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Barcodes Are Us

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BY KIM BELLARD

Usually I write about things where I see some unexpected parallel to healthcare, or something just amazed me, or outraged me (there are lots of things about healthcare like the latter).  But sometimes I run across something that just delights me.

So when I inexplicably stumbled across DNA Barcoding Technology for High Throughput Cell-Nanoparticle Study, by Andy Tay, PhD, my first thought was, oh, nanoparticles, that’s always interesting, then it hit me: wait, DNA has barcodes? 

How delightful.

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THCB Gang Episode 106, Thursday November 10

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After an early Fall hiatus, THCB Gang is back!! Joining Matthew Holt (@boltyboy) for #THCBGang on Thursday November 10 were medical historian Mike Magee (@drmikemagee); futurist Jeff Goldsmith; THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and policy consultant/author Rosemarie Day (@Rosemarie_Day1). You can imagine that elections were on our collective minds.

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.

And you thought Mastadons were extinct…

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by KIM BELLARD

Until last week, for me, “mastodon” only meant the giant animal that went extinct several thousand years ago (I was, it appears, unaware of the heavy metal band Mastodon). Now, as the result of Elon Musk’s purchase of Twitter, many Twitter users are being forced to take a look at alternatives, such as the social networking site Mastodon.

It’s possible that we are about the witness the Myspace-ization of Twitter, brought down by competition, bad management, and bad product decisions. In my usual “there must be a pony in here somewhere” fashion, there may be some lessons in the Twitter saga that healthcare might want to pay attention to.

As most know by now, Mr. Musk has been a Twitter power user for many years, and a frequent critic. In March of this year he started discussions about purchasing it. In short order, he threw out a bold bid, was rejected then accepted by Twitter’s board, tried to get out of the deal, was sued by Twitter, and closed the deal late last month. 

Then things got really rocky.   

Mr. Musk tried to reassure squeamish advertisers, only to make them and others even more nervous when he retweeted some disinformation. After a spike in hate speech on the site, he promised that, as much as he was buying Twitter out of his love for free speech, Twitter “cannot become a free-for-all hellscape, where anything can be said with no consequences!” Then he shocked observers (and Twitter employees) by suddenly laying off half the workforce, including much of the content moderation staff. Some are now being asked back, being told they were laid off “by mistake.”   

He then floated a balloon about charging $20 a month for Twitter’s blue verification, had a tweet argument with Stephen King about it, then went forward with a $7.99 plan, only to be punked by users illustrating the flaws. At this writing, the plan now appears to be on hold, at least until Tuesday’s mid-term elections. 

Advertisers appear to be fleeing, or at least curtailing spending.

As The Wall Street Journal put it: “In Elon Musk’s first week at Twitter Inc., he flouted much of the advice management gurus have dished out for decades.” It’s no wonder many Twitter users are looking at Mastodon.

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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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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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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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THCB Gang Episode 105, Thursday September 22 at 1pm PT, 4pm ET

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Joining Matthew Holt (@boltyboy) for #THCBGang on Thursday September 22 are delivery & platform expert Vince Kuraitis (@VinceKuraitis); THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and in a quick late switch everyone’s favorite cynical radiologist Saurabh Jha (@RogueRad) joins us too

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.

Start the Revolution without Us

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BY KIM BELLARD

Well, as usual, there’s a lot going on in healthcare.  There’s the (potential) Amazon – One Medical acquisition, the CVS – Signify Health deal, and the Walmart – United Healthcare Medicare Advantage collaboration.  Alphabet’s just raised $1b.  Digital health funding may be in somewhat of a slump, but that’s only compared to 2021’s crazy numbers. Yep, if you’re a believer that a revolution in healthcare is right around the corner, there’s a lot of encouraging signs.  

But I was in a Walmart the other day, and my thought was, these people don’t look like they care much about a revolution in healthcare. In fact, they don’t look like they much care about health generally.  That’s not a knock on Walmart or Walmart shoppers, that’s an assessment about Americans’ appetite for changes in our health care.  

That’s not to say we like our healthcare system.  A new AP-NORC survey found that 56% felt that the US did not handle healthcare well (curiously, 12% thought we handled it extremely/very well – huh?).  Prescription drugs, nursing homes, and mental health rated especially low.  We’d like the government to do more, but not, it would seem, if it means we pay higher taxes.

Much of what is wrong is our own fault. We know that we eat too many processed foods, that the food industry scientifically preys on us to target our weaknesses for fat, sugar, and salt, that we’d rather sit than drive and drive than walk, and that we are poisoning our environment, and, in turn, ourselves.  Given a choice between short term benefits versus long term consequences, though, we’ll eat that Oreo every time, literally and metaphorically.

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Putting the “e” in DNA

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BY KIM BELLARD

The Wall Street Journal had a great article a couple days ago that tickled my fancy on two fronts: DNA, and the deep ocean.  Both fascinate me. It introduced me to a term I’d not heard before but have now discovered is a thing: “eDNA.”  It’s something I suspect we’ll be hearing more about, and a technique we’ll be using much more, in the years to come.

The article, Finding New Drugs From the Deep Sea via ‘eDNA’, talks about a different approach to discovering potential sources of new medicines: “environmental DNA,” or eDNA.  As the US Geological Survey describes it: “Environmental DNA (eDNA) is nuclear or mitochondrial DNA that is released from an organism into the environment.” You may not want to know this, but “Sources of eDNA include secreted feces, mucous, and gametes; shed skin and hair; and carcasses.”

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