The decline in cognitive health, especially that leading to Alzheimer’s and other brain diseases, is one of the most feared conditions by patients and their families. It’s also one of the most expensive. But if we can predict it early there are things we can do to prevent or ameliorate it. The issue has been finding an easy and comprehensive way to monitor it as part of primary care. The team at Linus Health has been building a diagnostic solution for exactly that and claims that it’s now the right time to roll it out as part of general primary care. CEO David Bates, John Showalter, Chief Product Officer (a primary care doc) and Alvaro Pascual Leone, a neurologist and Chief Medical Officer, took me through an extensive end to end demo. This is a long and fascinating look at the state of play in neurology diagnosis, and discussion about what the future of brain health looks like. Matthew Holt
Above the Fold
Health Care in Abundance
By KIM BELLARD
A recent report from Moody’s Analytics, by chief economist Mark Zandi, had an eye-opening fact: the top 10% of earners in the U.S. – those who make $250,000 or more – now account for just shy (49.7%) of half of consumer spending. If that strikes you as unusual, you’re right. It is a record since at least 1989. Thirty years ago the comparable percentage was 36%.
“The finances of the well-to-do have never been better, their spending never stronger and the economy never more dependent on that group,” wrote Dr. Zandi. He added: “Wealthier households are financially more secure and thus more able and willing to spend their income. That is, they save less than they would otherwise.”
The rest of us are struggling to hold our own against inflation, not always successfully. It’s why companies like Costco and Walmart are trying to target upscale shoppers, while “value” oriented firms like Big Lots, Family Dollar, or Kohl’s are closing stores or even declaring bankruptcy.
This extreme bifurcation, of course, made me think of healthcare, where – as is famously known – half of all spending is attributable to only 5% of patients. In case you’d forgotten, in healthcare, half the population accounts for 97% of all spending, so the other half accounts for a measly 3%.
Now, you might say, neither of those is surprising: rich people spend more, and sicker people cost more. But somehow neither of those seems right to me.
I started thinking more about this after reading a recent New York Times op-ed from Ezra Klein. In it he makes the following assertion:
The answer to a politics ofscarcity is a politics of abundance, a politics that asks what it is that people really need and then organizes government to make sure there is enough of it.
Mr. Klein didn’t coin the phrase “politics of abundance,” but he and Derek Thompson did just write a book on the topic (Abundance) that discusses their thoughts at more length. I have not read the book, but I saw a quote from it that I quite liked: “What is scarce that should be abundant? What is hard to build that should be easy?”
And so we’re back to healthcare.
We seem to live in a country where healthcare is too scarce. A new analysis suggests that we have a looming shortage of hospital beds, and if you live in a rural area, it’s already here. If you believe the Association of American Medical Colleges, we have a looming physician shortage, and if you’re looking for primary care, it’s already here. We’re facing nursing storages, pharmacist shortages, nursing home worker shortages, home health worker shortages, to name a few. We even have shortages of many critical prescriptions, including some needed for cancer treatments.
Despite all these shortages or would-be shortages, of course, we manage to spend way more than other countries on healthcare. One can only imagine how much we might be spending if there were no shortages. I take that back: I’m not sure I can imagine.
In the category of things that are scarce that should be abundant, and/or things that are hard to build that should be easy, I’d probably put housing at the top but healthcare as a close second. The trouble is, when we pour more money into healthcare, as we are wont to do, we don’t seem to fill any of our many shortages, much less improve the quality of care or outcomes.
Continue reading…We Cannot Let RFK Jr Lead Us Backwards in Health
By ARIEL FRISTOE
As the artistic director of Out of Hand Theater, an arts organization that promotes anti-racism, social activism and health equity, I believe the recent appointment of Robert F. Kennedy, Jr. (RFK) as Secretary to the Department of Health and Human Services is beyond concerning. RFK is not a doctor, nor is he a scientist, yet he has been very vocal about his vaccine skepticism and has promoted misinformation about vaccine safety. Now, along with the removal of scientific information and warnings from the Centers for Disease Control (CDC) website, RFK’s appointment could lead to major increases in preventable and serious illnesses, outbreaks and deaths.
COVID-19 and its various mutations are still very much part of our daily landscape. According to the World Health Organization (WHO), more than 7 million COVID-related deaths have been reported since 2020 worldwide, nearly 2 million deaths were recorded in 2020 alone. The first vaccines were developed and became available by November 2020 and reported deaths from the last 28 days is 3,872, which is a 98.7% decrease from the onset of the pandemic. Vaccines work and save lives!
Diseases like smallpox and the bubonic plague were wiped out because scientists developed vaccines. Currently, with the “anti-vax” rhetoric being embraced and misinformation being so commonplace, reports of measles went from 4 cases in 2023 to 285 in 2024. Nine of these cases required hospitalization. The affected individuals include six children under four years old, 16 individuals aged 5-17, and two adults over 18 – the numbers rise as the days go by with 124 cases in in Texas in 2025 alone. We cannot and should not be going backwards where medicine is concerned.
Health experts are concerned that increasing nonmedical vaccine exemptions among schoolchildren could lead to more frequent outbreaks. Declining vaccination rates are worrisome as measles can cause serious illness, including hospitalization and brain swelling. I am not a doctor nor a scientist, but I place my trust in the actual doctors and scientists who have the greater good in mind when developing medicines to combat and prevent diseases. Why does this matter to me? Through our Equitable Vaccines program, we use art, information and conversation to encourage vaccine confidence and educate the community about resources so that we can create a healthier community, and we’re proud to have helped deliver 650 vaccines across Georgia. A healthy community is a strong community – and to me, that is the most valuable commodity over what is imported and exported.
As a woman, as a mother, as a human, I worry about our health and our children’s future with RFK Jr leading the Department of Health and Human Services. I implore that all of us contact our local and state representatives to express our concerns over RFK’s Department of Health and Human Services appointment. We cannot go backwards when we have the resources available to us to create a safe and healthy place for every citizen to thrive. We must prioritize our communities’ health and allow proven data to guide our most important decisions that impact those that are most precious to us.
Ariel Fristoe is the Artistic Director at Out of Hand Theater
Stuart Blitz, Hone Health
Stuart Blitz is COO and founder of Hone Health. He comes from a long career in health tech, notably at diabetes device pioneer Agamatrix. Stuart’s been working on his aggressive social media career, but in the background he co-founded Hone Health in the male health online telehealth/pharmacy space in March 2020 (great timing!). It’s now raised real money ($33m last month), has expanded to the other half of the population (women, too!), and is finding a space for itself in the cash-pay space where HIMS, Roman et al are well known. We had a great conversation about how that space is playing out and what Stuart thinks will work there, and what it means for health care overall–Matthew Holt
Natalie Schneider, Fort Health
Natalie Schneider is CEO of Fort Health, a relatively new entrant into the children’s mental health market. Fort Health’s modus operandi is to partner with (i.e. market via) pediatricians to get them to refer patients. They are delivering integrated care and something called collaborative care…a newer model that has more frequent and shorter interventions and is more affordable. Natalie is concerned that only 20% of current psychiatric care for pediatric patients is currently evidenced-based and measured. Part of their secret sauce is through a partnership with the Child Mind Institute, and they also deliver a series of educational offerings for parents. Fort Health has raised $16m & they’re pursuing a market by market expansion working with those pediatricians starting with New Jersey–Matthew Holt
Unlocking the power of sensor data in type 2 diabetes care
By GABRIELLE GOLDBLATT
Highly relevant, high-resolution data streams are essential to high-stakes decision making across industries. You wouldn’t expect an investment banker making deals without full market visibility or a grocery store to stock shelves without data on what’s selling and what’s not—so why are we not leaning more into data-driven approaches in healthcare?
Sensor-based measures, data collected from wearables and smart technologies, often continuously and outside the clinic, can drive more precise and cost-effective treatment strategies. Yet, in many cases, they’re not used to the fullest potential – either because they’re not covered by insurance or they’re treated as an add-on rather than an integral input to disease management. As a result, we lack sufficient clarity of the true value of treatments, making it difficult to discern which are high quality and which drive up the already sky-high cost of healthcare in the U.S.
Take type 2 diabetes (T2D), for example, which impacts upwards of 36 million Americans. Many people with diabetes also face comorbidities like cardiovascular disease, obesity, and kidney complications, which increase treatment complexity and costs. The range of treatments available to manage and treat T2D has grown significantly in recent years, from established therapies like metformin and insulin to newer options like virtual care programs and GLP-1 receptor agonists, which offer benefits that may extend to comorbidities.
This expanded treatment landscape promises to improve the standard of care, but it also makes it difficult for treatment options to stand out in an increasingly crowded market. This leads to treatment gaps, worsening comorbidities, and an annual burden of over $400 billion on the healthcare system.
Continue reading…Shocking: Trump Builds a Wall Between Basic and Applied Research
By MIKE MAGEE
The leaders of America’s scientific community seem genuinely surprised by the actions of the past three weeks. They expected to be spared the wrath of Trump because they believed that “Americans of all political persuasions have respect for science and celebrate its breakthroughs.”
Maybe so. But that is an inadequate defense against a multi-pronged attack which includes purposefully selecting unqualified hostiles to key management positions; restricting scientists travel and communications; censuring scientific discourse; and clawing back promised funding for research projects already underway. This “knee-capping” has extended beyond our geographic boundaries with Trump’s vengeful withdrawal from the WHO and the Musk inspired elimination of USAID.
“This too will pass,” whisper Republicans behind closed doors. But even so, the nature of scientific discovery and implementation is a complex rebuild. This is because the path from innovation to invention to implementation is interdisciplinary and requires collaborative interfaces and multi-year problem solving. Not the least of the challenges is gaining access, trust, and cooperation from the general public which requires funding, public education, and community planning.
Take for example a life saving device that is increasingly ubiquitous–found everywhere these days from rural high school cafeterias to the International Space Station and everywhere in between-– the Automated External Defibrillator or AED.
It is estimated that AED’s have the potential to save 1,700 American lives a year. Experts estimate that over 18,000 Americans have a life threatening cardiac arrest outside of a hospital with a shockable rhythm disturbance each year. But 90% don’t survive because access to an AED is delayed or not available. Without a correction in about ten minutes, you are likely to die. This means that the 6 pound AED has be where the patient is, the bystander has to know what to do with it, and there can be no delay.
Creating the modern day AED was a century long affair according to the “Institute of Electrical and Electronics Engineers” or IEEE .
Continue reading…What would a rational DOG(gi)E do(o)?
By MATTHEW HOLT
DOGE, or Doggie as Kara Swisher has been calling it, has gone from being a meme about Shiba Inus to a crypto scam to a group tearing the Federal government apart.So I thought I would use the title of this piece to make a joke. Like Musk’s humor it’s puerile and not funny. What’s also not funny is what Musk’s team has done to small government agencies, like USAID & CFPB that really help people, not to mention the irrational firing of thousands of government employees that appear to be screwing up the NIH, the National Parks, the FAA and much more. But it’s all got me thinking, what in health care should an effort to quickly rationalize government spending do?
Now I’m not proposing that there’s anything OK with the way Musk and his team have been blundering around the Federal government, telling lies about what it does and indiscriminately firing the people who have the most important responsibilities and then desperately trying to get them to come back. This has been pure ignorance theater, and it would be hilarious if it wasn’t so damaging. Equally importantly the places DOG(gi)E has started are stupid because they don’t spend much money. But the government spends a lot on health care –between two and three trillion dollars, depending on how you count it.
So if you wanted to save some money and potentially change the system, what would you do? First you’d take a deep breath and get some real data, and improve your understanding about what is actually happening. There are some areas in health care where the issues are well understood and the data is clear and there are others where it’s less obvious.
Let’s start with a relatively small one–spending on Federal Employees health benefits. Chris Deacon’s Linkedin posts are a constant source of fun and games, and she has been highlighting screwups in the FEHBP administration for a long time. Essentially the government via the OPM pays lots of different insurance companies to manage Federal employees’ health care. There is very poor oversight of what happens in those programs and when the OPM’s OIG points that out, not much happens. The plans (including Horizon Blues in NJ and BCBSNC and many others) have been caught being sloppy or fraudulent but not much has happened. All DOG(gi)E needs to do is read the report on the audits, or look at what GOA said about $1bn being spent on ineligible members in 2022 and apply their recommendations.
Next let’s get into something that requires a little more investigation. In America we buy (and sell) drugs in a mind-bogglingly complex way.
Continue reading…Goodbye, American Science
By KIM BELLARD
Many people don’t realize it, but a hundred years ago America was something of a scientific backwater. Oh, sure, we had the occasional Nobel laureate, but the center of science was in Europe, particularly Germany. Then in the early 1930’s the Nazis decided that “purity” – of political ideas, of blood – was more important than truth, making life uncomfortable at best and deadly at worst for their scientists. So hundreds of them fled, many of them ending up in the U.S. And – voila! – American science came of age and hasn’t looked back.
Until now. Now, I fear we’re going to suffer what Germany did, a brain drain that will bode well for some other country’s scientific fortunes.
Once of the first chilling announcements from the Trump Administration was that it was freezing NIH grants in order to ensure they were in compliance with Trump’s executive order banning DEI-related efforts. That froze some $1.5b in grant funding.
Piling on, the Administration announced that NIH grants would limit indirect costs to 15%. Sounds reasonable, you might say, but the vast machinery of U.S. biomedical research uses these “indirect” costs to fund the infrastructure that makes the research possible. Numerous state Attorney Generals immediately filed a lawsuit to block the cuts, claiming:
This research funding covers expenses that facilitate critical components of biomedical research, such as lab, faculty, infrastructure and utility costs. Without it, lifesaving and life-extending research, including clinical trials, would be significantly compromised. These cuts would have a devastating impact on universities around the country, many of which are at the forefront of groundbreaking research efforts – while also training future generations of researchers and innovators.
Oh, and on top of all this, as many as 1,500 NIH employees are in line to be laid-off.
Katie Witkiewitz, a professor at the University of New Mexico, lamented to The New York Times: “The N.I.H. just seems to be frozen. The people on the ground doing the work of the science are going to be the first to go, and that devastation may happen with just a delay of funding.”
Universities are similarly frozen, not sure when or how much money they can expect. The University of Pittsburgh has paused all Ph.D. admission, until it can better understand its funding future. One has to suspect it won’t be the only such program to do so, and we may never know how many would-be Ph.D. students will simply decide a future in U.S. science is too bleak to risk.
Continue reading…How hard is it to prove you have coverage?
A friend of mine who wants to stay anonymous (for now at any rate) had a crazy waste of time proving that he was eligibile for a medication on his plan. I thought his story might trigger a few of you! And yes Optum is of course part of United HealthGroup–Matthew Holt
Here is the ridiculous situation I had with filling a prescription through COBRA a few weeks back.
I spent 33 minutes on the phone on January 8th, 2025 before I finally navigated the maze that is American healthcare to the extent that a medication that has been prescribed for me by my doctor regularly for several years could be delivered to her office in time for my next appointment. OK, there is a need to verify health insurance coverage, but one might expect this to be a simple matter of checking eligibility->coverage->currency-with-premiums, and something that can be done asynchronously. Not so. Optum needed to verify the “paid-through date.” I pointed out that I’d already made four attempts to resolve this situation since December 19th, including on the last occasion by providing details of my COBRA policy to the Optum agent so that she could follow up with them to verify whatever it is they needed to verify. Apparently she hadn’t bothered, so here we were again.
What was required to resolve this in the end was literally a four-way conference call, which of course is absolutely ridiculous in the Information Age. With the primary Optum agent on the line, I conferenced in the COBRA hotline, but the automated voice confirming my “paid-through date” was not good enough for her to be able to vouch for me. I needed to get a human agent on the line. Meanwhile, the primary Optum agent conferenced in someone from their payments division. With all four of us on the phone, I did the introductions, then the second Optum agent asked the COBRA agent to repeat the paid-through date, give his name and a confirmation number, and that was enough information for the Optum payments person. The primary agent and I twiddled our thumbs on the line for another 5-10 minutes until the payments agent came back online to tell us that she had completed her work–at least for the coverage part.
But wait. There’s more. Now I needed to confirm my consent to the terms and conditions, which the agent had to read out to me in full, taking several minutes of her reading the small print, before I confirmed that I accepted. The final stage was for me to wait on hold again while she set up overnight delivery and then reconfirmed my appointment with my doctor. In the end, this was successful, but it cost me nearly 35 minutes in a process that is absolutely unnecessary.
Delay, Deny, Defend were the words inscribed on Luigi Mangione’s bullets. This was his point. They haven’t gotten the memo.
