Americans now support universal coverage.

And, more to the point, people see this increasingly in moral terms. They get it. It took many years—decades—to get to this point. But this summer’s debate clarified what our values are as a nation on access to health care via the structure of insurance, private and public.

Is It time For Physicians to Unionize?

Sep 12, 2017• 4

By NIRAN AL-AGBA, MD

Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the ‘working population’ from inequality, gaps in wages, and a political system failing to represent specific industry groups. Historically, unions organize skilled workers in a specific corporation, such as a railroad or production plant, however unions can organize numerous workers within a particular industry. Known as “industrial unionism”, the union gives a profession or trade a collective and representative voice. The existence of unions has already been woven into the political, economic, and cultural fabric of America; recent events suggest that it may be time for physicians and surgeons to unionize.

A labor union, is a body of workers who come together to achieve common objectives, such as improved safety, higher pay and benefits, and better working conditions. Union leadership bargains with employers on behalf of union members to negotiate labor contracts (collective bargaining.) This may include the negotiation of wages, work rules, complaint procedures, and regulations governing hiring, firing and promotion, or workplace policies.

The Decline and Fall of the Doctor-Patient Relationship

Sep 9, 2017• 12

By PAUL KECKLEY

The physician-patient relationship is a bedrock of the U.S. health system. Strong relationships are associated with higher ratings for physicians and better outcomes for patients but there’s a catch.

In Secretary of Health and Human Services’ Tom Price Senate confirmation and many times since, he has vowed his administration will seek to restore that relationship. But what patients associate with a strong relationship is increasingly at odds with how physicians think. And the gap between the two seems to be widening.

Background:

Per the American Medical Association, the physician-patient relationship is a formal or inferred relationship between a physician and a patient, which is established once the physician assumes or undertakes the medical care or treatment of a patient. It is a responsibility physicians don’t take lightly and most believe they do it well.

The physician-patient relationship has been widely studied. A framework developed by Ezekiel and Linda Manuel has been widely used to categorize the four roles physician play in these relationships: guardian, technical expert, counselor, and friend. In interacting with patients, physicians play all four. Researchers have linked a physician’s personality with their bedside manner. Surveys show most physicians lean toward a more paternalistic approach in dealing with patients and the majority think friendships with patients must be approached with caution. Academics have studied the dynamic between physicians and patients, observing that the physician is the ‘power’ figure in most. Studies have linked a physician known to have a prickly personality with more patient complaints and, in some specialties, a higher susceptibility to lawsuits. And physicians routinely compare notes among themselves about problem patients with whom interactions are routinely difficult.

The Best Positioned Tech Giant in Healthcare Today? The Answer May Surprise You.

Sep 7, 2017• 8

By DAVID SHAYWITZ, MD

When you think about tech giants playing in healthcare, you think of Google and the work Verily is doing; you think of Apple and their HealthKit and ResearchKit applications, as well as their rumored plans to organize all your medical data on your iPhone; you may even think of Amazon and their potential entry into the pharmacy market.

But the name you may hear about least–Facebook–may actually be the company influencing healthcare the most, and may also be the best positioned to support the patient-centered future that so many imagine and that Eric Topol described in The Patient Will See You Now (my Wall Street Journal review here).

At first blush, Facebook seems to be doing remarkably little in health; their most notable effort has arguably been providing the opportunity to list your organ donor status, an initiative which produced an immediate lift in organ donor registrations.