Kim Bellard

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I'm OK -- You, Maybe Not So Much

It is widely agreed that competition, or lack thereof, in health care is a problem.  The Wall Street Journal recently showed how Viagra and Cialis prices seem to move -- up, of course -- in lockstep. USA Today found Walgreens charging 1237% more than Costco, for the same drug.  Economists like Martin Gaynor have been discussing problems with competition in health care for years. The Harvard Business Review just published a lengthy article on the problem. But, it turns out, we may be ignoring an important competition that has real impacts on our health: with each other...

Imagining a Future American Culture of Health

One of the most thought-provoking articles I've read lately is Tom Vanderbilt's Why Futurism Has a Cultural Blindspot in Nautilus. In it, he discusses how our technological visions of the future seem to do much better on predicting the technology of that future than they do the culture in which they will be used. As he says, "But when it comes to culture we tend to believe not that the future will be very different than the present day, but that it will be roughly the same. Try to imagine yourself at some future date.... Chances are, that person resembles you now."

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In God We Trust, All Others (Don't) Pay Cash

I was intrigued by a recent Wall Street Journal article about how some retail establishments won't accept cash as a form of payment, citing Drybar, Sweetgreen, and at least one Starbucks location. Cashless is touted as faster, safer, easier to administer, and in line with most customers' preference. Indeed, a new study from the Pew Research Center found that 29% of all U.S. adults don't use cash at all in their typical week, up from 24% in 2015. The higher the household income, the less cash was used. Alistair Johnson writes in Forbes that, hey, if we're going to a cashless society, we should make it a cardless one as well, not simply replace our cash with those pieces of plastic we use for debit/credit. I think he's on to something there, and both discussions made me think about how we change the constructs of our everyday lives -- including in healthcare.

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In Healthcare, It's Placebos [Almost] All the Way Down

Two remarkable articles -- one on placebos, one on informed consent -- caught my attention.  To set them up, a famous, perhaps apocryphal, story: A scientist tried to explain the solar system to a lay audience.  When he finished, a skeptical woman told him he was wrong: the earth was flat, and rested on the back of a giant turtle. The scientist asked her what the turtle rested on.  "Another turtle," she replied confidently.  He then asked what that turtle was on.  The woman would have none of it.  "You can ask all you want, sir, but it's turtles all the way down." Faith is a funny thing.  Especially in health care. Let's start with placebos...

Innovation Needs Dumb Ideas

Over the years I've listened to many new-to-health-care entrepreneurs pitch their great new idea. They're so excited: health care is so inefficient! People are so frustrated by the system! It will be so easy to improve it! I usually end up thinking, "Oh, you poor people. You really don't know much about health care, do you?" They don't fully grasp the strange way it is bought and sold, the convoluted financing, or the layers of regulation. So I wish them well and wait to hear about their eventual failure. But now I'm thinking, maybe it is experts like me who are part of health care's problem. In Harvard Business Review, Ayse Birsel suggests that companies need to do more "reverse thinking," deliberately thinking up wrong ideas...

Is "Modern Medicine" Indistinguishable From Magic?

Evidently, most of health care's technologies are not yet sufficiently advanced. For example, just think about chemotherapy.  We've spent lots of money developing ever more powerful, always more expensive, hopefully more precise drugs to combat cancers.  In many cases they've helped improve cancer patients' lifespans -- adding months or even years of life.  But few who take them would say the drugs are without noticeable side effects -- e.g., patients often suffer nausea, vomiting, hair loss, fatigue, appetite loss, sexual issues, or a mental fog that is literally called "chemo brain."...

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Is China Already in the 21st Century in the Fields of AI for Healthcare and Quantum Computing?

It is 2018 everywhere, but not every country is treating being in the 21st century equally. China is rushing into it, even in healthcare, while the United States is tip-toeing its way towards the future. Especially in healthcare. Ready or not, the future is here...and the U.S. may not be ready...Artificial Intelligence: Yes, the U.S. has been the leader in A.I., with some of the leading universities and tech companies working on it. That may not be enough. A year ago China announced that it intended to be the world leader in A.I. by 2025. The Next Web recently concluded that China's progress since then "remains unchecked." China is far outspending the U.S. on A.I. research and infrastructure, coordinating efforts between government, research institutes, universities, and private companies. Dr. Steven White, a professor at China's Tsinghua University, "likens the country's succeed at all costs AI program to Russia's Sputnik moment." We have yet to have that wake-up call...

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Is Cloud Faxing the Solution to the Health IT Usability and Interoperability Crisis?

The Healthcare industry is in profound crisis as the HITECH Act of 2009 led medical facilities across the United States to spend in excess of $3 trillion on the purchase and implementation of expensive electronic health records (EHRs) under the Meaningful Use program. Yet, the most fundamental goals of electronic records Nirvana that were promised have not been achieved. For multiple reasons, EHRs have turned out to lack usability and be non-interoperable. In fact, most monopoly EHR vendors are engaged in what is commonly called “data blocking.” In most cases physicians are unable to obtain medical records for the patients they are seeing and patients have a hard time getting a hold of their own medical records. That means that the medical records are not available at the most important moment, the caregiver/patient encounter, and are not available to the patients themselves and their family members.

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Is Health Insurance Itself the Problem with the System?

I worked in the health insurance industry for a long time.  I helped introduce consumer-driven/high deductible plans to help foster cost-awareness.  I bought into the protection-against-big-expenses meme.  I personally have never not had health insurance.  So, by most standards, I should be biased in its favor.  But I'm beginning to wonder if health insurance itself is the problem, or at least a big part of the problem. I've written before about some of the new entrants into health insurance; more power to them, and the more the merrier.  What I continue to be disappointed by is that we're not really seeing fundamentally new approaches to what health insurance is.

Is It Time to Purchase Your Own Quantum Computer?

I want to talk about quantum computing – and why healthcare needs to looking ahead to it. Let’s start with this: for the low, low price of $5,000, you could have your very own quantum computer.  Spin Q Technology, a Chinese company, has recently introduced its Spin Q, a less expensive, less powerful version of its Spin Q Gemini, which went for $50,000.  Other quantum computers, such as those by Google, IBM, or D-Wave, have a few more zeroes in their price.  Spin Q Technology has a clear goal in offering this version:We believe that low-cost portable quantum computer products will facilitate hands-on experience for teaching quantum computing at all levels, well-prepare younger generations of students and researchers for the future of quantum technologies."

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Is Paying for Un-Healthiness the Core Problem with the US Healthcare System?

Health care needs a better business model. HHS reports that U.S. health care spending will surpass $10,000 per person this year, will grow almost 6% annually for the foreseeable future, and will consume over 20% of GDP by 2025.  About half of our spending goes for labor costs, with health care employment remaining one of the "bright spots" in our economy.  Indeed, health care jobs continued to soar even when the economy tanked in our most recent recession. Despite that steady growth, we continue to talk about a physician shortage, especially for primary care.  Medical school enrollment is at new highs, yet it is not projected to dent the demand...

 

Is Shkreli the Exception, or the Norm, in Big Pharma?

I didn't want to write about pharmaceutical companies.  They get enough bad press, and adding to it almost seems like piling on.  If Valeant is the poster company for outrage about drug pricing, it's less because what they are doing is unusual than it is because we suspect they are the norm. Honestly, I wanted to discuss McDonald's turning their Happy Meals boxes into VR headsets --I'm not making that up -- but, gosh darn it, it's almost like the pharmaceutical companies are daring me to talk about them.  So I will.

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Is the US Healthcare System Suffering from the Dunning-Kruger Effect?

Psychologist David Dunning, originator of the eponymous Dunning-Kruger effect, recently gave an interview to Vox's Brian Resnick. For those of you not familiar with the Dunning-Kruger effect, it refers to the cognitive bias that leads people to overestimate their knowledge or expertise. More importantly, those with low knowledge/ability are most likely to overestimate it. Does this make anyone else think of the U.S. healthcare system? Professor Dunning proposed the effect in 1999, in a paper in Journal of Personality and Social Psychology, along with then-graduate student Justin Kruger. Since then, it has become widely known and broadly applied (not always accurately, as Dr. Dunning explains in the interview).

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Is WeWork's Ecosystems Approach a Model for Healthcare Platforms?

Maybe you don't work in a WeWork office setting. Maybe you haven't ever visited one. Maybe you haven't even heard of WeWork. In that case, then you'll probably be surprised that this audacious real estate start-up now has a valuation close to $50b, with over 400,000 "members" in 100 cities across 27 countries (and they claim to "touch" 5 million people worldwide). Or that their plans go well beyond their unique twist towards office sharing. Who in healthcare is thinking about them, and who should be worried...or intrigued?...WeWork was never just about finding people and companies office space: it wanted to "help people work to make a life, not just a living." It focused on building a culture in its spaces, complete with amenities and events to help build a community among its members.

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It's 2019. Smartphones are Out...On to the Next Big Thing...

It's amusing to watch old movies where plot points often involved someone's inability to talk to the person they needed, in the pre-mobile phone era. We take our smartphone's omnipresence and virtual omnipotence as a given in our daily lives and treat even its temporary loss as a major inconvenience. So why are people already wondering if the smartphone era is almost over? Speculation on this is not new (voice has been touted as the next big platform for years), but intensified after Apple announced reduced revenue expectations earlier this year -- the first time in 16 years. It specifically cited slower iPhone sales in China and, even more jarring, said it would no longer break out unit sales of iPhones...

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