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A Whole New Ball Game. Same Problems to Solve, Though.

By STEVEN FINDLAY

I’ll dive right in, with the stipulation that this blog is initial reaction in a very fluid, unprecedented and soon-to-be even-more-intense political environment.  Fasten your seat belts!      

The ACA.   Replace is the critical word in “repeal and replace.”  Consensus is already emerging that Trump and the Republicans will indeed repeal the ACA in early 2017, via the reconciliation process Congress used earlier this year.  That resulted in the Senate’s first an only full ACA repeal vote.  Obama vetoed the bill, of course.   But Republicans demonstrated the do-ability of the reconciliation process.   Lacking 60 votes in the Senate, they’ll very likely try repeal again that way. Continue reading…

Apple Watch Leaves Patients Connected with No Where To Go

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By GRACE CORDOVANO, Ph.D., BCPA

The highly anticipated unveiling of the Apple Watch Series 4 caused a news and social media sensation. Apple coined the iconic timepiece as the “guardian of your health”, with health tracking functionalities such as the ability to detect atrial fibrillation (AFib) by a self-performed electrocardiogram (ECG). But from patients’ and carepartners’ perspectives, there is a long road to a universally accessible, seamlessly implemented, mass-adoption, and meaningful use for this wearable technology.

Many experts, such as Dr. Eric Topol a cardiologist at the Scripps Research Institute, and other reports, were quick to highlight concerns about the consequences of false positives. The Apple Watch was criticized as a source for unnecessary anxiety. A letter from the Center for Devices and Radiological Health (CDRH) of the FDA, which cleared the ECG app as a class II over-the-counter (OTC) device, highlighted the risks to health and potential mitigation measures that the Apple Watch posed. Unfortunately, the vast majority of concerns in the public domain haven’t emphasized the risks to health due to poor implementation, integration, and adoption strategies of digital tools and wearables.

The current health care system needs to be significantly refreshed as it is not positioned to simply drop in advancements, such as those offered by the Apple Watch Series 4, into everyday patient care. Having Dr. Ivor Benjamin, president of the American Heart Association (AHA), endorse the Apple Watch at the Apple Keynote Event did wonders for the mass marketing appeal. It would’ve have been more credible and demonstrated more value if he stated that the AHA devised a strategic clinical practice implementation guide for cardiologists, created patient education materials for using the Apple Watch, partnered with payers to incentivize doctors to adopt the technology, and reimburse for virtual consults to support remote patient monitoring (RPM).

Continue reading…

Will Apple Track Your Mind, Not Just Your Heart?

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By MICHAEL MILLENSON

If your heart throbs with desire for the new Apple Watch, the Series 4 itself can track that pitter-pat through its much-publicized ability to provide continuous heart rate readings.

On the other hand, if you’re depressed that you didn’t buy Apple stock years ago, your iPhone’s Face ID might be able to discover your dismay and connect you to a therapist.

In its recent rollout of the Apple Watch, company chief operating officer Jeff Williams enthused that the device could become “an intelligent guardian for your health.” Apple watching over your health, however, might involve much more than a watch.

The iPhone models introduced at the same time as the Series 4 all deploy facial analysis software. The feature works in part by projecting a grid of more than 30,000 infrared dots on the user’s face in order to create a three-dimensional map for user recognition. Continue reading…

THCB Spotlights: MIRA Fertility Tracker

By ZOYA KHAN

A couple weeks back, Matthew met with MIRA Fertility Tracker at TechCrunch Disrupt 2018. Sylvia Kang, CEO & Co-founder of MIRA, spoke to Matthew about her new fertility tester for women trying to track their cycles. It also has an AI component built into its system, in order to inform women the days they are most likely to get pregnant. MIRA also took center stage at #Health2con’s Venture Connect, placing 1st among a series of talented health tech startups. 

Zoya Khan is the Editor-in-Chief of THCB as well as an Associate at SMACK.health, a health-tech advisory services for early-stage startups.

Health in 2 Point 00 Episode 51

In this Episode of #healthin2pt00 Jess & I do a real recap of the Health 2.0 Conference. I mention some of the startups that I thought were great, including Supportiv, Tag.bio, Nebula Genomics, Bluestream Health, Medically Home, b.well, and Medsafe. I also want to highlight Krista from Project HEAL that started an organization to raise awareness about mental health & eating disorders. We also discuss #CMS and Ro receiving $88 million in its funding round- Matthew Holt

“Remember that Oath?”: EPCS and the Fight Against Opioid Abuse

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By SEAN KELLY, MD

As doctors, we all took an oath when we graduated from medical school to “do no harm” to patients. It is, therefore, our duty to speak up and take action when there is an opportunity to prevent harm and improve patient care, safety and well-being. On average, the opioid crisis is killing more Americans on a monthly basis than traumatic injuries. It is time for the medical community to raise its voice even more loudly in support of proven technology that helps curb this crisis.

This month, California Governor Jerry Brown became the latest state lawmaker to embrace electronic prescribing for controlled substances (EPCS) — joining nearly a dozen other states that have passed legislation mandating that health care providers and pharmacies use the technology. The Golden State law was signed at the same time the U.S. Senate passed a bill requiring e-prescriptions for any reimbursement under Medicare Part D.

Clearly, EPCS is emerging as a key tool in the fight against opioid abuse. And legislators aren’t alone in driving the trend — corporations are playing a key role as well. Walmart, one of the nation’s largest pharmacy chains, is requiring EPCS by January 1, 2020. In their press release, it was noted that “E-prescriptions are proven to be less prone to errors, they cannot be altered or copied and are electronically trackable.”

Continue reading…

Limitations of Randomized Controlled Trials

By SAURABH JHA

In the hierarchy of evidence-based medicine (EBM), randomized controlled trials (RCTs) are like Brahmins. But do Brahmins have flaws? I discuss these flaws with Dr. Anish Koka, a cardiologist, and essayist who has written extensively about RCTs in THCB.

Listen to our conversation at Radiology Firing Line Podcast.

About the author:

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partners

Health in 2 Point 00 Episode 50

Wow, today is the 50th Episode of Health in 2 Point 00. On today’s episode, we have something special for you: an Epic Guest Takeover at the Health 2.0 Conference from the “intellectual capital” (as Jessica puts it) that exists today in health care & health tech. Guest Starring Rasu Shrestha, UPMC; Daniel Kraft, Singularity University; Kyra Bobinet, engagedIN; Eugene Borukhovich, Bayer. I may or may not have given my two cents in the 2 minutes–Matthew Holt

A Guide to Making Machine Learning Work in Health Care

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Apologies on the hiatus for posting on THCB. As many of you know, I was running around getting Health 2.0 in order this past weekend. Today we are featuring a piece on understanding how machine learning can actually work in health care today-Matthew Holt

 

 
 
By LEONARD D’ AVOLIO, PhD

 

There’s plenty of coverage on what machine learning may do for healthcare and when. Painfully little has been written for non-technical healthcare leaders whose job it is to successfully execute in the real world with real returns. It’s time to address that gap for two reasons.

First, if you are responsible for improving care, operations, and/or the bottom line in a value-based environment, you will soon be forced to make decisions related to machine learning. Second, the way this stuff actually works is incredibly inconsistent with the way it’s being sold and the way we’re used to using data/information technology in healthcare.

I’ve been fortunate to have spent the past dozen years designing machine learning-powered solutions for healthcare across hundreds of academic medical centers, international public health projects, and health plans as a researcher, consultant, director, and CEO. Here’s a list of what I wish I had known years ago.

Continue reading…

A Rosa Parks Moment is Coming in Phase 1 Cancer Trials

By DAVID C. NORRIS, MD

I want to tell you about the most exciting discovery I’ve made in 2+ years of research on dose individualization methods for phase 1 cancer trials. This discovery has nothing to do with any of the technical problems I’ve confronted and solved along the way. It involves no gigantic equation, no table of simulations results, and no colorful plot. Rather, it’s a discovery about sources of power to innovate in drug development.

In general, how would you describe the balance of power between Big Pharma and the individual patient? The question seems ludicrous—maybe even offensive—in light of ongoing scandals with price-hikes and shortages for critical drugs. But in the special area of trial methodology, I’ve got a real surprise for you…

One result from my DTAT research has been a clear demonstration that 1-size-fits-all dose finding in phase 1 cancer trials can cut the value of a drug in half, or even drop it to zero by setting the drug up for failure in phase 2 or 3. Although this economic argument has never been made quite so explicit and rigorous, I am certain the underlying principle comes as no surprise to anyone. (I note hardly anyone bats an eye when I detail the math.) Continue reading…

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