Category: Uncategorized

When Push Comes to Shove: The AMA v. Dobbs. Part 1.

Nov 18, 2022

BY MIKE MAGEE

Should anyone present know of any reason that this couple should not be joined in holy matrimony, speak now or forever hold your peace.” Book of Common Prayer, Church of England, 1549

Last evening Trump rose from the ashes and declared it was time to “Make America Great and Glorious Again” (MAGAGA).

This past week, five days after the Midterm elections, AMA President, Jack Resnick, Jr., MD, raised his voice from the podium at the AMA Interim Meeting in Hawaii with the AMA’s own version of a call to action:

“But make no mistake, when politicians insert themselves in our exam rooms to interfere with the patient-physician relationship, when they politicize deeply personal health decisions, or criminalize evidence-based care, we will not back down…I never imagined colleagues would find themselves tracking down hospital attorneys before performing urgent abortions, when minutes count … asking if a 30% chance of maternal death, or impending renal failure, meet the criteria for the state’s exemptions … or whether they must wait a while longer, until their pregnant patient gets even sicker…Enough is enough. We cannot allow physicians or our patients to become pawns in these lies.”

Our Plants Should Be Plants

Nov 15, 2022

BY KIM BELLARD

It seems like most of my healthcare Twitter buddies are enjoying themselves at HLTH2022, so I don’t suppose it much matters what I write about, because they’ll all be too busy to read it anyway. That’s too bad, because I was sparked by an article on one of my favorite topics: synthetic biology.

Elliot Hershberg, a Ph.D. geneticist who describes his mission as “to accelerate the Century of Biology,” has a great article on his Substack: Atoms are local. The key insight for me was his point that, while we’ve been recognizing the power of biology, we’ve been going about it the wrong way. Instead of the industrialization of biology, he thinks, we should be seeking the biologization of industry.

His point:

Many people default to a mindset of industrialization. But, why naively inherit a metaphor that dominated 19th century Britain? Biology is the ultimate distributed manufacturing platform. We are keen to explore and make true future biotechnologies that enable people to more directly and freely make whatever they need where-ever they are.

The Dangers of EMR-Defaulted Prescription Stop Dates

Nov 10, 2022

By HANS DUVEFELT

It happens in eClinicalworks, I saw it in Intergy, and I now have to maneuver around it in Epic. Those EMRs, and I suspect many others, insert a stop date on what their programmers think (or have been told) are scary drugs.

In my current system all opioid drug prescriptions fall into this category. For a short term prescription that might perhaps be a good idea but for a longer-term or occasionally needed prescription it creates the risk of medical errors.

In Epic there is a box for duration, which is very practical for a ten day course of antibiotics. If I fill in the number 10 in the duration box, the medication falls off the list after 10 days. This saves me the trouble of periodically cleaning up the list.

Rethinking Newer Events

Nov 1, 2022

BY KIM BELLARD

It’s a lot more fun to write about exciting new technologies, or companies in other industries that healthcare could learn from, than to pick on healthcare for its many, well-known shortcomings, but there was an article in JAMA Forum last week that I had to note and perhaps expand on: A New Category of “Never Events” – Ending Harmful Hospital Policies, by Dave A. Chokshi, MD, MSc and Adam L. Beckman, BS (he is also an MD/MBA student).

The concept of a “Never Event” is well known by this point. Coined some twenty years ago by Ken Kizer, MD of the National Quality Form (NQF) and soon widely adopted and expanded, it recognizes that healthcare sometimes has egregious errors that shouldn’t happen: the wrong foot is amputated, the wrong drug/dosage is given, surgical instruments are left inside a patient, and so on. Organizations like The Leapfrog Group exist largely to try to measure and compare hospitals on such patient safety issues.

Interview: Sarah MacDonald, Author, The Cancer Channel

Nov 1, 2022• 1

by MATTHEW HOLT

I met Sarah MacDonald in the early 2000s. She is the ultimate extrovert who sings, cooks, maintains a huge circle of friends, and lives life to the fullest–all at a pace & level most of us can’t imagine. In the early 2010s Sarah was flying high. Newly married, trying to get pregnant, all while being a Silicon valley business exec who had increasingly senior roles at eBay. Then in 2012 she was diagnosed with two completely separate types of cancer. And in her head “The Cancer Channel” started playing nonstop.

That became the title of her book. I just read it and I literally couldn’t stop. It’s practical, it’s heart-wrenching, it’s warm, it’s funny (yes, funny!). And it’s an amazing look at the exact experience of someone going through cancer. Or in this case cancer x 2. I was lucky enough to interview Sarah (so there is a very happy ending). So please watch this and buy & read the book

The Secret Surveillance Capitalism That Suffuses Medicare

Oct 31, 2022

By MICHAEL MILLENSON

Imagine a government program where private contractors boost their bottom line by secretly mining participants’ personal information, such as credit reports, shopping habits and even website logins.

It’s called Medicare.

This is open enrollment season, when 64 million elderly and disabled Americans choose between traditional fee-for-service Medicare and private Medicare Advantage (MA) health plans. MA membership is soaring; within a few years it’s expected to encompass the majority of beneficiaries. That popularity is due in no small part to the extra benefits plans can provide to promote good health, ranging from gym membership and eyeglasses to meal delivery and transportation assistance.

There is, however, an unspoken price for these enhancements that’s being paid not in dollars but in privacy. To better target outreach, some plans are routinely accessing sophisticated analytics that draw upon what’s euphemistically labeled “consumer data.” One vendor boasts of having up to 5,000 “certified variables for every adult in America,” including “clinical, social, economic, behavioral and environmental data.”

Yet while companies like Facebook and Google have faced intense scrutiny, health care firms have remained largely under the radar. The ethical issue is obvious. Since none of this sensitive personal information is covered by the privacy and disclosure rules protecting actual medical data, it is being deliberately used without disclosure to, or explicit consent by, consumers. That’s simply wrong.

But a more fundamental concern involves the analyses themselves.

Pfizer’s Biotech Strategy: When a “Market Force” Partners with a “Market Mover”

Oct 27, 2022

by JESSICA DAMASSA, WTF HEALTH

The synergistic relationship between biotech’s and biopharma’s can dramatically change the way new drugs and vaccines are bought to market – helping advance innovation on BOTH sides in a very mutually beneficial way. I’ve got an inside look at how Pfizer is working with emerging biotech start-ups, thanks to this in-depth chat with Pfizer’s Senior Vice President of Business Innovation, Kathy Fernando.

Kathy is not only responsible for developing relationships with biotech’s on behalf of Pfizer, BUT during the pandemic she led Pfizer’s mRNA scientific strategy, which was integral to its ability to rapidly develop the Covid-19 vaccine. We geek out on the “cool science” that mRNA is – AND the new platforms that biotech’s are bringing to the table – and talk about the impact both are making on the business of Big Pharma, the hot biotech investment space, and, most importantly, patients.

We also get into a bigger conversation about innovation in the Life Sciences industry – with great insights that can be extended to the rest of healthcare quite easily. I ask point blank: Pfizer is a gigantic, global biopharma company…Why wouldn’t it do these types of innovations internally, in-house themselves? Why partner outside?

Kathy explains the magic that is unlocked when a “market force” partners with a “market mover” for the sake of innovation, and the lessons learned are far reaching and applicable no matter where you are in health innovation.

How is Pfizer looking at new models for collaborating with biotech companies? What are the key characteristics of Pfizer’s culture of innovation that have newly emerged or deepened as a result of their work on the Covid vaccine during the pandemic? We dive deep into the biopharma-biotech model and all it brings in terms of new science, breakthrough therapies, and brand-new business opportunities. Watch now!

Does Surviving The Plague Mean You Will Eventually Contract An Autoimmune Disease?

Oct 26, 2022

BY MIKE MAGEE

This Fall, I am teaching a 4-week course on “How Epidemics Have Shaped Our World” at the President’s College at the University of Hartford. It is, of course a timely topic, but also personally unnerving as we complete a third year under the shadow of Covid-19.

Where does one begin on a topic such as this? Yale historian, Frank M. Snowden, in his book “Epidemics and Society: From the Black Death to the Present”, made his intentions obvious. He would begin with the plaque. Why? His answer, “The word ‘plague’ will always be synonymous with ‘terror’”, and especially references:

Virulence: “It strikes rapidly, causing excruciating and degrading symptoms, and, if untreated, achieves a high case fatality rate (CFR)…of at least 50%.”

Art Is in the Eye of the Computer

Oct 25, 2022

BY KIM BELLARD

It turns out that I’ve been writing about Generative AI without even realizing there was something called Generative AI, such as articles about the robot artist Ai-Da, the AI image creator DALL-E, or patent protection for AI inventors. Generative AI refers to AI that strives not just to process and synthesize data but to actually be creative. It’s starting to both become more widespread and to attract serious attention from investors.

James Currier of investment firm NFX sees “Generative Tech” as the next big thing: “If crypto hadn’t happened, we’d probably be calling THIS Web3.” He distinguishes Generative AI from Generative Tech as:

Some have called it “Generative AI,” but AI is only half of the equation. AI models are the enabling base layers of the stack. The top layers will be thousands of applications. Generative Tech is about what will actually touch us – what you can do with AI as a partner.

He predicts Generative Tech will generate “trillions of dollars of value.” I’m hoping that healthcare is paying attention.

Sticks and Stones…

Oct 19, 2022

BY KIM BELLARD

According to the old saying, sticks and stones may break your bones, but names can never hurt you. I’m not sure that still applies in a social media environment that can have real impacts on mental health of both teenagers and adults, but I have to note that healthcare seems to be pretty sensitive about who calls whom what.

I’ll start with a new study from The Mayo Clinic about whether patients addressed their physicians by their first name. It’s a tricky thing to get a gauge on; one could do surveys of both populations, or implant observers in exam rooms, but these researchers had the clever idea of examining how patients addressed their physician when using portal messaging. They looked at over 90,000 messages from nearly 15,000 patients, with about 30,000 messages from 15,000 patients including a physician’s name (first or last).

The researchers don’t seem to have provided an overall percent of patients using the doctors’ first name, but they did report:

Female doctors were twice as likely as male doctors to be called by their first name;
DOs were similarly almost twice as likely as MDs to have their first name used;
Primary care doctors were 50% more likely than specialists;
Female patients were 40% less likely to use first names when addressing their physician.