THCB

Categories

Tag: Kim Bellard

The Most Important Thing

• 1

By KIM BELLARD

Jack Dorsey has some big hopes for bitcoin.  In a webinar last week, he said: “My hope is that it creates world peace or helps create world peace.”  The previous week Mr. Dorsey announced Square was starting a decentralized financial services (DeFi) business based on bitcoin, joining the previously announced Square bitcoin wallet.  

None of this should be a surprise.  At the Bitcoin 2021 conference in June, Mr. Dorsey said: “Bitcoin changes absolutely everything.  I don’t think there is anything more important in my lifetime to work on.”

I’m impressed that someone with as many accomplishments as Jack Dorsey picks something not obviously related to those accomplishments and decides it is the most important thing he could work on.  So, of course, I had to wonder: what might accomplished people in healthcare say was the most important thing they wanted to be working on?

For many these days, of course, it is the COVID-19 pandemic.  Not much has had a higher priority.  Highly effective vaccines have been developed, COVID-19 treatments have greatly improved, supply chains have been adjusted and readjusted, and countless public health measures have been tried.  Healthcare professionals have worked themselves to extremes.

For others, perhaps, it would be to address the extreme financial hardships the U.S. healthcare system can cause.  A new study in JAMA confirmed what is hiding in plain sight – hundreds of billions of medical debt.   Debt continued to rise despite ACA, especially in states that perversely chose not to expand Medicaid.  Efforts such as requiring hospital “price transparency” have largely failed.  Many large hospital systems continue to sue patients who can’t pay.  These hardships are unfair, immoral, and unique to the U.S.; addressing them should be important.

However, both the pandemic and financial obstacles contributed to, but did not cause, the big health inequities in the U.S. healthcare system.  People of color, people in lower socioeconomic classes, even women all face numerous inequities in the health care they receive and in the health they achieve.   These may reflect broader social inequities, but no one in healthcare should look at these without wanting to address them. 

Digital health has never been hotter. The pandemic reminded people how valuable telehealth can be, and investors are pouring money into digital health at astounding levels – some $19b in the first half of 2021 alone.  We may be in bit of a manic phase right now, but few doubt that digital health is going to be a big part of healthcare’s future. 

Then there’s artificial intelligence (A.I.).  No industry in 2021 can be ignoring it. Some well-publicized mishaps with IBM’s Watson or Babylon Health notwithstanding, A.I. in healthcare has already made impressive strides, such as DeepMind’s recent protein predictions or its successes in imaging.  A.I. is going to be built into our health care in the future, either in a supporting role or directly, and working on it has to be on many people’s wish list.  

Continue reading…

Health Care Should Go (Micro) Nuclear

• 1

By KIM BELLARD

I think of hospitals as the healthcare system’s nuclear power plants.  They’re both big, complex, expensive to build, beset with heavy regulatory burdens, consistently major components of their respective systems (healthcare and electric generation) yet declining in number.  Each is seen to offer benefits to many but also to pose unexpected risk to some.

Interestingly, there’s a “micro” trend for each, but aimed towards different ends.

Micro hospitals have been with us for several years.  They usually have only around ten beds, along with an emergency room, lab and imaging.  Dr. Tom Vo, CEO of Nutex Health, says: “We position ourselves between urgent care and a big hospital.”  A micro-hospital Chief Medical Officer admits: “We still partner with our larger hospital partners for patients who might require surgery or intensive care.” 

They’re not trying to reinvent hospitals so much as to support them and offer more convenience to patients.  Not so with micro reactors; they’re looking to revitalize their industry, which is in trouble.

According to the U.S. Energy Administration (E.I.A.), there are 94 U.S. nuclear reactors, at 56 nuclear power plants, in 28 states.  Only one new reactor has gone active in the U.S. since 1996, while almost two dozen are in various stages of decommissioning and only two new ones are under construction.  Overall, the U.S. gets about 20% of its power from nuclear reactors, while 13 countries get at least a quarter of their electricity from nuclear, with France leading the pack at 75%.     

We talk a lot about transitioning away from using fossil fuels to generate electric power, but none of the renewable options currently offers a realistic path towards replacing them.  Nuclear power is the proven alternative, but, as Dan Van Boom wrote in CNET, nuclear power has a PR problem.  No one wants a nuclear power plant in their backyard, no matter how big that backyard is.

Continue reading…

Up, Please

• 0

By KIM BELLARD

When I think of elevator operators, I think of health care.

Now, it’s not likely that many people think about elevator operators very often, if ever.  Many have probably never seen an elevator operator.  The idea of a uniformed person standing all day in an elevator pushing buttons so that people can get to their floors seems unnecessary at best and ludicrous at worse. 

But once upon a time, they were essential, until they weren’t.  Healthcare, don’t say you haven’t been warned. 

Elevators have been around in some form for hundreds of years, and by the 19th century were using steam or electricity to give them more power, but it wasn’t until Elisha Otis debuted the safety elevator that they came into their own.  New engineering techniques such as steel frames made skyscrapers possible, but safe elevators made them feasible; no one wanted to climb stairs for 10+ stories. 

Those generations of elevators weren’t quite like the ones we’re used to.  The speed and direction had to be controlled manually, the elevator had to be carefully brought to a stop at a floor, and the doors had to be opened and closed.  Managing all this was not something that anyone wanted to entrust to passengers.  Thus the role of the elevator operator.

But, of course, technology evolved, allowing for more automation.  According to elevator engineering expert Stephen R. Nichols:

Elevator buttons were introduced in 1892, electronic signal control in 1924, automatic doors in 1948, and in 1950 the first operatorless elevator was installed at the Atlantic Refining Building in Dallas. Full automatic control and autotronic supervision and operation followed in 1962, and elevator efficiency has steadily increased in other ways.

Elevator operators gradually transitioned from being mechanical operators to concierges, helping passengers find the right floors and making them more comfortable.  A 1945 elevator operators strike in New York City had a crippling effect.  As Henry L. Greenidge, Esq. wrote on Linkedin, “The public refused to go near the controls despite having watched the operators work the levers numerous times. The thought that a layperson could operate an elevator was simply an outrageous thought.” 

Continue reading…

THCB Gang Episode 61 – Thurs July 8

• 0

On Thursday’s #THCBGang Matthew Holt (@boltyboy) was joined by regulars, employer health expert Jennifer Benz (@jenbenz); patient safety expert and all around wit Michael Millenson (@MLMillenson); THCB regular writer Kim Bellard (@kimbbellard);  privacy expert and now entrepreneur Deven McGraw  (@HealthPrivacy); and–we were thrilled to have back–fierce patient activist Casey Quinlan (@MightyCasey). Lots of discussion about Casey’s latest patient experience as she continues to undergo the #METSparty.

If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

Make Mine Bioresorbable

• 0

By KIM BELLARD

I learned a new word this week: bioresorbable.  It means pretty much what you might infer — materials that can be broken down and absorbed into the body, i.e., biodegradable.  It is not, as it turns out, a new concept for health care – physicians have been using bioresorbable stitches and even stents for several years.  But there are some new developments that further illustrate the potential of bioresorbable materials. 

It’s enough to make Green New Deal supporters smile.

Bioresorbable stents and stitches are all well and good – who wants to be stuck with them or, worse yet, to need them removed? – but they are essentially passive tools.  Not so with pacemakers, which have to monitor and respond.  Medicine has made great progress in making pacemakers ever smaller and longer lasting, but now we have a bioresorabable pacemaker. 

Researchers from Northwestern University and The George Washington University just published their success with “fully implantable and bioresorbable cardiac pacemakers without leads or batteries.”  What their title might lack in pithy is more than offset by the scope of what they’ve done.  Fully implantable!  No leads!  No batteries!  And bioresorbable! 

Most pacemakers are, of course, designed to be permanent, but there are situations where they are implanted on a temporary basis, such as after a heart attack or drug overdose.  Dr. Rishi Arora, co-leader of the study, noted: “The current standard of care involves inserting a wire, which stays in place for three to seven days. These have potential to become infected or dislodged.” 

Dr. Arora went on to explain:

Instead of using wires that can get infected and dislodged, we can implant this leadless biocompatible pacemaker. The circuitry is implanted directly on the surface of the heart, and we can activate it remotely. Over a period of weeks, this new type of pacemaker ‘dissolves’ or degrades on its own, thereby avoiding the need for physical removal of the pacemaker electrodes. This is potentially a major victory for post-operative patients.

The device is only 15 millimeters long, 250 microns thick and weighs less than a gram, yet still manages to deliver electric pulses to the heart as needed.  It is powered and controlled using near field communications (NFC); “You know when you try to charge a phone wirelessly? It’s exactly the same principle,” GW’s Igor Efimov, a co-leader of the study, told StatNews. 

It dissolves over a period of days or weeks, based on the specific composition and thickness of the materials.

Continue reading…

Go Ahead, AI—Surprise Us

• 0

By KIM BELLARD

Last week I was on a fun podcast with a bunch of people who were, as usual, smarter than me, and, in particular, more knowledgeable about one of my favorite topics – artificial intelligence (A.I.), particularly for healthcare.  With the WHO releasing its “first global report” on A.I. — Ethics & Governance of Artificial Intelligence for Health – and with no shortage of other experts weighing in recently, it seemed like a good time to revisit the topic. 

My prediction: it’s not going to work out quite like we expect, and it probably shouldn’t. 

“Like all new technology, artificial intelligence holds enormous potential for improving the health of millions of people around the world, but like all technology it can also be misused and cause harm,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said in a statement.  He’s right on both counts.

WHO’s proposed six principles are:

  • Protecting human autonomy
  • Promoting human well-being and safety and the public interest
  • Ensuring transparency, explainability and intelligibility 
  • Fostering responsibility and accountability
  • Ensuring inclusiveness and equity 
  • Promoting AI that is responsive and sustainable

All valid points, but, as we’re already learning, easier to propose than to ensure.  Just ask Timnit Gebru.  When it comes to using new technologies, we’re not so good about thinking through their implications, much less ensuring that everyone benefits.  We’re more of a “let the genie out of the bottle and see what happens” kind of species, and I hope our future AI overlords don’t laugh too much about that. 

As Stacey Higginbotham asks in IEEE Spectrum, “how do we know if a new technology is serving a greater good or policy goal, or merely boosting a company’s profit margins?…we have no idea how to make it work for society’s goals, rather than a company’s, or an individual’s.”   She further notes that “we haven’t even established what those benefits should be.”

Continue reading…

THCB Gang Episode 59 – Thurs June 24, 1pm PT – 4pm ET

• 0

#THCBGang will feature special guest venture capitalist & massive over-achiever Justin Norden  (@JustinNordenMD) from GSR Ventures. Also joining Matthew Holt (@boltyboy) will be regulars, patient safety expert and all around wit Michael Millenson (@MLMillenson); WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa);  futurist Ian Morrison (@seccurve); & THCB regular writer Kim Bellard (@kimbbellard) 

Then video will be below at 1pm PT- 4pm ET. If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes  & Spotify channels.

Better Broadband for Better Health Care

• 0

By KIM BELLARD

Here’s a question that we don’t often ask: which is the U.S. more likely to accomplish – getting everyone health insurance, or broadband?  Hint: it’s probably not what you think.

The health insurance part of it is often debated.  We passed ACA, but the number of uninsured stubbornly remains at nearly 30 million, almost 10% of the population.  Still, except for residents of those 12 states that have refused to pass Medicaid expansion, everyone in the country has at least access to public or private health insurance, with subsidies available to many. 

Broadband hasn’t been around as long a health insurance, but it has become an integral part of our society, as the pandemic proved (ever try remote work or learning without broadband, much less telehealth?).   Unfortunately, some 20 million households lack broadband; assuming an average household size of about 2.5, that’s some 50 million people, which is way more than the number of uninsured. 

Welcome to the digital divide.   

Everyone seems to agree increasing access to broadband is a good goal.  It’s part of President Biden’s proposed infrastructure plan, and even many Republicans support some funding towards the goal, as in a recent bipartisan proposal. 

We often think about the issue as being a rural problem, similar to the problem of electricity availability in rural areas before the Rural Electrification Act (1936).  It’s just hard, or at least expensive, to wire all those vast spaces, those farms and small communities that comprise much of America. 

The fact of the matter, though, is that of those 20 million households without broadband, some 15 million of them are urban households.  A higher percent of rural households may lack broadband, but, in terms of actual numbers of households lacking it, it is urban dwellers.  For the most part, broadband is available in their neighborhood; they just can’t afford it (or don’t see the need).  

Continue reading…

Twins For Everyone!

• 0

By KIM BELLARD

I have lived my entire life as a twin, and, while it isn’t an unalloyed blessing, on balance I’d recommend it.  Most of you, though, probably aren’t twins and have missed the experience.  Don’t worry: you may still get a chance – with a digital twin. 

It could have profound implications for your health and for healthcare generally.

A digital twin, in case you are not familiar with the concept, is a virtual representation of a physical object.  It is created from data about that physical object, and is fed ongoing data (e.g., via IoT) about it to keep the model accurate. 

The concept is not new, often attributed to Michael Grieves at the Florida Institute of Technology in 2002.  Dr. Grieves saw the value of the concept for manufacturing; for example, GE’s Aircraft Engines has been using them to make their engines safer and more efficient.  Other applications include building maintenance, data centers, and even creating a digital twin of the whole planet.

People have seen the potential of digital twins for healthcare for years.  Back in 2016, GE’s Digital CEO Bill Ruh predicted:

I believe we will have a digital twin at birth, and it will take data off of the sensors everybody is running, and that digital twin will predict things for us about disease and cancer and other things. I believe we will end up with health care being the ultimate digital twin. Without it, I believe we will have data but with no outcome, or value.

We’re not there yet, not nearly, but it’s coming.

Continue reading…

THCB Gang Episode 57 – Thurs June 10

• 0

Episode 57 of “The THCB Gang” will be live on Thursday, June 10, 1pm PT 4pm ET. Matthew Holt (@boltyboy) will joined by regulars: medical historian Mike Magee (@drmikemagee), THCB regular writer Kim Bellard (@kimbbellard) and futurist Ian Morrison (@seccurve). And we have a special guest, health care equity analyst at Hedgeye, Emily Evans (@HedgeyeEEvans)

You might guess that the latest meme stock Clover Health (CLOV) might make an appearance! But that won’t be all!

The video is below. If you’d rather listen, the audio is preserved as a weekly podcast available on Fridays on our iTunes  & Spotify channels