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WeChat to Many, WeDoctor to Some

By KIM BELLARD

You’ve probably heard about TikTok, especially lately.  President Trump wanted a ban on it, and seems to have endorsed a deal for a U.S.-based version of it.  The hundred million U.S. users, and probably their parents, are undoubtedly watching the sequence of events with mixed amusement and concern. 

But you may have paid less attention to what’s been going on with WeChat, another China-based app.  WeChat was part of the original proposed ban, which a federal judge blocked this weekend, hours before it was due to go into effect (the Commerce Department plans to appeal).  The ban is on “transactions,” which, in WeChat’s case, covers a lot of ground. 

TikTok was overlooked by authority figures for a long time because it was mostly used by young people and mostly for what seemed, to them, to be trivial purposes.  Not so with WeChat; it is deeply engrained in users’ lives, including for their health.  

WeChat is owned by Tencent Holdings, one of China’s internet giants.  It has been described as a “Swiss Army knife” app, able to do many tasks – not just messaging and social networking, but also games, shopping, and payments.  You can order food or book travel.  For many users it is a primary source of news, which is part of the problem. 

It is also important to users’ health.  WeChat is, according to CMI Media, “fast becoming the #1 online healthcare destination in China.”  It offers, among other things, health content (some in partnership with U.S. firms), health products, telehealth, a network of “trusted” doctors, a form of health insurance, and WeDoctor.  The latter provides online health enquiry service, psychological support, prevention guidelines and real-time pandemic reports,” and is free to the user.  It is available “24/7 for people all over the world.”

Most notably, WeDoctor is preparing for an IPO for late this year/early 2021, which could value it as high as $10b.  I would again note the “24/7 for people all over the world.”

If we’re worried about what information China might glean from the video-watching habits of teenagers, think about how worried we should be about China having access to what health information users sought, what medical advice they got, and what health products they ordered.

China is famed for its “Great Firewall,” which restricts which outside internet platforms – like Google or Facebook – can be used within its borders.  Equally important, the Chinese government monitors what happens on WeChat and other internet platforms/apps, and does not allow news or opinions it finds objectionable, or subversive.  You might think you are in your own Facebook or Twitter bubble in the U.S., but in China – or on WeChat – that bubble is shaped and controlled by the government. 

As a result, Politico reported, “Now young online Chinese, once conduits for new ideas that challenge the power structure, are increasingly part of Beijing’s defense operation.”  Even U.S. users find their worldview shaped by the content they are allowed to see.  As The New York Times said, “it has helped bring Chinese censorship to the world.”

“All of a sudden I discovered talking to others about the issue didn’t make sense,” one user told The New York Times.  “It felt like if I only watched Chinese media, all of my thoughts would be different.”

There are estimated to be 19 million U.S. users, out of WeChat’s 1.2 billion users; most are people with family or friends in China, who rely on the app to stay in touch.  The U.S. may argue it is worried about what financial and personal information might be going to the Chinese government, but it should be equally worried about what “information” is being served to U.S. users. 

Think, for example, what it might tell U.S. users about COVID-19 vaccines.

The U.S. moves make some worry that we’re becoming more like China, leading to the “splinternet” where, as Vox explained, “your experience of the internet increasingly depends on where you live and the whims of the ruling parties there.” 

Vox goes on to note:

Nations are increasingly pursuing various forms of internet sovereignty, from Russia building a walled-off intranet to India regularly shutting down the internet in areas of social unrest to some European nations introducing a right to be forgotten from search engines.

It is the opposite of the open access, no borders version of the internet that most of us have believed in for the past thirty years.  Aaron Levie, CEO of cloud-computing company Box Inc, warned in The Wall Street Journal: “U.S. tech companies have far more to lose if this becomes a precedent.  This creates a Balkanization of the internet and the risk of breaking the power of the internet as one platform.”

One Congressional official told Wired:

We are finally having the debate China had two decades ago, when it put in the Great Firewall because it found foreign technology threatening its political system. Only now is America catching up with foreign technology that is a direct threat to our open system.

But Jason Healey, an expert on cyber conflict, competition and cooperation at Columbia University, told The New York Times: “The vision for a single, interconnected network around the globe is long gone. All we can do now is try to steer toward optimal fragmentation.”

Somehow, “optimal fragmentation” isn’t how I want to think of my internet experience; I suspect that fragmentation won’t be so optimal.

Even if some version of the ban on WeChat goes through, it’s not clear how effective it would be.  Options like using VPNs or downloading the app from non-store channels may allow users to continue to use it.  In any cases, The Washington Post reported that “the administration does not intend to prosecute anyone for finding new ways to use the apps.” 

In discussing the effect of potential WeChat bans with The New York Times, Fang Kecheng, a professor at the Chinese University of Hong Kong, said: “Information is like water. Water quality can be improved, but without any flow, water easily grows fetid.”  He didn’t carry the analogy further, but I will: information is like water, in that, eventually, it will get to where it wants to go. 

We don’t have a U.S. platform as versatile as WeChat; we don’t even have a health platform as capable as WeChat’s health capabilities.  But, if we’re not careful, WeChat might become that platform.   

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

THCB Gang Episode 25 9/17

Joining Zoya Khan (@zoyak1594) on Episode 25 of “The THCB Gang” were regulars patient advocate Grace Cordovano (@GraceCordovano), writer Kim Bellard (@kimbbellard), policy & tech expert Vince Kuraitis (@VinceKuraitis), data privacy expert Deven McGraw (@healthprivacy), and guest Rosemarie Day, Founder & CEO of Day Health Strategies (@Rosemarie_Day1). Rosemary’s book “Marching Towards Coverage” is out now. The conversation revolved around new health technology policies, Medicaid Expansion programs, the 2020 election, and the steps to get to universal health coverage. Oh, and you can take Rosemary’s quiz about what type of a health activist you are!

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

Healthcare Can Learn From Chess

By KIM BELLARD

Oh, gosh, two of my favorite things are in the news together: Twitch and chess. 

Just kidding.  I barely know what Twitch is, and the last time I played chess was, well, not in this century (and, even then, not well).  But I’m not kidding about their convergence.  Chess has become a big hit on Twitch, especially in these COVID times. 

I figure, if two such seemingly divergent things are meshing, there must be some lessons there, even for healthcare. 

For those of you over, say, fifty, Twitch is an online service that facilitates livestreaming, particularly of gaming.  That is, people watch other people playing games, such Fortnite or League of Legends. 

E-sports, as this is known, have become a big thing; colleges are even giving out scholarships for e-sports.   Major news outlets, such as The New York Times and The Washington Post, reported on Twitch re-signing video game star Tyler Blevins, a.k.a “Ninja,” much as they might have reported an NFL team signing a star player. 

As I write, 2.7 million people are livingstreaming on Twitch.  Its all-time concurrent viewers peak is just over 6 million.  There were 1.6 billion hours watched in August, with over 11 billion year-to-date.  It draws more viewers than network television hits. There are 93,000 live channels at this moment. 

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THCB Gang Episode 24!

Episode 24 of “The THCB Gang” was live-streamed on Thursday, September 10th! Watch it below!

Joining Matthew Holt (@boltyboy) were some of our regulars: WTF Health Host Jessica DaMassa (@jessdamassa), patient & entrepreneur Robin Farmanfarmaian (@Robinff3), writer Kim Bellard (@kimbbellard), policy & tech expert Vince Kuraitis (@VinceKuraitis), and guest Mike Magee, a medical historian & health economist (@drmikemagee). The conversation was incredibly wide-ranging and one of the best we’ve had in a while–not the least because Mike Magee gave us a great base with how our non -health system somehow did actually act as a cohesive force in society before tech, then COVID19 broke it up!

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

A New Kind of Labor Day

By KIM BELLARD

This is probably the strangest Labor Day in decades, perhaps ever.   Tens of millions of workers remain unemployed due to the COVID-19 pandemic.  Many of those who are still working are adapting to working from home.  Those who are back at their workplace, or never left, are coping with an array of new safety protocols. 

Those who work in the right industries – like the NBA – may get tested regularly but most workers have to figure out for themselves when to quarantine and when to get tested.  For many workers, such as health care workers, people of color, and workers with underlying health issues, going to work is literally a life-or-death calculation. 

No wonder that experts, like Dr. David B. Agus, are calling for companies to have Chief Health Officers. 

Labor Day was originally intended to celebrate the labor movement, but these days labor unions don’t have much to celebrate.  Only around 10% of U.S. workers belong to a labor union; both the number and the percent of unionized workers has been in steady decline over the past few decades. 

Now Labor Day is mainly an extra day off for most, the unofficial end to summer, and, this year, possibly the springboard to a new surge in COVID-19 cases, due to holiday celebrations.  Dr. Anthony Fauci warned:

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The Wrong Legacies

By KIM BELLARD

I read two articles this week that got me thinking, Robert Charette’s “Inside the Hidden World of Legacy IT Systems” (IEEE Spectrum) and Douglas Holt’s “Cultural Innovation” (Harvard Business Review).   Both deal with what I’ll call legacy thinking. 

It’s a particular problem for healthcare.

———-

If you work in a large organization, especially one that has been around for at least a few decades, the words “legacy system” probably strikes angst in you.  If you’ve dealt with such an organization, legacy systems probably contributed to problems you may have had with them.  Think about health insurance claims systems, hospital billing systems, financial institution account records, or practically any government system. 

Dr. Charette points out:

Though these systems run practically every aspect of our lives, we don’t give them a second thought because, for the most part, they function. It doesn’t even occur to us that IT is something that needs constant attention to be kept in working order.”

Because they usually work OK, management often doesn’t want to risk the potential disruption of replacing or modernizing them, so they get older and older, with more and more layers built on them, and with the people who originally built them or understand the language they are written in (e.g. COBOL) gone. 

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Thriving in COVID Times

By KIM BELLARD

These are, no question, hard times, due to the COVID-19 pandemic.  In the U.S., we’re closing in on 180,000 deaths in the U.S.  Some 40 million workers lost their jobs, and over 30 million are still receiving unemployment benefits.  Hundreds of thousands, if not millions, of small businesses are believed to have closed, and many big companies are declaring bankruptcy.  Malls, retailers, and restaurants have been among the hardest hit. 

Yes, these are hard times.  But not for everyone. 

Last week Target announced what CNBC called a “monster quarter.”  Sales for online and stores open at least a year jumped 24% for the quarter ending August 1 – peak COVID-19 days – and profits were up an astonishing 80%.  Its CEO specifically referenced the pandemic, as shoppers sought safe and convenient shopping options.

It is not just Target doing well.  No one should be surprised that Amazon is doing well, as more turn to online shopping and Amazon’s quick delivery, but The Wall Street Journal reports that Bog Box stores generally are doing well, including not just Target but also Walmart, Home Depot, Lowe’s, Costco, and Best Buy.  The efforts they were taking to compete with Amazon, such as increased online sales and curbside pickup, served to help them survive the pandemic’s effects. 

Similarly, if you’re a streaming service like Netflix or Disney+, the pandemic has been great for business.  Video conferencing services like Zoom are booming.  Car dealers are struggling, but not online car sales

And, of course, if you’re a cloud computing service supporting all these shifts to online, the world has become even more dependent on you.  “Many customers are scaling beyond their wildest projections,” Carrie Thorp of Google Cloud told WSJ

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THCB Gang Episode 22, 8/20

Episode 22 of “The THCB Gang” was live-streamed on Thursday, August 20th! Watch it below.

Joining Matthew Holt (@boltyboy) today are some of our regulars: writer Kim Bellard (@kimbbellard), patient safety expert Michael Millenson (MLMillenson), MD & hospital system exec Rajesh Aggarwal (@docaggarwal), data privacy expert Deven McGraw (@healthprivacy), and Casey Quinlan (@MightyCasey). The conversation revolved around the responsibilities of the CDC & HHS, why the data hasn’t been shared properly around COVID19 transmission, and why payers & providers are cautiously innovating health care.

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

An Epic Fight for the Metaverse

By KIM BELLARD

 You might have missed it amongst all the headlines about the U.S.P.S., the 2020 elections, and, of course, that little thing we call the pandemic, but Fortnite got kicked off Apple’s App Store (and subsequently Google Play).

I’m not a gamer, but I am fascinated by gaming, because, as Steven Johnson put it, “The Future is where people are having the most fun.” Tim Sweeney, the founder and CEO of Epic Games, Inc., which makes Fortnite, seems to be having a lot of fun. And he thinks the future is the Metaverse.

Healthcare, take note.

The tech giants were reacting to Epic allowing “permanent discounts” on developer fees for in-game purchases made directly, rather than going through Apple or Google. Developers thus avoid the 30% commission charged in those Stores. Mr. Sweeney has been railing about the commission level for some time, leading to the recent decision.

Apple tried to justify its action:

Today, Epic Games took the unfortunate step of violating the App Store guidelines that are applied equally to every developer and designed to keep the store safe for our users. As a result their Fortnite app has been removed from the store. Epic enabled a feature in its app which was not reviewed or approved by Apple, and they did so with the express intent of violating the App Store guidelines regarding in-app payments that apply to every developer who sells digital goods or services.

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Take Your Mom to Work

By KIM BELLARD

If you are a working mom, or married to one, or simply know one, you know that it is tough to balance a job and raising a child even under ideal circumstances.  Even if she has a supportive spouse, chances are that it is the mom who ends up providing the most child care, and whose career it impacts the most.

But, of course, these are not ideal circumstances.  Prior to the pandemic, women had made great strides in the workforce; more women had payroll jobs than men, for example (although they continued to be paid less for them).  Those gains quickly came crashing down once the pandemic hit.  It is believed to be the first time that job and incomes losses have hit women harder than men.  Some are calling our pandemic-driven economic downturn a “shecession” as a result.   

That’s bad enough, but the even bigger danger is that the pandemic could set back women’s careers for a generation. 

recent study by Collins, et. alia confirmed what most might have guessed: in the wake of the pandemic, women are more likely than men to have reduced their work hours to take on additional child care responsibilities due to school/daycare closing — four or five times as much.  

The study found that:

Scaling back work is part of a downward spiral that often leads to labor force exits—especially in cases where employers are inflexible with schedules or penalize employees unable to meet work expectations in the face of growing care demands.  

We are also concerned that many employers will be looking for ways to save money and it may be at the expense of mothers who have already weakened their labor market attachment.

Even more worrying, lead author Caitlyn Collins, a professor at Washington University, says: “Our findings indicate mothers are bearing the brunt of the pandemic and may face long-term employment penalties as a consequence.”  

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