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The Science of Clinical Intuition

By HANS DUVEFELT

In 2002, Dr. Trisha Greenhalgh published a piece in the British Journal of General Practice titled Intuition and Evidence – Uneasy Bedfellows? In it she writes eloquently about the things Christer Petersson and I have written articles on and emailed each other about. He mentioned her name and also Italian philosopher Lisa Bortolotti, and I got down to some serious reading. These two remarkable thinkers have described very eloquently how clinical intuition actually works and describe it as an advanced, instantaneous form of pattern recognition.

Clinical Intuition (should we start calling this CI, as opposed to the other, electronic form of pattern recognition, AI – Artificial Intelligence?) begins with clinical patient experience but is cultivated through reflection, writing and dialogue with other physicians. And as Petersson and I have both written, there isn’t enough of the latter in medicine today. Both of us do as much reflecting and writing as we can, but we both know that more collegial interchange can make all of us better clinicians. Greenhalgh writes:

The educational research literature suggests that we can improve our intuitive powers through systematic critical reflection about intuitive judgements–for example, through creative writing and dialogue with professional colleagues. It is time to revive and celebrate clinical storytelling as a method for professional education and development. The stage is surely set for a new, improved–and, indeed, evidence-based–‘Balint’group.
— Read on www.ncbi.nlm.nih.gov/pmc/articles/PMC1314297/

Bortolotti, the philosopher, makes the case that experts are more intuitive than novices, a skill that only comes with experience, and have developed advanced pattern recognition abilities that allow them to make decisions faster than possible when only using analysis and reasoning. Her article is quote-heavy. She writes:

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Matthew’s health care tidbits

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

In this week’s health care tidbits, a little bit of light was shone on two of the dirty tricks health insurers play. First San Diego is suing Molina, Centene (owner of Healthnet) & Kaiser for misleading patients about which providers are in their networks. Apparently Healthnet & Kaiser’s directories were 35% inaccurate and Molina 80%! Now this may be incompetence, but it is not only false advertising, it’s also a way of weeding out high cost patients who may leave when they can’t find a specialist that will take them–and of course avoiding a high cost patient is a nice earner for health plans.

The next trick is double billing. In this lawsuit unearthed by Bob Herman of Axios, Aetna which was being paid to manage an employer’s health network subbed out PT care to an Optum network. Optum then also charged an admin fee. Meaning the provider got less and the patient had to pay more. So while Aetna and United Healthgroup may appear to be fierce competitors, they’re happy to cooperate when it comes to ripping off their clients.

More bad behavior by health plans and I didn’t even mention them cheating on Medicare Advantage RAFs! But the CEO of Chenmed did.

If we are going to let health insurers profit from handling employer and taxpayer business, we should see those arrangements in the clear light of day. Time for some heavy handed Federal regulation, methinks.

Why I Seldom Recommend Vitamins or Supplements

By HANS DUVEFELT

People here in northern Maine, as in my native Sweden, don’t get a whole lot of natural sunlight a good part of the year. As a kid, I had to swallow a daily spoonful of cod liver oil to get the extra vitamin D my mother and many others believed we all needed. Some years later, that fell out of fashion as it turned out that too much vitamin A, also found in that particular dubious marine delicacy, could be harmful.

This is how it goes in medicine: Things that sound like a good idea often turn out to be not so good, or even downright bad for you.

Other vitamins, like B12, can also cause harm: Excess vitamin B12 can cause nerve damage, just as deficiency can.

Both B12 and D can be measured with simple blood tests, but the insurance industry doesn’t pay for screening. That is because it hasn’t been proven that testing asymptomatic people brings any benefit. In the case of B12, it is well established that deficiency can cause anemia and neuropathy, for example. But here is no clear evidence what the consequences are of vitamin D “deficiency”. A statistically abnormal result is not yet known to definitely cause a disease or clinical risk, in spite of all the research so far, but we’re staying tuned.

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#Healthin2Point00, Episode 220 | Olive’s massive raise, Ro buys Kit, plus funding for Tendo & SWORD

Today on Health in 2 Point 00, I’m cheering England’s win against Germany this week – but Jess keeps us on track with health tech deals. Olive gets another $400 million, bringing their total up to $902 million – with $802 million of that since March 2020. Tendo Systems gets $50 million in a Series A, working on communication between providers and consumers. General Catalyst strikes again, this time in a round with SWORD Health raising $85 million in a Series C, bringing their total to $135 million. This is an MSK company, with a lot of good investors here. Finally, Ro buys Kit an at-home testing company – how does Hims stack up now? And, in case you missed it, Sharecare hits the NYSE today – get the scoop from Jess’s interview with their CEO yesterday. –Matthew Holt

CONFERENCE UPDATE–Policies|Techies|VCs: What’s Next For Health Care?

By MATTHEW HOLT & JESS DAMASSA

Last month we told you about the new conference bringing together the CEOs of the next generation of virtual & real-life care delivery and all the permutations thereof. That’s all those companies raising huge venture rounds and really getting to scale. You’ll see them at Policies|Techies|VCs: What’s Next For Health Care?, and they include Glen Tullman (Transcarent), Jonathan Bush (Zus Health) Roy Schoenberg (AmWell) and 17 more leaders in digital health.

Now we are announcing another 16 great speakers, including 2 publicly-traded digital health company CEOs!  And we’ll announce a further 16 next week! You can register here or learn how to sponsor. This week’s new additions are:

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Owen Tripp
Grand Rounds

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Paul Johnson
Lemonaid Health

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Mario Schlosser
Oscar

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Anil Sethi
Ciitizen

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Ashwini Zenooz
Commure

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Russ Johannesson
Glooko

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Jim Pursley
Hinge Health

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Peter Hames
Big Health

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Daniel Brillman
Unite Us

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Arif Nathoo
Komodo Health

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Raj Singh
Accolade

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Tim Barry
VillageMD

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Steve Yaskin
Health Gorilla

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Sean Duffy
Omada Health

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Stephanie Papes Strong
Boulder Care

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Abner Mason
ConsejoSano

THCB Gang Episode 60 – Thurs July 1

Episode 60 of “The THCB Gang” was live-streamed on Thursday, July 1st. Matthew Holt (@boltyboy) was joined by policy consultant/author Rosemarie Day (@Rosemarie_Day1); THCB Editor and soon-to-be medical student at Yale, and first time #THCBGang participant Christina Liu (@ChristinayLiu) and–making a rare but welcome appearance –venture investor & soccer mogul Marcus Whitney @marcuswhitney We had a great wide ranging chat about Medicaid, venture capital and the unnecessarily excessive rigors of applying to medical school, and what that means for health equity.

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.

Go Ahead, AI—Surprise Us

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.”

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Sharecare ($SHCR) Hits NASDAQ Tomorrow, CEO Jeff Arnold on Closing the SPAC IPO

By JESSICA DaMASSA, WTF HEALTH

Sharecare ($SHCR) starts trading on the NASDAQ tomorrow and CEO Jeff Arnold has come back to catch us up on what’s happened since April when we first spoke and took a deep-dive into Sharecare’s population-health-slash-care-navigator-slash-health-security business model. That interview (watch here: https://youtu.be/P6DzFbtiLWg) digs into the $400 million/year revenue model Jeff’s built so far, and now THIS CHAT picks up where we left off — mere hours before Sharecare heads into the public market. valued at just under $4 billion dollars, with ZERO Debt and $400 million in cash to invest in scaling up.

Turns out a lot can happen while you’re waiting for your paperwork to be signed! So what’s new? How about the $50 million dollar private placement Anthem has made into business? Jeff explains how this kind of backing from the country’s second largest health insurance company is not only a win when it comes to securing a customer base, but also how it will likely impact product roadmap. The Anthem investment was closely linked to Sharecare’s January acquisition of health tech startup Doc.AI, which had been working with Anthem on some very payer-friendly tools that will likely be expanded. And speaking of expansion? Jeff’s already made more than a dozen acquisitions to build up Sharecare’s three main verticals over the years– what else could they possibly need now? Tune in for all the last-minute news and numbers before $SHCR pops tomorrow!

CareAlign, fixing that physician workflow–demo & interview

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By MATTHEW HOLT

I recently interviewed Subha Airan-Javia, the CEO of CareAlign. CareAlign is a small company that is working to fix the clinician workflow by creating a tool for all those interstitial gaps that the big EMRs leave, and now get moved to and from paper by the care team. In this interview she tells me a little about the company and shows how the product works. I found it very impressive

Full transcript below

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