Each week an episode of “The THCB Gang” (this was Episode 3) is streamed live here (below) and is also preserved as a weekly podcast and available on our Itunes & Spotify channels a day or so later. Each week 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the shit about health care business, politics, practice, and tech. It tries to be fun but serious and informative!
If, as they say, necessity is the mother of invention, then you’d have to say that the COVID-19 pandemic is proving to be the mother of invention and innovation. And, like Isaac Hayes sang about Shaft, it is a “bad mother…(shut your mouth).”
Many believe that the Allies won WWII in large part because of how industry in the U.S. geared up to produce fantastic amounts of weapons and other war materials. It took some time for businesses to retool and get production lines flowing, during which the Axis powers made frightening advances, but once they did it was only a matter of time until the Allies would prevail.
Similarly, COVID-19 is
making scary inroads around the world, while businesses are still gearing up to
produce the number of ventilators, personal protective equipment (PPE), tests,
and other badly needed supplies. COVID-19 is currently outnumbering
these efforts, but eventually we’ll get the necessary equipment in the needed
This piece is part of the series “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?” which explores whether it’s possible to advance interoperability while maintaining privacy. Check out other pieces in the series here.
If you live in one of the jurisdictions that have imposed stay-at-home requirements, you’re probably making your essential excursions — grocery store, pharmacy, even walks — with a wary eye towards anyone you come across. Do they have COVID-19? Have they been in contact with anyone who has? Are they keeping at least the recommended six feet away from you? In short, who is putting you at risk?
Well, of course, this
being the 21st century, we’re turning to our smartphones to help us try to
answer these questions. What this may lead to remains to be seen.
We long ago seemed to
shrug off the fact that our smartphones and our apps know where we are and
where we have been. No one should be surprised that location is of
importance to tracking the spread of COVID-19. No one should be surprised
that it is already being used. We may end up being surprised at how it
will be used.
We are in strange days, and they
are only going to get stranger as COVID-19 works its way further through our
society. It makes me think of Benjamin Franklin’s response when asked
what kind of nation the U.S. was going to be: “A Republic, if you
can keep it.”
The versions of that response that COVID-19 have me wondering about are: “A federal system, if we can keep it,” and, more specifically, “a healthcare system, if we can keep it.” I’ll talk about each of those in the context of the pandemic.
In times of national emergencies — think 9/11, think World Wars — we usually look to the federal government to lead. The COVID-19 pandemic has been declared a national emergency, but we’re still looking for strong federal leadership. We have the Centers for Disease Control, infectious disease experts like Dr. Anthony Fauci, and a White House coronavirus task force. But real national leadership is lacking.
What do the coronavirus
and Navy ships have in common? For that matter, what do our military
spending and our healthcare spending have in common? More than you might
think, and it boils down to this: we spend too much for too little, in large
part because we tend to always be fighting the wrong wars.
I started thinking about this a couple weeks ago due to a WSJ article about the U.S. Navy’s “aging and fragmented technology.” An internal Navy strategy memo warned that the Navy is “under cyber siege” by foreign adversaries, leaking information “like a sieve.” It grimly pointed out:
adversaries gain an advantage in cyberspace through guerrilla tactics within
our defensive perimeters. Once inside, malign actors steal, destroy
and/or modify critical data and information.
If you are not an IKEA
fan, or haven’t been spending any time in Dubai, you may have missed the
chain’s marketing campaign to help promote its second store in the area.
Titled “Buy With Your Time,” customers got store credits for how long
they spent getting to the store.
Gosh, that’s something
that should make any self-respecting critic of the U.S. healthcare system perk
up. Count me as intrigued.
The campaign involved
checking the customer’s Google Maps’ Trip tab to determine how long it took
them to get to the store. IKEA benchmarked the average hourly wage in
Dubai, and converted the travel time into how much credit they’d
generated. It works out to about $29/hour, or $0.48 per minute.
Spend long enough getting there and you could get a free coffee table or even a
bookcase. Prices in the store include the equivalent time currency.
Tesla is now, by market cap, the second largest auto manufacturer (after Toyota). Its market cap exceeds U.S. auto makers Ford, G.M., and Fiat/Chrysler — combined. This despite selling less than 400,000 vehicles in 2019, a figure that is more than the prior two years combined.
Tesla has made its bet on the future of electric cars. It didn’t invent them. It isn’t the only auto manufacturer selling them. But, as The Wall Street Journalrecently said:
Investors increasingly see the future of the car as electric—even if most car buyers haven’t yet. And lately, those investors are placing bets on Tesla Inc. to bring about that future versus auto makers with deeper pockets and generations of experience.
A recent analysis
suggested a big reason why, and its findings should give those in healthcare
some pause. Tesla’s advantage may come, in large part, from its supply
The term “moral
injury” is a term originally applied to soldiers as a way to help explain
PTSD and, more recently, to physicians as a way to help explain physician burnout.
The concept is that moral injury is what can happen to people when “perpetrating,
failing to prevent, or bearing witness to acts that transgress deeply held
moral beliefs and expectations.”
I think healthcare
generally has a bad case of moral injury.
Melissa Bailey, writing for Kaiser Health News, looked at moral injury from the standpoint of emergency room physicians. One physician decried how “the real priority is speed and money and not our patients’ care.” Another made a broader charge: “The health system is not set up to help patients. It’s set up to make money.” He urged that physicians seek to understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”
Facebook CEO Mark Zuckerberg believes “at some point in the 2020s, we will get breakthrough augmented reality glasses that will redefine our relationship with technology.” He went on to elaborate:
Instead of having devices that take us away from the people
around us, the next platform will help us be more present with each other and
will help the technology get out of the way. Even though some of the early
devices seem clunky, I think these will be the most human and social technology
platforms anyone has built yet.
We’re pretty proud of
modern medicine. We’ve accumulated a very intricate understanding of how
our body works, what can go wrong with it, and what are options are for
tinkering with it to improve its health. We’ve got all sorts of tests,
treatments, and pills for it, with more on the way all the time.
However, there has been
increasing awareness of the impact our microbiota has on our health, and I
think modern medicine is reaching the point classical physics did when quantum
physics came along.
pictured the atom as kind of a miniature solar system, with well-defined
particles revolving in definite orbits around the solid nucleus. In
quantum physics, though, particles don’t have specific positions or exact
orbits, combine/recombine, get entangled, and pop in and out of
existence. At the quantum level everything is kind of fuzzy, but quantum
theory itself is astoundingly predictive. We’re fooled into thinking our
macro view of the universe is true, but our perceptions are wrong.
So it may be with modern
medicine. Our microbiota (including both the microbiome and mycobiome) both provide the fuzziness and dictate a significant portion of