By KIM BELLARD

Among the many things that infuriate me about the U.S. healthcare system, health systems sending their patients to collections – or even suing them – is pretty high on the list (especially when they are “non-profit” and./or faith-based organizations, which we should expect to behave better).

There’s no doubt medical debt in the U.S. is a huge problem. Studies have found that more than 100 million people have medical debt, many of whom don’t think they’ll ever be able to pay it off. Kaiser Family Foundation estimates Americans owe some $220b in medical debt, with 3 million people owing more than $10,000. It’s oft cited that medical debts are the leading cause of bankruptcy, although it’s quite not clear that is actually true.

So you’d think that helping pay off that debt would be a good thing. But it turns out, it’s not that simple.

A new study from the National Bureau of Economic Research (NBER) by Raymond Kluender, et. alia, found that, whoops, paying off people’s medical debt didn’t improve their credit score or financial distress, made them less likely to pay future medical bills, and didn’t improve their mental health.

“We were disappointed,” said Professor Kluender told Sarah Kliff in The New York Times. “We don’t want to sugarcoat it.”

The researchers worked with R.I.P. Medical Debt, a non-profit that buys up medical debt “at pennies on the dollar,” to identify people with such debt, and then compared people whom R.I.P. Medical Debt had helped versus those it had not. One set of people had hospital debts that were at the point of being sold to a collection agency, and another had debts that had already been sent to collection. And, perhaps to highlight how little we understand our healthcare system, they asked experts in medical debt what their expectations for the experiment were.

Much to everyone’s surprise, having debt paid off made no difference between control and debt-relief groups. I.e.,

• “We find no average effects of medical debt relief on the financial outcomes in credit bureau data in either of our experiments.
• We similarly estimate economically small and statistically insignificant effects on other measures of financial distress, credit access, and credit utilization.
• We find that debt relief causes a statistically significant and economically meaningful reduction in payment of existing medical bills.
• We estimate statistically insignificant average effects of medical debt relief on measures of mental and physical health, healthcare utilization, and financial wellness, with “opposite-signed” point estimates for the mental health outcomes relative to our prior.”

In short: 

Our findings contrast with evidence on the effects of non-medical debt relief and evidence on the benefits of upstream relief of medical bills through hospital financial assistance programs. Our results are similarly at odds with views of the experts we surveyed, pronouncements by policymakers funding medical debt relief, and self-reported assessments of recipients of medical debt relief. 

Amy Finkelstein, a health economist at the MIT and a co-director of J-PAL North America, a nonprofit group that provided some funding for the study, told Ms. Kliff: “The idea that maybe we could get rid of medical debt, and it wouldn’t cost that much money but it would make a big difference, was appealing. What we learned, unfortunately, is that it doesn’t look like it has much of an impact.”

If only it was that easy.

To be clear, there were three key statistically significant effects:

• “small improvements in credit access for the subset of persons whose medical debt would have otherwise been reported to the credit bureaus,
• modest reduction in payments of future medical bills, and
• worsened mental health outcomes, concentrated among those who had the largest amount of debt relieved and those who received phone calls to raise awareness and salience of the intervention.”

The authors admitted they had not expected the mental health results and had no good explanation, but their “preferred interpretation is that recipients of the cash payments viewed the transfers as insufficient to close the gap between their resources and needs, raising the salience of their financial distress and harming their mental health.”

As Neale Mahoney, an economist at Stanford and a co-author of the study, told Ms. Kliff: “Many of these people have lots of other financial issues. Removing one red flag just doesn’t make them suddenly turn into a good risk, from a lending perspective.”

The authors concluded:

Nonetheless, our results are sobering; they demonstrate no improvements in financial well-being or mental health from medical debt relief, reduced repayment of medical bills, and, if anything, a perverse worsening of mental health. Moreover, other than modest impacts on credit access for those whose medical debt is reported, we are unable to identify ways to target relief to subpopulations who stand to experience meaningful benefits.

On the other hand, Allison Sesso, R.I.P. Medical Debt’s executive director, told Ms. Kliff that study was at odds with what the group had regularly heard from those it had helped. “We’re hearing back from people who are thrilled,” she said.

As statisticians would say, anecdotes are not data.

————-

Removing medical debt seems like a can’t-lose idea. A number of states and local governments have passed programs to pay off medical debt (most working with R.I.P. Medical Debt) and a number of others are considering it.

Last fall the Consumer Financial Protection Bureau initiated rulemaking that would remove medical bills from credit reports. It has also, according to NPR, “penalized medical debt collectors, issued stern warnings to health care providers and lenders that target patients, and published reams of reports on how the health care system is undermining the financial security of Americans.”

Director Chopra admits: “Of course, there are broader things that we would probably want to fix about our health care system, but this is having a direct financial impact on so many Americans.”

If nothing else, the new study should remind us that our health system is best at putting band-aids on problems rather than solving them. The problems we should be addressing include: why are so many charges so high, why aren’t people better protected against them, and why don’t more Americans have enough resources to pay their bills, especially unpredictable ones like from health care services?

I’m glad R.I.P. Medical Debt is doing what it is doing, but let’s not kid ourselves that it is solving the problem.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By KIM BELLARD

It’s been almost four years since I first wrote about microplastics; long story short, they’re everywhere. In the ground, in the oceans (even at the very bottom), in the atmosphere. More to the point, they’re in the air you breathe and in the food you eat. They’re in you, and no one thinks that is a good thing. But we’re only starting to understand the harm they cause.

The Washington Post recently reported:

Scientists have found microplastics — or their tinier cousins, nanoplastics — embedded in the human placenta, in blood, in the heart and in the liver and bowels. In one recent study, microplastics were found in every single one of 62 placentas studied; in another, they were found in every artery studied.

One 2019 study estimated “annual microplastics consumption ranges from 39,000 to 52,000 particles depending on age and sex. These estimates increase to 74,000 and 121,000 when inhalation is considered.” A more recent study estimated that a single liter of bottled water may include 370,000 nanoplastic particles. “It’s sobering at the very least, if not very concerning,” Pankaj Pasricha, MD, MBBS, chair of the department of medicine at the Mayo Clinic, who was not involved with the new research, told Health. 

But we still don’t have a good sense of exactly what harm they cause. “I hate to say it, but we’re still at the beginning,” Phoebe Stapleton,a professor of pharmacology and toxicology at Rutgers University, told WaPo.

A new study sheds some light – and it is not good. It found that people with microplastics in their heart were at higher risk of heart attack, stroke, and death. The researchers looked at the carotid plaque from patients who were having it removed and found 60% of them had microplastics and/or nanoplastics. They followed patients for three years to determine the impacts on patients’ health and found higher morbidity/mortality.

“We are reasonably sure that the problem comes from a frailty of the plaque itself,” says Giuseppe Paolisso, a professor of internal medicine and geriatrics at the University of Campania Luigi Vanvitelli in Naples, Italy, and one of the study’s authors. “We suppose due to the fact that the plaques with microplastics and nanoplastics have a higher degree of inflammation, this kind of plaque can be broken more easily; and once they are broken, they can go into the blood streams.”

“This is pivotal,” Philip Landrigan, an epidemiologist and professor of biology at Boston College, who was not involved in the study, wrote in an accompanying opinion piece. “For so long, people have been saying these things are in our bodies, but we don’t know what they do.” He went on to add: “If they can get into the heart, why not into the brain, the nervous system? What about the impacts on dementia or other chronic neurological diseases?”

Scary stuff.

If that isn’t scary enough, an article last year in PNAS found: “Indeed, it turns out that a host of potentially infectious disease agents can live on microplastics, including parasites, bacteria, fungi, and viruses.” Even worse: “Beyond their potential for direct delivery of infectious agents, there’s also growing evidence that microplastics can alter the conditions for disease transmission. That could mean exacerbating existing threats by fostering resistant pathogens and modifying immune responses to leave hosts more susceptible.”

However much you’re worrying about microplastics, it’s not enough.

Marine ecologist Randi Rotjan of Boston University is blunt: “Cleaning up microplastics is not a viable solution. They are ubiquitous in our environment. And macroplastics are going to break down to microplastics for millennia. What we can do is try to understand the risk” Francesco Prattichizzo, one of the researchers in the new study, agrees, warning: “Plastic production is steadily increasing and is projected to continue increasing, so we must know how [and] if any of these molecules affect our health.” 

That’s easier said than done. As WaPo notes:

Part of the problem is that there is no one type of microplastic. The tiny plastic particles that slough off things like water bottles and takeout containers can be made of polyethylene, or polypropylene, or the mouth-twisting polyethylene terephthalate. They might take the form of tiny spheres, fragments or fibers.

Sherri Mason,director of sustainability at Penn State Behrend in Erie, Pa. told WaPo that, when it comes to assigning cause and effect: “Cigarettes are definitely easier than microplastics.” In the good news/bad news category, she added: “Probably over the next decade we’ll get a lot of good data. But we’ll never have all of the answers.”

Unfortunately, the amount of microplastics just keeps growing. Professor Stapleton told WaPo: “It’s almost like a generational accumulation. Forty years ago we didn’t have as much plastic in the environment as we do now. What will that look like 20 years from now?”

We can’t even imagine.

“The first step is to recognize that the low cost and convenience of plastics are deceptive and that, in fact, they mask great harms,” Professor Landrigan pointed out. Similarly, Lukas Kenner, a professor of pathology at the Medical University of Vienna, suggested to WaPo: “I’m a doctor, and we have our principle: ‘Don’t harm anybody. If you just spill plastics everywhere, and you have no idea what you’re doing, you’re going exactly against this principle.”

Microplastics are similar to cigarettes in that the health risks of the latter were pointed out years before any action was taken, and even then many people still smoke. It’s even more similar to climate change, in that we’ve had plenty of warning, and the impacts are starting to be clear, but the dangers accumulate over such a long period of time that no one feels compelled to act.

It’s also like climate change in that the fossil fuel companies bear a significant amount of the blame. Dr. Londrigan charges: “They realize that their market for burning fossil fuels is going down, yet they’re sitting on vast stocks of oil and gas and they’ve got to do something with it. So they’re transitioning it to plastic.” 

Perhaps biology will save us, with bacteria eating the microplastics. Or maybe it be robotics,  with nanobots doing the work. But we’ve been talking about engineering our way out of climate change for thirty plus years, and yet here we are, in climate crisis. I’m not holding my breath (although I’d ingest fewer microplastics that way) about fixing microplastics anytime soon.

We’ve all got a long list of things to worry about, but if microplastics isn’t already on yours, you should add it.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By KIM BELLARD

Nice try, Wendy’s. During an earnings call last month, President and CEO Kirk Tanner outlined the company’s plan to try a new form of pricing: “Beginning as early as 2025, we will begin testing more enhanced features like dynamic pricing and day-part offerings along with AI-enabled menu changes and suggestive selling.” 

None of the analysts on the call questioned the statement, but the backlash from the public was immediate — and quite negative. As Reuters described it: “the burger chain was scorched on social media sites.”

Less than two weeks later Wendy’s backtracked – err, “clarified” – the statement. “This was misconstrued in some media reports as an intent to raise prices when demand is highest at our restaurants,” a company blog post explained. “We have no plans to do that and would not raise prices when our customers are visiting us most.”

The company was even firmer in an email to CNN: “Wendy’s will not implement surge pricing, which is the practice of raising prices when demand is highest. This was not a change in plans. It was never our plan to raise prices when customers are visiting us the most.”

OK, then. Apology accepted.

At this point it is worth explaining a distinction between dynamic pricing and the more familiar surge pricing. As Omar H. Fares writes in The Conversation: “Although surge pricing and dynamic pricing are often used interchangeably, they have slightly different definitions. Dynamic pricing refers to any pricing model that allows prices to fluctuate, while surge pricing refers to prices that are adjusted upward.”

Uber and other ride sharing services are well known for their surge pricing, whereas airlines’ pricing is more dynamic, figuring out prices by seat by when purchased by who is purchasing, among other factors.

Wendy’s wouldn’t be the first company to use dynamic pricing and it won’t be the last. Drew Patterson, co-founder of restaurant dynamic pricing provider Juicer, told The Wall Street Journal that dozens of restaurant brands used his company’s software. The company’s website doesn’t publicize those brands, of course. Still, he emphasized: “You need to make it clear that prices go up and they go down.” 

Dave & Busters is public about its pricing strategy. “We’re going to have a dynamic pricing model, so we have the right price at the right time to match the peak demand,” Dave & Buster’s CEO Chris Morris said during an investor presentation last year.  On the other hand, Dine Brands (Applebee’s/IHOP) Chief Executive John Peyton said. “We don’t think it’s an appropriate tool to use for our guests at this time.”

The potential revenue benefits are obvious, but there are risks, as Wendy’s quickly found out. Mr. Fares says: “One of the biggest risks associated with dynamic pricing is the potential negative impact on customer perception and trust. If customers feel that prices are unfair or unpredictable, they may lose trust in the brand.”

What Wendy’s tried to announce is not ground-breaking. Catherine Rampell pointed this out in a Washington Post op-ed:

In other words, things will be cheaper when demand is low to draw in more customers when there’s otherwise idle capacity. Lots of restaurants do this, including other burger chains. It’s usually called “happy hour.” Or the “early-bird special.” Non-restaurants do it, too. Think the weekday matinee deals at your local movie theater or cheaper airfares on low-traffic travel days.

Indeed, The Wall Street Journal reported: “An estimated 61% of adults support variable pricing where a restaurant lowers or raises prices based on business, with younger consumers more in favor of the approach than older ones, according to an online survey of 1,000 people by the National Restaurant Association trade group.” 

I wonder what the support would have been if the question had been about healthcare instead of restaurants. 

Like it or not, some form of dynamic pricing will come to healthcare. Want a private room instead of semi-private? Surge pricing. Willing to see a nurse practitioner instead of a physician? Dynamic pricing. Want to buy prescription drugs in the U.S. instead of in Europe? Surge pricing. Want a doctor’s appointment Monday morning instead of Tuesday? Surge pricing. Need an ER visit Saturday night instead of Sunday afternoon? Surge pricing.

Some of these healthcare has been doing for years. Others, and even more insidious ones, are coming.

We have to know that the private equity firms that have invested in healthcare have to be interested. Yashaswini Singh and Christopher Whaley wrote in The Hill: “Over the last decade, private equity firms have spent nearly $1 trillion on close to 8,000 health care deals, snapping up practices that provide care from cradle to grave: fertility clinics, neonatal care, primary care, cardiology, hospices, and everything in between.”

They go on to warn: “Although research remains mixed on how it affects quality of care, there is clear evidence that private equity ownership increases prices. These firms aim to secure high returns on their investments — upwards of 20 percent in just three to five years — which can conflict with the goal of delivering affordable, accessible, high-value health care.”

Dynamic pricing has to look good to these firms. Surge pricing would look even better.              

But one doesn’t have to be owned by private equity to be rapacious in healthcare. Everyone is looking for margins, everyone is looking to maximize revenue, and consumers – A.K.A. patients – grumble about prices but pay them anyway, especially if their health insurance company is paying most of the cost. In today’s healthcare world, if you are a CEO or CFO and you’re not considering dynamic pricing, it’s close to malfeasance.

To me, the scariest part of Wendy’s plan wasn’t the dynamic pricing but the “AI-enabled menu changes and suggestive selling.” Upcoding has been a problem in healthcare for as long as there has been coding, but when we get an AI-enabled menu of treatment options and suggested selling (aka treatments), well, we haven’t seen anything yet.

Maximize away.  

Look, I’m not going to Wendy’s even if they pay me, but I take my wife out on Valentine’s Day even though I know the restaurant has surged the hell out of its prices. Some things you pay for, and, when it comes to healthcare pricing, every day is Valentine’s Day.

I’m resigned to the fact that dynamic pricing has a toehold in healthcare already, but I’m holding out hope that we can use AI to help us make those recommendations and set those prices to deliver the most effective, efficient care, not just to maximize profits.

Wait Till Health Care Tries Dynamic Pricing

Nice try, Wendy’s. During an earnings call last month, President and CEO Kirk Tanner outlined the company’s plan to try a new form of pricing: “Beginning as early as 2025, we will begin testing more enhanced features like dynamic pricing and day-part offerings along with AI-enabled menu changes and suggestive selling.” 

None of the analysts on the call questioned the statement, but the backlash from the public was immediate — and quite negative. As Reuters described it: “the burger chain was scorched on social media sites.”

Less than two weeks later Wendy’s backtracked – err, “clarified” – the statement. “This was misconstrued in some media reports as an intent to raise prices when demand is highest at our restaurants,” a company blog post explained. “We have no plans to do that and would not raise prices when our customers are visiting us most.”

The company was even firmer in an email to CNN: “Wendy’s will not implement surge pricing, which is the practice of raising prices when demand is highest. This was not a change in plans. It was never our plan to raise prices when customers are visiting us the most.”

OK, then. Apology accepted.

At this point it is worth explaining a distinction between dynamic pricing and the more familiar surge pricing. As Omar H. Fares writes in The Conversation: “Although surge pricing and dynamic pricing are often used interchangeably, they have slightly different definitions. Dynamic pricing refers to any pricing model that allows prices to fluctuate, while surge pricing refers to prices that are adjusted upward.”

Uber and other ride sharing services are well known for their surge pricing, whereas airlines’ pricing is more dynamic, figuring out prices by seat by when purchased by who is purchasing, among other factors.

Wendy’s wouldn’t be the first company to use dynamic pricing and it won’t be the last. Drew Patterson, co-founder of restaurant dynamic pricing provider Juicer, told The Wall Street Journal that dozens of restaurant brands used his company’s software. The company’s website doesn’t publicize those brands, of course. Still, he emphasized: “You need to make it clear that prices go up and they go down.” 

Dave & Busters is public about its pricing strategy. “We’re going to have a dynamic pricing model, so we have the right price at the right time to match the peak demand,” Dave & Buster’s CEO Chris Morris said during an investor presentation last year.  On the other hand, Dine Brands (Applebee’s/IHOP) Chief Executive John Peyton said. “We don’t think it’s an appropriate tool to use for our guests at this time.”

The potential revenue benefits are obvious, but there are risks, as Wendy’s quickly found out. Mr. Fares says: “One of the biggest risks associated with dynamic pricing is the potential negative impact on customer perception and trust. If customers feel that prices are unfair or unpredictable, they may lose trust in the brand.”

What Wendy’s tried to announce is not ground-breaking. Catherine Rampell pointed this out in a Washington Post op-ed:

In other words, things will be cheaper when demand is low to draw in more customers when there’s otherwise idle capacity. Lots of restaurants do this, including other burger chains. It’s usually called “happy hour.” Or the “early-bird special.” Non-restaurants do it, too. Think the weekday matinee deals at your local movie theater or cheaper airfares on low-traffic travel days.

Indeed, The Wall Street Journal reported: “An estimated 61% of adults support variable pricing where a restaurant lowers or raises prices based on business, with younger consumers more in favor of the approach than older ones, according to an online survey of 1,000 people by the National Restaurant Association trade group.” 

I wonder what the support would have been if the question had been about healthcare instead of restaurants. 

Like it or not, some form of dynamic pricing will come to healthcare. Want a private room instead of semi-private? Surge pricing. Willing to see a nurse practitioner instead of a physician? Dynamic pricing. Want to buy prescription drugs in the U.S. instead of in Europe? Surge pricing. Want a doctor’s appointment Monday morning instead of Tuesday? Surge pricing. Need an ER visit Saturday night instead of Sunday afternoon? Surge pricing.

Some of these healthcare has been doing for years. Others, and even more insidious ones, are coming.

We have to know that the private equity firms that have invested in healthcare have to be interested. Yashaswini Singh and Christopher Whaley wrote in The Hill: “Over the last decade, private equity firms have spent nearly $1 trillion on close to 8,000 health care deals, snapping up practices that provide care from cradle to grave: fertility clinics, neonatal care, primary care, cardiology, hospices, and everything in between.”

They go on to warn: “Although research remains mixed on how it affects quality of care, there is clear evidence that private equity ownership increases prices. These firms aim to secure high returns on their investments — upwards of 20 percent in just three to five years — which can conflict with the goal of delivering affordable, accessible, high-value health care.”

Dynamic pricing has to look good to these firms. Surge pricing would look even better.              

But one doesn’t have to be owned by private equity to be rapacious in healthcare. Everyone is looking for margins, everyone is looking to maximize revenue, and consumers – A.K.A. patients – grumble about prices but pay them anyway, especially if their health insurance company is paying most of the cost. In today’s healthcare world, if you are a CEO or CFO and you’re not considering dynamic pricing, it’s close to malfeasance.

To me, the scariest part of Wendy’s plan wasn’t the dynamic pricing but the “AI-enabled menu changes and suggestive selling.” Upcoding has been a problem in healthcare for as long as there has been coding, but when we get an AI-enabled menu of treatment options and suggested selling (aka treatments), well, we haven’t seen anything yet.

Maximize away.  

Look, I’m not going to Wendy’s even if they pay me, but I take my wife out on Valentine’s Day even though I know the restaurant has surged the hell out of its prices. Some things you pay for, and, when it comes to healthcare pricing, every day is Valentine’s Day.

I’m resigned to the fact that dynamic pricing has a toehold in healthcare already, but I’m holding out hope that we can use AI to help us make those recommendations and set those prices to deliver the most effective, efficient care, not just to maximize profits.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By KIM BELLARD

Perhaps you’ve heard about the controversial Alabama Supreme Court ruling about in-vitro fertilization (IVF), in which the court declared that frozen embryos were people. The court stated that it has long held that “unborn children are ‘children,’” with Chief Justice Tom Parker – more on him later – opining in a concurring opinion:

Human life cannot be wrongfully destroyed without incurring the wrath of a holy God, who views the destruction of His image as an affront to Himself. Even before birth, all human beings bear the image of God, and their lives cannot be destroyed without effacing his glory.

Seriously.

Many people have already weighed in on this decision and its implications, but I couldn’t resist taking some pleasure in seeing “pro-life” advocates tying themselves in knots trying to explain why, when they legislated that life begins at conception, they didn’t mean this kind of conception and that kind of life.

John Oliver was typically on point, noting that the Alabama ruling was “wrong for a whole bunch of reasons. Mainly, if you freeze an embryo it’s fine. If you freeze a person, you have some explaining to do.”

The case in question wasn’t specifically about IVF, nor did the ruling explicitly outlaw it. It was a case about a patient who removed stored embryos and accidentally dropped them, and the couples whose embryos were destroyed wanted to hold that patient liable under the Wrongful Death of a Minor Act. The court said they could. Note, though, that neither the patient nor the clinic was being charged with murder or manslaughter…yet.

Although the Alabama Attorney General has already indicated he won’t prosecute IVF patients or clinicians, the ruling has had a chilling effect on fertility clinics in the states, with The University of Alabama at Birmingham health system and others indicating they were putting a pause on IVF treatments.

Justice Parker has long been known as something of a theocrat; as The New York Times wrote:

Since he was first elected to the nine-member court in 2004, and in his legal career before it, he has shown no reticence about expressing how his Christian beliefs have profoundly shaped his understanding of the law and his approach to it as a lawyer and judge.

His concurring opinion claimed: the state constitution had adopted a “theologically-based view of the sanctity of life.” Alabama is not alone. Kelly Baden, the vice president for public policy at the Guttmacher Institute, told BBC: “We do see that many elected officials and judges alike are often coming at this debate from a highly religious lens.”

Speaker Johnson has said:

The separation of church and state is a misnomer. People misunderstand it. Of course, it comes from a phrase that was in a letter that Jefferson wrote. It’s not in the Constitution. And what he was explaining is they did not want the government to encroach upon the church — not that they didn’t want principles of faith to have influence on our public life. It’s exactly the opposite.

And here we are.

Many Republicans are backtracking on the ruling.

Alabama Republican Governor Kay Ivey said she was “working on a solution.” Alabama legislators are already working on bills to protect IVF, clarifying that in vitro fertilization doesn’t count, with life only beginning when implanted in a uterus. Oh, OK, then.

Presumed Republican presidential nominee Donald Trump says he “strongly” supports IVF, and Republican Speaker of the House Mike Johnson said: “I believe the life of every single child has inestimable dignity and value. That is why I support IVF treatment, which has been a blessing for many moms and dads who have struggled with fertility,” Alabama Senator Tommy Tuberville somewhat hilariously managed to somehow both support the ruling and the need for IVF.

Eric Johnston, president of the Alabama Pro-Life Coalition, admitted:

It’s a win philosophically for the pro-life movement because it carries on the pro-life recognition of unborn life. But you get into a very difficult situation, where you have this medical procedure that’s accepted by most people, and then how do you deal with it? That’s the dilemma… But I think the pro-life community in general supports IVF, and I’ve known and worked with many people who have had children via IVF. And at the same time, they think abortion is wrong. This issue is so different from abortion, but it has to do with life.

The trouble is, red states are scrambling all over themselves passing ever-more restrictive abortion laws, with the “life begins at conception” mantra, and, despite what Speaker Johnson and other House Republicans say now, 125 of them have cosponsored the Life at Conception Act that makes no exception for IVF.

Gosh, who could have guessed IVF would be impacted by all this?  Well, anyone who thought about it for a half second.

Although IVF only accounts for about 2% of births, it has been around for decades. An untold number of embryos are routinely stored (frozen) and, in some cases, destroyed. Now people like Republican Governor Greg Abbott would have us believe IVF is taking us all by surprise:

These are very complex issues where I’m not sure everybody has really thought about what all the potential problems are and as a result, no one really knows what the potential answers are. And I think you’re going to see states across the country come together grappling with these issues and coming up with solutions.

Once a fetus or an embryo is a person, what rights do they have, when do they qualify for tax credits/welfare/child support, and how do their rights compare to other people? As Jacob Holmes suggested in the Alabama Political Reporter: “Imagine you are in an in vitro fertilization clinic that is on fire, and you have time to save only 100 frozen embryos or a single 2-year-old child.” Do you save the most “lives,” or the only one actually breathing?

I know what I’d do.

I would be remiss if I didn’t note that Alabama has the third highest infant mortality rate in the U.S. (thank you, Arkansas and Mississippi!), and that it was one of 15 (red) states that is rejecting federal funds to help feed hungry children doing the summer (Alabama has some 500,000 such children).  

Evidently, unborn or frozen “people” matter more than live ones.

—————

These are, I admit, complex ethical issues, but trying to legislate them, especially from the standpoint of one particular religious point-of-view, is only going to lead to more outcomes like we’re seeing in Alabama. Democracy demands that we do better to listen than to tell.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By KIM BELLARD

Recently in The Washington Post, author Daniel Pink initiated a series of columns he and WaPo are calling “Why Not?” He believes “American imagination needs an imagination shot.” As he describes the plan for the columns: “In each installment, I’ll offer a single idea — bold, surprising, maybe a bit jarring — for improving our country, our organizations or our lives.”

I love it. I’m all in. I’m a “why not?” guy from way back, particularly when it comes to health care.

Mr. Pink describes three core values (in the interest of space, I’m excerpting his descriptions):

• Curiosity over certainty. The world is uncertain. Curiosity and intellectual humility are the most effective solvents for unsticking society’s gears.
• Openness over cynicism: Cynicism is easy but hollow; openness is difficult but rich.
• Conversation over conversion: The ultimate dream? That you’ll read what I’ve written and say, “Wait, I’ve got an even better idea,” and then share it.

Again, kudos. One might even say “move fast and break things,” but the bloom has come off that particular rose, so one might just say “take chances” or “think different.” Maybe even “dream big.”

Around the same time I saw Mr. Pink’s column I happened to be reading Adam Nagourney’s The Times: How the Newspaper of Record Survived Scandal, Scorn, and the Transformation of Journalism. In the early 1990’s The Times (and the rest of the world) was struggling to figure out if and how the Internet was going to change things. Mr., Nagourney reports how publisher Arthur Sulzberger (Jr) realized the impact would be profound:

One doesn’t have to be a rocket scientist to recognize that ink on wood delivered by trucks is a time consuming and expensive process.

I.e., contrary to what many people at The Times, and many of its readers, thought at the time, the newspaper wasn’t the physical object they were used to; it was the information it delivers. That may seem obvious now but was not at all then.  

Which brings me to health care. Contrary to what many people working in healthcare, and many people getting care from it, might think, healthcare is not doctors, hospitals, prescriptions, and insurance companies. Those are simply the ink on wood delivered by trucks that we’re used to, to use the metaphor.

And it doesn’t take a rocket science to recognize that what we call health care today is a time consuming and expensive process – not to mention often frustrating and ineffective.

Why not do better?

I also thought about health care when reading Mr. Nagourney’s book when he described the conflict between the journalism side of the company versus the business side: was the newspaper about the articles it published, with the advertising just there to support them, or was it really an advertising platform that needed the content the journalists created to bring eyeballs to it? In healthcare, is it about helping patients with their health, or is it a way to provide income to the people and organizations involved in their care?

I.e., is it about the mission or the margins?

If you think that’s too cynical, I’ll point to Matthew Holt’s great article in The Health Care Blog arguing that many hospitals systems are now essentially hedge funds that happen to provide some care, while also creating scads of rich executives. Or to how an actual hedge fund is buying a hospital. Or to how, indeed, private equity firms are buying up health care organizations of all types, even though many experts warn the main impact is to raise costs and adversely impact care. Or to how Medicare Advantage plans may be better at delivering insurer profits than quality care.

I could go on and on, but it seems clear to me that healthcare has lost its way, mistaking how it does things from what it is supposed to be for. If healthcare has become more about making a small number of people rich than about making a lot of people healthier, then I say let’s blow it up and start from first principles.

There’s a “Why Not?”

Mr. Holt’s “Why Not?” is to take a measly $38b from the $300b he estimates those hospitals are sitting on, and invest it in primary care, such as the Federally Qualified Health Centers (FQHCs). Primary care needs the money; the hospitals/hedge funds, not so much. Amen to that.

A couple years ago I proposed an even wilder idea: let’s give every physician $2 million – maybe even $2.5 million – annually. We say we value them, so let’s reward them accordingly. The caveat: from that they’d have to pay for all of their patients’ health care needs – referrals, prescriptions, hospital stays, etc. I posited that they’d negotiate much better deals with their compatriots than we seem to be able to do. Lots of details to be worked out, but it falls into the “Why Not?” category.

Here’s another audacious Why Not: it’s fairly well known that CEO to worker pay ratios have skyrocketed from a modest 20-1 in the 1960’s to something like 344-1 now. There’s no evidence I’ve seen that the ratios are any better in healthcare. Since no profession in healthcare is more respected and relied on than nurses, I propose – maybe making it a condition for receiving any federal funds — that no healthcare organization should have an executive compensation  to nurse compensation ratio that exceeds 20 (and I do mean compensation rather than salary, to avoid the bonus/stock shenanigans that executives have relied on). 

If that sounds low, I’d pity the executive who wants to argue with straight face that he/she is more than twenty times more important than nurses. I bet they couldn’t find many patients who’d agree, or any nurses.

———–

If you work in healthcare, you should ask yourself: is what I do the ink, the wood, or the delivery truck, or is it truly integral to what healthcare should be in 2024?  If you think your job should be more about health and less about the business of health, why not make it so?

And the rest of us should be asking ourselves: is the healthcare we get still the equivalent of a print newspaper? We don’t have to be rocket scientists to recognize that, in 2024, we should be expecting something better – cheaper, faster, more interactive, more personal, and much more impactful.

Why not, indeed?

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By KIM BELLARD

We’ve had some cold weather here lately, as has much of the nation. Not necessarily record-breaking, but uncomfortable for millions of people. It’s the kind of weather that causes climate change skeptics to sneer “where’s the global warming now?” This despite 2023 being the warmest year on record — “by far” — and the fact that the ten warmest years since 1850 have all been in the last decade, according to NOAA.

One of the parts of the globe warming the fastest is the Arctic, which is warming four times as fast as the rest of the planet. That sounds like good news if you run a shipping company looking for shorter routes (or to avoid the troubled Red Sea area), but may be bad news for everyone else.  If you don’t know why, I have two words for you: zombie viruses.

Most people are at least vaguely aware of permafrost, which covers vast portions of Siberia, Alaska, and Canada. Historically, it’s been literally frozen, not just seasonally but for years, decades, centuries, millennia, or even longer. Well, it’s starting to thaw.

Now, maybe its kind of cool that we’re finding bodies of extinct species like the woolly mammoth (which some geniuses want to revive). But also buried in the permafrost are lots of microorganisms, many of which are not, in fact, dead but are in kind of a statis. As geneticist Jean-Michel Claverie of Aix-Marseille University, recently explained to The Observer: “The crucial point about permafrost is that it is cold, dark and lacks oxygen, which is perfect for preserving biological material. You could put a yoghurt in permafrost and it might still be edible 50,000 years later.”

Dr. Claverie and his team first revived such a virus – some 30,000 years old — in 2014 and last year did the same for some that were 48,000 years old. There are believed to be organisms that ae perhaps a million years old, far older than we’ve been around. Scientists prefer to call them Methuselah microbes, although “zombie viruses” is more likely to get people’s attention.

He’s worried about the risks they pose.

He told The Observer: “At the moment, analyses of pandemic threats focus on diseases that might emerge in southern regions and then spread north. By contrast, little attention has been given to an outbreak that might emerge in the far north and then travel south – and that is an oversight, I believe. There are viruses up there that have the potential to infect humans and start a new disease outbreak.”

Well, you might shrug; there’s new viruses and pathogens coming along all the time, as COVID reminded us. The difference, Dr. Claverie pointed out, is this: “Our immune systems may have never been in contact with some of those microbes, and that is another worry. The scenario of an unknown virus once infecting a Neanderthal coming back at us, although unlikely, has become a real possibility.”

Jill Brandenberger, climate security research lead at the Pacific Northwest National Laboratory told USA Today. “We know there’s bacterial, fungal and viral pathogens that are in permafrost. We know that upon thaw, all three of those classes of pathogens could be released. What we don’t know is how viable it is for them to stay alive and then infect.” Tell that to the people who died in the anthrax outbreak in 2016, in northwest Siberia.

It’s worse than just the permafrost warming. Dr. Claverie warns:

The danger comes from another global warming impact: the disappearance of Arctic sea ice. That is allowing increases in shipping, traffic and industrial development in Siberia. Huge mining operations are being planned, and are going to drive vast holes into the deep permafrost to extract oil and ores.

Those operations will release vast amounts of pathogens that still thrive there. Miners will walk in and breath the viruses. The effects could be calamitous.

Marion Koopmans, of the Erasmus Medical Center in Rotterdam, agrees, telling The Observer:

If you look at the history of epidemic outbreaks, one of the key drivers has been change in land use. Nipah virus was spread by fruit bats who were driven from their habitats by humans. Similarly, monkeypox has been linked to the spread of urbanisation in Africa. And that is what we are about to witness in the Arctic: a complete change in land use, and that could be dangerous, as we have seen elsewhere.

And, if you’ve started to get your head around all that, if the permafrost thawing isn’t scaring us enough with the zombie viruses, there’s also a vicious global warming cycle involved. It turns out that permafrost is believed to have double the amount of carbon than is currently in the atmosphere, and which thawing permafrost releases in the form of methane and carbon dioxide.

“Methane is a potent greenhouse gas,” said Dr. Thomas Birchall of the University Center in Svalbard, who was the lead author on a new study. “At present, the leakage from below permafrost is very low, but factors such as glacial retreat and permafrost thawing may ‘lift the lid’ on this in the future.”  And, as it turns out, another new report concluded, such leakage is not being factored into most of our existing climate models.

“What happens to the carbon in permafrost is one of the biggest unknowns about our future climate,” said Christina Schaedel, senior research scientist at Woodwell Climate Research Center and lead author of the report. “Earth system models are critical to predicting where, how and when this carbon will be released, but modeling teams currently don’t have the resources they need to depict permafrost accurately. If we want more accurate climate predictions, that needs to change.”

We don’t even have good ways to accurately estimate the thawing of the permafrost, although we’re starting to use satellite data and – you guessed it! — AI to help improve those estimates.

So if your five-year-old is worried that global warming will impact Santa’s North Pole home, you can still reassure him/her about that, but there’s not much reassurance we can give kids about what permafrost thawing means for zombie viruses and accelerated global warming.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By KIM BELLARD

Last week HHS announced the appointment of its first Chief Competition Officer. I probably would have normally skipped it, except that also last week, writing in The Health Care Blog, Kat McDavitt and Lisa Bari called for HHS to name a Chief Patient Officer. I’ll touch on each of those shortly, but it made me think about all the Chiefs healthcare is getting, such as Chief Innovation Officer or Chief Customer Experience Officer.  

But what healthcare may need even more than those is a Chief Contrarian. 

The new HHS role “is responsible for coordinating, identifying, and elevating opportunities across the Department to promote competition in health care markets,” and “will play a leading role in working with the Federal Trade Commission and Department of Justice to address concentration in health care markets through data-sharing, reciprocal training programs, and the further development of additional health care competition policy initiatives.” All good stuff, to be sure.

Similarly., Ms. McDevitt and Ms, Bari point out that large healthcare organizations have the staff, time, and financial resources to ensure their points of view are heard by HHS and the rest of the federal government, whereas: “Patients do not have the resources to hire lobbyists or high-profile legal teams, nor do they have a large and well-funded trade association to represent their interests.” They go on to lament: “Because of this lack of access, resources, and representation, and because there is no single senior staff member in the federal government dedicated to ensuring the voice of the patient is represented, the needs and experiences of patients are deprioritized by corporate interests.” Thus the need for a Chief Patient Officer. Again, bravo.

The need for a Chief Contrarian – and not just at HHS – came to me from an article in The Conversation by Dana Brakman Reiser, a Professor of Law at Brooklyn Law School. She and colleague Claire Hill, a University of Minnesota law professor, argue that non-profit boards need to have “designated contrarians.”

They propose:

We believe nonprofit boards should require their members to take turns serving as “designated contrarians.” When it’s their turn for this role, board members would be responsible for asking critical questions and pushing for deeper debate about organizational decisions.

Their idea draws upon research from Lindred (Lindy) Greer, a professor of organizational behavior then at Stanford GSB and now at Michigan Ross. Her research suggested that teams need a “skilled contrarian” to improve its effectiveness. “It’s important for teams to have a devil’s advocate who is constructive and careful in communication, who carefully and artfully facilitates discussion,” Professor Ross concluded.

Her research, conducted with Ruchi Sinha, Niranjan Janardhanan, Donald Conlon, and Jeff Edwards, found that teams with a lone dissenter outperformed teams with no dissenters, or teams where everyone dissents. The key, they believe, was not to create conflict but to help identify differences and resolve resulting conflicts in non-confrontational ways.

Professors Reiser and Hill worry that “board members often fail to ask hard questions and challenge the organization’s paid staff – especially when there are more than a dozen or so people serving as directors.” They might assume everyone shares their “good intentions,” or they might just be uncomfortable “rocking the boat.”

I would argue that the same is true throughout most organizations, whether in the C-Suite or in the rest of workforce. Who is asking the hard questions?

Professors Reiser and Hill believe they have a solution:

We propose that trustees take turns being a designated contrarian, temporarily becoming a devil’s advocate obliged to challenge proposed board actions.

To be clear, they wouldn’t be naysayers out to block everything. They would instead ask probing questions and offer feedback on reports by executives and officers. They would also initiate critical discussions by challenging conventional wisdom.

The goal, they say, “would be to encourage debate and reflection about the nonprofit’s decisions, slowing – or halting, if necessary – the approval of business as usual.” Again, there’s nothing unique about non-profits or even about boards here.

If you have a team, a management staff, a C-Suite, a board (non-profit or not), or a federal agency, you need a contrarian. Someone who is not afraid to point out when, as they say, the emperor has no clothes. Who is not afraid to ask those hard questions, to rock that boat. Who realizes the status quo is not only not good enough but also never is going to last.

Organizations whose boats don’t get rocked enough are likely to capsize sooner or later.

Picking the right person(s) is crucial. Someone who is too abrasive will just create more conflict and will eventually get frozen out. On the other hand, as Professor Reiser points out: “Serving a term as contrarian will not magically transform a passive and deferential person into someone who actively challenges dominant voices or forcefully advocates alternatives. And directors wearing the contrarian hat may be too easily discounted if others perceive them as merely mouthing their assigned lines.”

It’s not a role that anyone can fill, or that everyone should, but a role that is important which someone does.

———

It has been said that organizations that need innovation units or a Chief Innovation Officer aren’t truly innovative; it needs to be baked into the culture. Similarly, needing a Chief Customer Experience Officer means customer experience is not integral to the mission. If HHS needs a Chief Competition Officer or a Chief Patient Officer, it is validation that HHS has been coopted by the special interests that healthcare is full of, and those interests aren’t primarily about patients. We need to reflect upon that; simply naming those Officers won’t be enough.

By the same token, if your organization needs a Chief Contrarian or designated contrarians, that means it doesn’t encourage healthy dissent or seek ideas that don’t reflect existing paradigms. That’s a problem.

I am, I have to admit, something of a contrarian by nature. I never had an official role as such, but I never shied away from speaking up (even when it wasn’t in my best career interests).  But, boy, if I’d had the chance to be a Chief Contrarian or a designated contrarian, I’d have loved it!

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

by KIM BELLARD

Well: 2024. I’m excited about the Paris Olympics, but otherwise I’d be just as happy to sleep through all the nonsense that the November elections will bring. In any event, I might as well start out talking about one of the hottest topics of 2023 that will get even more so in 2024: AI.

In particular, I want to look at what is being billed as the “AI PC.” 

Most of us have come to know about ChatGPT. Google has Bard (plus DeepMind’s Gemini), Microsoft is building AI into Bing and its other products, Meta released an open source AI, and Apple is building its AI framework. There is a plethora of others. You probably have used “AI assistants” like Alexa or Siri.

What most of the large language model (LLM) versions of AI have in common is that they are cloud-based. What AI PCs offer to do is to take AI down to your own hardware, not dissimilar to how PCs took mainframe computing down to your desktop.  

As The Wall Street Journal tech gurus write in their 2024 predictions in their 2024 predictions:

In 2024, every major manufacturer is aiming to give you access to AI on your devices, quickly and easily, even when they’re not connected to the internet, which current technology requires. Welcome to the age of the AI PC. (And, yes, the AI Mac.)

What’s coming is what engineers call “on-device AI.” Like our smartphones, our laptops will gain the ability to do the specialized computing required to perform AI-boosted tasks without connecting to the cloud. They will be able to understand our speech, search and summarize information, even generate images and text, all without the slow and costly round trip to a tech company’s server.

The chip companies are ready. Intel just announced their new AI PC chip. It believes that its new Intel® Core Ultra processor will change PCs forever: “Now, AI is for everyone.” If you’re used to thinking about CPU and GPU, now you’ll have to think about “NPU” – neural processing units.

Intel promises: “With AI-acceleration built into every Intel® Core Ultra processor, you now have access to a variety of experiences – enhanced collaboration, productivity, and creativity – right at your desktop.” It further claims it is working with over 100 developers and expects those developers to offer over 300 “AI-accelerated features” in 2024.

Rival AMD has also released its own AI chips. “We continue to deliver high performance and power-efficient NPUs with Ryzen AI technology to reimagine the PC,” said Jack Huynh, SVP and GM of AMD computing and graphics business. “The increased AI capabilities of the 8040 series will now handle larger models to enable the next phase of AI user experiences.”

And, of course, AI chip powerhouse Nvidia isn’t sitting idly in the AI PC race.  It says that already: “For GeForce RTX users, AI is now running on your PC. It’s personal, enhancing every keystroke, every frame and every moment.”

Nvidia sees four advantages to AI PCs:

• Availability: Whether a gamer or a researcher, everyone needs tools — from games to sophisticated AI models used by wildlife researchers in the field — that can function even when offline.
• Speed: Some applications need instantaneous results. Cloud latency doesn’t always cut it.
• Data size: Uploading and downloading large datasets from the cloud can be inefficient and cumbersome.
• Privacy: Whether you’re a Fortune 500 company or just editing family photos and videos, we all have data we want to keep close to home.

The PC manufacturers are getting ready. DigitalTrends’ Fionna Agomuoh spoke to multiple Lenovo executives, who are all-in on AI PCs. “Put simply,” she writes. “Lenovo sees the “AI PC” as a PC where AI is integrated at every level of the system, including both software and hardware.”  Lenovo Executive Vice President of Intelligent Devices Group, Luca Rossi, cited an example with gaming: “We apply certain AI techniques to improve the gaming experience. By making the machine understand what kind of usage model you’re going to do and then a machine fine tunes, the speed, the temperature, etc.”

AMD’s Jason Banta believes “the AI PC will be the next technological revolution since the graphical interface,” which is a pretty startling statement. He elaborated:

Prior to this, you kind of just typed commands. It wasn’t quite as intuitive. You saw the graphical interface with the mouse, and it really changed the way you interacted the productivity. How you got things done, how it felt. I think AI PC is going to be that powerful if not more powerful.

Mr. Banta also believes that having AI built into the PC will make AI cheaper, more secure, and more private.

HP’s CEO Enrique Lores told CNBC in November that AI capabilities will spur PC sales: “we think this is going to double the growth of the PC category starting next year.” Technology research form Canalys predicts 60% of PCs shipped in 2027 will be AI-capable. IDC analysts are similarly bullish, saying: “The integration of AI capabilities into PCs is expected to serve as a catalyst for upgrades, hitting shelves in 2024.”

Windows Central reports that Microsoft plans to release Surface Pro 10 as its first AI PC. Surface Laptop 6 may also feature AI capabilities, although what exactly those capabilities are for either device remain unclear.

And, yes, when we say “AI PC,” we’ll also be seeing AI Mac. “Apple may not wax eloquent about AI but it knows very well that the use cases for this technology are booming and that the development work will require unprecedented computing power,” Dipanjan Chatterjee, an analyst at Forrester, told CNN. “That’s a huge emerging opportunity, and Apple wants a piece of that pie.”

The people who aren’t quite ready are us.

Moral of the story: in the not-too-distant future, saying “AI PC” will be redundant. AI capabilities will be built-in, assumed – and not just in your PC but also your phone, your watch, your car, all of your devices. Some of those capabilities will be local, some may be boosted by nearby networked devices, others will rely on the cloud.

I’ll be interested in how any learning that a local AI gains is passed along to other versions, and vice-versa. E.g., my health devices will know things about how my health is impacted by various treatments, and some of those should be pooled with other patient data for broader meaning.

Just like 2023, AI is going to continue to surprise and impress us in 2024.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By KIM BELLARD

Congratulations, America. We have another new record, albeit a dismal one. According to the Department of Housing and Urban Development (HUD), there are now 653,000 homeless people, up 12% from the prior year. As one can imagine, compiling such a number is problematic at best, and no doubt misses a non-trivial number of such unfortunate people.

“Homelessness is solvable and should not exist in the United States,” said HUD Secretary Marcia L. Fudge. Well, yeah, like kids without enough food, pregnant women without access to adequate prenatal care, or people without health insurance, yet here we are.

HUD says that the increase was driven by people who became for the first time, up some 25%. It attributes this to “a combination of factors, including but not limited to, the recent changes in the rental housing market and the winding down of pandemic protections and programs focused on preventing evictions and housing loss.” As with the recent increase in child poverty, the lessons that we should have learn from our COVID response didn’t survive our willingness to put the pandemic behind us.

Jeff Olivet, executive director of the U.S. Interagency Council on Homelessness, told AP: “The most significant causes are the shortage of affordable homes and the high cost of housing that have left many Americans living paycheck to paycheck and one crisis away from homelessness.” The National Low Income Housing Coalition estimates we’re missing some 7 million affordable housing units, so I suppose we should be relived there are “only” 653,000 homeless people.

“For those on the frontlines of this crisis, it’s not surprising,” Ann Oliva, CEO of the National Alliance to End Homelessness, also told AP. Indeed, we’ve all seen news accounts of homeless encampments spreading seemingly out of control, many of us have spotted homeless people as we go about our daily lives, and yet most of us don’t want either homeless people or low income housing units in our neighborhoods.

We often tell ourselves that homeless people are mentally ill or drug users, but data suggests that most are homeless due to economic reasons.  As many as 60% of them are still working, but just can’t afford housing. Too many of us are one missing paycheck away from being on the street.

They’re more likely to be victims of crimes than criminals; in fact, BBC reports that violence against homeless people – including homicide – seems to be on the rise, although there is no systemic tracking of such violence.

In a searing piece in The Atlantic,  Annie Lowrey blasts our lack of anything resembling a national housing policy. She notes: “…today’s HUD is not much of a housing agency. And it is definitely not much of an urban-development agency.” Secretary Fudge told her: “HUD is doing all in our power to invest in those who have often been left out and left behind.” And that’s a big part of the problem.

As Ms. Lowry laments, despite the obvious housing crisis and record number of homeless,

Yet legislators have not passed a significant bill to get people off the streets and out of shelters. Joe Biden has not signed a law to increase the supply of rental apartments in high-cost regions or to protect families from predatory landlords. Congress has not made more families eligible for housing vouchers, or passed a statute protecting kids from the trauma of eviction, or set a goal for the production of new housing.

“The country’s lack of a national housing policy is part of the reason we are in a housing crisis,” she says, “and Washington needs to take a real role in ending it.”

What really got my attention was that a number of states and cities – most of them run by Democrats – want the Supreme court to overturn Martin vs. Boise, which ruled that evicting homeless people who had no choice of indoor housing was “cruel and unusual punishment” and thus unconstitutional. If you want to evict them from their outdoor housing, the court said, you better have places to put them.

Seems reasonable to me. I mean, they’re already homeless; where else do you expect them to go? It doesn’t help that many places are criminalizing homelessness, as though it was a choice those people were making.

I don’t usually look to Texas for solutions to social issues, but when it comes to the homeless, it may be a leader. Over the last decade, Texas has decreased its homeless population by nearly a third, in part because it builds more housing, and less expensive housing.

Cities such as Austin, Houston, and San Antonio have been particular innovators. Houston has cut its homeless population by two-thirds. There was a concerted city-county effort to coordinate the work of public agencies and over 100 non-profits. (Outgoing) Houston Mayor Sylvester Turner brags. “Instead of a hundred NGOs competing with each other, we’ve kind of pulled them all together. They’re now operating under a single umbrella, The Way Home.”

The focus is to get homeless people into housing first, then address their other issues. As The Way Home says, “first, we give them a key.” Then they work on providing them supportive services to help stabilize their lives. Even law enforcement is on board; Harris County Sheriff Ed Gonzalez says:

“…I think it’s important for us to recognize that it really is a public health issue: How can we better develop those systems of care, to better route people where they may need to be, rather than just looking at it through the lens of policing.”

That sure beats just breaking up encampments.

Meanwhile, Austin has focused on providing “tiny homes,” while San Antonio has built a huge homeless shelter. It’s important to note that these are local initiatives; Texas itself provides very little state funding for the homeless.  None of these cities has “solved” homelessness, but they’ve shown ways to lessen it.

————

Like poverty, homelessness isn’t inevitable; it is a policy choice. Sociologist Matthew Desmond, author of the must-reads Poverty and Evicted, told Ms. Lowrey: “Think of lining up families who qualify for food stamps and only one in four families gets to eat. That’s exactly how we treat housing policy today. It doesn’t make a lot of sense, because, without stable shelter, everything else falls apart.” Accordingly, Ms. Lowrey asserts: “affordable housing for everyone, everywhere, and the end of homelessness should be the policy priority now.”

We may not be able to end homelessness, but we can and should stop treating them as undesirables and start treating them as people – people who first and foremost need a place to live.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By KIM BELLARD

There were many things I could have written bout this week – e.g., in A.I., in quantum computing, even “transparent wood” — but when I saw some news about biological robots, I knew I had my topic.

The news comes from researchers at Tufts University and Harvard’s Wyss Institute. Their paper appeared in Advanced Science, introducing “a spheroid-shaped multicellular biological robot (biobot) platform” that they fondly dubbed “Anthrobots.” Importantly, the Anthrobots are made from human cells.

Let’s back up. In 2020, senior researcher Michael Levin, Ph.D., who holds positions at both Tufts and Harvard, worked with Josh Bongard, Ph.D. of the University of Vermont to create biological robots made from frog embryo cells, which they called Xenobots.  They were pretty impressive, capable of navigating passageways, collecting material, recording information, healing themselves from injury, and even replicating for a few cycles on their own, but the researchers wanted to find out if they could create biological robots from other types of cells – especially human cells.

Well, the new research showed that they could. They started with cells from adult trachea, and without genetic modification were able to demonstrate capabilities beyond those Xenobots had demonstrated. Lead author Gizem Gumuskaya, a PhD. student said: “We wanted to probe what cells can do besides create default features in the body. By reprogramming interactions between cells, new multicellular structures can be created, analogous to the way stone and brick can be arranged into different structural elements like walls, archways or columns.”   

The Anthrobots come in different shapes and sizes, and are capable of different motions. Ms. Gumuskaya is quite excited about their capabilities:

The cells can form layers, fold, make spheres, sort and separate themselves by type, fuse together, or even move. Two important differences from inanimate bricks are that cells can communicate with each other and create these structures dynamically, and each cell is programmed with many functions, like movement, secretion of molecules, detection of signals and more. We are just figuring out how to combine these elements to create new biological body plans and functions—different than those found in nature.

Even better, Ms. Gumuskaya pointed out: “Anthrobots self-assemble in the lab dish. Unlike Xenobots, they don’t require tweezers or scalpels to give them shape, and we can use adult cells – even cells from elderly patients – instead of embryonic cells. It’s fully scalable—we can produce swarms of these bots in parallel, which is a good start for developing a therapeutic tool.”

They tested Anthrobots’ healing capabilities by scratching a layer of neurons, then exposed the gap to a cluster of Anthrobots called a “superbot.”  That triggered neuron growth only in that area. The researchers noted: “Most remarkably, we found that Anthrobots induce efficient healing of defects in live human neural monolayers in vitro, causing neurites to grow into the gap and join the opposite sides of the injury.”

“The cellular assemblies we construct in the lab can have capabilities that go beyond what they do in the body,” said Dr. Levin. “It is fascinating and completely unexpected that normal patient tracheal cells, without modifying their DNA, can move on their own and encourage neuron growth across a region of damage.”

Xi “Charlie” Ren, a tissue engineer at Carnegie Mellon University who was not involved with the research, told Science that the work “is amazing, and groundbreaking,” and “opens the way to personalized medicine.” Ron Weiss, a synthetic biologist at the Massachusetts Institute of Technology who also was not involved with the work added: “Levin demonstrated that cells can be coached to do something they would never have done on their own.”

Some researchers are not yet convinced. Jamie Davies, a developmental biologist at the University of Edinburgh in Scotland, who was not involved in the 2020 study or this recent one, told Scientific American: “I cannot see how these clumps of cells with flailing cilia merit the term ‘bot.” Dr. Levin and his team, of course, don’t believe the movements are random, and that Anthrobots “could be designed to respond to their environment, and travel to and perform functions in the body, or help build engineered tissues in the lab.”

The ultimate hope is that clinicians would be able to use Anthrobots created from a patient’s own cells to perform therapeutic work. Those bots shouldn’t trigger an immune response, would be bioresorbable, and couldn’t survive outside the lab or the body (making risk of any unintended spread minimal).

The researchers see a wide variety of potential uses in health care:

…various applications can be imagined, including but not limited to clearing plaque buildup in the arteries of atherosclerosis patients, bulldozing the excess mucus from the airways of cystic fibrosis patients, and locally delivering drugs of interest in target tissues. The possible applications will represent those arising from exploiting surprising novel behaviors of cells and engineering new ones via future synthetic biology payloads, such as novel enzymes, antibodies, and other ways to manipulate the cells they traverse and interact with. They could also be used as avatars for personalized drug screening,^[32] having the advantage of behavior over simple organoids, which could be used to screen for a wider range of active, dynamic phenotypes.

That’s 21^st century medicine. That’s the kind of health care I want to see.

The researchers have a number of research areas they want to further explore, including:

• What other cells can Anthrobots be made of?
• What other behaviors might they exhibit, and in what environments?
• What other tissue types can they repair or affect in other ways?
• Can transcriptional or physiological signatures be read out in living bots, that reflect their past and immediate interactions with surrounding cellular or molecular landscapes?
• Do they have preferences or primitive learning capacities, with respect to their traversal of richer environments?

As researchers like to say, more research is required – and, from where I’m sitting, eagerly awaited.

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OK, so these aren’t like the cute robots you see doing flips. They’re not the nanobots many of us have been waiting for. We don’t (yet) have to worry about Asimov’s Three Laws of Robotics with them. But, boy, if we’re going to have robots crawling around inside us doing therapeutic things – and we are — what could be better than a biological robot made from your own cells?

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor