The Health Care Blog – Page 286 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Science Fiction Coming to Life

Jan 13, 2018• 9

By DAVID SHAYWITZ, MD

Given the size and scope of the annual J.P. Morgan (JPM) Healthcare meeting (I resisted the temptation to say “diversity”), everyone in town – the minority who actually attend the formal presentations, and the many others who show up in San Francisco to meet and network – comes away with a slightly different experience.

With this caveat (and with the explicit reminder/disclosure that I now work at a life science venture fund, and as always, I’m speaking only for myself), I left the meeting with two fairly pronounced takeaways.

JPM: Two Contrasting Takeaways

First, this feels like an unbelievable, almost magical time in biopharma – a colleague described it (in a good way) as science fiction coming to life. Biological technologies, approaches, and ambitions that might have been dismissed as fantasies only a few years ago now are part of the fabric of the industry – and increasingly, it seems, clinical care. Gene therapy, gene editing, cell therapy, immune modulation – these modalities, alone and in combination, are what many in and around biopharma are contemplating, and the sorts of programs many drug development organizations are hoping to prosecute. It’s hardly surprising many JPM participants emerged with the sense of optimism my Forbes colleague Matthew Herper so accurately captured.

I was equally surprised by what I saw – or more accurately, didn’t see – through the lens of data and technology. As I’ve shared on Twitter, in addition to life science opportunities, I aspire to focus on the elusive middle-ground between tech and life science, and identify and invest in grounded, implementation-focused tech-powered startups that can improve how impactful new treatments are discovered, evaluated, and delivered. However, my overwhelming impression from this year’s JPM is that while data and tech may be embraced at the level of the C-suite, and while everyone professes an interest in AI, these emerging approaches and ways of thinking have generally not penetrated most biopharma organizations at the line/operations level, and have generally not yet impacted how these organizations actually approach their basic work of discovering and developing new therapeutics. Exploratory innovation initiatives, of course, abound, as do data wrangling and integration efforts (see here, eg), but these activities as yet seem to have had minimal impact on how most R&D is actually prosecuted within these organizations.

From what I can gather, it’s not a hostility to technology as much as a sense that it’s not immediately clear to most of those in the trenches how (or even whether) the emerging technologies will meaningfully impact the work they need to do, and many are concerned about, or at least wary of, the additional work it may create. Most acknowledge the possibility that big data and emerging analytics will likely be useful eventually, but few see these changes on the immediate horizon.

A Surprisingly Logical Argument in Favor of Head Transplantation

Jan 13, 2018• 2

By ARTHUR CAPLAN PhD & LISA KEARNS

Not since Rene Descartes gazed from his garret window in early 17th-century Paris and wondered whether those were men or hats and coats covering “automatic machines” he saw roaming the streets has the issue of personal identity and your cranium been of such import. Descartes feared a world that he alone occupied due to deception by the devil. Today we face a different mind-body challenge in the form of a devil we know: Italian neuroscientist Sergio Canavero. He recently announced that the first human head transplant is imminent.

For bioethicists, the moral critiques of this surgery practically write themselves: Are we merely our bodies? How can a person so ill as to wish to trade in his lifelong corporeal companion be considered competent to consent to such a drastic procedure? How can family members consent to donate a body that they could very well run into — and recognize — at the beach or gym? What if a left-handed person received a right-handed body? What if a lifelong Chicago Bears fan woke to find himself attached to the green-and-gold-tattooed torso of a former Packers fan? Would transplant recipients need to buy whole new wardrobes? Who will pay?

We were among those early to carry ethical torches and morally indignant pitchforks at this transplant ahead of its time. Caplan not long ago called Canavero’s work “crackpot science,” writing that “everything about Canavero’s activity is ethically wrong” while incisively reminding all that “[m]oving a head is not akin to moving a light bulb to a new socket.” Ever at the forefront of translational bioethics, Caplan was, as is his wont, quick to integrate electrical engineering with bioethics on the frontier of the emerging field he wittily dubbed, cephalogy.

More recently we decided to hole up in our own, 21st-century garrets: putty-colored, fluorescent-lit boxes seven stories above a lower midtown Manhattan block. It was here that we took the time over a lunch of offal things to explore the real risks and benefits of head transitioning, and it was here that we realized that we had been coming at the problem completely the wrong way. Remember good facts make for good ethics. What Canavero is planning isn’t really a head transplant, but a body transplant. “Heads up!” he cried, when he should have threatened, “Bodies down!”

New Evidence in JAMA Shows Insurance Gaps Leave Some Cancer Patients Without Treatment

Jan 12, 2018• 1

BY BAILEY FITZGERALD

“How long do I have?”

The man was just diagnosed with lung cancer.

“That depends,” his doctor says. “What insurance do you have?”

New research suggests that conversations like these may be actually taking place across the country. Todd Pezzi and colleagues analyzed a national database for treatment outcomes for patients with limited stage non-small cell lung cancer, a diagnosis with high rates of response to treatment. The results, reported in JAMA Oncology last week were astounding: patients with Medicare, Medicaid, or no health insurance received different, and often worse, care than those patients with other types of health insurance. These patients were less likely to receive radiation therapy in addition to chemotherapy, part of the standard of care treatment. And they found that patients with Medicare or Medicaid were significantly less likely to survive their cancer than their counterparts with private insurance.

Clearly, the health insurance system is broken if different insurances determine what treatment a patient will get, even when there is a proven standard of care. Forcing patients and doctors to continue under what has been famously referred to as the patchwork quilt of our healthcare system is leaving people out in the cold.

These findings should alarm anyone who may be a patient one day – which, of course, is everyone. For me, a resident in internal medicine, the findings are also disquieting and discouraging. It’s frustrating to think that the best and most evidence-based treatments I spend many hours per week learning about may not even be available for some of my patients. I worry about being a part of a healthcare system where science and ethics take a backseat to billing groups.

The Individual Mandate’s Dead. What Happens Next?

Jan 11, 2018• 6

By STEVEN FINDLAY

The demise of the ACA individual mandate, along with Trump’s and Republicans’ efforts to repeal Obamacare in 2017, will trigger in election year 2018 a new phase of the long-running, bitter battle over the fate of ACA, the insurance marketplaces, and the direction of health reform in general.

Surprisingly, the Democrats appear to have the upper hand for the moment. Republican efforts to repeal the ACA in 2017 were deeply unpopular—only about 20 percent of the U.S. population supported them. Independents and moderate Republicans, in Congress and among voters, were notably opposed. And in the Senate, moderates killed the various ACA repeal bills (albeit by narrow margins).

The Republican tax bill is also unpopular.

Recent special election results in Virginia and Alabama—put Republicans off-balance and on-notice as well. In particular, the Alabama result bends the vote math in the Senate against any repeat ACA repeal efforts in 2018, and very likely beyond.

But, perhaps most surprising, the resurgence of interest in “coverage for all,” universal coverage, and “health care as a right” that started with Bernie Sander’s campaign in 2016 has continued to gain traction, even among some conservatives.

Separating the Art of Medicine From Artificial Intelligence

Jan 9, 2018• 5

By HUGH HARVEY, MD

Artificial intelligence requires data. Ideally that data should be clean, trustworthy and above all, accurate. Unfortunately, medical data is far from it. In fact medical data is sometimes so far removed from being clean, it’s positively dirty.

Consider the simple chest X-ray, the good old-fashioned posterior-anterior radiograph of the thorax. One of the longest standing radiological techniques in the medical diagnostic armoury, performed across the world by the billions. So many in fact, that radiologists struggle to keep up with the sheer volume, and sometimes forget to read the odd 23,000 of them. Oops.

Surely, such a popular, tried and tested medical test should provide great data for training AI? There’s clearly more than enough data to have a decent attempt, and the technique is so well standardised and robust that surely it’s just crying out for automation?Continue reading…

Is Marital Status in a Febrile 5-year-old Child Important?

Jan 9, 2018• 3

By NIRAN AL-AGBA, MD

My pediatric practice is one which harkens back to days long ago when physicians knew their patients and pertinent medical histories by heart. My 81-year-old father and I were in practice together for the past 16 years; he still used the very sophisticated “hunt and peck” to compose emails. The task of transitioning to an electronic record system seemed insurmountable, so we remain on paper. Our medical record system has not changed in almost five decades. I would not have it any other way.

This past spring, he walked into my office shaking his head in disbelief after thumbing through a stack of faxes. “Can you believe this 16-page emergency room note has no helpful information about the patient?”

This was not a shock to me. The future of medicine will include robots who are paid to collect reams of useless data to provide nothing in the way of health or care. Regardless, the government and third-party payors will extoll upon the virtues of their inept system as life expectancy falls.

Fifty years ago, there was a close relationship between a physician and their patient grounded in years of familiarity. Physicians took a history, performed a physical exam, and developed an assessment and plan. Diagnosis in a child with fever would be descriptive, like Bacterial Infection, Otitis Media, Fever of Unknown Cause, or Viral Illness. Parents were advised to provide supportive care, involving clear liquids, fever medication, and follow up precautions if the child worsened.

What Is An Abnormal Test Result?

Jan 9, 2018• 6

By ROBERT MCNUTT, MD

Most teachers of evidence-based-medicine talk about tests as “positive, or negative”. A positive test is one in which the result of the test is abnormal; a negative test is one in which the test’s result is normal. A problem with this way of teaching about the value of test results is that often physicians and patients think there are only two possible test results, normal or not. However, test results are never just, “normal or abnormal”; test results may take on many values, not just two. ,

Researchers distinguish normal test results by performing the test in people who are well. For example, 100s of normal people will have blood tests done and the test results will vary over a narrow range. A serum potassium test result may be as low as 3.0 and as high as 4.0 in normal people, for example. An abnormal test result for potassium, then, is one whose value is greater than the highest in the range of values in normal people. But, the greater the potassium level, the more the diagnostic and treatment decisions may vary. In tesing, the magnitude of the result matters.

A key concept in testing is that the value of any test result may vary. The more abnormal it is, the more information it “contains” in terms of making a diagnosis. This may seem self evident, but failing to consider the absolute value of a test result is a common cause of missing the correct diagnosis in my experience.Continue reading…

Are you in SF? What are you doing on Wednesday?

Jan 8, 2018

If you’re in San Francisco for JP Morgan Week, you can’t miss the hottest event focusing on new investment trends in health tech and the revolution in choice within the consumer landscape.

Check out the full agenda of our 4th annual WinterTech conference!

Here is what’s happening during our WinterTech conference that makes it unique from every other event happening during JP Morgan Week:

Mark Ganz, CEO of Cambia Health giving a keynote presentation on how to create seamless health care experiences to meet the needs of consumers.
Bakul Patel, Associate Director for Digital Health at the FDA in a panel discussion on the opportunities, roadblocks, and regulations within the field of digital therapeutics.
Investment Strategies Past and Present: a look into 2017 trends, surprises, and flops. Plus predictions for 2018 by VC firms GE Ventures, Canaan, Fifty Years, NEA, and B Capital Group.
Four chats between 4 VCs and their CEOs on their relationships, how they work together, and where their companies are going next.
Live demos from some of the most innovative companies in the digital healthcare space includingParsley Health, Neurotrack, Habit, and much more!
Access to the Investor Breakfast where start-ups and investors discuss business models and explore portfolios.
Launch winners from previous years – hear what Healthvana, a patient engagement platform that delivers interpreted lab results; and Cardinal Analytx Solutions, which identifies next year’s new high cost members before a high cost event occurs, are up too since they appeared at Health 2.0.

Register today to get the latest on new heath tech investments, see live tech demos, and network with hundreds of health tech VCs, CEOs, and thought leaders.

A New Non-Partisan Panel to Monitor the President’s Health

Jan 7, 2018• 4

By ARTHUR CAPLAN PhD & JONATHAN MORENO PhD

The White House has announced that President Trump has scheduled an annual physical exam for Jan. 12. The President will go to Walter Reed National Military Medical Center in Bethesda, Md., the largest military hospital in the nation. White House press secretary Sarah Huckabee Sanders says Dr. Ronny Jackson, a rear admiral in the U.S. Navy who has served as physician to the President since 2013, “will give a readout of the exam after it’s completed.”

Some may have greeted this announcement with relief. Finally, concerns about the President’s slurred speech, overall mental health, crummy diet and obesity will be publicly addressed. Don’t get your hopes up.

A physical tends to be just that—an assessment of the physical not the mental. The evaluation of mental health in a standard physical is, to be polite, very cursory.

And while it is good that Trump at 71 will get a physical, he is under no obligation to reveal anything concerning that the exam turns up. When you are Commander-in-Chief and an Admiral reports on your exam, it is very clear that the Admiral had better be prudent about what gets said about the boss. Same goes for those on active duty at Walter Reed who perform the exam. Moreover, Trump has the same right to privacy that you or I do when we choose to get a physical or undergo any other medical procedure. It is up to him what he reveals to the rest of us.

The White House is well aware that they control what we will learn about the President’s health. And control the results they will.

The Price of Progress

Jan 4, 2018• 24

By ANISH KOKA, MD

No one knows who Bennie Solis is anymore.

He had the misfortune of being born in the early 1960s marked for death. He had a rare peculiar condition called biliary atresia – a disease defined by the absence of a conduit for bile to travel from his liver to his intestinal tract. Bile acid produced in the liver normally travels to the intestines much like water from a spring travels via ever larger channels to eventually empty into the ocean. Bile produced in the liver with no where to go dams up in the liver and starts to destroy it.

That the liver is a hardy organ was a fact known to the ancient Greeks who told the tale of the punishment given to the god Prometheus for stealing fire from the gods. Chained to a mountain, an eagle would feast on his liver by day. The liver would regenerate by night to allow the eagle a full meal on its return making this a truly eternal punishment.

So it is that the poisoned human liver remarkably continues to function to allow beautiful appearing normal children to be born. It would make the eventual discovery of the disease all the more painful. How could that beautiful child harbor something so black inside?

When Bennie was born, every child with his condition had one fate. Death.

And it did not come slowly. As the liver becomes progressively damaged and scarred, the flow of blood through the liver is impeded. The obstructed blood, seeking a way to return to the heart, travels through collateral channels. These vessels, normally minute and invisible in the esophagus and the stomach, now become engorged and thin walled and prone to rupture. Complicating matters even further, the body lacks clotting factors that were normally synthesized by the liver, giving blood the consistency of water. The horrors only multiply. Blood pours from the mouth and rectum when vessels rupture, free fluid fills the abdominal cavity, the lack of bile in the intestine means fat isn’t absorbed, and the body starves. When death mercifully does intervene, it arrives as the liver completely loses its ability to manage toxins, sending the children into a coma.