Month: October 2021

Get Ready for Deepfakes

Oct 13, 2021

By KIM BELLARD

The Tom Cruise TikTok deepfakes last spring didn’t spur me into writing about deepfakes, not even when Justin Bieber fell so hard for them that he challenged the deepfake to a fight. When 60 Minutes covered the topic last night though, I figured I’d best get to it before I missed this particular wave.

We’re already living in an era of unprecedented misinformation/disinformation, as we’ve seen repeatedly with COVID-19 (e.g., hydroxychloroquine, ivermectin, anti-vaxxers), but deepfakes should alert us that we haven’t seen anything yet.

ICYMI, here’s the 60 Minutes story:

The trick behind deepfakes is a type of deep learning called “generative adversarial network” (GAN), which basically means neural networks compete on which can generate the most realistic media (e.g., audio or video). They can be trying to replicate a real person, or creating entirely fictitious people. The more they iterate, the most realistic the output gets.

#Healthin2Point00, Episode 233 | Another $2B in deals, including Devoted’s whopping valuation

Oct 12, 2021

Today on Health in 2 Point 00, we’re thinking about changing our name to Health in 2 Billion 00. Devoted Health confirmed its $11 billion valuation, bumping it to $12 billion after you count the additional $1.2 billion coming in. Now onto the other 2 billion in deals, BetterUp raises $300 million in a Series C, bringing their total to $569.8 million for performance coaching and resilience training. Honor is growing fast – it raises $370 million ($300M of that is debt), bringing their total to $625M. Elemy, formerly called Sprout, raises $219 million, for children’s behavioral health. Finally, MindMaze raises $125 million, bringing their total to $235 million, working on gamifying digital neurotherapeutics. —Matthew Holt

Medicine is a Moving Missile, Aiming for a Dangerous, Elusive Target

Oct 11, 2021

By HANS DUVEFELT

(Desperate times called for desperate measures.)

In the tech world, we have come to expect our devices to become outdated and obsolete very quickly. The biggest tech companies in the world didn’t even exist a few years ago. Bitcoin, a virtual currency which at least I can’t wrap my head around, seems to be more attractive than gold.

I get the sense most people embrace or at least accept the speed of change in tech.

But medical advances that occur rapidly are frightening to many people. Vaccine hesitancy, for example, involves concerns and characterizations like “unproven” and “guinea pigs”.

But can we as a society strive for and reward rapid progress in one area and reject it in another, especially if we feel threatened by outside forces or phenomena – be that a virus, climate change or the collapse of our economy’s infrastructure like supply chains and raw materials.

Tech has its own momentum, more driven by profit motives than altruistism or a desire just to make peoples lives better. Medicine clearly has profit as a driving force, but also a goal of improving life for people. Curing or mitigating disease must rank higher than making life more convenient.

THCB Spotlights: Dan Goldsmith and Jennifer Goldsmith, Tendo

Oct 8, 2021

Today on THCB Spotlight, Matthew sits down with Tendo’s CEO, Dan Goldsmith, and President, Jennifer Goldsmith. Tendo is in the patient engagement space, and Jennifer tells us about the vision behind the company – to become that trusted connection between patients, clinicians, and caregivers via software that creates a seamless and consumer-driven experience throughout that care journey. They talk to us about the plethora of point solutions for patient engagement, and how the platform approach that Tendo takes is meant to support a patient’s comprehensive needs without placing the full burden on the patients themselves.

THCB Gang Episode 66 – Thurs October 7

Oct 7, 2021

Joining Matthew Holt (@boltyboy)on THCBGang were policy consultant/author Rosemarie Day (@Rosemarie_Day1) ; delivery & tech expert Vince Kuraitis (@VinceKuraitis); and Queen of all employer benefits related issues Jennifer Benz (@Jenbenz)

We dive into the latest machinations in Congress, talked a lit about the practicalities and impacts of vaccination mandates, and had a long discussion about the tech platforms being built out of incumbent health systems.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

State of Connecticut’s New ‘Episodes-of-Care Health Plan’ Could Be Key to Scaling Value-Based Care

Oct 7, 2021

By JESSICA DaMASSA, WTF HEALTH

Signify Health (NYSE: SGFY) has called their approach “Value-Based Care 2.0” and, today, they’ve received an important designation from CMS that could set an exciting precedent for scaling up episodes-of-care, value-based models for the under 65 commercial health insurance market. The plan to receive this important approval as an Advanced Alternative Payment Model (AAPM) is the State of Connecticut’s health plan – a massive plan that covers the State’s 220,000 employees and retirees. To talk about what this first-of-its-kind approval signals for the future of value-based payment models are the State of Connecticut’s Comptroller Kevin Lembo and Signify Health’s CEO Kyle Armbrester.

What’s so important here is the combination of episodes-of-care (which is like value-based care-lite) and the under-65 market (which is not as rich with value-based care case studies as the over-65 Medicare market). That a State government with a massive population of covered lives AND a vested interest in helping keep local hospitals and health systems vibrant economic engines in the community is leading the way on this novel payment model design is significant. And, Comptroller Lembo gives us the details about how he’s viewing it as a win-win – after quite a few battles along the way. To win in health innovation, you’ve got to follow the dollar! Tune into this chat to see where it’s headed as episodes-of-care models get a huge boost from CMS.

#Healthin2Point00, Episode 232 | Cue Health goes public + funding for Stellar, eVisit, & Neuroglee

Oct 7, 2021

Today on Health in 2 Point 00, Jess and I are at UCSF – we’ll be providing color commentary for the UCSF Health Awards, so tune in tonight for that. On Episode 232, Jess asks me about more deals including Stellar Health raising $60 million, Cue Health going public (and stealing the HLTH ticket), and eVisit raising $45 million for its telehealth solution. Finally, Neuroglee raises $10 million in an Alzheimer’s play. —Matthew Holt

The Vaccine Brawl – A Legal Battle in Process

Oct 6, 2021

By MIKE MAGEE

The power to mandate vaccines was litigated and resolved over a century ago. Justice John Marshall Harlin, a favorite of current Chief Justice Roberts, penned the 7 to 2 majority opinion in 1905’s Jacobson v. Massachusetts. Its impact was epic.

In 1905, Massachusetts was one of 11 states that required compulsory vaccinations. The Rev. Henning Jacobson, a Lutheran minister, challenged the city of Cambridge, MA, which had passed a local law requiring citizens to undergo smallpox vaccination or pay a $5 fine. Jacobson and his son claimed they had previously had bad reactions to the vaccine and refused to pay the fine believing the government was denying them their due process XIV Amendment rights.

In deciding against them, Harlan wrote, “liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own [liberty]…”

Of course, a state’s right to legislate compulsory public health measures does not require them to do so. In fact, as we have seen in Texas and Florida among others, they may decide to do just the opposite – declare life-saving mandates (for masks or vaccines) to be unlawful. At least 14 states have passed laws barring employer and school vaccine mandates and imposing penalties in Republican-controlled states already.

So state powers are clearly a double-edged sword when it comes to health care.

Questions anyone?

You Want to 3D Print What

Oct 5, 2021

By KIM BELLARD

You know we’re living in the 21^st century when people are 3D printing chicken and cooking it with lasers. They had me at “3D printing chicken.”

An article in NPJ Science of Food explains how scientists combined additive manufacturing (a.k.a, 3D printing) of food with “precision laser cooking,” which achieves a “higher degree of spatial and temporal control for food processing than conventional cooking methods.” And, oh, by the way, the color of the laser matters (e.g., red is best for browning).

Very nice, but wake me when they get to replicators…which they will. Meanwhile, other people are 3D printing not just individual houses but entire communities. It reminds me that we’ve still not quite realized how revolutionary 3D printing can and will be, including for healthcare.

The New York Times profiled the creation of a village in Mexico using “an 11-foot-tall three-dimensional printer.” The project, being built by New Story, a nonprofit organization focused on providing affordable housing solutions, Échale, a Mexican social housing production company, and Icon, a construction technology company, is building 500 homes. Each home takes about 24 hours to build; 200 have already been built.

We Shouldn’t Tolerate Sloppy Allergy Lists

Oct 4, 2021

By HANS DUVEFELT

The medication and allergy lists seem like they would be the most important parts of a health record to keep current and accurate. But we all see errors too often.

I think it shouldn’t be possible to enter an allergy without describing the reaction. Because without that information the list becomes completely useless.

The other day I saw a patient who needed an urgent CT angiogram. The allergy list said “All Contrast Materials”, which isn’t even “structured data entry”, and thus not recognized by the computer if my EMR (Me again, Greenway!) would have been clever enough to check for allergies when I order a CT scan.

After a lot of probing, the “allergy” in this case turned out to be a host of nonspecific, chronic symptoms after several lumbar CT myelograms in a short period of time many years ago.

Some people claim to be penicillin allergic because “it never works”. Others list ciprofloxacin or sulfa antibiotics because they get a yeast infection after taking them. Others were slightly nauseous after their first dose of an SSRI like fluoxetine or fatigued after starting gabapentin.

Some symptoms listed as allergies are poorly understood. For example, morphine causes itching in many patients, even skin manifestations like blushing as well as sweating. But this is not usually a histamine mediated symptom, and not an allergy. Other opioids, like hydromorphone, tend to have less risk for itching.

Cough from ACE inhibitors isn’t a true allergy, but we often note that in our allergy lists. People with this side effect can safely be switched to angiotensin receptor blockers, ARBs.