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Rethinking Newer Events

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BY KIM BELLARD

It’s a lot more fun to write about exciting new technologies, or companies in other industries that healthcare could learn from, than to pick on healthcare for its many, well-known shortcomings, but there was an article in JAMA Forum last week that I had to note and perhaps expand on: A New Category of “Never Events” – Ending Harmful Hospital Policies, by  Dave A. Chokshi, MD, MSc and Adam L. Beckman, BS (he is also an MD/MBA student).  

The concept of a “Never Event” is well known by this point.  Coined some twenty years ago by Ken Kizer, MD of the National Quality Form (NQF) and soon widely adopted and expanded, it recognizes that healthcare sometimes has egregious errors that shouldn’t happen:  the wrong foot is amputated, the wrong drug/dosage is given, surgical instruments are left inside a patient, and so on.  Organizations like The Leapfrog Group exist largely to try to measure and compare hospitals on such patient safety issues.

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Interview: Sarah MacDonald, Author, The Cancer Channel

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by MATTHEW HOLT

I met Sarah MacDonald in the early 2000s. She is the ultimate extrovert who sings, cooks, maintains a huge circle of friends, and lives life to the fullest–all at a pace & level most of us can’t imagine. In the early 2010s Sarah was flying high. Newly married, trying to get pregnant, all while being a Silicon valley business exec who had increasingly senior roles at eBay. Then in 2012 she was diagnosed with two completely separate types of cancer. And in her head “The Cancer Channel” started playing nonstop.

That became the title of her book. I just read it and I literally couldn’t stop. It’s practical, it’s heart-wrenching, it’s warm, it’s funny (yes, funny!). And it’s an amazing look at the exact experience of someone going through cancer. Or in this case cancer x 2. I was lucky enough to interview Sarah (so there is a very happy ending). So please watch this and buy & read the book

The Secret Surveillance Capitalism That Suffuses Medicare

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By MICHAEL MILLENSON

Imagine a government program where private contractors boost their bottom line by secretly mining participants’ personal information, such as credit reports, shopping habits and even website logins.

It’s called Medicare.

This is open enrollment season, when 64 million elderly and disabled Americans choose between traditional fee-for-service Medicare and private Medicare Advantage (MA) health plans. MA membership is soaring; within a few years it’s expected to encompass the majority of beneficiaries. That popularity is due in no small part to the extra benefits plans can provide to promote good health, ranging from gym membership and eyeglasses to meal delivery and transportation assistance.

There is, however, an unspoken price for these enhancements that’s being paid not in dollars but in privacy. To better target outreach, some plans are routinely accessing sophisticated analytics that draw upon what’s euphemistically labeled “consumer data.” One vendor boasts of having up to 5,000 “certified variables for every adult in America,” including “clinical, social, economic, behavioral and environmental data.” 

Yet while companies like Facebook and Google have faced intense scrutiny, health care firms have remained largely under the radar. The ethical issue is obvious. Since none of this sensitive personal information is covered by the privacy and disclosure rules protecting actual medical data, it is being deliberately used without disclosure to, or explicit consent by, consumers. That’s simply wrong.

But a more fundamental concern involves the analyses themselves.

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Pfizer’s Biotech Strategy: When a “Market Force” Partners with a “Market Mover”

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by JESSICA DAMASSA, WTF HEALTH

The synergistic relationship between biotech’s and biopharma’s can dramatically change the way new drugs and vaccines are bought to market – helping advance innovation on BOTH sides in a very mutually beneficial way. I’ve got an inside look at how Pfizer is working with emerging biotech start-ups, thanks to this in-depth chat with Pfizer’s Senior Vice President of Business Innovation, Kathy Fernando.

Kathy is not only responsible for developing relationships with biotech’s on behalf of Pfizer, BUT during the pandemic she led Pfizer’s mRNA scientific strategy, which was integral to its ability to rapidly develop the Covid-19 vaccine. We geek out on the “cool science” that mRNA is – AND the new platforms that biotech’s are bringing to the table – and talk about the impact both are making on the business of Big Pharma, the hot biotech investment space, and, most importantly, patients.

We also get into a bigger conversation about innovation in the Life Sciences industry – with great insights that can be extended to the rest of healthcare quite easily. I ask point blank: Pfizer is a gigantic, global biopharma company…Why wouldn’t it do these types of innovations internally, in-house themselves? Why partner outside?

Kathy explains the magic that is unlocked when a “market force” partners with a “market mover” for the sake of innovation, and the lessons learned are far reaching and applicable no matter where you are in health innovation.

How is Pfizer looking at new models for collaborating with biotech companies? What are the key characteristics of Pfizer’s culture of innovation that have newly emerged or deepened as a result of their work on the Covid vaccine during the pandemic? We dive deep into the biopharma-biotech model and all it brings in terms of new science, breakthrough therapies, and brand-new business opportunities. Watch now!

Does Surviving The Plague Mean You Will Eventually Contract An Autoimmune Disease?

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BY MIKE MAGEE

This Fall, I am teaching a 4-week course on “How Epidemics Have Shaped Our World” at the President’s College at the University of Hartford. It is, of course a timely topic, but also personally unnerving as we complete a third year under the shadow of Covid-19.

Where does one begin on a topic such as this? Yale historian, Frank M. Snowden, in his book “Epidemics and Society: From the Black Death to the Present”, made his intentions obvious. He would begin with the plaque. Why? His answer, “The word ‘plague’ will always be synonymous with ‘terror’”, and especially references:

Virulence: “It strikes rapidly, causing excruciating and degrading symptoms, and, if untreated, achieves a high case fatality rate (CFR)…of at least 50%.”

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Art Is in the Eye of the Computer

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BY KIM BELLARD

It turns out that I’ve been writing about Generative AI without even realizing there was something called Generative AI, such as articles about the robot artist Ai-Da, the AI image creator DALL-E, or patent protection for AI inventors.  Generative AI refers to AI that strives not just to process and synthesize data but to actually be creative.  It’s starting to both become more widespread and to attract serious attention from investors.  

James Currier of investment firm NFX sees “Generative Tech” as the next big thing: “If crypto hadn’t happened, we’d probably be calling THIS Web3.”  He distinguishes Generative AI from Generative Tech as: 

Some have called it “Generative AI,” but AI is only half of the equation. AI models are the enabling base layers of the stack. The top layers will be thousands of applications. Generative Tech is about what will actually touch us – what you can do with AI as a partner.

He predicts Generative Tech will generate “trillions of dollars of value.”  I’m hoping that healthcare is paying attention.

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Sticks and Stones…

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BY KIM BELLARD

According to the old saying, sticks and stones may break your bones, but names can never hurt you.  I’m not sure that still applies in a social media environment that can have real impacts on mental health of both teenagers and adults, but I have to note that healthcare seems to be pretty sensitive about who calls whom what.  

I’ll start with a new study from The Mayo Clinic about whether patients addressed their physicians by their first name.  It’s a tricky thing to get a gauge on; one could do surveys of both populations, or implant observers in exam rooms, but these researchers had the clever idea of examining how patients addressed their physician when using portal messaging.  They looked at over 90,000 messages from nearly 15,000 patients, with about 30,000 messages from 15,000 patients including a physician’s name (first or last).

The researchers don’t seem to have provided an overall percent of patients using the doctors’ first name, but they did report:

  • Female doctors were twice as likely as male doctors to be called by their first name;
  • DOs were similarly almost twice as likely as MDs to have their first name used;
  • Primary care doctors were 50% more likely than specialists;
  • Female patients were 40% less likely to use first names when addressing their physician.
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A Country Doctor Reads: What if Burnout Is Less About Work and More About Isolation? (NYT)

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BY HANS DUVEFELT

This weekend I read a piece in The New York Times that put a slightly different slant on what burnout, in the case of physician burnout, is or is caused by. We have heard theories from being asked to do the wrong thing, like data entry, to “moral injury” to my favorite, “burnout skills“, when you keep trying to do the impossible because people praise you when you pull it off.

Tish Harrison Warren’s piece is a dialog between her and psychiatrist/author Curt Thompson. He focuses on isolation as a driver of burnout:

Assume that if you’re burned out, your brain needs the help of another brain. Your brain is not going to be OK until or unless you have the experience and opportunity of being in the presence of someone else who can begin to ask you the kind of questions that will allow you to name the things that you’re experiencing.

The moment that you start to tell your story vulnerably to someone else, and that person meets you with empathy — without trying to fix your loneliness, without trying to fix your shame — your entire body will begin to change. Not all at once. But you feel distinctly different.

I’m not as lonely in that moment because you are with me. And I sense you sensing me. That’s a neural reality.

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The college football fans that beat COVID and the experts that couldn’t

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BY ANISH KOKA

The COVID pandemic was supposed to herald the end of the idea that a smaller government is a better government. The experts who desperately seek to be in charge of a sprawling bureaucratic state told us that it was only a powerful central authority that could do what was needed to safeguard individual liberties at a time when a highly contagious respiratory virus was spreading across the globe.

New Zealand may have imposed draconian policies that did not even allow its own citizens to return, but scenes of cheering unmasked New Zealanders stood in sharp contrast to empty seats in American stadiums when teams were allowed to play. If only US politicians possessed the iron will of New Zealand premier Jacinda Arden, Americans too could have ‘freedom’.

But in so many ways, the New Zealand example demonstrates the utter foolishness and shortsightedness of the central planners that seized control globally. A year after New Zealand took their victory lap COVID arrived in New Zealand and a very much masked Prime Minister noted that “very soon we will all know people who have Covid-19 or we will potentially get it ourselves”

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Better Living Through Better Design

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BY KIM BELLARD

We’re almost two weeks past Hurricane Ian. Most of us weren’t in its path and so it just becomes another disaster that happened to other people, but to those people most impacted it is an ongoing challenge: over a hundred people dead, hundreds of thousands still without power, tens of thousands facing a housing crisis due to destroyed/damaged homes, and estimated $67b in damages.  It will take years of rebuilding to recover.  

In the wake of a natural disaster like a hurricane – or a tornado, a flood, even a pandemic – it’s easy to shrug our shoulders and say, well, it’s Mother Nature, what can we do?  There’s some truth to that, but the fact is there are choices — design choices — we can make to mitigate the impacts. A Florida community called Babcock Ranch helps illustrate that.

Babcock Ranch is located a few miles inland from Ft. Myers, which was devastated by Ian.  It bills itself as “America’s first solar-powered town,” with an impressive array of almost 700,000 solar panels. More than that, it was built with natural disasters in mind: all utilities are underground, it makes use of natural landscaping to help contain storm surges, streets are designed to divert floodwaters, making use of multiple retaining ponds. 

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