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Hey, How About Starship Earth?

By KIM BELLARD

I missed the job announcement on the company website.  I missed it again when the company posted the job on Linkedin.  I missed it when Eric Ralph tweeted that the posting was “probably the coolest job posting I’ve read in years.”  Fortunately, though, I follow Isaac Kohne (MD, PhD), and I did see his tweet:

Yes, I’m talking about SpaceX.  Yes, the job is for a “Starship Medical Engineer.”  Yes, it’s to help SpaceX’s mission to Mars, whenever that might be.  Who knows, the job might even entail going to Mars, although that’s not spelled out. 

I am not, of course, remotely qualified for such a job.  In fact, I don’t even know anyone who might be.  But I agree with Mr. Ralph that it’s probably the coolest job posting I’ve seen in years, maybe ever.  And I even more agree with Dr. Kohne: it could be an “opportunity to rethink a bigger broken system.”

Hint: I don’t think he’s talking about just the SpaceX mission. 

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#Healthin2Point00, Episode 214 | One Medical acquires Iora, plus funding for HumanFirst & many more

Today on Health in 2 Point 00, Jess pokes fun at me because my primary care provider has acquired a Medicare provider – One Medical buys Iora Health for $2.1 billion in stock. This deal is curious because these are two very different organizations. Next, HumanFirst (formerly Elektra Labs) raises $12 million in a Series A, bringing their total to $15 million, working on distributed clinical trials. Medallion raises $20 million in a Series A to address barriers for digital health providers around state licensing rules, and Aunt Bertha raises $27 million working on the social determinants of health and getting social care resources to patients. Finally, Grand Rounds and Doctor on Demand acquire Included Health, an LGBTQ+ focused care navigation platform. —Matthew Holt

The Art of Medicine is Not an Algorithm

By HANS DUVEFELT

The Art of Medicine is such a common phrase because, for many centuries, medicine has not been a cookie cutter activity. It has been a personalized craft, based on the science of the day, practiced by individual clinicians for diverse patients, one at a time.

Unlike industrial mass production, where everything from raw materials to tools to manufacturing processes are standardized and even automated or performed by robots, physicians work with raw materials of different age, shape and quality in what is more like restoration of damaged paintings or antique automobiles.

The Art of Medicine involves knowing how and with which tools to take something damaged or malfunctioning and make it better. There are general principles, but each case is different to at least some degree. In many cases there are different ways to improve something that is malfunctioning, but patients may prefer fixing certain aspects of a complex problem because of their individual needs.

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Matthew’s health care tidbits, week ending Jun 5

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, I can’t quite leave the $3.5bn Babylon Health SPAC investor document alone. Yes, it’s crazy but not as crazy as you might think. Essentially it’s saying that it’s going to be a better tech enabled version of Oak Street or Agilon. Babylon has put less effort into the medical group management side of the puzzle than Oak Street or Agilon but it hasn’t done nothing. It’s been running GP clinics in the UK for years and now has two Medicare Advantage networks in California w 52k lives. It only did $79m in rev in 2020 but that was presumably mostly in software. They’re aiming for $320m in rev in 2021 (presumably mostly from the medical groups) & $710m in 2022.

In comparison Oak Street’s forecast is $1.3bn in 2021 and $2bn in 2022. So Babylon is shooting to be 25% of its size. Today’s Oak Street market cap is ~$14,5bn, so 25% of that is close to the $3.5bn Babylon is trying to get investors to pay.

Then there’s the story, which is that the bot tech can reduce all types of patient health spend which will increase the margin. Of course their actual mileage may vary. I do love the chart from their investor prez, which not only assumes that they can reduce medical spend abut also that they get to keep those savings long term. I’m not sure the “Partner” in the chart below will be as convinced.

This was the cause of much hilarity on this week’s #THCBGang.

As I said crazy but not completely crazy. And you never know, maybe better care?

U.S. Science Embrace of Wuhan “Gain-Of-Function” Viral Research Proved A Slippery Slope

By MIKE MAGEE

The truth hurts.

Eighteen months into a disaster that has claimed 3.5 million lives around the globe, the truth is seeping out. Human error likely caused the Covid pandemic, and America’s Medical-Industrial Complex was right in the middle of it.

Signs of a “great awakening” have emerged from various corners in the month of May.

On May 14, UNC’s top virologist, Ralph Baric, who worked closely with Wuhan chief virologist and batwoman extraordinare, Shi Zhengli, signed on with 17 other scientists to a Science editorial that demanded a reexamination of Covid’s causality writing “theories of accidental release from a lab and zoonotic spillover both remain viable.”

On May 26, Francis Collins, head of the NIH, which funded in part Zhengli’s risky bat virus research (more on that in a moment), admitted to Congressional investigators that “we cannot exclude the possibility of some kind of a lab accident.”

And on June 3rd, on MSNBC’s Morning Joe, the ever-present Tony Fauci advised all who would listen “to keep an open mind.” What he would like us to open our minds to is not a Chinese run weaponized microbe conspiracy, but simply scientific recklessness and human error.

It’s now well established that three Wuhan virology scientists were hospitalized in the Fall of 2019 with Covid. But the initial report from the Wuhan Municipal Health Commission, China, of this cluster of cases of pneumonia was only released on the last day of 2019.

It took only 50 more days for the tight knit group of global research virologists to get their act together and pen a Lancet editorial in which they stated “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin,” and that they  “overwhelmingly conclude that this coronavirus originated in wildlife.”

Their coordinator-in-chief was one Peter Daszak, chartered power broker within the U.S. Medical Industrial Complex and president of New York based EcoHealth Alliance which was a major funder of Shi Zhengli’s work in Wuhan.

Daszak is known for adopting militarized terms in the battle against global infectious diseases. In 2020 he wrote in the New York Times, “Pandemics are like terrorist attacks: We know roughly where they originate and what’s responsible for them, but we don’t know exactly when the next one will happen. They need to be handled the same way — by identifying all possible sources and dismantling those before the next pandemic strikes.”

Daszak’s argument that risks involved in Shi Zhengli’s Wuhan bat viruses were justified as defensive and preventive was convincing enough to the NIH and the Department of Defense that his EcoHealth Alliance was funded from 2013 to 2020 (contracts, grants, subgrants) to the tune of well over $100 million – $39 million from Pentagon /DOD funds, $65 million from USAID/State Dept., and  $20 million from HHS/NIH/CDC.

As veteran Science reporter Nicholas Wade deciphered in a classic article in Science – The Wire, “For 20 years, mostly beneath the public’s attention, they had been playing a dangerous game. In their laboratories they routinely created viruses more dangerous than those that exist in nature. They argued they could do so safely, and that by getting ahead of nature they could predict and prevent natural “spillovers,” the cross-over of viruses from an animal host to people. If SARS2 had indeed escaped from such a laboratory experiment, a savage blowback could be expected, and the storm of public indignation would affect virologists everywhere, not just in China.”

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#Healthin2Point00, Episode 213 | Babylon’s SPAC IPO, plus big raises for Thirty Madison & Intrinsic

Today on Health in 2 Point 00, we’re talking about our new conference in September: Policies, Techies, & VCs: What’s Next for Health Care. On Episode 213, Jess ask me about some massive deals. Thirty Madison gets $140 million – they are now a unicorn. Babylon Health is going public via a SPAC – $575 million expected to be raised during this with a $3.6 billion valuation. Coming out of stealth, Intrinsic raises $113 million in the eCommerce space — and Dr. Oz is in this one. —Matthew Holt

THCB Gang Episode 56 – Thurs June 3

Episode 56 of “The THCB Gang” was recorded live on Thursday, June 3. Matthew Holt (@boltyboy) was joined by regulars: medical historian Mike Magee (@drmikemagee), THCB regular writer Kim Bellard (@kimbbellard) and health futurist Jeff Goldsmith; WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa) snuck in later after she finished up at the Going Digital: Behavioral Health Conference across the virtual street.

We really got into it on two issues — the Wuhan lab “leak” issue and Babylon Health’s IPO — lots of fun and no little disagreement!

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

#Healthin2Point00, Episode 212 | DayTwo, Hello Heart, Pack4U, and Curebase

Today at Health in 2 Point 00, Jess and I are presenting at the Going Digital: Behavioral Health conference today — tune in later for that. On Episode 212, our buddies at DayTwo get $37 million for the gut microbiome. Hello Heart raises $45 million, bringing their total to $68.2 million – this is for high blood pressure management. Pack4U, which is like the knockoff version of Pill Pack, raises $20 million. Swedish telemedicine company Doktor.se raises $50 million, and Curebase raises $15 million for decentralized clinical trials. —Matthew Holt

Voicemail, Repeat Requests and Multitasking: Inefficiencies in Today’s Healthcare

By HANS DUVEFELT

My nurse regularly gets at least 50 voicemails every day, many saying “please call me back”.

I have one patient who frequently tests the patience of our clinic staff by calling multiple times for the same thing. He is the most dramatic example of what seems to be a widely held belief that physicians, nurses and medical assistants sit at their desks and answer phone calls all or most of their time. But when we do, we are often hampered by busy signals, phone tag or “voice mail not set up”. Electronic messaging isn’t a panacea, because patients don’t necessarily know what we need to know in order to answer their questions correctly and efficiently at first contact.

Pharmacies, too, create duplicate requests that bog down our workdays. In my EMR, if an electronic refill request doesn’t get a response the day it comes in, the “system” sends a repeat request every day until it gets done. This is one reason I look like I am further behind on “tasks” than I really am. To top it off, every single refill request generated by the “system” comes with a red exclamation point next to it. This happens even when a patient has just picked up their last 90 day refill – a case where I theoretically should have 89 days to respond. Meanwhile, my system has no way of flagging truly urgent refill requests. This “alarm fatigue” is common in EMRs today.

The business model in today’s healthcare is that reimbursable activities (seeing patients in person or via telemedicine) are scheduled back to back, all day long. There is a universal assumption that this will still provide enough slack to deal with prescription refills, phone calls, incoming reports and the further ordering and feedback to patients prompted by them. And did I mention EMR documentation? Multitasking, or rather, constantly switching between different kinds of tasks, is not a sane or efficient way to work.

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Bias, Before First Breath

How structural racism and implicit bias impact America’s babies, even prior to birth

By ELLIE STANG

Becoming a new mother in America is more dangerous for some mothers than it should be. Each year, 700 women die in childbirth or from pregnancy-related causes in the United States, the highest number of any developed nation. 

Health inequities in America mean that overwhelmingly, Black women and their infants are the ones impacted: Black mothers are 243% more likely to die from pregnancy than white ones. These discrepancies are wide ranging: American Indian and Alaska Native women are also 2x more likely to experience an adverse outcome as compared to  their white counterparts. Too many of our mothers are dying of preventable causes. The CDC estimates that 70% of maternal deaths are avoidable – which helps underscore the urgent need to create tangible change. 

Recent forces have helped shine a long overdue spotlight on the Black maternal mortality crisis in America. In April, the Biden Administration released a proclamation during Black Maternal Health Week, and planned legislative changes to address implicit bias in healthcare and apply funding where it is truly needed. Congress is fielding the “Momnibus” bill, which would fund grassroots organizations at the community level, actively establish bias training programs, and fill gaps created by social determinants of health (SDOH). Late last year, the HHS released an action plan to reduce maternal mortality and adverse outcomes by 50% in five years.

It is heartening to see action finally being taken: our mothers deserve more. At the same time, while we champion standardized and equal access to care for all of our mothers, we cannot overlook the newest cry in the room: the infant’s. Even before drawing her first breath, a baby girl’s future will be irrevocably shaped by structural racism and socioeconomic factors way beyond her control. 

That’s why, to address health inequities, we must begin with our babies. Despite great advances in NICU technology and managed healthcare, infant mortality is on the rise – and it disproportionately affects Black babies. Today, black infants are twice as likely to die as their white counterparts

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