Health in 2 point 00 — Episode 26

This week we’re on location in Europe! Sitges near Barcelona to be exact, the site of the 2018 HIMSS Europe & Health 2.0 Conference. There, with our friend Jennifer Lannon from .health acting as emergency camera crew, Jessica DaMassa pins me down about HHS CTO Bruce Greenstein, Bayer & cannabis, Entraprenurses and where HIMSS/Health 2.0 is going next in Europe. It’s all in a day’s work (well 2 minutes) in Health in 2 point 00! — Matthew Holt

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Bad Blood & Mad Love at Theranos—Psychopaths at Work

I’ve been kidding John Carreyrou on Twitter that I was going to give Bad Blood, his tale about the Theranos fraud, a one star review because he never sent me a preview copy. But it’s a barn burner, and I can’t recommend it enough, even though I spent my own $13.95 on the Kindle version!

By now the story is well known. The young blonde Stanford drop out with the baritone voice says she’s going to change lab testing forever, then hides in stealth in Silicon Valley. I caught a few whispers over the years that this company was doing something but as lab testing was a little away from the mainstream of health tech, I didn’t ever bother to look for more. And then in 2014 Holmes gets into Fortune and from a distance we are all cheering her on because she’s figured out a new way to disrupt a stodgy industry. The first Carreyrou piece is published in the WSJ in late 2015—even though Murdoch was a huge investor–and over the next 2 years massive fraud is exposed.

About when Holmes was starting to talk about stuff, and after the Walgreens deal eventually went live (mid 2014) there was the very odd series of events when Holmes appeared to agree to come talk at Health 2.0 and but shortly afterwards she and her PR team went totally radio silent on us. I was told by one PR flack that he’d heard that another conference had told her to choose between us and them (TedMed? I’m guessing) but who knows. She appeared at TechCrunch in September 2014 and had the interviewer Jon Shieber’s blood drawn with his results coming back while she was on stage—clearly faked we now know. I saw her interviewed by a fawning Toby Cosgrove at Cleveland Clinic, where she said that Carreyrou was lying. I stood at the end of a receiving line full of people asking her to sign things for their daughters as she was such an inspiration. When I got to the front I asked her why she didn’t come to Health 2.0 and invited her to come the next time. With me in line was Medcity News Editor Chris Seper who asked for an interview. After about 15 seconds of her not saying anything, a PR flack jumped in, pulled us away from her, got our cards and said she’d get back to us. I’m still waiting

But what is just remarkable about this whole thing is how little due diligence was done by investors who plunked down hundreds of millions.

No one seems to have bothered asking Novartis, Pfizer and a few others who did the original small trials what happened. All of them pulled out. And the biggest idiots of the lot are Steve Burd, former CEO of Safeway, and Jay Rosen, Medical Director at Walgreens. I met Jay Rosen a couple of times when Walgreens was doing some innovation work at Health 2.0. He used that “I’m Dr J and I used to play basketball” line with me, and frankly he appeared to be a total blowhard. (Hey I meet a bunch of those and usually no harm done!) But there was a real lab expert called Kevin Hunter on the team and everyone at Walgreens just ignored his warnings. Incredible.

Safeway had the same problem. Their medical director at the time, Kent Bradley (a good guy who’s been at Health 2.0 several times), tried to warn the boss but Steve Burd wasn’t having any of it. I suspect this tale won’t do his Burd Health consulting group much good.

Basically by mid-2013 Theranos had convinced Safeway and Walgreens to shell out more than $100m each on no data. And that was enough for the big name, but ignorant private investors to pile in. Once that happened Holmes and Balwani, her (no one seems to be able to believe it) boyfriend, basically doubled down on the fraud.

Could anyone else have done anything? I’ve met Michael Esquivel, the well known health tech lawyer, plenty of times (even went to his birthday party as I know his brother-in-law well). I never realized that he was general counsel at Theranos in the early days, but it appears that when he figured it out, he just left and moved on. Again hard to know what else he could have done. Frankly given the treatment meted out to Tyler Shultz, Erika Chueng and whoever the actual Alan Beam is, I’m not surprised that most of the ex-employees just kept it to themselves. They were followed by private investigators, sued & threatened with ruin.  And the ones who did blow the whistle end up getting nothing out of it. Tyler Shultz’s parents are in debt for $400K of legal fees because his grandfather is an old fool. And Rochelle Gibbon’s has lost her husband, Ian, as direct consequence.

Still much kudos to the small group who did get in touch with Adam Clapper, the pathawlagy blogger, who pointed out that what he saw was very unlikely to work. It looks like he closed down in late 2015 possibly under pressure from Theranos. Huge kudos that those who did talk to Carreyrou. And of course huge kudos to Carreyrou himself who managed to write this book and keep the whole story going for the better part of 3 years.

Meanwhile Holmes and Balwani just come over as paranoid psychopathic assholes. Boies, the well-known Democratic lawyer comes off even worse, as a paranoid psychopathic asshole bully . And he’s an idiot as he got paid in stock! Plus he lost Bush v Gore so we can blame him for that too! Now he’s moved on to Uber it’s time for the new management there to get rid of him.

As has been shown by the reaction of most of the world to Donald Trump, average people just don’t know how to react to psychopaths, and the Theranos story proves that not only ordinary employees but also some of the wealthiest people in the world are no exceptions.

On the other hand, perhaps it would have been fun for the fraud to drag on a bit longer, perhaps to an Uber-esque level of funding rounds. Given that the Waltons, DeVos and Murdoch all lost $100m+, perhaps we should be congratulating Holmes for sticking it to unpleasant right-wing billionaires, and just be sad that none of them will even notice the actual level of losses they took.

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WTF Health | Scaling Up NLP with Simon Beaulah of Linguamatics

WTF Health – ‘What’s the Future’ Health? is a new interview series about the future of the health industry and how we love to hate WTF is wrong with it right now. Can’t get enough? Check out more interviews at www.wtf.health

What can you find diving into the black hole of healthcare’s unstructured data? Natural Language Processing (NLP) seems to be the ‘tech du jour’ this year, so I spoke to early-entrant Simon Beaulah of Linguamatics about the big picture of NLP-plus-AI and the tech’s evolving role in improving care by putting together a more complete ‘patient narrative’ in the EMR.

Wanna hear his thoughts on what’s next for NLP in terms of scaling? Jump in at 2:15 mark.

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Double Standards, Trojan Style

The University of Southern California (USC) appears to look the other way when male physicians harass or assault women. In reality, sexual violence spares no occupation, including medicine, but the way an organization responds to crime against women indicates a certain level of integrity. The World Health Organization estimates sexual violence affects one-third of all women worldwide. In a nation where women make up 50% or more of each incoming medical school class, only sixteen percent of medical school deans are female, making gender imbalance in leadership positions nearly impossible to overcome.

For the second time in less than a year, USC President C.L. Max Nikias is grappling with sexual misconduct allegations against a physician faculty member. Complaints go back to the early 1990s from staff and patients about inappropriate comments and aggressive pelvic exams done by Dr. George Tyndall, the only full-time gynecologist for the past three decades at the campus clinic. USC ignored complaints until a nurse contacted the campus rape crisis center.

Dr. Tyndall was initially suspended pending inquiry and forced to resign shortly thereafter. More than 100 complaints have been received and five are suing USC. Astonishingly, the founded complaints against Dr. Tyndall were never turned over to authorities or reported to the Medical Board of California. USC defended this decision, asserting there was no legal obligation to report misconduct. USC has a moral and ethical duty to protect students, staff, and faculty, yet failed on both counts.

USC is no stranger to scandal. In 2007, Dr.  Carmen Puliafito, MD, a Harvard Medical School graduate, was chosen as Dean at the USC School of Medicine. His background held clues he would cause trouble. Just prior to arrival at USC, Puliafito settled a lawsuit for throwing a “tantrum” and committing assault and battery against an optometrist named Marc Brockman at the University of Miami. During the trial, Miami University disclosed they had previously investigated sexual harassment complaints against Puliafito too.

Puliafito was a strategic fundraiser, bringing in over $1 billion in donations for the Trojans; however, he kept company with criminals and documented his illicit drug use on video. His nightlife came to screeching halt when a 21-year-old female companion overdosed in a Pasadena hotel room and an ambulance transported her to the hospital. Police confiscated more than 1 gram of methamphetamine from the hotel room, but inexplicably, no police report was filed until three months later identifying Puliafito as a witness to the overdose.

An anonymous witness phoned the office of the USC President Nikias and reported Puliafito’s activities.  Ten days later, Puliafito resigned, however President Nikias never filed a complaint with the California Medical Board or the authorities. When the LA Times discovered Puliafito was still practicing as part of the USC faculty, President Nikias issued a ‘mea culpa’ admitting “they could have done better.” Unfortunately, his next choice was anything but better.

Dr. Rohit Varma succeeded Puliafito as Dean at the School of Medicine but resigned amid scandal after less than a year. He had settled a sexual harassment claim in 2003 and was disciplined by USC. Varma – then a 40-year-old junior professor – attended a conference with a young international student he was supervising. He allegedly told his student that the grant they were travelling on only supported staying in a single shared room. When the student protested, Varma took her phone and threatened to have her visa revoked. USC reached a $135,000 settlement with the woman, of which Varma paid $11,000. He was ordered to complete sexual harassment counseling and denied a promotion, yet one year later, earned full professorship, as if nothing ever happened.

Is USC defending “bad boys” with little regard for women? Or is there something else going on? One might argue that threatening your subordinate with visa revocation is borderline sociopathic. Are they being protected because they are physicians or simply because they are men?

The only way to answer this question is to look at what happens when a female physician and male physician have a hostile interaction. One evening, Dr. Meena Zareh, a cardiology resident at USC, reported being summoned to a windowless call room by Dr. Guillermo Cortes, her direct supervisor, to discuss a patient. When she attempted to leave, Dr. Cortes allegedly overpowered her, blocked the door, and assaulted her. Dr. Zareh shared the incident with a co-worker afterward but did not report it to law enforcement or the residency program for fear of reprisal until three months later. Dr. Cortes denied allegations and was placed on administrative leave pending investigation.

Dr. Cortes was allowed to return to work but was barred from unsupervised contact with Dr. Zareh. Reprisals toward Dr. Zareh began almost immediately, a signal of mounting institutional pressure to sweep her allegations under the rug. One male supervisor suggested she take a leave of absence, while others recommended deferring fellowship training or changing residency programs. Dr. Zareh is suing USC and LA County for mishandling her report of sexual assault, a mistake in which USC seems to be accumulating expertise. If the pattern holds, Dr. Cortes will get a promotion, a raise, and may become a future Dean at the Keck School of Medicine.

While double standards remain alive and well in academia, there are rays of hope. Dr. Laura Mosqueda, a geriatric physician, is one of those. She is the first woman chosen to lead the Keck School of Medicine since it was established in 1885. It is about damn time.  In the race to become a top-tier program, I have no doubt Dr. Mosqueda will achieve a great deal more than her predecessors.  After all, how could she do any worse?

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A Picture is Worth a Thousand Words

These days I’m spending a lot of time getting in depth with many tech companies. From time to time I’ll be asking those innovators to tell their story on THCB, and suggest what problems they are solving. First up is Meghan Conroy from CaptureproofMatthew Holt

Today’s doctors are communicating with their patients less than ever before, even as their days grow longer and busier. Physicians are pressured to see more patients in shorter encounters, while at the same time shouldering more of the administrative and documentation tasks associated with electronic medical records (EMR). The result is physicians who are spending more time looking at patients’ EMRs than looking at – or interacting with – the patients themselves.

Research bears this out. A recent RAND study shows that providers are frustrated by the high volume of clerical work, and the implementation of poorly designed technology, that hamper their efforts to deliver effective, efficient care. Primary care physicians spend nearly two hours on EMR tasks for every hour of direct patient care, with an average of six hours – more than half their workday – interacting with the EMR during and after clinic hours. The same study found that U.S. physicians’ clinical notes are, on average, four times as long as those in other countries.

No wonder the country is facing an epidemic of physician burnout. Doctors have become high paid data entry workers rather than caregivers. They are tethered to their screens, filling out countless forms and responding to multiple messages, eating into their face-to-face time with patients. With more patients to see, they have less time to prep for each encounter, leading to sub-optimal patient experiences and poorer outcomes.

Ironically, while technology helped create this problem, it also could provide the solution. Today, there are new tools that can help providers make patient visits more efficient, enhancing the quality of care. These tools range from Augmedix’s tech-enabled virtual scribes, intelligent personal assistants like Amazon’s Alexa which could transcribe doctors notes during appointments, and blockchain which could decentralize data and put it into patients’ hands.

The most compelling use of these new technologies liberates clinicians from the tedious and time-consuming work of inputting words into EMRs. My company CaptureProof converts people’s mobile phones into a secure, easy-to-use connected health tool for documenting and communicating vital patient information visually. These replace extensive note-taking in the EMR. Literally a picture is worth more than a thousand words and it only takes 13 milliseconds to scan versus 7.7 minutes to read and 3h20min to write.

The advent of these technologies means that the time has come to replace the standard of written medical records with visual reports. By empowering providers with faster, more accurate and meaningful visual data, these technologies can liberate them from the tyranny of inputting and reading thousands of words each day in EMRs, and allow them get back to doing what they are meant to do – providing quality care to patients. By contextualizing data over time visually, patients and providers can track health and healing.  Objectively comparing data will allow for more informed decisions and ultimately, improved care and a better patient experience.

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