The Health Care Blog – Page 129 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Art of Asking: What Else is Going on?

Mar 15, 2021

By HANS DUVEFELT

Walter Brown’s blood sugars were out of control. Ellen Meek had put on 15 lbs. Diane Meserve’s blood pressure was suddenly 30 points higher than ever before.

In Walter’s case, he turned out to have an acute thyroiditis that caused many other symptoms that came to light during our standard Review of Systems.

Ellen, it turned out, was pretty sure her husband was having an affair with one of his coworkers. And, since this wasn’t the first time, she was secretly working on a plan to move out and file for divorce. She admitted she’d always had a tendency to stress eat.

Diane’s daughter had just announced that she was pregnant by a man she wasn’t sure wanted to be around in the long run.

How do we know whether a patient’s subjective symptoms, laboratory values or even their vital signs are caused by their known medical conditions, a new disease or their state of mind?

We are often tempted to proceed down familiar tracks and tackle seemingly straightforward problems with medications: More insulin would take care of Walter’s blood sugar. Ellen could use a couple of months of phentermine. Diane needed a higher dose of lisinopril or perhaps some hydrochlorothiazide.

As Sherlock Holmes said, “there is nothing more deceptive than an obvious fact”.

#Healthin2Point00, Episode 190 | Forward Health, Cedar, & Babylon

Mar 12, 2021

Today on Health in 2 Point 00, primary care appears to have jumped the shark because there is a deal in this episode in which the investors on the round are probably Jess’s favorite group of investors ever. Forward Health raises $225 million in a Series D – there’s Softbank money in this round as well as The Weeknd – but why didn’t they just go public? Patient billing company Cedar raises $200 million, bringing their valuation up to $3.2 billion, although I’m not too impressed by the concept. Finally, Babylon is making inroads into the U.S. from the U.K., buying a California-based provider group. —Matthew Holt

Inside Owlet’s SPAC IPO: From Smart Sock Baby Monitor to Data-Driven Pediatric Healthcare Co

Mar 12, 2021

By JESSICA DaMASSA, WTF HEALTH

Oh Baby! Connected digital nursery startup, Owlet Baby Care, just announced their SPAC IPO and intention to take their infant smart sock from baby monitor to FDA-approved medical device. I talk with Owlet’s co-founder & CEO, Kurt Workman, to find out why the baby health tech company (which has raised $48M in venture funding) has decided to take the business public in order to pursue its plans for growth as a pediatric healthcare company caring for baby “from conception to kindergarten.” Kurt gets into the details behind the work Owlet’s team is doing now to get their device FDA-approved in two different ways, and how they’re using Livongo Health’s remote monitoring/data analytics/telehealth model as a precedent for pursuing health insurance reimbursement. There may be lots of market skepticism out there about wearables – particularly socks, and especially with infants – but this deep-dive into Owlet’s vision for data-driven parenting provides a pretty compelling vision for both better and more cost-effective baby care, and the bonus of a better night’s sleep for new parents. Owlet’s calling it an $81 BILLION DOLLAR addressable market, and Kurt believes that it stands alone in terms how its bringing together full-stack connected technology and a consumerized healthcare experience to bridge the gap from hospital to home.

THCB Gang Episode 46, Thursday March 11

Mar 11, 2021

THCB Gang featured lawyer & privacy expert Deven McGraw, (@Healthprivacy), Health IT girl and WTF Health Host Jessica DaMassa (@jessdamassa), and policy expert consultant/author Rosemarie Day @Rosemarie_Day1). We’ve had far too many Y chromosomes on lately but also joining Matthew Holt (@boltyboy) for this one will be futurist Ian Morrison (@seccurve) and Fard Johnmar (@fardj), from digital health consultancy Enspektos.

We dove into the health care implications of the new $1.9 trillion stimulus bill, and had a great chat about where health and digital health go next.

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

The Art of Listening: When the Inner Voice Whispers

Mar 10, 2021

By HANS DUVEFELT

“I worry, so you don’t have to”, is how I explain to patients when something about their story or physical exam makes me consider that they may have something serious going on.

The worst thing you can do is give false reassurance without serious consideration. And the next worst thing you can do is be an alarmist and needlessly frighten your patient. Finding and explaining the balance between those two extremes is a big part of the art of medicine.

A few times in my career I have struggled with doubt or worry after a patient visit. Did I miss anything, did I order the right test? We all have those moments, but we have personal limits as to how much of such doubt we can handle in the long run.

During my training and early career in Sweden there was more tolerance for physician fallability. Doctors have not been sitting on any pedestals for a couple of generations there. Here, the climate is different: We may not be revered like we were in the past, but if we make errors in judgement, the personal consequences for us can be devastating.

The way to navigate this treacherous territory is first of all to not travel alone. Everything we do is for our patient, so we must maintain a partnership. We are the experts, but we should not make decisions that aren’t shared. I keep coming back to the notion that today’s doctors are guides.

#Healthin2Point00, Episode 189 | DispatchHealth, TytoCare and Highmark Health

Mar 9, 2021

Today on Health in 2 Point 00, we’re wishing Jess a happy belated birthday! On Episode 189, Jess asks me about DispatchHealth raising a massive $200 million Series D, bringing their total up to $403 million, providing in-home urgent care. TytoCare raises another $50 million for their Series D, bringing their total up to $155 million, providing tech-enabled health at home with their device and providers. Finally there’s a partnership with Highmark Health, Google Cloud, Verily, and OnDuo – what’s going on with this lot? —Matthew Holt

Your Health Data May Be a NFT

Mar 9, 2021• 1

By KIM BELLARD

I must admit, after I wrote about digital currency last week, I did not expect to be writing about crypto anytime soon. Then I heard about “non-fungible tokens” (NFTs) and got a sense of the hype they were causing — how I could I resist?

There may even be a connection to health care.

You may have seen the Nyan Cat (pictured below), which is not new; it turns 10 in April. What is new is that last month its creator “sold” it. You may be thinking, wait, the GIF is everywhere, anyone can download it, so in what sense could he “sell” it?

That’s where NFTs come in. As you may know, “fungible” means that two things can be interchanged; one dollar is just like any other dollar, one bitcoin is like any other bitcoin, one electron is like any other electron. Non-fungible, then, means the item in question is unique, and this is where the “token” comes in. Basically, NFTs use digital certificates via blockchain to mark that something is one-of-a-kind, a claim of digital ownership.

Nadya Ivanova, chief operating officer of research firm L’Atelier explained NFTs to The Wall Street Journal:

Think of it like a digital passport that comes with an asset. They allow for this trust and authenticity to be established in a way that we haven’t been able to do before, whether it’s with physical assets or digital assets.

Artists have been using NFTs for a few years now, and auction house Christie’s is auctioning off the “First Purely Digital NFT-Based Work of Art Ever Offered by a Major Auction House,” featuring the digital artist Beeple (aka Mike Winklemann). Christie’s promises:

…the buyer receives the artwork file containing a digital signature from the artist and all vital details including time of creation, edition size and a record of any prior sales. These details are permanently attached to the artwork, providing an enduring guarantee of value.

NFTs have gone beyond art. The NBA is all over this, with NBA Top Shot selling highlight clips; one of Lebron dunking just went for $200,000. Maverick’s owner Mark Cuban is a big proponent. “The tech is real,” he told CNBC. “The impact is real, and permanent.”

Kelsey Mellard, CEO Sitka

Mar 9, 2021

By MATTHEW HOLT

Kelsey Mellard is CEO of Sitka, one of the emerging companies that’s providing specialty consults online to primary care docs. They’ve been building a specialty care network that can be accessed by asynchronous video, slightly different to some of their competition. Most of their customers are capitated medical groups, like ChenMed, trying to reduce their spend on specialty physician care (as Kelsey calls it the “unmanaged Part B spend bucket”). I asked her how it works, where the company is going (think virtual care integration), and whether it will be needed in the future. (You can guess her answer to the latter!)

Pandemic Accelerants: Life Under the “New-Normal.”

Mar 8, 2021• 1

By MIKE MAGEE

Confrontation is good. Governor Abbott’s “We are getting out of the business of telling people what they can and cannot do” was “Neanderthal thinking” as President Biden said. Insurrectionist Richard Bennett, whose feet sat on Speaker Pelosi’s desk two month’s ago, does need to cool his jets in jail awaiting trial. And states lagging in immunizing teachers, opening schools, and accelerating their vaccine efforts need to realize that they will be held accountable by voters in the near future.

That is surface turbulence, but quietly below the surface, there are other transformational forces underway fueled by pandemic accelerants.

How long would it have taken under normal circumstances to advance equitable access to broadband and tech devices for all students in America? A decade from now, would we have advanced teacher skills in long-distance learning to the degree we are now witnessing? And how many at-home workers will be willing to return to off-site offices in the near future?

These are just a few of the questions being considering as we return to “normal” or life under the “new-normal.” And while we are all doing our best to cope with the fear and worry that comes with change, most of our collective anxiety is now focused on economic security and jobs.

This past month we added 379,000 jobs. Sounds great, that’s if you ignore the fact that there remain 9.5 million fewer jobs in our economy compared to a year ago, or that first-time jobless claims rose last week. As former Federal Reserve economist Julia Coronado reported, “We’re still in a pandemic economy.”

Correlative Adventures with COVID

Mar 5, 2021• 3

By ANISH KOKA

“The patient in room 1 should be a quick one, its an addon, they just need a prescription for ivermectin”

I’m a bit puzzled by this sentence from my assistant doing his best to help me through a very busy day in the clinic that I’m already behind in. I walk into the room, a script pad stuffed into my hand as I enter the room, to meet a very nice couple. The wife sits patiently with hands crossed on the exam table.

“So, you’re here for Ivermectin?”, I ask.

Why yes, a trip to Texas is planned.. COVID is in the air, the internet, and some important people who have ‘inside knowledge’ have raised doubts about the vaccine. Some other people who quite possibly could be the same people, have also suggested prophylactic ivermectin is the better bet to prevent these good people from catching COVID.

Ivermectin is a drug known to work against parasites. The virus angle relates to in vitro data that suggests Ivermectin inhibits the host importin alpha/beta-1 nuclear transport proteins, which are part of a key intracellular transport process that viruses use to enhance infection by suppressing the host’s antiviral response. In addition, ivermectin may interfere with the attachment of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein to the human cell membrane. Ivermectin demonstrates a broad spectrum of activity in-vitro against a variety of viruses like dengue, Zika, HIV, and yellow fever. Unfortunately, despite this in vitro activity, no clinical trials have reported a clinical benefit for ivermectin in patients with these viruses.

Ivermectin does inhibit Sars-Cov2 viral replication in cell cultures. However, pharmacokinetic studies suggest that achieving the plasma concentrations necessary for the antiviral efficacy detected in vitro would require administration of doses up to 100-fold higher than those approved for use in humans. Even though ivermectin appears to accumulate in the lung tissue, predicted systemic plasma and lung tissue concentrations are much lower than 2 µM, the half-maximal inhibitory concentration (IC50) against SARS-CoV-2 in vitro. Subcutaneous administration of ivermectin 400 µg/kg had no effect on SARS-CoV-2 viral loads in hamsters, though there was a reduction in olfactory deficit and a reduction in the interleukin (IL-6:IL-10) ratio in lung tissues.

Since the pandemic began, there have been a number of small randomized controlled trials of ivermectin in mild COVID patients that show more rapid viral clearance, but not too much else. The prophylaxis data is considerably more sparse, and is of the retrospective variety. Basically take a number of countries that use Ivermectin variably and compare the incidence of COVID in those countries.