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The Market Forces Behind Vaccine Passports

By SAURABH JHA

Unlike medical meetings, rendering Beethoven’s Ninth Symphony isn’t easy on Zoom, so the local orchestra has been furloughed and their members work for Uber.  The opera house wants to reopen, preferably before we reach the elusive herd immunity threshold. They mandate vaccinations for their artists, not least because the performers can keep their masks off. Should they extend this requirement to their patrons?  

Vaccine passports, proof of immunity against SARS-CoV-2, to work, dine, fly or watch shows, are controversial. Opponents say they blithely disregard decency, are operationally onerous, and hurt liberty. Worryingly, they create a caste system, which wouldn’t be as concerning if based on just immunology. Such a two-tiered system could sadly mirror societal inequities because it’s the poor who may disproportionately be left unvaccinated. Supporters of vaccine passports further the very structural disadvantages they seek to end.

When arguments are too compelling they likely betray an obvious simplicity. Too often arguments against mandates assume they’d be a government fiat. The opponents recline on the country’s inherently liberal streak conjuring visions of rugged individuals fighting unelected bureaucrats. They say with undisguised pride “this isn’t who we are. We’re the US, not New Zealand. We can’t be controlled.”

This narrative is so tightly embedded in right-of-center discourse that it’s now folklore bordering on an Ayn Rand fairy tale. The narrative is nonsense. The state is too incompetent to either govern adeptly or tyrannize efficiently. Case-in-point: CDC’s easily forgeable paper vaccine certificate. If the state were serious about prying on people’s antibodies, it’d have made the immunosurveillance digital.

The obsession with big government should be antiquated. By censoring content, Facebook and Twitter showed that freedom can more efficiently be curtailed by the private sector. Bottom-up censorship is arguably more powerful than top-down censorship because it has buy-in from a segment of the market. It may very well be the private sector which demands vaccine passports, which begs two questions – why and why not?

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THCB Gang Episode 47, Thursday March 18

Joining me , Matthew Holt (@boltyboy), on THCB Gang this week were fierce patient activist Casey Quinlan (@MightyCasey), consumer advocate & CTO of Carium, Lygeia Ricciardi (@Lygeia), THCB regular authors radiologist Saurabh Jha (@roguerad) & cardiologist Anish Koka (@anish_koka), with futurist Jeff Goldsmith on hand to keep us all honest. We started with Casey’s current health journey and Anish’s inability to get vaccines for his clinic — and this moved to a really fun and raucous discussion about whether the public sector can work in health care, whether we need to mandate the vaccine and if America is becoming a failed state! Great stuff!

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

1896 – The Birth of Radiology

By SAURABH JHA and JEANNE ELKIN

Mr. Smith’s pneumonia was clinically shy. He didn’t have a fever. His white blood cells hadn’t increased. The only sign of an infection, other than his cough, was that his lung wasn’t as dark as it should be on the radiograph. The radiologist, taught to see, noticed that the normally crisp border between the heart and the lung was blurred like ink smudged on blotting paper. Something that had colonized the lungs was stopping the x-rays. 

Hundred and twenty-five years ago, Wilhelm Conrad Roentgen, a German physicist and the Rector at the University of Wurzburg, made an accidental discovery by seeing something he wasn’t watching. Roentgen was studying cathode rays – invisible forces created by electricity. Using a Crookes tube, a pear-shaped vacuum glass tube with a pair of electrodes, Roentgen would fire the cathode rays from one end by an electric jolt. At the other end, the rays would leave the tube through a small hole, and generate colorful light on striking fluorescent material placed near the tube. 

By then photography and fluorescence had captured literary and scientific imagination. In Arthur Conan Doyle’s Hound of the Baskervilles, the fire-breathing dog’s jaw had been drenched in phosphorus by its owner. Electricity and magnetism were the new forces. Physicists were experimenting in the backwaters of the electromagnetic spectrum without knowing where they were. 

On November 8th, 1895, when after supper Roentgen went to his laboratory for routine experiments, something else caught Roentgen’s eyes. Roentgen closed the curtains. He wanted his pupils maximally dilated to spot tiny flickers of light. When he turned the voltage on the Crookes tube, he noticed that a paper soaked in barium platinocyanide on a bench nine feet away flickered. Cathode rays traveled only a few centimeters. Also, he had covered the tube with heavy cardboard to stop light. Why then did the paper glow?

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THCB Gang Live Episode 39

Episode 39 of “The THCB Gang” will live-streamed on Thursday, Jan 21. You can see it below!

Matthew Holt (@boltyboy) was joined by regulars: futurists Ian Morrison (@seccurve) & Jeff Goldsmith, surgeon and now digital health entrepreneur Raj Aggarwal (@docaggarwal), radiologist Saurabh Jha (@roguerad), and patient advocate Robin Farmanfarmaian (@Robinff3).

Like the nation we took a big collective sigh of relief. We then talked a lot about COVID vaccinations, what the newly (sort of) Dem-led Senate is going to do on stimulus and health care , and we fnished on all that money pouring into digital health, while the stock market goes crazy. It was all good grist for the #THCBGang’s mill.

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

THCB Gang Episode 32

Episode 32 of “The THCB Gang” was live-streamed on Thursday, November 12th. The video is below.

Matthew Holt (@boltyboy) will be joined by some of our regulars: WTF Health Host Jessica DaMassa (@jessdamassa), radiologist Saurabh Jha (@RougeRad), MD-turned entrepreneur Jean-Luc Neptune (@jeanlucneptune), benefits communications leader Jennifer Benz (@jenbenz), THCB’s Editor-in-Chief me (zoykskhan) and guest Jeff Goldsmith, President of Health Futures, Inc. The conversation followed the post-election frenzy around COVID-19 response, the vaccines, the ACA, and what a Dem. president means for the United States in terms of 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 Khanproducer

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

Doctors Urge Caution in Interpretation of Research in Times of COVID-19

September 9, 2020

To:      

American College of Cardiology

American College of Chest Physicians

American College of Physicians

American College of Radiology

American Heart Association

American Society of Echocardiography

American Thoracic Society

European Association of Cardiovascular Imaging

European Society of Cardiology

European Society of Radiology

Heart Rhythm Society

Infectious Disease Society of America

North American Society of Cardiovascular Imaging

Radiologic Society of North America

Society of Cardiovascular Magnetic Resonance

Society of Critical Care Medicine

Society of General Internal Medicine

Society of Hospital Medicine


Dear Society Leadership:

We are a group of clinicians, researchers and imaging specialists writing in response to recent publications and media coverage about myocarditis after COVID-19. We work in different areas such as public health, internal medicine, cardiology, and radiology, across the globe, but are similarly concerned about the presentation, interpretation and media coverage of the role of cardiac magnetic resonance imaging in the management of asymptomatic patients recovered from COVID-19.

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The Story of an American Mask Distributor

By SAURABH JHA

Seven weeks before President Trump declared COVID-19 a federal emergency heralding the economic lockdown, Jesse’s customers began cutting their orders. Jesse sells garments and cotton, imported predominantly from India, to wholesalers and retailers, big and small, in malls across the North East corridor.  His business had a good January. December was like any December. But February was different.  His customers, reassuring him that it wasn’t personal, were predicting a falling demand for their products because of COVID-19. They may be over reacting, but better shortage than glut, they felt.

Jesse, who has no medical background, had heard of a virus which quarantined cruise ships, but nothing seemed foreboding back in February. He had tuned out the President, who was being his usual clownish self. It was business as usual in Manhattan, where he lives. He received reassuring messages from public health figures about the novel coronavirus. New York City’s mayor was particularly upbeat, urging New Yorkers to mingle with even more vigor.

Jesse didn’t know how to reassure his customers. A week later, more customers cancelled their orders. By middle of February, the orders halved. Being a businessman, not philosopher, it mattered not to him why his customers had seemingly overestimated COVID-19’s threat. What mattered is that they had. Since his business operated on small margins, the reverberations could be substantial. The first order of the day was reducing the output of his factory in India which was running on all cylinders.

The second order of the day was survival. If his customers’ fears came true, his business would be destroyed. Jesse had no qualms accepting government bailout. But this was long before the federal government announced relief for businesses. The virus had yet to strike Italy. COVID-19, like Chengiz Khan, seemed to prefer the eastern perimeters of the Silk Road.

In his culture, Jesse Singh is an American Sikh hailing from the Punjab – there’s a simple rule. When customers don’t want a certain product, find something else to sell. His family motto is that you should love the act of selling, not the product being sold (the motto sounds better when said by a Punjabi in Punjabi).  

Another Punjabi rule, technically not a rule but part of their cultural RNA, is that Punjabis don’t sit idle. During the partition of the subcontinent, thousands of Sikhs arrived at Delhi train station hungry, battered, penniless, and homeless, after losing their homes and families to the mobs. After feeling sorry for themselves for a couple of days, they started selling tea and biscuits on the railway platforms.

If the panic from coronavirus could shut old businesses it surely could open new ones, Jesse thought. A soaring demand for personal protective equipment (PPE) seemed obvious. Since N-95 supply was regulated, he threw his weight behind surgical masks, believing that they’d be demanded by healthcare workers and eventually the general public. He decided to import a small batch on a trial basis.

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THCB GANG, Episode 20

Episode 20 of “The THCB Gang” was live-streamed on Thursday, July 30th! Watch it below!

Joining Matthew Holt were some of our regulars: writer Kim Bellard (@kimbbellard), MD & hospital system exec Rajesh Aggarwal (@docaggarwal), health futurist Ian Morrison (@seccurve), WTF Health Host Jessica DaMassa (@jessdamassa), and guest Jennifer Benz, communications leader at Segal Benz (@jenbenz). We discussed how employers & health plans need to build trust in order to improve engagement data, how health consumers’ are changing the way they interact with health care, and how to support patients when they are accessing the system.

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

The 2020 Pandemic Election

The 2020 US election will be vicious, with a nasty pandemonium following a nasty pandemic.

By SAURABH JHA, MD

When the COVID-19 pandemic is dissected in the 2020 presidential election debates, Donald Trump will be at a disadvantage. The coronavirus has killed over 100,000 Americans and maimed thousands more. The caveat is that deaths per capita, rather than total deaths, better measure national failure, and by that metric the US fares better than Belgium, Italy and the United Kingdom. New York City owns a disproportionate share of the deaths, but this hyperconnected megapolis is an outlier whose misfortunes can’t be used to draw conclusions about administrative competence for the country as a whole.

Nevertheless, even after introducing nuance, the numbers aren’t flattering. President Donald Trump may claim that the US dodged the calamity predicted by the epidemiological models, which foretold millions of deaths. To be fair, we don’t know the counterfactual — Jeremiads aren’t verifiable. The paradox of successful mitigation is that we can’t see the future we dodged, precisely because we avoided it.

Reducing the death count logarithmically, rather than merely arithmetically, won’t be celebrated because as bad as the worst case scenario could have been, the situation still looks awfully bad. Many still disbelieve the high death toll predicted by epidemiologists early on, particularly Trump supporters who believe the response to the virus, specifically the economic shutdown, has been criminally disproportionate. One can’t simultaneously believe that COVID-19 is no more dangerous than the seasonal flu and that Trump saved millions from the coronavirus. The constituency that acknowledges the lethality of COVID-19 and credits Trump for decisive action against it is small.

Triangle of Incompetence

Trump’s challenger, former Vice President Joe Biden, will charge that fewer Americans would have died had the Trump administration acted earlier. Trump may be accused of having blood on his hands, but such rhetoric is unnecessary. Biden’s team can simply show a montage of Trump’s bombast where he downplayed COVID-19’s lethality, dismissed doctors’ concerns about the shortage of personal protective equipment or exaggerated how well the US was containing the pandemic. Incidentally, the most iconic picture of the administration’s scornful indifference is the current vice president, Michael Pence, visiting a hospital without a mask, surrounded by health-care workers wearing masks.

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