THCB

Categories

Category: Uncategorized

A Country Doctor Reads: What if Burnout Is Less About Work and More About Isolation? (NYT)

BY HANS DUVEFELT

This weekend I read a piece in The New York Times that put a slightly different slant on what burnout, in the case of physician burnout, is or is caused by. We have heard theories from being asked to do the wrong thing, like data entry, to “moral injury” to my favorite, “burnout skills“, when you keep trying to do the impossible because people praise you when you pull it off.

Tish Harrison Warren’s piece is a dialog between her and psychiatrist/author Curt Thompson. He focuses on isolation as a driver of burnout:

Assume that if you’re burned out, your brain needs the help of another brain. Your brain is not going to be OK until or unless you have the experience and opportunity of being in the presence of someone else who can begin to ask you the kind of questions that will allow you to name the things that you’re experiencing.

The moment that you start to tell your story vulnerably to someone else, and that person meets you with empathy — without trying to fix your loneliness, without trying to fix your shame — your entire body will begin to change. Not all at once. But you feel distinctly different.

I’m not as lonely in that moment because you are with me. And I sense you sensing me. That’s a neural reality.

Continue reading…

The college football fans that beat COVID and the experts that couldn’t

• 1

BY ANISH KOKA

The COVID pandemic was supposed to herald the end of the idea that a smaller government is a better government. The experts who desperately seek to be in charge of a sprawling bureaucratic state told us that it was only a powerful central authority that could do what was needed to safeguard individual liberties at a time when a highly contagious respiratory virus was spreading across the globe.

New Zealand may have imposed draconian policies that did not even allow its own citizens to return, but scenes of cheering unmasked New Zealanders stood in sharp contrast to empty seats in American stadiums when teams were allowed to play. If only US politicians possessed the iron will of New Zealand premier Jacinda Arden, Americans too could have ‘freedom’.

But in so many ways, the New Zealand example demonstrates the utter foolishness and shortsightedness of the central planners that seized control globally. A year after New Zealand took their victory lap COVID arrived in New Zealand and a very much masked Prime Minister noted that “very soon we will all know people who have Covid-19 or we will potentially get it ourselves”

Continue reading…

Better Living Through Better Design

BY KIM BELLARD

We’re almost two weeks past Hurricane Ian. Most of us weren’t in its path and so it just becomes another disaster that happened to other people, but to those people most impacted it is an ongoing challenge: over a hundred people dead, hundreds of thousands still without power, tens of thousands facing a housing crisis due to destroyed/damaged homes, and estimated $67b in damages.  It will take years of rebuilding to recover.  

In the wake of a natural disaster like a hurricane – or a tornado, a flood, even a pandemic – it’s easy to shrug our shoulders and say, well, it’s Mother Nature, what can we do?  There’s some truth to that, but the fact is there are choices — design choices — we can make to mitigate the impacts. A Florida community called Babcock Ranch helps illustrate that.

Babcock Ranch is located a few miles inland from Ft. Myers, which was devastated by Ian.  It bills itself as “America’s first solar-powered town,” with an impressive array of almost 700,000 solar panels. More than that, it was built with natural disasters in mind: all utilities are underground, it makes use of natural landscaping to help contain storm surges, streets are designed to divert floodwaters, making use of multiple retaining ponds. 

Continue reading…

What Does It Mean To Be Human?

By MIKE MAGEE

“These are unprecedented times.”

This is a common refrain these days, from any citizen concerned about the American experiment’s democratic ideals.

Things like – welcoming shores, no one is above the law, stay out of people’s bedrooms, separation of church and state, play by the rules, fake news is just plain lying, don’t fall for the con job, stand up to bullies, treat everyone with the dignity they deserve, love one another, take reasonable risks, extend a helping hand, try to make your world a little bit better each day.

But I’ve been thinking, are we on a downward spiral really? Or has it always been this messy? Do we really think that we’ve suddenly bought a one-way ticket to “The Bad Place”, and there are no more good spots to land – places that would surprise us, with an unpredicted friendship, a moment of creative kindness, something to make you say, “Wow, I didn’t see that coming.”

I’m pretty sure I’m right that human societies, not the least of which, America, will never manage perfection. But is it (are we) still basically good. What does it mean to be human, and more specifically American?

Continue reading…

About That Cancer Moonshot

BY KIM BELLARD

Joe Biden hates cancer.  He led the Cancer Moonshot in the Obama Administration, and, as President, he reignited it, vowing to cut death rates in half over the next 25 years.  Last month, on the 60th anniversary of President Kennedy’s historic call for an actual moonshot, he vowed “to end cancer as we know it. And even cure cancers once and for all.”

But, as several recent studies show, cancer is still surprising us.  

Continue reading…

Has “Disruption” Reached Its Sell-by Date? 

• 2

BY JEFF GOLDSMITH

If you read the business press, as I do every day, It is impossible to escape the “disruption” meme. Clayton Christiansen’s 1997 Innovator’s Dilemma explored how established businesses are blindsided by lower cost competitors that undermine their core products, and eventually destroy their businesses. Classic examples were the displacement of film-based cameras by digital cameras and then cell phones, the destruction of retail shopping by Amazon and of video rental by streaming video services.

A Civic Religion

Perhaps because Christiansen’s analysis arrived at the peak of the first Internet boom, it generated a high level of anxiety in the corporate world. It did not seem to matter that Christiansen’s analysis was riddled with flaws, meticulously detailed in Harvard colleague Jill Lepore’s takedown in the New Yorker in 2014.

By then, the disruption thesis had become a cornerstone of a kind of civic religion, an article of faith and an indispensable staple of fundraising pitches in the venture and private equity worlds.   No one seemed to be asking how great a trade for the society was, say, tiny Craigslist taking down the newspaper business by drying up its classified ad revenues.   

Disrupting a $4 Trillion Health System

I believe that, twenty five years on, the notion of disruptive innovation has reached its “sell-by” date. At least in healthcare, the field of commerce I follow most closely, it is now doing more harm than good. The healthcare version of the disruption thesis was found in Christiansen’s “Innovator’s Prescription”, written with health industry maverick Dr. Jerome Grossman in 2009. Christiansen and Grossman forecast that innovations such as point-of-care testing, retail clinics, and special purpose surgical hospitals threatened to take down healthcare incumbents. 

A swarm of breathless (and reckless) healthcare disruption forecasts shortly followed. 

Continue reading…

Explorations in French Health Care! (Or what I did on my vacation!)

• 1

By MATTHEW HOLT

This is a personal story about this blog’s publisher (me!) but it has just enough health care stuff to keep it relevant!

This year I finally got invited on the annual week-long mountain bike ride run by my friend JB and his ex Taiwan/Hong Kong buddies. I’ve actually been practicing and training most of the summer and arrived pretty confident even though I knew it would be tough. This edition is in Provence in France.

Before it all went wrong

And then…..2 hours in on the first day it turns out I was too confident…

Back in 2002 I smashed my knee snowboarding into a tree. When I told him my dad said ” You silly twit”

I actually was a silly twit this time too. I was on a new bike (a rental) that was actually much more advanced than my usual one and had a feature I had barely practiced with (a drop seat) that requires a new technique. It had rained heavily the day before so it was wet (& living in California I have very limited experience mountain biking in the rain), and I was behind the pack as my chain had come off. (There was a guide sweeping the rear who fixed it for me). So when I got to the first challenging down hill slope I didn’t do the sensible thing of stopping & walking to the bottom to check it or do what 75% of the group did and walked their bike down it, I just thought, “I can do that’ and plunged down it. Not quite sure exactly why I fell but I went over the bars slightly to the right (luckily missed a tree) & hit the ground on the downslope hard on my right side. In any sport any one of new equipment, new environment, new technique means you should err on the side of caution and I had all 3, yet just went for it! Very bad decision!

After I got up I thought I had just badly winded myself. The guide helped me back on the bike & I rode on. For the next 5 miles or so he helped push me up the steeper bits of a climb (he had an eBike). I actually did a slightly less challenging but still tough downslope section & a friend gave me a big dose of Tylenol at the next stop point. I actually crashed again after that (slipped on a wet rock) but landed ok on my elbow which was padded (as were my knees but not my torso) and only had some slight scratches but I made it to lunch feeling sore but OK.

Continue reading…

Truth and Trust in Science: Are They Negotiable?

BY MIKE MAGEE

“The key is trust. It is when people feel totally alienated and isolated that the society breaks down. Telling the truth is what held society together.”

Those words were voiced sixteen years ago in Washington, D.C. It was October 17, 2006. The HHS/CDC sponsored workshop that day was titled “Pandemic Influenza – Past, Present, Future: Communicating Today Based on the Lessons from the 1918-1919 Influenza Pandemic.”

The speaker responsible for the quote above was writer/historian and Johns Hopkins School of Public Health adviser, John M. Barry. His opening quote from George Bernard Shaw set a somewhat pessimistic (and as we would learn 14 years later, justified) tone for the day:

Continue reading…

The Society for Participatory Medicine Presents a Creative Learning Exchange: Community Health Access and Equity 

I’ve been on the board of the Society for Participatory Medicine for a few years and we are kicking off a series of “Creative Learning Events”. There’ll be two in the balance of 2022 and hopefully one a quarter thereafter. Should be great in-person AND online exchanges about getting participatory medicine into the hear of the health care system. Here’s details on the first one, October 20, in Boston and everywhere else!–Matthew Holt

Participatory Medicine is a movement in which patients, caregivers and healthcare professionals actively collaborate and encourage one another as full partners in healthcare. 

The Society for Participatory Medicine with the support of our sponsor NRC Health Presents A Creative Learning Exchange(CLE): Community Health Access and Equity

Date: October 20, 2022 Time: 12:00 noon – 4:00pm (Lunch Is Included for In-Person)

Location: Brown Advisory, 100 High Street, 9th Floor, Boston, MA 02110

For more details and to REGISTER TODAY click here.

The Society for Participatory Medicine believes that the culture of healthcare is not benefiting everyone equally and needs to change. And healthcare won’t get better until healthcare culture gets better. We want to drive this change by enabling collaboration, education, information sharing, and communication among patients, caregivers, and health care professionals. Join the movement! 

This Creative Learning Exchange, in-person and online hybrid event, will be highly interactive and participatory, using a ‘Neighbors at Each Table’ approach to engaging you in facilitated discussion and brainstorming. 

These discussions will focus on applying the Participatory Medicine Manifesto behaviors in culturally and racially diverse communities to enable access and equity in care. Your ideas, insights and solutions that emerge will be curated by SPM to build a toolkit of participatory medicine guidelines. These will be shared with you and through SPM’s social networks, website and blog. 

For more details and to REGISTER TODAY click here.


Thank you to our series sponsor NRC Health. Thanks to Massachusetts General Hospital Equity & Community Health for sponsoring the meal. Thanks for Brown Advisory for proving the venue & AV.

The Future of Clinical Trials at Pfizer

BY JESSICA DaMASSA

From de-centralized clinical trials to real world data (RWD), real world evidence (RWE), and even social media, the future for clinical research at Pfizer sounds increasingly tech-enabled and focused on meeting and engaging patients where they are.

Pfizer’s Head of Clinical Trial Experience, Judy Sewards, and Head of Clinical Operations & Development, Rob Goodwin, drop in to chat about what Pfizer’s approach to clinical research looks like now, after the rapid evolution it underwent to “lightspeed” the development of the Covid-19 vaccine.

The big change? Rob says they are “obsessed” with de-centralized trials, with nearly 50% of clinical trial visits still happening virtually. And, beyond the convenience factor, both point to de-centralization as a critical factor in being able to recruit more patients into trials as well as improve the diversity of their participant groups. In the end, the decentralized approach, says Judy, is “not just a matter of equity, but good science as well.”

And what about improvements to the cost of drug development? Is it too soon to tell if de-centralization will make an impact on the bottom line? Innovation may be expensive to implement at first, but, explains Rob, “If you can recruit your trial faster, overall, the cost of development goes down and speed to the patient goes up.”

We chat through the full suite of benefits that de-centralized clinical trials are bringing Pfizer and its patient populations, and get into the utility of real-world data, which also saw new notoriety when the Covid-19 vaccine was being developed. How is RWD impacting clinical research even when it’s not being used as evidence in a regulatory approval process? Watch and find out more about how data innovation is shaping the future of pharma!