Tag: Mike Magee

Defanging HIPAA: How Your De-identified Data Was Re-identified For Profit.

May 26, 2022

BY MIKE MAGEE, M.D.

Arthur Sackler continues to demonstrate just how wealthy one can become by advantaging patients and their diseases.

He’s been dead since 1987, but his ghost continues to access your personal health data, pushes medical consumption and over-utilization, and expands profits exponentially for data abusers well beyond his wildest dreams. Back in 1954, he and his friend and secret business partner, Bill Frohlich, were the first to realize that individual health data could be a goldmine. That relationship would still be a secret had it not been exposed in a messy family inheritance feud unleashed by his third wife after Sackler’s death.

That company, IMS Health, was taken public and listed on the NYSE on April 4, 2014, transferring $1.3 billion in stock. I’ll come back to that in a moment. But in the early years, the pair realized that the data they were collecting would multiply in value if it could be correlated with a second data set. That dataset was the AMA’s Physician Masterfile which tracked the identity and location of all physicians in America from the time they entered medical school.

How About This Opportunity, Health Tech Investors? Promoting Contraception vs. Banning Abortion

May 13, 2022

By MIKE MAGEE

Dr. Linda Rosenstock has an M.D. and M.P.H. from Johns Hopkins, and was a Robert Wood Johnson Clinical Scholar. She is currently Dean Emeritus and Professor of Health Policy and Management at UCLA’s Fielding School of Public Health, but also spent years in government, and was on President Obama’s Advisory Group on Prevention, Health Promotion and Integrative and Public Health.

In the wake of the release of Justice Alito’s memo trashing Roe v. Wade, she was asked to comment about the status of abortion in America. Here is what she said:

“The broader the access to proven family planning methods, the lower the unintended pregnancy rate and the lower the abortion rate. We can’t underestimate the role of educating and empowering women – and men – about these issues.”

These are not simply the opinions or insights of a single health expert. They are backed up by the following facts:

Since 1981, abortion rates in U.S. women, age 15 to 44, have declined by nearly two thirds from 29.3 per 1000 to 11.4 per 1000.

2. Approximately half of all pregnancies in the U.S. are unintended. Of those unintended, approximately 40% of the women chose to terminate the pregnancy by abortion – either procedural or chemically induced.

3. The decline in the number of abortions has coincided with increased access to long-acting reversible contraception, including IUD’s and contraceptive implants. These options are now safe, increasingly covered by insurers, and more accessible to at-risk populations.

4. The increasing inclusion of sex education in middle school and high school curricula has been accompanied by a decline in high school sexual activity by 17% between 2009 and 2019.

5. There were 629,898 abortions recorded by the CDC in 2019. For every 1000 live births that year, there were 195 other women who chose to terminate their pregnancies. Almost half of the 1st trimester abortions are now chemically induced through Plan B-type pills.

What is clear from these figures is that knowledge and access to contraception is the best way to decrease the number of abortions in America.

THCB Gang Episode 89, Thursday April 28, 1pm PT 4pm ET

Apr 28, 2022

Joining Matthew Holt (@boltyboy) on #THCBGang on April 28 for an hour of topical and sometime combative conversation on what’s happening in health care were: THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); medical historian Mike Magee (@drmikemagee); patient safety expert and all around wit Michael Millenson (@mlmillenson) & Principal of Worksite Health Advisors Brian Klepper (@bklepper1). Matthew had COVID so didn’t do much & Kim ran the show. Lots of discussion on telehealth, primary care, private equity and much more…

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Dara’s “Hero Quest”: How About Embracing Universal Health Care in America?

Apr 25, 2022

By MIKE MAGEE

Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book, “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” Bottom line: Refusing the call is a bad idea.

George Lucas was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship. On June 21, 1988, Bill Moyers interviewed Campbell and began with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.”

Asked to comment, Campbell said, “He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.”

Systems gone awry? Think Putinesque Russia, or Psycho-pernicious Trumpism, or Ultra-predatory Capitalism.

Dara Kharowshaki, the CEO at Uber, who took over the company from uber-bro, Travis Kalanick, is a fan of Campbell’s and understands the journey of a hero – departure, initiation, return. Perhaps that is why he defines “movement” as fundamental to life…adding deliberately the qualifier “movement in the right direction.” In an interview in December, 2021, with Brian Nowak, Equity Analyst, U.S. Internet Industry, for Morgan Stanley, he pushed for corporate engagement in a range of issues including “sustainability, safety, equity, and anti-racism – these are all issues that go to the core of who we are, and our identity.”

How did health care escape that list, especially considering the companies investment in “Uber Health” – a health care delivery service promoting speed, care coordination, privacy, and cost-effective and reliable transport to and from care-giving brick and mortar?

It may have something to do with the fact that Uber has fought tooth and nail to avoid providing health care as a benefit to its drivers. In 2020, the company joined Lyft, DoorDash and other gig companies in throwing $205 million into a lobbying effort in California titled “Yes on 22”.

Ukraine’s Secret Weapon – “Moral Superiority”

Apr 5, 2022

BY MIKE MAGEE

Two hundred and ten years ago, on September 7, 1812, a Putinesque commander, narrowly won a battle, but lost a war and entered a downward cycle that ended his reign. The battle was the Battle of Borodino, a town on the river Moskva, 70 miles west of Moscow. The commander was Napoleon.

The facts are clear-cut: Napoleon arrived with 130,000 troops, including his 20,000 Imperial Guards, and 500 guns. Opposing him were 120,000 Russians with 600 guns. The battle engaged from 6 AM to Noon. The French took 30,000 casualties, while the Russians lost 45,000 men, but survived to fight another day.

As Leo Tolstoy describes the scene of carnage on page 818 of his epic novel, War and Peace, in 1867, “Several tens of thousands of men lay dead in various positions and uniforms in the fields and meadows where for hundreds of years peasants of the villages…had at the same time gathered crops and pastured cattle. At the dressing stations, the grass and soil were soaked with blood over the space of three acres. Crowds of wounded and unwounded men of various units, with frightened faces, trudged on…Over the whole field, once so gaily beautiful with its gleaming bayonets and puffs of smoke in the morning sun, there now hung the murk of dampness and smoke and the strangely acidic smell of saltpeter and blood. Small clouds gathered and began to sprinkle on the dead…”

But in the next paragraphs, it becomes clear that Tolstoy’s intent and focus is not to describe why and how Napoleon had won the Battle of Borodino, but rather how this was the beginning of the end of his army and the Napoleonic reign.

Tolstoy writes: “For the French, with the memory of the previous fifteen years of victories, with their confidence in Napoleon’s invincibility, with the awareness that they had taken part of the battlefield, that they had lost only a quarter of their men, and that they still had the intact twenty-thousand-man guard, it would have been easy to make the effort (to advance and annihilate the Russians)….But the French did not make that effort….It is not that Napoleon did not send in his guard because he did not want to, but that it could not be done. All the generals, officers, and soldiers of the French army knew that it could not be done, because the army’s fallen spirits did not allow it….(They were) experiencing the same feeling of terror before an enemy, which, having lost half his army, stood as formidably at the end as at the beginning of the battle. The moral strength of the attacking French was exhausted…(For the Russians, it was) a moral victory, the sort that convinces the adversary of the moral superiority of his enemy and of his own impotence, that was gained by the Russians at Borodino.”

The Russians not only retreated, but did not stop in Moscow, continuing another 80 miles beyond their beloved city. But as Tolstoy describes, “In the Russian army, as it retreats, the spirit of hostility towards the enemy flares up more and more; as it falls back, it concentrates and increases.”

As for the French, they take Moscow but stop there. Again from Tolstoy, “During the five weeks after that, there is not a single battle. The French do not move. Like a mortally wounded beast, which, losing blood, licks its wounds, they remain in Moscow for five weeks without undertaking anything, and suddenly, with no cause, flee back…without entering a single serious battle…”

Putin’s aging dreams of conquest likely are Napoleonic in scale. But as his hesitant forces observe the Borodino-like human carnage that they have unleashed on Mariupol, at the estuary of the Kalmius and Kalchik rivers, and prepare to enter Kyiv, the first eastern Slavic state which, a Millennium ago, acquired the title “Mother of Rus Cities”, their vulnerability and lack of “moral strength” is already apparent. Lacking a rational stated goal other than dominance, the young Russian conscripted soldiers and their commanders must certainly grow more concerned day by day. They too have become entrapped, and are “experiencing the same feeling of terror before an enemy, which, having lost half his army, stood as formidably at the end as at the beginning of the battle.”

As for Putin, like Napoleon, he may feel the winds of fate blowing heavily on his shoulders even now. Napoleon did make it back to Paris. But three years after the Battle of Borodino and the 5-week occupation of Moscow, he met his Waterloo on June 16, 1815, at the hands of the Duke of Wellington. He died in exile on the island of Helena on May 5, 1821. In his last will, he wrote, “I wish my ashes to rest on the banks of the Seine, in the midst of that French people which I have loved so much.”

Putin likely feels a similar love for Mother Russia, but ultimately the Russian people may choose not to return the affection.

Mike Magee, MD is a Medical Historian and Health Economist, and author of “CodeBlue: Inside the Medical Industrial Complex.“

THCB Gang Episode 86, Thursday March 24th, 1pm PT 4pm ET

Mar 23, 2022

Joining Matthew Holt (@boltyboy) on #THCBGang on March 24 for an hour of topical and sometime combative conversation on what’s happening in health care and beyond were fierce patient activist Casey Quinlan (@MightyCasey); patient safety expert and all around wit Michael Millenson (@MLMillenson); THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and back from his travels in Mexico and medical historian Mike Magee (@drmikemagee).

Special guest this week was population health and primary care expert Ines Vigil, who developed that program at Johns Hopkins but now hangs her hat at Clarify Health &is the author of Population Health Analytics. We dived deep into what populations health means. What we need to do to make it work and whether it’s real or not!

You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Reflections From the Ukraine

Mar 7, 2022

By MIKE MAGEE

The English translator of Tolstoy’s epic Russian novel, “War and Peace”, Richard Pevear, writes in his introduction, “The book is set in the period of the Napoleonic wars (1805-1812) and tells the interweaving historical events of two very different families of the Russian nobility – the severe Bolonskys and the easygoing Rostovs – and of a singular man reminiscent of the author himself – Count Pierre Bezukhov. It embodies the national myth of ‘Russia’s glorious period’ as Tolstoy himself called it…”

On page 348, in a moment of intense introspection, the very same Pierre broodingly reflects, “What is bad? What is good? What should one love, what hate? Why live, and what am I? What is life and what is death? What power rules over everything?”

Pierre’s mind provides this very dark response, “You will die – and everything will end. You will die and learn everything – or stop asking.”

Will Microbes Finally Force Modernization of the American Health Care System?

Feb 14, 2022

BY MIKE MAGEE

Science has a way of punishing humans for their arrogance.

In 1996, Dr. Michael Osterholm found himself rather lonely and isolated in medical research circles. This was the adrenaline-infused decade of blockbuster pharmaceuticals focused squarely on chronic debilitating diseases of aging.

And yet, there was Osterholm, in Congressional testimony delivering this message: “I am here to bring you the sobering and unfortunate news that our ability to detect and monitor infectious disease threats to health in this country is in serious jeopardy…For 12 of the States or territories, there is no one who is responsible for food or water-borne surveillance. You could sink the Titanic in their back yard and they would not know they had water.”

Osterholm’s choice of metaphor perhaps reflected his own frustration and inability to alter the course of the medical-industrial complex despite microbial icebergs directly ahead.

Does Digital Health Technology Have a “Famous Trio” in the Making?

Feb 9, 2022

By MIKE MAGEE

Yale historian, Frank M. Snowden wisely notes in his 2020 book, “Epidemics and Society”, that “We must avoid the pitfall of believing the driver of scientific knowledge is ever a single genius working alone.”

His insight came to mind this week as I was reviewing the January 11, 2020 Forbes article by Seth Joseph, health tech policy correspondent, titled “What Bubble? Digital Health Funding Year in Review 2021.”

By one measure of success – dollars invested – it’s been a banner year. According to Joseph, there was over $29 billion funded, and 729 digital health US-based startups in 2021. But according to Scott Barclay, Managing Director at Insight Partners, who is quoted generously in the Forbes piece, “digital health is still in its relative infancy.”

This level of churn, passion, and (some might say) financial frenzy is reminiscent of another moment in scientific history – the latter half of the 19th century. Over a few decades, “The Germ Theory” was fleshed out with unprecedented and remarkable human progress following in its wake.

The breakthroughs were not the result of 729 often-repetitive and unoriginal ideas, but rather the work of three successive innovators whose work built on each other, combining innovation, technology and health.

Snowden termed the three “The Famous Trio.”

The first was Louis Pasteur (1822-1895) a chemist with a sharp eye and mind. He had been hired to find a solution for wine and milk that was spoiling too fast. The tools he wielded were mostly observational, including a still primitive microscope. With it, Pasteur was able to identify putrefying microbes as causal but went two steps further. He noted that a heating process killed the microbes and halted the product putrefaction, and tied the microscopic organisms to specific human diseases. With this knowledge, he unveiled a commercial process of serial attenuation of disease-causing microbes that allowed safe inoculation of humans and acquired immunity.

The second of the trio was Robert Koch (1834-1910), a physician 20 years younger than Pasteur. While studying Anthrax at the University of Gottingen, he visualized the large causative bacteria, introduced it into a lab animal, and reproduced the disease. Going one step further, he described resistant spores of the bacteria, identified them in grazing fields, and proved that eating grass laden with spores could spread Anthrax between animals. His careful investigative approach led to the uncovering of the etiology of tuberculosis and to “Koch’s Postulates”, four steps still in place today, which when followed, constitute laboratory-based scientific proof of a theory. Beyond this, Koch was a technology innovator, teaming up with the Carl Zeiss optical company, whose lenses, in combination with specialized tissue stains and fixed culture mediums, allowed Koch to visualize and describe M. tuberculosis.

The third innovator was Joseph Lister (1827-1912), a professor of surgery at Edinburgh. Thanks to the development of ether and nitrous oxide in the 1840s, pain management intra-operatively was under partial control. Improving techniques and tools helped control blood loss. But post-operative infection remained a persistent and deadly threat. Viewing the work of Pasteur and Koch, Lister recognized the possibility that contamination with microbes might be the cause. In carefully designed studies, employing hand scrubbing, sterilization of tools, and spraying the patient with carbolic acid, rates of post-operative sepsis declined. Other colleagues added sterile gowns, gloves, and masks, merging these added measures with Lister’s support.

Arguably, the life-saving “Germ Theory” was the work product of complementary insights and serial incremental progress. It might then be reasonable to ask, of the $29 billion funded 729 digital health tech US-based startups in 2021, how many represent additive and progressive insights that might eventually lead to game-changing advances in the health of America?

Scott Barclay appears to be mining this same territory. In Forbes, he says, “The green shoots of the past 10 years are turning into new vibrant ecosystems that are growing, but young. We are early in what may turn out to be a two-decade epoch of super innovative ideas, strong founders with execution experience bringing change to a $4T sector of the economy that has been sclerotic and in many parts oligopolistic. The majority of the largest digital health companies in 2040 public markets have not yet been started.”

Does Digital Health Technology have a “Famous Trio” in the making to link infrastructure, AI diagnostics, and evidence-based health? Who are they, and how do they complement each other?

Mike Magee, MD is a Medical Historian and Health Economist, and author of “CodeBlue: Inside the Medical Industrial Complex.“

Ecology and Technical Advance

Feb 4, 2022

By MIKE MAGEE

It is fair to say that the vast majority of Americans know more about viruses today than they did 24 months ago. The death and destruction in the wake of COVID-19 and its progeny have been a powerful motivator. Fear and worry tend to focus one’s attention.

Our collective learnings are evolving. We have already seen historic comparisons to other epidemics. Just search “The 10 worst epidemics” for confirmation. But one critical area which has been skimmed over, and only delicately probed (if at all) is the ecology or “the ecological point of view.”

For those interested, let me recommend “Natural History of Infectious Disease” published in 1972 by Nobel laureate and Australian biologist Sir Macfarlane Burnet and his colleague David O. White.

Chapter 1 begins: “In the final third of the twentieth century, we of the affluent West are confronted with no lack of environmental, social, and political problems, but one of the immemorial hazards of human existence is gone. Young people today have had almost no experience of serious infectious disease…For the first time in history deaths in infancy and childhood are not predominantly from infection.” But a few sentences on, they add this addendum, “Infectious diseases may be almost invisible, but it is still potentially as important as ever it was.”

Americans are all too familiar with the living biologic organism named COVID-19. By now, they know what it looks like, the role of its outer spikes, its nuclear makeup, and genetic alterations that allow the creation of derivative variants and vaccines. But in addition to its biological science, it also has an ecological life as well.