Author Archives

Christina Liu

Five Weight Loss Myths I am Constantly Fighting

May 13, 2021• 5

By HANS DUVEFELT

1) EXERCISE MORE

I talk to people almost every day who think they can lose weight by exercising. I tell them that is impossible. I explain that it takes almost an hour of brisk walking to burn 100 calories, which equals one apple or a ten second binge on junk food. To lose a pound a week, you need to reduce your calorie intake by about 500 per day – that would be the equivalent of five hours of moderate exercise every day. We’d have to quit our jobs to do that.

2) EAT MORE FRUITS AND VEGETABLES

The other fallacy I hear all the time is that, somehow, adding “healthy” fruits and vegetables can make a person lose weight. I tell them that adding anything to their daily calorie intake will have the opposite effect. I more or less patiently explain that our job is to figure out what to take away instead of what to add. Maybe substituting a fruit for a Whoopie pie is healthy in other ways, but it has almost nothing to do with weight loss.

3) EAT BREAKFAST

A third fallacy is that eating a healthy breakfast will ensure weight loss. To explore this one, I ask: “Are you often hungry?”

So many of my overweight patients deny ever feeling hungry – that gnawing feeling in the pit of your stomach and the low blood sugar onfusion and weakness I feel by 9 or 10 am after doing barn chores on an empty stomach (only coffee).

When I hear “I never feel hungry”, I don’t recommend starting a good breakfast habit because that would likely increase a person’s daily calorie intake. But when I hear that a breakfast skipper goes for the doughnuts mid morning due to hunger, I certainly recommend eating breakfast. When I do, I always point out that the typical American cereal and banana breakfast, along with soft drinks, is actually the major reason for our obesity and diabetes epidemics.

A Timex Healthcare System

May 12, 2021• 1

By KIM BELLARD

Those of us of a certain age remember the Timex slogan that bragged about its watches’ durability: “It takes a licking and keeps on ticking.” A recent article about our military, of all things, made me wish we had a healthcare system that prized that kind of durability.

I can never resist analogies between the U.S. healthcare system and the U.S. military system. They’re both huge, they’re both wildly expensive, they both rely on a combination of high tech and front-line people, and they both protect us from threats. In some ways, both are the best in the world, and, in other ways, both have weaknesses that are embarrassing. And, as I wrote last year, both are often still fighting the wrong wars.

The article is by national security expert JC Herz on the Atlantic Council’s website: A plea to the Pentagon: Don’t sacrifice resilience on the altar of innovation. Boy, that sure applies to healthcare too.

Ms. Herz notes how Americans love innovation, but:

This mythos informs a narrative that what is valuable is The New—the upgrade to something bigger, badder, and sexier…What the United States needs to reinvigorate its defense base, compete with China, and win the global economy must be more innovation.

Except the United States does not suffer from a lack of innovation; it suffers from a lack of resilience.

Screening for Depression: Then What?

May 11, 2021• 1

By HANS DUVEFELT

Primary Care is now mandated to screen for depression, among a growing host of other conditions. That makes intuitive sense to a lot of people. But the actual outcomes data for this are sketchy.

“Don’t order a test if the results won’t change the outcome” was often drilled into my cohort of medical students. Even the US Public Health Service Taskforce on Prevention admits that depression screening needs to take into consideration whether there are available resources for treatment. They, in their recommendation, refer to local availability. I am thinking we need to consider the availability in general of safe and effective treatments.

If the only resource when a patient screens positive for depression is some Prozac (fluoxetine) at the local drugstore, it may not be such a good idea to go probing.

The common screening test most clinics use, PHQ-9, asks blunt questions about our emotional state for the past two weeks. This, in my opinion, fits right into the new American mass hysteria of sound bites, TikTok, Tweets, Facebook Stories, instant messages, same-day Amazon deliveries and our worsening pathological need for stimulation and instant gratification.

10 Design Considerations for Vaccine Credentials

May 10, 2021

By ADRIAN GROPPER

As COVID-19 vaccines become widely, if not fairly, available in different regions, both the public and private sector are working to develop vaccine credentials and associated surveillance systems.

Information technology applied to vaccination can be effective, but it can also be oppressive, discriminatory, and counter-productive.

But these systems can be tuned to reflect and address key concerns.

What follows is a list of ten separable concerns, and responsive design strategies. The concept of separation of concerns in technology design offers a path to better health policy. Because each concern hardly interacts with the others, any of them can be left out of the design in order to prioritize more important outcomes. Together, all of them can maximize scientific benefit while enhancing social trust.

Authenticity

An inspector should be assured that a vaccine certificate was not tampered with and that it was issued to the presenter. This need not imply any privacy risk, or even need a network connection. One such method for authenticating vaccine credentials adds a human-recognizable and machine-readable face photo to a standard 2D barcode. It works with paper as well as mobile phone presentations.

The digital divide

For this concern, paper credentials have equity and privacy advantages. Equity, because paper is cheap and well understood. Privacy, because there is no expectation that a person must unlock and show a mobile phone. Digitally signed certificates that also include a photo, like #1 above, can be copied for convenience without risk of fraud.

“Necessitous Men Are Not Free Men” – Words to Remember

May 7, 2021• 2

By MIKE MAGEE

In the second half of the 19^th century, Emily Dickinson wrote a short poem that could easily have been a forward looking tribute to two American Presidents – one from the 20^th, the other the 21^st century.

Dickinson’s poem “A WORD is dead” is hardly longer than its title.

“A WORD is dead

When it is said,

Some say.

I say it just

Begins to live

That day.”

She certainly was on the mark when it came to President Franklin Delano Roosevelt’s signature legislation. FDR’s New Deal, extending from 1933 to 1939, ultimately came down to just three words – the 3R’s – Relief , Recovery, and Reform.

He promised “Action, and action now!” This included a series of programs, infrastructure projects, financial reforms, a national health care program and industry regulations, protecting those he saw as particularly vulnerable including farmers, unemployed, children and the elderly. And he wasn’t afraid to make enemies. Of Big Business, he said in a 1936 speech in Madison Square Garden, “They are unanimous in their hate for me – and I welcome their hatred.”

But he was also a political realist. And by his second term of office Justice Hughes and his Conservative dominated Supreme Court had begun to undermine his legislative successes and were threatening his signature bill- the Social Security Act. So FDR compromised, and in the face of withering criticism from the AMA, postponed his plans for national health care.

#Healthin2Point00, Episode 204 | Vida, Headway, & Neuroelectrics, plus RCM acquires VisitPay

May 6, 2021

Today on Health in 2 Point 00, I am over the moon excited about Chelsea’s Champion’s League semi-final win. But on Episode 204, we have some big deals to cover too. First, Vida Health gets $110 million in a Series D bringing their total to $188 million. Next, R1 RCM acquires VisitPay for $300 million, integrating patient financial engagement into their revenue cycle management offerings. It’s Mental Health Awareness Month, and mental health startup Headway raises $70 million – do they have a chance in that crowded space? Finally, Neuroelectrics gets $17.5 million for their neurostimulation cap helping with epilepsy and depression. —Matthew Holt

Inside Vida Health’s $110M Series D & Big Push into Digital Mental Health

May 5, 2021

By JESSICA DaMASSA, WTF HEALTH

It’s another mega-round for a digital health chronic condition management startup, as Vida Health closes its $110M Series D – AND adds a pair of big-name insurers to their cap table. Vida’s Founder & CEO, Stephanie Tilenius, gets into the good news about the funding round, which was led by growth equity fund, General Atlantic, and brought managed care giant Centene (a Vida customer) and multinational insurer AXA into the mix.

Beyond the funding – and the extra “insurance side” endorsement it gives to the virtual chronic condition care space – what’s interesting about Vida now is how its “whole person” approach, which integrates physical health care and mental health care, is very much tilting to mental health these days.

While overall revenue has tripled since last year, Stephanie talks about how the 6000% year-over-year growth for her mental health services has played into that rise, and how the new funding will be used to further expand those offerings.

Does this mean we need to start naming Vida as a competitor to digital mental health companies like Ginger, Modern Health, and Talkspace? And, how does this impact their positioning among the field of other health tech chronic care co’s? For those who may have forgotten, Vida went out the gate with a platform that was designed to treat both the mental-and-physical aspects of chronic disease, while others like Omada and Livongo-now-Teladoc acquired-and-integrated behavioral health providers to augment their physical-first offerings and satisfy customer demands. Will it now prove easier for Vida to scale-up and scale-out, having been built for both “mind and body” from the very beginning? Stephanie’s got her opinion, big plans, and now a treasury to rival those key competitors across both fields of care. Tune in for all the details!

#Healthin2Point00, Episode 203 | Privia goes public, Vocera acquires PatientSafe Solutions & more

May 4, 2021

Today on Health in 2 Point 00, Jess hardly knows the value of $100 million anymore – is it a salary, is it an entire fund, is it one single round? On Episode 203, Jess and I cover Vocera buying PatientSafe Solutions and Privia going public with a $3.7 billion market cap. Cash-paid healthcare services company Sesame gets $24 million in a Series B, Ceribell gets $53 million in a Series C for its portable EEG, and Summus Global gets $21 million in a Series B providing virtual specialist care. —Matthew Holt

We Are All Designers

May 4, 2021

By KIM BELLARD

Raise your hand if you had to go through the Hunger Games labyrinth to score a COVID-19 vaccine earlier this year – figuring out which phone number(s)/website(s) to try, navigating it, answering all the questions, searching for available appointments within reasonable distances, and, usually, having to try all over again. Or, raise your hand if you’ve had trouble figuring out how to use an Electronic Health Record (EHR) or an associated Patient Portal.

Maybe you thought it was you. Maybe you thought you weren’t tech-savvy enough. But, a trio of usability experts reassure us, it’s not: it’s just bad design. And we should speak up.

“Everyone everywhere: A distributed and embedded paradigm for usability,” by Professors Michael B. Twidale, David M. Nichols, and Christopher P. Lueg, was published in Journal of the Association for Information Science and Technology (JASIST) in March, but I didn’t see it until the University of Illinois School of Information Sciences (where Dr. Twidale is on faculty) put out a press release a few days ago.

The authors believe that bad design has costs — to users and to society — yet: “The total costs of bad usability over the life of a product are rarely computed. It is almost like we as a society do not want to know how much money has been wasted and how much irritation and misery caused.”

Whatever the numbers are, they’re too high.

As Dr. Twidale said:

Making a computer system easier to use is a tiny fraction of the cost of making the computer system work at all. So why aren’t things fixed? Because people put up with bad interfaces and blame themselves. We want to say, ‘No, it’s not your fault! It is bad design.'”

He specifically referenced the vaccine example: “When hard to use software means a vulnerable elderly person cannot book a vaccination, that’s a social justice issue. If you can’t get things to work, it can further exclude you from the benefits that technology is bringing to everyone else.”

Digital Mental Health Hits Mainstream: Cigna’s Behavioral Health CMO on National Rollout of Ginger

May 3, 2021

By JESSICA DaMASSA, WTF HEALTH

Cigna is making digital mental health services available to its entire nationwide network of 14 million members, and it’s selected health tech startup, Ginger to deliver the new benefit. Cigna’s Chief Medical Officer for Behavioral Health, Doug Nemecek, and Ginger’s CEO, Russ Glass, stop by to discuss the deal and why Cigna is making such a commitment to expanding its behavioral health offering.

This is about more than just dealing with mental health in the aftermath of Covid; Cigna is actually looking at Ginger’s behavioral health coaching model as preventative. Will other health plans follow suit? Could expanded coverage for lower-acuity mental health services become commonplace? Doug talks about what’s ahead for mental health care from a population health standpoint, and how services like Ginger’s give primary care docs a standard, trusted provider to which they can refer patients when it comes to increasingly common concerns like depression and anxiety. For Russ and Ginger, who talk about using virtual care to right the “supply-and-demand imbalance” in mental health care, what will more than doubling their current client base (from 10 million to 24 million) do to their own ability to provide supply? It’s a moment-of-truth for the business of digital mental health and we’ve got the details!