It’s late late at #hin2pt00 central. But somehow Jessica DaMassa wakes me up enough to get my views on Redbrick & Virgin Pulse, the VA finally inking the Cerner deal and Iora Health getting another $100m to build out their primary care model. Be warned, Jessica thinks I’m not full of cheer about any of it!–Matthew Holt
Above the Fold
The Ethics of Keeping Alfie Alive
By SAURABH JHA
Of my time arguing with doctors, 30 % is spent convincing British doctors that their American counterparts aren’t idiots, 30 % convincing American doctors that British doctors aren’t idiots, and 40 % convincing both that I’m not an idiot.
A British doctor once earnestly asked whether American physicians carry credit card reading machines inside their white coats. Myths about the NHS can be equally comical. British doctors don’t prostate every morning in deference to the NHS, like the citizens of Oceania sang to Big Brother in Orwell’s dystopia. Nor, in their daily rounds, do they calculate opportunity costs for keeping patients alive on ventilators.
Conversations such as this are vanishingly rare.
Administrator: “It’s costing an arm and leg keeping this sick baby alive – to balance the annual budget we need to stop dialyzing a granny.”
ICU doctor: “We’ll have to send poor Ethel to her grave. That’s a shame. She was beginning to grow on me.”
Health Ethicist: “Wait, let me check with National Institute of Clinical Excellence, the rationing experts, who should be relieved of intensive care first. Perhaps it should be Winston, not Ethel – because Winston is an alcoholic. We need to make rationing scientific and fair.”
‘Immigrants’ Bring Patient Engagement Energy
An Irish software expert who’d been helping companies sell on eBay walks into a room with a Slovenian inventor who’d built a world-class company in the “accelerator beam diagnostics market.” (Don’t ask.) What they share is not just foreign birth, but “immigration” to health care from other fields. Both have come to the MedCity Invest conference in Chicago seeking funding for start-ups focused on patient engagement. They’re not alone in their “immigrant” status, and their experience holds some important lessons.
Eamonn Costello, chief executive officer of patientMpower, works out of a rehabbed brick building in Dublin next to the famed Guinness brewery at St. James Gate. An electronic engineer who’s worked at companies like Tellabs, Costello became interested in healthcare in 2012 when his father was in and out of the hospital with pancreatic cancer. What struck him was the lack of any monitoring on how patients fared between doctor appointments or hospitalizations.
When in 2014 a friend working in healthcare approached him, they looked at building an app for different illnesses.Continue reading…
SMACK.Health–Getting Clear on the Concept
I’m going to be announcing some big changes on THCB and with my overall services in the next little bit. So to prepare for this, here’s a rather good explanation I did last year in Australia of what I mean by SMACK.health — randomly the interviewer was Jessica DaMassa with whom I now do #Healthin2pt00 — Matthew Holt
Will Cancer Drugs Ever Be As Affordable As Retrovirals in Low and Middle Income Countries?
In 2014, the majority of international health aid was dedicated to HIV. So, one might reasonably assume that this is the largest health problem facing the world. Yet, HIV only constitutes 4% of the global burden of disease. In 2014, noncommunicable diseases (NCDs) made up 50% of the entire disease burden, but only received 2% of all global health funds.
The disease burden of NCDs is fast outpacing that of infectious diseases. Despite this, the proportion of global health financing dedicated to combatting NCDs has remained constant over the past 15 years at 1 to 2%.
Currently, 32.6 million individuals are living with cancer (diagnosed in the last five years). In 1970, 15% of new cases were in low- and middle-income countries. In 2008, 56% were in low- and middle-income countries. By 2030, this proportion is expected to be 70%. So, not only is the burden of NCDs rising globally, but it is also beginning to disproportionately affect countries with the least resources to deal with them.
But, if NCDs have been steadily increasing in low- and middle-income countries, why has global action not followed suit? Continue reading…
Health in 2 point 00, Episode 24
In this edition of Health in 2 point 00, Jessica DaMassa asks me about enterprise sales (Qventus, Medicity, Health Catalyst), DTC vs Enterprises as a market, the VA allowing nationwide telehealth,, and the TEAP & TEFCA frameworks (that last answer may have overran the 2 minutes a tad!) — Matthew Holt
Mudit Garg, Qventus on the $30m raise
Another day, another $30m round in health tech. On Monday Qventus raised that from Bessemer Partners, with Mayfield, Norwest and NY Presbyterian kicking in too. That brings their total to $43m in so far–not bad for a 75 person company that is in the somewhat obscure space of using AI to improve hospital operations. Qventus sucks in data and delivers operational suggestions to front line managers. Of course given that somewhere between $1-1.5 trillion goes through America’s hospitals each year, there’s huge potential for saving money. And given that most hospitals are being paid fixed cost per case, anything that can be done to improve throughput and increase productivity drops to the bottom line and is thus likely to meet interested buyers. I talked to CEO Mudit Garg about the problem, his company’s solution and what they were going to do next.
The Case For Real World Evidence (RWE)
Randomized control trials – RCTs – rose to prominence in the twentieth century as physicians and regulators sought to evaluate rigorously the performance of new medical therapies; by century’s end, RCTs had become, as medical historian Laura Bothwell has noted, “the gold standard of medical knowledge,” occupying the top position of the “methodologic heirarch[y].”
The value of RCTs lies in the random, generally blinded, allocation of patients to treatment or control group, an approach that when properly executed minimizes confounders (based on the presumption that any significant confounder would be randomly allocated as well), and enables researchers to discern the efficacy of the intervention (does it work better – or worse – than controls) and begin to evaluate the safety and side-effects.
The power and value of RCTs can be seen with particular clarity in the case of proposed interventions that made so much intuitive sense (at the time) that it seemed questionable, perhaps even immoral, to conduct a study. Examples include use of a particular antiarrhythmic after heart attacks (seemed sensible, but actually caused harm); and use of bone marrow transplants for metastatic breast cancer (study viewed by many as unethical yet revealed no benefit to a procedure associated with significant morbidity).
In these and many other examples, a well-conducted RCT changed clinical practice by delivering a more robust assessment of an emerging technology than instinct and intuition could provide.
Alfie Evans and the Medical Ethics of Suffering
Sadly, the case of Alfie Evans came to a close this week, as he passed away in his hospital room surrounded by his parents. The debate over the medical ethics involved goes on.
Ultimately, there are extensive moral, philosophical, and medical issues involved with the policies over these cases. They are complicated, messy, and often times heart wrenching. But let’s put some misconceptions aside to begin with, some propagated by the most extreme and emotional participants in this debate.
Those of us that took issue with the handling of this case for the most part do not believe the doctors involved were evil, murdering individuals. There was no malicious intent from the NHS or physicians involved. I am sure the physicians meant well, from their point of view.
A second point: this was not a case about preservation of resources for the greater good. In this case, the parents had found alternative sources to fund the care they wished for their son. So those arguing that we need to make such decision to prioritize money for those that can be aided the most is largely off target, and not relevant to the case at hand. I also don’t believe that the single payer system of the NHS in England inherently caused their mistakes; I think any system that is blind to its own deficiencies could lead to such mistakes.
That said, what were the issues that were in dispute here?
First and foremost, what was the ultimate intent of the care providers in this specific case? Both sides basically admitted, early on, that Alfie’s prognosis was dire. The reality is this child was likely going to die, and even the experts preferred by the parents readily admitted this in court documents.
Health in 2 point 00, Episode 23
In this start your weekend off right edition, Jessica DaMassa asks me about Andy Slavitt’s new Town Hall venture fund announced at HLTH, the ATHN buyout, Novartis paying Michael Cohen, Trump’s drug price speech & Lyra Health’s $45m raise….all in 2 minutes–Matthew Holt
