COVID-19 & Fertility Care: Remote Monitoring Meets Fertility Benefits for Better At-Home Option

By JESSICA DaMASSA, WTF HEALTH

Trying to achieve pregnancy with fertility treatments can be challenging, stressful, and expensive in the best of times — let alone a global pandemic. Since the COVID-19 outbreak in the U.S., fertility care has been basically “paused,” and women attempting to conceive have been left with a very different set of decisions and options for care than were available pre-pandemic. So, how does fertility care shift from the clinic to the home? Tammy Sun, co-founder & CEO of fertility benefits startup Carrot Fertility, and Lea Von Bidder, co-founder & CEO of Ava, a women’s health tech startup best-known for its ovulation tracking bracelet, stop by to talk about how they are redefining the how, when, and where of fertility care for greater success outside the doctor’s office.

What’s smart about this partnership? How the two companies are working together to build off the biometric data collected by Ava’s tracker, basically adopting a remote monitoring approach to collecting and analyzing data in the home in effort to either help optimize the chances of getting pregnant naturally, or better inform the IVF or other medically-assisted procedures that will return as options as the pandemic wanes. From the impact on would-be-parents and their employers to the sentiment of women’s health investors, we talk through the opportunities and challenges of expanding fertility care in the home.

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Silence Can Be Deadly: Speak up for Safety in a Pandemic

By LISA SHIEH MD, PhD, and JINGYI LIU, MD

Jingyi Liu

Lisa Shieh

There have been disturbing reports of hospitals firing doctors and nurses for speaking up about inadequate PPE. The most famous case was at the PeaceHealth St. Joseph hospital in Washington, where Dr. Ming Lin was let go from his position as an ER physician after he used social media to publicize suggestions for protecting patients and staff.  At Northwestern Memorial Hospital in Chicago, a nurse, Lauri Mazurkiewicz warned colleagues that the hospital’s standard face masks were not safe and brought her own N95 mask. She was fired by the hospital. These examples violate a culture of safety and endanger the lives of both patients and staff. Measures that prevent healthcare workers from speaking out to protect themselves and their patients violate safety culture. Healthcare workers should be expected to voice their safety concerns, and hospital executives should be actively seeking feedback from frontline healthcare workers on how to improve their institution’s Covid-19 response.

Share power with frontline workers

According to the Institute for Healthcare Improvement, it is common for organizations facing a crisis to assume a power grab in order to maintain control. As such, it is not surprising that some hospitals are implementing draconian policies to prevent hospital staff from speaking out. While strong leadership is important in a crisis, it must be balanced by sharing and even ceding power to frontline workers. All hospitals want to provide a safe environment for their staff and high-quality care for their patients. However, in a public health emergency where resources are scarce and guidelines change daily, it’s important that hospitals have a systematic approach to keep up.

Learn from the aviation industry

The aviation industry is an example of an industry that has benefited tremendously from protocolizing safety culture. Flight recorder data from the 1970s suggested that many aviation disasters occur because communication breaks down between crew members. The KLM Flight 4805 crash in 1977 and the United Flight 173 crash in 1978 were caused by captains overruling the concerns of their copilots. For this reason, the aviation industry created the Crew Resource Management (CRM) protocol. CRM emphasizes teamwork and communication and is based on the premise that everyone: captains, co-pilots and flight attendants alike, have equal responsibility in maintaining safety. CRM harkened a paradigm shift from the previous culture of ‘captain is god’. The incorporation of CRM into aviation training is a major reason why aviation is much safer today.  Hospitals should strive to create a similar safety culture in responding to COVID, where physicians, nurses and hospital leadership have equal responsibility in maintaining the safety of patients and providers.

How to maintain safety culture during a pandemic

Below, we have provided some principles and examples for a healthcare focused “CRM” to help hospitals maintain safety culture during the Covid-19 pandemic.

1. Adopt a team mindset: Hospitals are large hierarchical institutions often driven by top-down management. This can lead to operational disasters such as dwindling PPE supplies, prolonged turnaround times for COVID testing, inadequate safety protocols, and more. Hospital leaders should make themselves accessible to the input of frontline workers. They should view their staff as not just pairs of hands, but as employees with crucial knowledge to improve the hospital’s Covid-19 response.
2. Solicit feedback from frontline workers: Hospital leadership should actively solicit feedback from frontline workers to identify opportunities for improvement. At Stanford, we hold weekly virtual town hall meetings where all staff are invited to virtually send questions and concerns to Department of Medicine leadership. The answers are recorded and then made available on the internet for anyone to access. We also conducted focus groups with representatives from across Stanford Healthcare. Topics which consistently arose during discussion include access to appropriate PPE, being exposed to Covid-19 at work and taking the infection to family and not having rapid access to testing if needed, just to name a few.
3. Communicate with regularity and transparency: Covid-19 is a rapidly evolving situation. Timely and transparent communication regarding the state of the hospital and foreseeable challenges is critical to maintaining provider trust.  Many difficult truths will arise during these conversations, but if they are not shared, they will never be addressed.  At Stanford, we receive daily newsletters on how many SARS-cov2 tests were run in the last 24 hours, how many were positive, how many patients are on the floor/ICU and other metrics. We are also updated on how many days of PPE we have available, and what additional sourcing options the administration is pursuing in case we run out.
4. Maintain psychological safety: Psychological safety is defined as the belief that one will not be punished or humiliated for speaking up. Psychological safety occurs when there are safe spaces that expect individuals to speak up. The goal is to encourage honest feedback from every corner of the hospital, from the linens department to the intensive care nurses. Psychological safety is destroyed when management implements draconian consequences for speaking up, as was the case at St. John’s Health Center in Santa Monica, CA when nurses were suspended after they requested N95 masks while working in a coronavirus ward. In addition to the ongoing pandemic, another crisis emerges when healthcare workers are afraid to speak up.
5. Establish expectations of speaking up: Workers should not only feel empowered to express concerns regarding safety, they should know that there’s an expectation that they will do so. There are many widely available tools that healthcare workers can use to express and escalate safety concerns. At Stanford, one of the commonly used tools is ARCC (Ask a question, Request a change, voice a Concern, Chain of Command). For example, a resident physician could inform their chief residents, “Are you aware that we are only being limited to one N95 mask per week? I’d like to request more masks as I am concerned that reusing N95 masks will increase our risk for contracting Covid-19. This is a safety issue that endangers both residents and patients, I’d like to discuss this issue with the department of medicine leadership”. 

Healthcare workers should not be punished for speaking up, especially when their primary goal is to protect themselves and patients. We hope the above suggestions will help hospitals maintain a strong safety culture during their Covid-19 response. Maintaining a safety culture during the time of Covid-19 is not just important, it’s a matter of life or death.

Lisa Shieh, MD, PhD is a clinical professor in the division of hospital medicine and department of medicine at Stanford Healthcare, as well as an associate chief quality officer for Stanford Healthcare and medical director of quality improvement programs for graduate medical education.

Jingyi Liu, MD is a resident physician in internal medicine at Stanford Healthcare.  Twitter: @JingyiLiu8

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And We Thought Pandemics Were Bad

By KIM BELLARD

Those of us of a certain age, or anyone who loves classic movies, remember the famous scene in “The Graduate” when Benjamin Braddock is given what is intended as a helpful clue about the future.  “Plastics,” one of his father’s friends says.  “There’s a great future in plastics.”

Well, we’re living in that future, and it’s not all that rosy.  Plastics have, indeed, become an integral part of our world, giving billions of us products that we could never otherwise have or afford.  But our future is going to increasingly be driven by an unintended consequence of the plastics revolution: microplastics. 

And that’s not good.

Microplastics are what happens to plastic after it has gone through the wringer, so to speak.  Plastic doesn’t typically decompose, at least not in any time frame we’re capable of grasping, but it does get broken down into finer and finer particles, until they reach microscopic levels (thus “microplastics”).  We’ve known for some time that plastics were filling our landfills, getting caught in our trees and bushes, washing up on our shorelines, even collecting in huge “garbage patches” in the ocean.  But it wasn’t until more recently that we’ve found that plastics’ reach is much, much broader than we realized, or could see.

The ocean full of microplastics, and fish are as well. They’re in our drinking water. Indeed, “There’s no nook or cranny on the surface of the earth that won’t have microplastics,” Professor Janice Brahney told The New York Times.  

Dr. Brahney was coauthor on a recent study that found microplastics were pervasive even in supposedly pristine parts of the Western U.S.  They estimated that 1,000 tons of “plastic rain” falls every year onto protected areas there; 98% of soil samples they took had microplastics.  Dr. Brahney pointed out that, because the particles are both airborne and fine, “we’re breathing it, too.”  

She admitted: “It’s really unnerving to think about it.”

This troubling study is only one of several recent related studies.  A study in early June found microplastics circulating even on deep sea floors.  Another study took samples from microscopic creatures on King George Island, isolated between Antarctica and the tip of South America.  “If microplastics can enter the food web here, they can probably do so almost anywhere on earth,” wrote coauthor Tancredi Caruso.  “But this is exactly what colleagues and I discovered.”  

The authors believe: “there is a very high risk that they have already deeply penetrated the soil food web, potentially with negative impacts on the interactions between plants and soil.”  

If you’re still not convinced, Fast Company reports on two studies that found microplastics are being absorbed by roots of plants, ending up in the fruits and vegetables we eat.  Microplastics were found in apples, broccoli, carrots, lettuce, pears, potatoes, and wheat.  Fruits seem to have more than vegetables, possibly due to their trees’ larger root system.  One of the researchers, Professor Willie Peijnenburg of Leiden University, said that, even ignoring the health risks, “simply, most people don’t like to be eating plastics.”

Yet we are.

Last but not least, another recent paper Microplastics in Terrestrial Ecosystems, stressed the need to look at the broad impacts of microplastics on the entire ecosystem.  For example: “Deposition and accumulation of microplastics can affect soil properties, with consequences for process rates and net primary production (NPP), causing feedbacks to the atmosphere, including greenhouse gases (GHGs). So far, nanoplastic has unknown consequences for this system.”  They may also alter water flow in soil and rate of erosion.  The authors conclude: “Feedbacks to the Earth system can be expected…Microplastic pollution is an international problem.”

The trouble is we just don’t know what the impacts of microplastics are on our health.  Some particles may have harmful chemicals and pollutants, most are largely carbon, but few natural systems, including our bodies, can break them down.  We may excrete many of the particles we get, but we get a lot.  One study warned: 

In all biological systems, microplastic exposure may cause particle toxicity, with oxidative stress, inflammatory lesions and increased uptake or translocation. The inability of the immune system to remove synthetic particles may lead to chronic inflammation and increase risk of neoplasia. Furthermore, microplastics may release their constituents, adsorbed contaminants and pathogenic organisms

The same is happening to our entire food chain, as well as to our atmosphere, soil, and water, and it’s largely an accumulative process.  As Dr. Brahney noted to The Washington Post, ” We are producing something that doesn’t go away, and just because we can’t see it doesn’t mean it’s not there.”

We know that lead is bad for us, such as in our drinking water.  We’ve identified many carcinogens, such as asbestos or dioxin, to which we’re trying to reduce our exposure.  We understand that air pollution is bad for us.  But we haven’t gotten our heads around the fact that remnants of all those plastic water bottles, to name one common source, are literally everywhere, down to the cellular level.  And we don’t really have any idea what it is doing to us, our food supply, or the planet on which we live.  

“Microplastics are now considered an emerging food safety concern, but we really don’t have all the answers yet,” microbiologist Dave Love told Discover earlier this year.     Dr. Love admits, “At the end of the day, there’s not a clear consensus yet on what the advice should be for consumers.”  

Prata, et. alia urged:

Nonetheless, knowledge on microplastic toxicity is still limited and largely influenced by exposure concentration, particle properties, adsorbed contaminants, tissues involved and individual susceptibility, requiring further research.

Everyone agrees more research is necessary, but meanwhile, we keep producing more plastics, which end up, well, everywhere, at every size, right down to nanoparticles.  It doesn’t take a microbiologist to realize that is not good, and is certainly going to get worse.

Right now, the world is (understandably) preoccupied with another microscopic object, the coronavirus.  COVID-19 is infecting tens of millions of worldwide and killing hundreds of thousands.  It would be ironic if microplastics prove to be the greater threat to us, the world, and everything in it.  

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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Community Organizations Can Reduce the Privacy Impacts of Surveillance During COVID-19

By ADRIAN GROPPER, MD

Until scientists discover a vaccine or treatment for COVID-19, our economy and our privacy will be at the mercy of imperfect technology used to manage the pandemic response.

Contact tracing, symptom capture and immunity assessment are essential tools for pandemic response, which can benefit from appropriate technology. However, the effectiveness of these tools is constrained by the privacy concerns inherent in mass surveillance. Lack of trust diminishes voluntary participation. Coerced surveillance can lead to hiding and to the injection of false information.

But it’s not a zero-sum game. The introduction of local community organizations as trusted intermediaries can improve participation, promote trust, and reduce the privacy impact of health and social surveillance.

Balancing Surveillance with Privacy

Privacy technology can complement surveillance technology when it drives adoption through trust borne of transparency and meaningful choice.

We can try to understand privacy technology from the perspective of decentralization. Decentralization keeps all personally identifiable information under the user’s control, therefore offering total transparency over its use and total choice over how it is used.

Ideally, managing contact tracing, testing, test interpretation, symptom reporting, health records, relationships, and location history should be decentralized. This information should be entirely under the control of the individual, and contribute only aggregated learning to the collective — using differential privacy, homomorphic encryption, and split learning.

While these technologies are still too immature and expensive to be useful for the present pandemic, current technology does not force a binary choice between absolute decentralization and coerced government surveillance. Partial decentralization of technology and technology policy at the level of a cooperative, community, or town can leverage the trust many have in their local relationships and the peace of mind that comes from the ability to choose what information to share with whom.

Focus on the Community

Technology for contact tracing and immunity monitoring requires widespread adoption to be effective. But this adoption, like access to physicians and testing, often happens locally.

Still, a community that adopts technology A with policies B can benefit even if, 20 miles away, another community implements technology C with policies D. To the extent that these technologies share some common standards, they can effectively report valuable statistics to state and national entities without the release of significant personal information.

Technology for contact tracing, symptom reporting, and checking immunity status can be incrementally deployed, one community at a time, and customized to the prevalence of virus, demographics, and employment profiles of each community. Local hospitals, physician practices, and pharmacies, together with the local board of health can suggest appropriate policies, and community leaders can issue the call to action that leads to adoption. Large employers can contribute resources appropriate to the local situation as a matter of self-interest.

There are hundreds of groups around the world developing contact tracing, symptom reporting and immunity status apps. They range from state actors to hobbyists to private finance. Many of them introduce new privacy technology based on cryptography, blockchain-based decentralized identifiers, and digital credentials. Apple and Google are planning to update their mobile phone operating systems to launch a decentralized contact tracing platform, an attempt to improve privacy that all the while gives them surveillance power that will impact society long after the pandemic is over. A shift in power from the state to private multinational corporations in the name of privacy seems unwarranted. Can we do better?

Building on Decentralized Health Records

A volunteer group led by physicians, nurses and health industry professionals, including Dr. Michael Chen and myself, has been exploring decentralized, patient-controlled health records for over 5 years.

In a homeless health record project with Emory Healthcare, we demonstrated how a trusted shelter could support their constituents’ adoption of privacy-preserving health records technology while also providing convenient access for authorized clinicians and the Medicare database. Our work has also influenced, and been cited in, official plans by the Indian government.

Our community-led decentralization approach to building trust can reduce anxiety in contact tracing and add context to immunity reports. We treat sensitive personal data (e.g., lab results, location history, and risk factors) as part of a connected but patient-controlled health record much as our assets are connected through a bank account we control. We allow credentialed clinicians, including doctors, pharmacists, and public health officers to issue immunity credentials the way they would write a prescription. We call this the Trustee® Immunity Passport. It is standards-based, free and open source software that can be used by any app developer and any community as a trust-building framework.

Our technology has uncovered the importance of community support for building trust by shifting control over sensitive personal information away from federal, state, and corporate networks. Technology that leverages trusted local institutions and trusted clinicians can promote both health and economic recovery during and after the COVID-19 pandemic.

Adrian Gropper, MD, is the CTO of Patient Privacy Rights, a national organization representing 10.3 million patients and among the foremost open data advocates in the country. This post originally appeared on Bill of Health here.

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Gastrointestinal Diseases in America: The Costly Impact on Employers and Patients

SPONSORED POST

By SAM HOLLIDAY

Medically reviewed by Jenny Blair, MD

Gastrointestinal diseases like inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), and irritable bowel syndrome (IBS) are more prevalent—and costlier—than many employers realize. Up to 70 million Americans are affected by gastrointestinal (GI) diseases each year—twice as many people as those living with diabetes (34.2 million).^[1],[2] Overall direct healthcare costs for GI diseases are estimated to be $136 billion each year in the U.S., more than heart disease ($113bn) and mental health disorders ($99bn) [Figure 1]^[3]. However, GI conditions are often overlooked by employers as they consider their benefit offerings, even though a large proportion of their workforce is likely living and struggling with these conditions.

The Rising Direct Cost of GI Conditions

Irritable bowel syndrome, characterized by symptoms like recurring abdominal pain, constipation and diarrhea, affects as many as 15% of people worldwide^[4]—though only 5 to 7% of people receive a diagnosis.^[5] While this low diagnosis rate limits the value of cost estimates, the direct medical costs of IBS, excluding prescriptions and over-the-counter medicines, have been estimated to be $10 billion (or nearly $14 billion in today’s dollars) in the US.^[6] Medication spend is another cost driver as IBS patients receive an average of 3 to 7 medications annually.^[7] That’s 2 to 3 more prescriptions than a person without IBS would receive over a year.

Another important financial consideration for IBS is out-of-pocket (OOP) spend incurred by patients on over-the-counter medications, probiotics and functional medicine providers. One survey of about 600 people with IBS found that patients spent an average of $288 (2020 equivalent: $693) during a three-month period on over-the-counter and alternative therapies for IBS symptoms.^[8] A 2007 study published in the journal Alimentary Pharmacology and Therapeutics looked at the OOP spend among people with IBS and found that individuals incurred an annual average of $406 OOP costs for the treatment of IBS symptoms.^[9]

A significant driver of GI spend is inflammatory bowel disease (Crohn’s disease, ulcerative colitis and related forms of colitis), which affects 3 million American adults^[10] and about 70,000 children.^[11] In 2014, the total financial burden of IBD was estimated to range between $14.6 billion and $31.6 billion, annually.^[12] Another study of 52,782 IBD patients showed direct medical costs of IBD to be $22,987 annually—three times higher than the direct cost of care for people without IBD.^[13]

Working Americans are also up against another common chronic GI condition: GERD, commonly referred to as acid reflux. According to the National Institutes of Health, GERD affects about 20% of the US population.^[14] However, GERD prevalence is likely underestimated, as many patients self-manage or don’t pursue treatment.^[15] A 2007 study estimated that employees with GERD account for annual health benefit costs of $6,878 each ($8,664 in today’s dollars), which is $3,355 ($4,226 in 2020 dollars) more than their counterparts without GERD.^[16]

In addition to costs that are directly attributable to GI care, these patients also experience a high rate of mental health conditions like anxiety and depression. One study showed that 25% to 30% of IBS patients suffer from depression or anxiety, a rate up to 6 times higher than the control population.^[17] And with a growing body of evidence supporting the idea that the brain and gut influence each other’s functioning, the mental health costs related to GI conditions are likely to be significant.

All of these statistics underscore the high direct costs of GI conditions like IBD, IBS or GERD. However, they’re not the only costs employers and patients face.

The Toll on Productivity and Other Indirect Costs

Indirect costs, which are largely incurred by an employer, include costs related to decreased work productivity, worker turnover, family medical leave, absenteeism and presenteeism. These conditions cause periods of intense discomfort, pain, constipation, diarrhea, nausea and other symptoms that can cause employees to miss days of work or struggle to maintain productivity when they are in pain or frequently need to use the restroom.^[18] Due to stigma, these are not conditions that patients readily talk about, so many employer benefit leaders may not be aware of the prevalence and impact of these conditions, similar to the situation with mental health conditions until the past few years.

It’s estimated that the indirect costs of IBS are as high as $20 billion; however, this estimate from 2001 is based on IBS patients who sought out medical care.^[19] The true costs could be significantly higher, as many IBS patients suffer without seeking care due to challenges with current care models that we’ll describe in an upcoming post.

Absenteeism and presenteeism—defined as missed days from work and productivity loss at work, respectively—among people with IBS is also higher when compared to the general population. One study that analyzed the 2015 IBS in America survey found that both students and employed workers report missed school or work and reduced productivity at work due to IBS symptoms.^[20] Specifically, 1885 students or employed workers with IBS said that symptoms impacted their productivity an average of 8.0 days over the course of the month; the same group also reportedly missed about 1.5 days of work or school because of IBS [Figure 2]. Another survey of workers in five European countries found that presenteeism affected about one-quarter of those with IBS, but only about 16% of those without IBS.^[21]

GERD is another GI condition associated with high rates of presenteeism and absenteeism. One study published in the Journal of Occupational and Environmental Medicine looked at 11,653 employees with GERD and compared them with 255,616 employees without GERD from a database of US employees’ administrative health care and payroll data. Study authors found that employees with GERD had 41% more sick leave days, 59% more short-term disability days, 39% more long-term disability days, and 48% more workers’ compensation days than employees without GERD.^[22] These findings highlight the impact GERD has on productivity in the workplace, and yet GERD remains an unseen, yet widespread, health issue. 

Other Hidden Factors Driving Costs

There are GI-specific cost drivers, including lengthy diagnostic processes and unnecessary or overused tests, that aren’t seen in other chronic conditions like diabetes. There unfortunately are not simple and cost-effective biomarkers for these GI conditions, which drives significant variation in the diagnostic process.

For example, GIs have differing beliefs around how to best diagnose IBS. Community providers often view it as a diagnosis of exclusion that requires ruling out other conditions via expensive testing. Experts, however, more often endorse a positive diagnosis pathway, which has been shown to be noninferior. These differing diagnostic approaches can greatly impact the patient experience and healthcare spending. A 2013 study published in the journal Clinical Gastroenterology and Hepatology put the cost of diagnosis by exclusion at $1,042.62, while the cost of a positive diagnosis path was $57.19 (in 2020 dollars).^[23],[24] Yet a survey found that 72% of community gastroenterologists still believe IBS requires a diagnosis of exclusion; these physicians order 1.6 more diagnostic tests than their counterparts who use a positive diagnosis pathway.^[25] Keep in mind, too: within the 2015 IBS in America survey, 1962 patients reported that it took on average 4 years to receive an IBS diagnosis [Figure 3].^[26] 

Within the IBD community, it’s commonly known that the time to reach an IBD diagnosis is both lengthy and expensive, with nearly half of IBD patients spending more than 2 years trying to obtain a diagnosis.^[27]

GERD is also impacted by “mismanaged” healthcare costs. Data shows that 10% to 40% of upper GI endoscopies, used for diagnosing, monitoring or treatment, do not conform to guidelines—further driving healthcare spending for employers and their workforces.^[28]

GI diseases present unique challenges for employers looking to supply employees with high-quality benefits that provide a great experience at a predictable cost.

New Solutions Are Needed for GI Conditions

People living with these prevalent GI conditions often struggle to determine the triggers of flares in their symptoms that cause the biggest negative impact on their health, quality of life and productivity. They need new solutions that understand the complexity of their situation, take the time to get to know them and develop and test personalized solutions to minimize the impact of their condition on their life. Many times the support people want and need does not seem available to them from today’s “sick care” approach to healthcare.

In our next post we will highlight what we’ve learned by interviewing and surveying thousands of patients living with IBD, IBS, GERD, SIBO and other prevalent GI conditions. We will discuss failure points in the current US healthcare model that leave these people feeling alone in their journey to get their disease under control, often turning to online communities for guidance, paying out of pocket for functional medicine providers, or just avoiding care altogether and trying to manage on their own in silence.

We will then lay out what we believe a new model of GI care looks like and how it addresses these unique challenges to get better outcomes with a 10-fold better patient experience while controlling costs for employers.

If you want to learn more about Oshi Health and our new model of GI care, please reach out!

_

Sam Holliday is the CEO of Oshi Health. He is passionate about creating a new, technology-enabled model of GI care that solves the main pain points experienced by patients with digestive health conditions, including several of his family members. His career prior to Oshi has been focused on the intersection of healthcare and technology, particularly around population health and patient engagement, including roles at a tech-enabled diabetes coaching company, an electronic health record company and a leading provider of healthcare marketing solutions. Sam holds an MBA in Healthcare Management and Finance from The Wharton School and lives in New York City.

Jenny Blair is a writer and journalist covering science, medicine, and the humanities. She earned her MD at Yale University, then completed a residency in emergency medicine at the University of Chicago. After several years in practice, she transitioned to working with words and ideas full-time. Jenny has contributed to Discover, New Scientist, Washington Spectator, and Medtech Insight, among other publications. She lives in New York City.

Sam Holliday is the CEO of Oshi Health. He is passionate about creating a new, technology-enabled model of GI care that solves the main pain points experienced by patients with digestive health conditions.

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^[1]https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/opportunities-challenges-digestive-diseases-research-recommendations-national-commission and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787318/

^[2]https://professional.diabetes.org/sites/professional.diabetes.org/files/media/sci_2020_diabetes_fast_facts_sheet_final.pdf

^[3]https://www.jwatch.org/na47723/2018/10/23/burden-and-costs-gastrointestinal-disease-ushttps://www.jwatch.org/na47723/2018/10/23/burden-and-costs-gastrointestinal-disease-us

^[4] https://www.aboutibs.org/facts-about-ibs/statistics.html

^[5] https://gi.org/topics/irritable-bowel-syndrome/#

^[6] https://www.ncbi.nlm.nih.gov/pubmed/15298528

^[7]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5598808/#bibr12-1756283X17718677

^[8] https://www.ajmc.com/journals/supplement/2005/2005-04-vol11-n1suppl/apr05-2021ps07-s16?p=1

^[9] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2036.2007.03370.x

^[10] https://www.cdc.gov/ibd/data-statistics.htmhttps://www.cdc.gov/ibd/data-statistics.htm

^[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702263/

^[12]https://www.ajmc.com/journals/supplement/2016/importance_of_selecting_appropriate_therapy_inflammatory_bowel_disease_managed_care_environment/importance_of_selecting_appropriate_therapy_inflammatory_bowel_disease_managed_care_environment_report_economic_implications_ibd

^[13]https://academic.oup.com/ibdjournal/article/26/1/1/5490919

^[14]https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts

^[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936305/

^[16] https://ift.tt/3eADJDV

^[17] https://ift.tt/382PQHK and https://ift.tt/3fVNA7J

^[18]http://www.multivu.com/players/English/7634451-aga-ibs-in-america-survey/docs/survey-findings-pdf-635473172.pdf

^[19]https://www.ajmc.com/journals/supplement/2005/2005-04-vol11-n1suppl/apr05-2021ps07-s16?p=1

^[20] https://www.ncbi.nlm.nih.gov/pubmed/31419572

^[21]https://allergan-web-cdn-prod.azureedge.net/allerganuk/allerganukzinc/media/allergan-uk/uk_global_ibs_impact_report.pdf

^[22] https://www.ncbi.nlm.nih.gov/pubmed/18188078

^[23] https://data.bls.gov/cgi-bin/cpicalc.pl?cost1=913.59&year1=201201&year2=202002

^[24] https://www.cghjournal.org/article/S1542-3565(13)00096-7/fulltext

^[25] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887205/

^[26]http://www.multivu.com/players/English/7634451-aga-ibs-in-america-survey/docs/survey-findings-pdf-635473172.pdf page 34

^[27]https://academic.oup.com/ibdjournal/article-abstract/25/Supplement_1/S14/5308155?redirectedFrom=fulltext

^[28] https://www.medicaleconomics.com/modern-medicine-feature-articles/treatment-gerd-evolving

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THCB Gang Episode 15, LIVE 1PM PT/4PM ET

Episode 15 of “The THCB Gang” will be live-streamed on Thursday, June 25th. Tune in below!

Joining Matthew Holt are our regulars: health futurist Ian Morrison (@seccurve), writer Kim Bellard (@kimbbellard), WTF Health Host Jessica DaMassa (@jessdamassa), radiologist Saurabh Jha (@RougeRad), policy expert Vince Kuraitis (@VinceKuraitis), and THCB’s Editor-in-Chief, Me (@zoyak1594)! It will be an interesting conversation focused on increasing COVID-19 rates, updates in health policy, and how the new generation is dealing with the health care industry.

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

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Health in 2 Point 00, Episode 130 | DispatchHealth, BrightInsight, Cedar, Big Health, Redox & Plume

Sadly conferences have all gone digital, but Jess and I are still here covering deals on Health in 2 Point 00. On Episode 130, DispatchHealth gets $136 million, providing in-home health care by sending a tech to your house, BrightInsight gets $40 million to help biopharma and medtech companies leverage connected devices and develop digital health tools, Cedar raises $102 million for their medical billing software, Big Health raises $39 million for digital mental health tools Sleepio and Daylight, Redox lays off a quarter of their staff, and Plume raises a $2.9 million seed round, providing telehealth for trans individuals. —Matthew Holt

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How Traditional Health Records Bolster Structural Racism

By ADRIAN GROPPER, MD

As the U.S. reckons with centuries of structural racism, an important step toward making health care more equitable will require transferring control of health records to patients and patient groups.

The Black Lives Matter movement calls upon us to review racism in all aspects of social policy, from law enforcement to health. Statistics show that Black Americans are at higher risk of dying from COVID-19. The reasons for these disparities are not entirely clear. Every obstacle to data collection makes it that much harder to find a rational solution, thereby increasing the death toll.

In the case of medical research and health records, we need reform that strips control away from hospital chains and corporations. As long as hospital chains and corporations control health records, these entities may put up barriers to hide unethical behavior or injustice. Transferring power and control into the hands of patients and patient groups would enable outside auditing of health practices; a necessary step to uncover whether these databases are fostering structural racism and other kinds of harm. This is the only way to enable transparency, audits, accountability, and ultimately justice.

A recent review in STAT indicates that Black Americans suffer three to six times as much morbidity due to COVID-19. These ratios are staggering, and the search for explanations has not yielded satisfying answers.

“The Sutter and MIT studies cast doubt on whether individual risk factors are as important as social determinants of health in affecting someone’s chances of contracting severe and even fatal COVID-19,” the article explains. “To reduce the U.S. death toll now that many states are seeing a new surge in cases, [Philip Alberti, senior director for health equity research at the AAMC] said, ‘our response to this disease must look beyond the strictly medical.”

Social determinants have a large impact on hospitalization rates. To study and correct structural racism we will need to link a person’s social determinants to their medical records and compare white vs. Black, state by state and county by county. This raises two related problems: privacy and analysis.

There is no more private information than one’s personal records. It’s unlikely that anyone, Black or white, will trust this combination to government or corporate institutions. That implies that the combined information will need to be under the control of the individual themselves. But analysis, almost by definition, requires access to many different people’s records as well as sophisticated methods consistently applied by experts.

Contact tracing in a pandemic illustrates these two related problems. The privacy component is a person’s detailed record of social contacts and medical symptoms. The analysis component is the trained public health agent that seeks to access a person’s record and link it to the contact records of other people while also sending valuable epidemiologic data upstream to scientists and politicians. Trust in the process is essential. A lack of trust in the public health agent leads to a lack of individual cooperation, delayed science, and political manipulation. Trust is enhanced when the records are strictly controlled by the individual, using open source and easily peer-reviewed technology. Trust is also enhanced when analysis methods are open source, consistent across counties, states, and nations, and supervised by trusted community representatives.

Today’s institutional health records obscure systemic racism because they are not trusted to include social determinants of health and they are not transparent or consistent in how they are analyzed. These health records are not controlled by the individual patient. Under HIPAA, they can be used and shared by the institution without patient consent or even after-the-fact transparency. The use of our records is routinely manipulated to increase revenue through enhanced billing as well as through sharing with for-profit companies that use the records to create trade-secret medical analytics that, in turn, add cost to future patients. Current trends around individual control of health records are not encouraging. In response to the opioid crisis, privacy protections over sensitive behavioral health information are being reduced, making the voluntary contribution of accurate social determinants data even less likely in the future.

The analysis of health records is also impeded by institutional control. The hospitals that hold our health records compete among each other for subsidies and with privately financed startups for patients. Objective quality data and price transparency required to compare value is almost non-existent after decades of “managed care” and “value-based payment” promises. For their part, our politicians and policymakers routinely manipulate access to analytics in order to obscure disparities in access to the social determinants of health such as housing, education, and health insurance. As reported by STAT, an analysis by scientists at the Harvard T.H. Chan School of Public Health notes that less than half of U.S. states disaggregate COVID-19 cases or deaths by race/ethnicity:

“For example, data from the COVID-19 tracking project [5] suggests that only ~21 states currently report COVID-19 cases or deaths disaggregated by race/ethnicity, and among those that do, substantial proportions (typically ≥50%) of cases and deaths are of unknown or missing race/ethnicity.”

The alternative to institutional control of health records is universal health records that are controlled by the individual under policies suggested and supported by an individual’s chosen community.

Universal health records would be equally accessible to physicians, public health agents, medical and social scientists. The artificial barriers to access and analysis posed by institutions and political jurisdictions would be reduced. The quality of our medical science and public policy would still depend on some privileged elites, but at least we, as patients and citizens, would gain the advice and support of our own communities.

Adrian Gropper, MD, is the CTO of Patient Privacy Rights, a national organization representing 10.3 million patients and among the foremost open data advocates in the country.

This post originally appeared on Bill of Health here.

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Will the Public Health Emergency Policy Changes for Telehealth & Remote Monitoring Stick?

By JESSICA DaMASSA, WTF HEALTH

With about one month left on the existing 90-day Public Health Emergency that’s eased regulations and improved reimbursement to help make telehealth, remote monitoring, and other virtual care services easier for providers to implement and patients to use, health tech companies across the US are wondering what it will take to make these changes permanent. One of digital health’s few ‘DC Insiders,’ Livongo Health’s VP of Government Affairs, Leslie Krigstein, gets us up-to-speed on what’s happening on Capitol Hill and what we can expect moving forward. What changes will (literally) require an Act of Congress? And what can be handled by HHS and CMS? From codes and co-pays to e-visits and licensing, Leslie breaks it down and tells us whether or not we can continue to expect a ‘health tech-friendly’ agenda in Washington DC.

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TikTok Teen’s Time

By KIM BELLARD

I knew about TikTok, but not “TikTok Teens.”  I was vaguely aware of K-Pop, but I didn’t know its fans had common interests beyond, you know, K-Pop.  I’d been tracking Gen X and Millennials but hadn’t really focused on Gen Z.  It turns out that these overlapping groups are quite socially aware and are starting to make their influence felt.  

I can’t wait for them to pay more attention to health care.  

This is the generation that has grown up during/in the wake of 9/11, the War on Terror, the War on Drugs, the 2008 recession, the coronavirus pandemic, and the current recession — not to mention smartphones, social media, online shopping, and streaming.  Greta Thunberg is Gen Z, as is Billie Eilish, each of whom is leading their own social movements.  This generation has a lot to protest about, and a lot of ways to do it.

They were in the news this past weekend due to, of all things, President Trump’s Tulsa rally.  His campaign had boasted about having a million people sign up for the rally, only to find that the arena was less than a third filled.  An outdoor rally for the expected overflow crowd was cancelled.  

It didn’t take long for the TikTok Teens/K-Pop fans to boast on social media about their covert — to us older folks — campaign to register for the rally as a way to gum up the campaign efforts.  Steve Schmidt, an anti-Trump Republican strategist, tweeted: “The teens of America have struck a savage blow against @realDonaldTrump.”

One social media influencer explained to The New York Times: 

It spread mostly through Alt TikTok — we kept it on the quiet side where people do pranks and a lot of activism.  K-pop Twitter and Alt TikTok have a good alliance where they spread information amongst each other very quickly. They all know the algorithms and how they can boost videos to get where they want.

Most doubt that these efforts had much to do with the low attendance — it can be more likely attributed to concerns over COVID-19 and/or the concurrent Juneteenth celebrations/Black Lives Matter protests — but they were responsible for cluttering up the Trump campaign’s efforts to collect supporter/donor information from the registration.  As a subversive guerilla marketing campaign, it was brilliant — and effective.  

It was not their first such involvement.  One of the surprises with the BLM protests have been the number young people in attendance, of all races.  Jose Antonio Vargas, an immigration advocate,  described the coalition of young white, black, Latino, and Asian protesters as “a new kind of majority…We have arrived at a real cultural shift.”  

Pew Research Center recently profiled Gen Z, finding them more ethnically and racially diverse, more education, more tech savvy, and, politically, “progressive and pro-government.”  They are not, as you might have guessed, likely to be Trump supporters.  Axios predicted: “Generation Z is coming of political age…Gen Z is likely to continue engaging even after the [BLM] protests end because of the power of smartphones and social media.”   

Earlier this month, in The Atlantic, Kaitlyn Tiffany profiled how K-Pop fans (or “kpop stans”) had broadened their social media efforts to support social movements, such as BLM.  She described their strategy:

They would not use any of their normal promotional hashtags to boost their favorite music, instead keeping themselves and the platform focused on the message of Black Lives Matter. They would repurpose accounts that normally track chart positions and celebrity Instagram posts to instead disseminate information about how to support the protests. They would clog up every police department’s digital efforts. They would flood racist hashtags like #whitelivesmatter and #alllivesmatter with more concert footage to render them useless.

Reuters described TikTok’s involvement in the BLM protests as its “Arab Spring” moment, comparing it to Twitter’s importance in those events.  “Because the BLM movement has been present in society for such a long time, my generation has been able to use TikTok to spread awareness through the lens of a young person’s mindset,” one teen said.  One BLM organizer pointed out: “The younger crowd does not want to be on Facebook and they are not on Facebook. They are on SnapChat and TikTok.”  

Political strategist Tim Fullerton told The Washington Post: 

The bigger story, long-term, is that it’s really impressive to see young people using TikTok as an organizing tool. And I do think that we’re going to see a lot of that in the lead-up to November. That’s a difficult audience to reach, so it could be a powerful tool.  They’re using their voice in a new and different way and engaging people.  They clearly did something that hadn’t been done before.

All that is great, but it doesn’t mean Gen Z is also leading the charge on healthcare, even during the pandemic.  They’re no more likely to wear masks than other age groups, and are less likely to get vaccinated for it once one is available.   In many states experiencing a resurgence of COVID-19 cases, young people are increasingly being the ones infected.  

NPR reported: “some public health experts said the increase is because some younger adults may perceive they are less at risk than their parents or grandparents and are more likely to venture back into society as it reopens.”  That attitude is part of the reason that young people may be unwittingly spreading the disease, according to results from Japan.  

Dr. Thomas Tsai, a professor at Harvard’s School of Public Health, warns:

We need to change our whole thinking about COVID-19 during this stage of the pandemic.  It’s difficult to contain the virus physically because you have younger individuals, who may be pre-symptomatic or mildly symptomatic, who are going about their normal lives and reengaging with society.”

Epidemiologist Dr. Judith Malmgren told NPR that reaching Gen Z is different: “They are not reading print media. You need to be on social media. You need to use short sentences. You need to use very direct messaging.”  Another epidemiologist, Dr. Wafaa El-Sadr, added: “I think young people can potentially have a very, very valuable role if we can harness their energy and attention.”

If.

This is the generation that is going to inherit our apathy towards climate change and huge budget deficits.  It shouldn’t have to inherit our dysfunctional healthcare system as well.  If they are looking for big, important social challenges, well, Defund Health Care!

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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