Tag: Kim Bellard

THCB Gang, Episode 40

Jan 28, 2021

THCB Gang was held live on Thurs Jan 28 1pm PT -4pm ET. The recording is below.

Joining me, Matthew Holt (@boltyboy) were fierce patient activist Casey Quinlan (@MightyCasey), consultant/author Rosemarie Day @Rosemarie_Day1), THCB regular health writer Kim Bellard (@kimbbellard); employer health expert Jennifer Benz (@jenbenz) & patient safety expert and all around wit Michael Millenson (@MLMillenson).

There was almost nothing to talk about. No inauguration, no riots, pandemic under control via vaccination….oh wait. Actually a lot to talk about with the vaccination rollout, the likelihood of health policy changing in the COVID relief bill, and how the wild world of Gamestop stock trading might impact Digital Health –well we didn’t talk about that but we did talk about employers and what they were going to do!

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

And You Thought Health Insurance Was Bad

Jan 27, 2021

By KIM BELLARD

I spend most of my time thinking about health care, but a recent The New York Times article – How the American Unemployment System Failed – by Eduardo Porter, caught my attention. I mean, when the U.S. healthcare system looks fair by comparison, you know things are bad.

Long story short: unemployment doesn’t help as many people as it should, for as much as it should, or for as long as it should.

It does kind of remind you of healthcare, doesn’t it?

The pandemic, and the associated recession, has unemployment in the news more than since the “Great Recession” of 2008 and perhaps since the Great Depression. Last spring the unemployment rate skyrocketed well past Great Recession levels, before slowly starting to subside. Still, last week almost a million people filed for unemployment benefits, reminding us that unemployment is still an issue.

Keep in mind that unemployment rates do not tell the full story, as they don’t count those only “marginally attached” to the workforce – people who would like to work but have given up – and counts part-time workers who would like to work full time as “employed.” The “true” unemployment rate is reckoned to be much worse than the official rate.

Congress has enacted several COVID relief measures, including in late December, to extend duration, amount, and applicability of unemployment benefits, but our unemployment systems remain predominantly state designed and administered. The shortcomings of these systems have been severely exposed over the past few months: neither the processes nor the actual technologies supporting them proved robust enough for the volume of applicants. Last December Pew Trusts reported that “unemployment payments were weeks late in nearly every state.”

The Cost of Free Speech

Jan 13, 2021

By KIM BELLARD

Well, you’d have to say that the past week has been interesting. It’s not every week that Joe Biden “officially” won the 2021 election, again, as Congress certified the election results. It’s not every century when the U.S. Capitol is overrun by hostile forces. And it’d never been true before that Twitter and Facebook banned President Trump’s accounts, or that various tech companies belatedly acted on the threat that Parler poses. Oh, and we hit new daily records for COVID-19 deaths (over 4,000) and hospitalizations (over 132,000) in case you’d forgotten there is still a pandemic going on.

Yes, all in all, a very “interesting” week.

I’m going to skip talking about the horror that was the Capitol insurrection, in part because I fear that we’re going to find out more details that will make it clear that it was even worse than we now know. Similarly, I’m not going to dwell on the shame that Republicans should feel about the fact that two-thirds of their House members still voted to object to certifying the election results even after they’d been forced to flee from the terrorists who sought that very goal with their violence.

Instead, let’s talk about “free speech,” and the social media platforms that helped foster the violence and are now trying to do something about that.

Health Care: Don’t Be Evil

Jan 5, 2021

By KIM BELLARD

Google’s corporate motto – written in its original Code of Conduct — was once “Don’t be evil.” That softened over time; Alphabet changed it to “Do the right thing” in 2015, although Google itself retained the slogan until early 2018. Some Alphabet employees think Google/Alphabet has drifted too far away from its original aims: they’ve formed a union in order to try to steer the company back to its more idealistic roots.

Parul Koul and Chewy Shaw, two Alphabet software engineers, announced the Alphabet Workers Union in a New York Times op-ed, vowing to live by the original motto, and to do what they can to ensure that Alphabet and its various companies do as well. They assert: “We want Alphabet to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.”

It’s past time that health care workers, including physicians and executives, stood up for the same thing.

Ms. Koul and Mr. Shaw cite several grievances, including payouts to executives accused of sexual harassment, the firing of a leading AI expert over her efforts to address bias in AI, and company efforts to “keep workers from speaking on sensitive and publicly important topics.” Doing the work, even doing it well and being well paid for it, is not enough:

We care deeply about what we build and what it’s used for. We are responsible for the technology we bring into the world. And we recognize that its implications reach far beyond the walls of Alphabet.

Their goal is for Alphabet “to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.” Alphabet, they say, “has a responsibility to prioritize the public good. It has a responsibility to its thousands of workers and billions of users to make the world a better place.”

Investors may not quite agree.

No Names, Please

Dec 23, 2020

By KIM BELLARD

Feeling good about your holiday spending? You’ve made it through most of this mostly horrible 2020, maybe lost a job or even a loved one, but still probably found a way to buy presents for your loved ones and maybe even to give some money to charity. Indeed, charitable giving was up 7.5% for the first half of 2020, despite the economic headwinds.

Then there’s MacKenzie Scott.

Ms. Scott, as you may recall, is the former wife of Amazon founder/CEO Jeff Bezos. She got Amazon stock worth some $38b in their 2019 divorce, which is now estimated to be worth around $62b. She just gave away $4.2b – and that’s on top of $1.7b she gave away in July.

In case your math skills are impaired, that’s $6b in six months, which Melissa Berman, chief executive officer of Rockefeller Philanthropy Advisors told Bloomberg: “has to be one of the biggest annual distributions by a living individual.” Ms. Scott has vowed: “I will keep at it until the safe is empty.”

Kenzie Bryant, writing in Vanity Fair, marveled: “It gives a whole new meaning to “fuck-you money.”

Private foundations are required to distribute at least 5% of their endowments each year; Ms. Scott not only has given away 10% of her net worth this year alone, but she hasn’t even used a foundation to do so. As The New York Times reported: “Ms. Scott’s operation has no known address — or even website. She refers to a “team of advisers” rather than a large dedicated staff.”

She doesn’t make recipients plead for money through grant applications. She doesn’t specify how the money is to be used, or require reports on how it is spent. She doesn’t expect her name on anything. She doesn’t even make public how much she is giving each recipient (although some choose to do so).

THCB Gang Episode 35, Dec 10

Dec 10, 2020

Episode 35 of “The THCB Gang” was live-streamed Thursday, Dec 10. You can watch it below.

Matthew Holt (@boltyboy) was joined by not one but two of America’s leading health futurists Ian Morrison (@seccurve) and Jeff Goldsmith; Patient advocate Grace Cordovano (@GraceCordovano); health writer Kim Bellard (@kimbbellard); employer health expert Jennifer Benz (@jenbenz); and surgeon and innovation dude Raj Aggarwal (@docaggarwal).

There was lots of conversation about who is going to pay for what health care. What are big employers going to do. How is the vaccine going to roll out and are we ready? What does it all mean for the future of hospitals, doctors, employers, innovation and more.

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

This is Your Brain on Microwaves

Dec 7, 2020

By KIM BELLARD

Those of us of a certain age well remember the 1987 ad campaign from the Partnership for a Drug-Free America. It equated frying an egg to what drugs did to our brains. The ad certainly impacted awareness, but it is less clear that it impacted drug use or, for that matter, that it actually was like what drugs did to our brains.

Well, it turns out that there is something that can scramble our brains, but it’s microwaves, and it appears that “malevolent actors” are using them to do just that. We’re now in the age of “directed, pulsed radiofrequency energy.”

There were reports coming out of Havana in 2016 of State Department employees complaining of mysterious symptoms, including dizziness, fatigue, headaches, memory loss, balance issues, and hearing loss. Over the next couple years there were more reports, in Cuba and in other countries, including China and Russia, with CIA officers also seemed to be common targets. It has been labeled “the Havana syndrome.”

As least 44 people from Cuba and 15 from China were treated at Center for Brain Injury and Repair at the University of Pennsylvania, with more believed to have been treated elsewhere. No one could pin down exactly what was happening.

Now the National Academies of Science, Engineering and Medicine has issued a report concluding that the directed, pulsed microwave bursts were “the most plausible mechanism” to explain what happened. They evaluated but ruled out other mechanisms, such as background microwaves, chemical agents, infectious diseases, and even “psychological issues.”

Committee chairman David Relman, a professor of medicine at Stanford University, said:

The committee found these cases quite concerning, in part because of the plausible role of directed, pulsed radiofrequency energy as a mechanism, but also because of the significant suffering and debility that has occurred in some of these individuals. We as a nation need to address these specific cases as well as the possibility of future cases with a concerted, coordinated, and comprehensive approach.

One thing in particular that concerned the Committee was the presence of persistent symptoms in many victims – “persistent postural-perceptual dizziness (PPPD), a functional (not psychiatric) vestibular disorder that may be triggered by vestibular, neurologic, other medical and psychological conditions and may explain some chronic signs and symptoms in some patients.” i.e., not only can you be impacted by such an attack, but the impairment can last an indefinite time.

Healthcare on the Edge

Dec 1, 2020

By KIM BELLARD

Perhaps you read about, or were directly impacted by, the massive, multi-hour Amazon Web Services (AWS) outage last week. Ironically, AWS’s effort to add capacity triggered the outage, although apparently was not the root cause. It’s no surprise that AWS sought to add capacity; it, like most cloud service vendors these days, has seen skyrocketing growth. Even healthcare has jumped into the cloud in a big way.

But, as the outage reminds us, sometimes having core computing functions done in far-off data centers may not be always a great idea. Still, we’re not about to go back to local mainframes or networked PCs. The compromise may be edge computing.

Definitions vary, and the concept is somewhat amorphous, but goal is to move as much computing to the “edge” of networks, primarily to reduce latency. PwC predicts: “Now, with the rise of IoT, the centralised cloud is moving down and out, and edge computing is set to take on much of the grunt work.”

As they describe it:

With edge, instead of pushing data to the cloud to be computed, processing is done by devices ‘at the edge’ of your network. The grunt work is done closer to the user, at an edge gateway server and then select or relevant data is sent to the cloud for storage (or back to your devices).

The oft-cited example is self-driving cars; you really don’t want the AI to wait a single millisecond longer than necessary to make a potentially life-saving decision. An article in Nextgov pointed out:

Thus, a Tesla isn’t just a next-generation car; it’s an edge compute node. But even with Tesla, a relatively straightforward use case, building and deploying the edge node is just the beginning. In order to unlock the full promise of these technologies, an entire paradigm shift is required.

What, Us Worry

Nov 25, 2020

By KIM BELLARD

2020 has been an awful year. Hurricanes, wildfires, murder hornets, unjustified shootings, a divisive Presidential election, and, of course, a pandemic. Most of us are spending unprecedented amounts of time sheltering in place, millions have lost their jobs, the economy is sputtering, and over a quarter million of us didn’t survive to Thanksgiving. If you haven’t been depressed at some point, you haven’t been paying enough attention.

Within the last two weeks, though, there has finally been some cause for hope. Whether you want to credit Operation Warp Speed or just science doing what it does, we are on the cusp of having vaccines to battle COVID-19. First Pfizer/BioNTech, then Moderna, and most recently, AstraZenica, announced vaccines that appear to be highly effective.

We’re having our Paul Revere moment, only this time with good news. The vaccines are coming! The vaccines are coming!

It strikes me, though, that our enthusiasm about these vaccines says a lot about why the U.S. has had such a hard time with the pandemic; indeed, it tells us a lot about why our healthcare system is in the state it is. We’re suckers for the quick fix, the medical intervention that will bring us health.

Unless you were alive when Woodrow Wilson was President, COVID-19 has been the worst public health crisis of our lifetime. It took some time for us to fully realize how bad it was going to be, and, even then, most of us underestimated exactly how bad that would be. We may still be underestimating how bad these next few months will be.

Healthcare’s Bridge Fire

Nov 17, 2020• 2

By KIM BELLARD

We had a bridge fire here in Cincinnati last week. Two semis collided in the overnight hours. The collision ignited a blaze that burned at up to 1500 degrees Fahrenheit and took hours to quell. Fortunately, no one was killed or injured, but the bridge remains closed while investigators determine how much damage was done. It is expected to remain closed for at least another month.

Unfortunately, the bridge in question is the Brent Spence Bridge, which is the focal point for I-71 and I-75 between Ohio and Kentucky. It normally carries over 160,000 vehicles daily, and is one of the busiest trucking routes in the U.S. Over $1 billion of freight crosses each day. There are other bridges nearby, but each requires significant detouring, and none were designed for that traffic load.

What makes this all so galling is that it has been recognized for over 25 years that the bridge has been, to quote the Federal Highway Administration, “functionally obsolete” – yet no action was taken to replace it. This most recent disaster was a disaster hiding in plain sight.

Just like, as the coronavirus pandemic has illustrated, we have in health care.

The Brent Spence Bridge was opened in 1963, intended to carry a maximum of 80,000 vehicles daily. That had been surpassed by the 1990’s, causing calls to replace it with a newer, bigger bridge. At one time, Rep. John Boehner, from the Cincinnati area, was Speaker of the House and Kentucky’s Mitch McConnell was Senate Majority leader, yet were not able to obtain funding for the replacement, despite strong support from then President Obama and, in turn, President Trump.