Truth and Trust in Science: Are They Negotiable?

BY MIKE MAGEE

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

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

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

“What we learn from history is that we do not learn anything from history.”

This was two years after the close of the 2002-2004 SARS epidemic with 8,469 cases and an 11% case fatality, and six years before MERS jumped from Egyptian camels to humans, infecting over 2,500 humans with a kill rate of 35% (858 known deaths.)

Specifically, John Barry was there that day in 2006 to share lessons learned from another epidemic, the 1918 Flu Epidemic which is now estimated to have killed roughly 700,000 Americans among a population that was roughly 1/4 our current size, with 2/3 of the deaths occurring over just a 14 week period from September through December, 1918.

The main point that Barry was trying to make that day focused on public communication during an epidemic, namely that “The truth shall set you free.”

Here were some of his 2006 reflections on 1918, a public health catastrophe at a time when the U.S. was focused on promoting strength not weakness during WW I.

“At best, they communicated half-truths, or even out-right lies. As terrifying as the disease was, the officials made it more terrifying by making little of it, and they often underplayed it. Local officials said things like ‘if normal precautions are taken, there is nothing to fear’…”

“Communication was rarely honest, because honesty would hurt morale.”

“There was a lot of cognitive dissonance. People heard from authorities and newspapers that everything was going fine, but at the same time, bodies were piling up.”

 “Many times public health officials knew the truth but did not tell it. ..In many cases they were just plain lying.”

“The attitude of authorities was: ‘This isn’t happening, don’t worry about it.’”

Barry’s primary message that day was that communication breeds trust, and without trust, society breaks down. His words:

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

“The fear was so great that people were afraid to leave home or talk to one another. Everyone was holding their breath, almost afraid to breathe, for fear of getting sick.”

“False reassurance is the worst thing you can do. Don’t withhold information, because people will think you know more. Tell the truth— don’t manage the truth. If you don’t know something, say why you don’t know, and say what you need to do to know. Drown people with the truth, rather than withhold it.”

“The final lesson of 1918, a simple one yet one most difficult to execute, is that…those in authority must retain the public’s trust.”

But clearly that day, there was also a bit of a self-congratulatory air as well, an arrogance that today rings naive. John Barry says, “Today, I think, as opposed to back in 1918, we don’t have as much of a problem with misinformation…I want to emphasize that it is not likely that public health officials would tell outright lies.”

Twelve years later, on the 100th Anniversary of the 1918 Flu Epidemic, Barry re-released his New York Times best seller, “The Great Influenza: The Story of the Deadliest Pandemic in History”, a title that may not hold up as long as Covid-19 stubbornly holds on.

With Covid came Trump and his sycophants, and Barry’s theory (that mistrust can destroy societal order) was put to the test. In a 2020 interview at the University of Rochester, Barry holds strong to his messaging. “Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.”

It is perhaps too easy to lay our current problems all on poor leadership at the top. Would that have been enough to deny the threat initially for months, and then spread false claims on fake cures, and then declare victory again and again prematurely? Was the public not somehow primed to accept such nonsense?

In the world I lived in for many decades, a profit driven world with vast rewards for scientific entrepreneurs, a world where progress up an integrated career ladder required cooperation, support for medical marketing on steroids, and bending the truth while turning a blind eye to errors of omission, truth was negotiable and trust was for the uninitiated.

Mike Magee M.D. is a Medical Historian and the author of “CODE BLUE: Inside the Medical-Industrial Complex”

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Health Care Execs Behaving Badly

BY KIM BELLARD

In the midst of a pandemic during which health care workers proved themselves to be very bit the heroes we like to think of them as being, it’s sobering to be reminded that the system they work in is filled with perverse incentives that work against patients’ best interests.  Four pieces of excellent journalism – two from The New York Times, and two from Kaiser Health News — this week brought that front and center.  

If you haven’t read them yet, I urge you to do so, but, while you might enjoy the writing, don’t expect to enjoy their content.

Let’s start with two articles in The New York Times “Profits over Patients” series by Jessica Silver-Greenberg and Katie Thomas: They Were Entitled to Free Care. Hospitals Hounded Them to Pay and How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits.  Both focus on “non-profit” hospitals – Providence, serving the northwest/west/southwest, and Bon Secours Mercy Health, serving Midwest/east/southeast (and Ireland).  

Providence used a program called Rev-Up, designed by McKinsey, to solicit payments from patients who should have been entitled to free care due to their incomes.  “Ask every patient, every time,” employees were instructed.  And, “If patients did not pay, Providence sent debt collectors to pursue them.”  The state of Washington thinks this happened to at least 55,000 patients.

Mind you, Providence gets huge tax breaks in part to support such free care, and claims that it provides some $1.9b in these kinds of “community benefits.”  The article notes: “Providence is sitting on $10 billion that it invests, Wall Street-style, alongside top private equity firms. It even runs its own venture capital fund.”  The article also points out that Providence’s charity care only accounts for 1% of revenue, versus an average of 2% for non-profits nationwide.  

Providence’s CFO told the reporters that the findings “are very concerning and have our attention.”  OK, then.  I’m not sure which would be worse: that the CFO was complicit in the scheme, or was truly unaware it was going on. 

The second article focused on a Bon Secours Mercy Health hospital in Richmond (VA), Richmond Community.  It is an inner city hospital, serving a primarily Black population and now consisting mostly of an emergency room, yet it managed to the highest profit margins of any hospital in Virginia, some 44%, which yields over $100 million in profits.

It did so by using a federal program (340B) that allows certain hospitals to buy prescription drugs at greatly reduced prices, yet charge the full amount to insurers.  The hospitals are supposed to reinvest those profits into improving care and facilities, yet Bon Secours used them to invest in more profitable neighborhoods.  

“Bon Secours was basically laundering money through this poor hospital to its wealthy outposts,” one ER physician told the reporters.  

Bon Secours claims it has invested millions in the hospital and the community, but skeptics think it is more interested in real estate deals and the outlying hospitals.  After a merger with Mercy Health in 2018, Richmond’s former mayor said: “There was a major shift from being mission-oriented to being unashamedly, unabashedly profit-oriented.”

Both systems are not only non-profits, they’re also faith-based/mission organizations. We should expect better.

——————

Lauren Weber of Kaiser Health News focused on the dual pain of losing a baby and being sent to collections for the care in Shattered Dreams and Bills in the Millions: Losing a Baby in America.  

In one case, a couple had a baby with a congenital heart defect.  She survived some eight months, with the billing meter running the whole time.  The bills ultimately reached $2.5 million, a figure that proved to be incorrect, yet they still had a $4,000 deductible and several charges not covered by insurance.  Then they got the $26.50 collection notice.  

I mean, really? 

Ms. Weber highlights two other couples whose surprise bills came just as they were undergoing that unique pain of losing a child.  Dealing with them cost time and emotional energy the families couldn’t spare. “I just wanted to be with Bennett; that’s all I wanted to do,” one mother told her. “And I just spent hours on these phone calls.”

These bills “compounded their suffering during a time when they were just trying to process their loss.” Shame on the organizations responsible for that.

Finally, Ms. Weber also had time to report on Private Equity Sees the Billions in Eye Care as Firms Target High-Profit Procedures.  As many as 8% of ophthalmologists are in practices owned by private equity firms, and “Acquisitions have escalated so much that private equity firms now are routinely selling practices to one another.” 

KHN’s analysis found: “Sixteen of the 25 private equity firms identified by industry tracker PitchBook as the biggest health care investors have bought stakes in optometry and ophthalmology practices.”

Ms. Weber writes that the private equity groups “buy up these practices — or unify them under franchise-like agreements — with the hopes of raising profit margins by cutting administrative costs or changing business strategies,” but the real upside comes from upselling patients:

For example, doctors can use lasers instead of cutting eye lenses manually, offer multifocal eye lenses that can eliminate the need for glasses, or recommend the astigmatism fix that Green said she was sold. Often, patients pay out-of-pocket for those extras — a health care payday unconstrained by insurance reimbursement negotiations. And such services can take place in outpatient and stand-alone surgery centers, both of which can be more profitable than in a hospital setting.

One Johns Hopkins analysis found that acquired practices got an extra 20% in their insurance reimbursements, as well as increased patient volume.  KHN’s own analysis found that private equity firms like to invest in doctors who are frequent prescribers of expensive macular degeneration drugs.  “The private equity model is a model that focuses on profitability, and we know they are not selecting practices randomly,” one expert told Ms. Weber.

This is not about care; this is not about patients.  This is about money.

————–

I’m not naïve.  I know there are profits in health care, and, generally, I’m OK with that.  A CEO of a non-profit I once worked for preached: “No margin, no mission.”  But there’s a line, or a slippery slope, when the margin becomes the mission.  When you’re sending struggling families to collections, when you’re overprescribing expensive drugs or services, when you’re laundering money from poor communities to wealthier ones – come on, you know that’s wrong.  

To the health care executives who develop, oversee, or benefit from them: we’re watching.  

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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NeuroFlow & The Tech that Jumps the Care Gaps Between Physical Check-ups & Mental Health Care

By JESSICA DaMASSA, WTF HEALTH

Mental health infrastructure company, NeuroFlow, is a tech platform that integrates into care management systems and EHRs to help clinicians and care managers identify behavioral health conditions in patients as they are getting physical health exams like annual check-ups, post-partum exams, and more. Founder & CEO Chris Molaro joins us from NeuroFlow’s new headquarters just hours before their grand opening to talk about how the startup – which has raised a total $32 million, including a $20 million Series B led by Magellan Health – is helping health systems and health plans integrate and automate workflows so they can better identify, risk-stratify, and serve patients who need mental health services.

Right off the bat, Chris starts out by explaining what NeuroFlow IS by what it IS NOT; NeuroFlow is not a telehealth company and it doesn’t directly deliver mental health care to any patients. Instead, it is a platform that makes it easier for those who are working with patients to be able to more consistently screen for mental health issues, provide follow-up support, and transition patients to the right level of mental health care via a step-care model complete with referral pathways.

The care management component of NeuroFlow gets splashier from here, with the ability to integrate and analyze data from wearable devices and free-form data sources like text messages with providers to flag anomalies in everyday behaviors that might be clues that could indicate that someone may in distress. How else does the tech help build a bridge from physical check-up to mental health care providers, particularly in an era where the supply-and-demand imbalance for mental healthcare is so off? We talk all things scaling-up, how the “modular” business model works, AND we find out why NeuroFlow’s new offices are so important to the company and its Philly roots. Watch now!

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

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

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

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

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

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

For more details and to REGISTER TODAY click here.

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

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

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

For more details and to REGISTER TODAY click here.

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

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The Future of Clinical Trials at Pfizer

BY JESSICA DaMASSA

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

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

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

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

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

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THCB Gang Episode 105, Thursday September 22 at 1pm PT, 4pm ET

Joining Matthew Holt (@boltyboy) for the 101st #THCBGang on Thursday September 22 are delivery & platform expert Vince Kuraitis (@VinceKuraitis); THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and fierce patient activist Casey Quinlan (@MightyCasey);

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.

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Ribbon Health & Provider Data’s Holy Grail: The Accurate Provider Directory

BY JESSICA DaMASSA

It’s one of the greatest mysteries of the era of health data digitization: Why is provider directory still so hard to get right?? Ribbon Health’s co-founder & CEO Nate Maslak explains how Ribbon (which started out in the symptom-checker biz) pivoted to take on, once-and-for-all, the miserable state of provider data management to not only fix provider directories (which are still wrong 50% of the time!), but also referral management systems, health plan enrollment data, and now, thanks to those new price transparency rules, price lists.

“All of the different use cases we focus on around enrollment, referral management, provider data management for directory…” explains Nate, “These are actually the same problem that use different words to describe it because of the different parts of the ecosystem that we’re in.” So, as Ribbon gets the process right for provider directory by building an underlying tech platform that uses predictive analytics and network effect methodologies to work its magic to validate-and-verify that kind of healthcare data, then it can apply that framework to ANY healthcare data to the same end. And, maybe one day, layer member-facing services – like instant-booking with a doc – on top of them.

Backed by nearly $54 million from Andreesen Horowitz and General Catalyst, and we get into what makes this startup’s take on one of the oldest healthcare infrastructure issues so appealing. From platform to business model (which serves a mix of health plans, provider orgs and patient-facing solutions) to grand plans for the future (which include figuring out how “API as a platform” can further productize provider data management and power care decisions) we chat with Nate on all things Ribbon Health.

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When Medical Error Becomes Personal, Activism Becomes Painful

BY MICHAEL MILLENSON

In the mid-1990s, researching a book about the quality of medical care, I discovered how the profession had for years been ignoring evidence about the appalling death toll from preventable medical error. Though I’d never myself experienced an error, I became an activist.

Recently, however, a relative was a victim, and the frustrating persistence of error became personally painful.

Thanks to my relative being acutely aware of the need to be alert (and a bit of luck), no harm was caused by what could have been a serious medication mistake. That was the good news. The bad news is that even Famous Name Hospitals, like the one where my relative was treated, are rarely doing everything possible to forestall the impact of inevitable human fallibility.

September 17 was World Patient Safety Day, and the theme for the next 12 months is “Medication Without Harm.” That makes this an opportune time to examine more closely what the profession euphemistically calls a “medication misadventure.”

My relative’s care began how you’d expect from a renowned academic medical center. From the time she was admitted, there was top-notch treatment for a complex set of conditions. Then, one day, a nurse came into the room to infuse a solution of magnesium, an essential electrolyte. And here is where patient alertness paid off.

Two hours into an expected three-hour infusion, with an IV in one arm, my relative used her other arm and an iPad to access the hospital’s patient portal, which, thanks to a Congressional mandate, discloses patient test results. In the portal my relative saw that her magnesium levels were actually normal. By chance, a doctor came by on a regular rounding, and my relative showed her the results. The doctor checked the electronic health record (EHR), spoke to the nurse and then quickly stopped the infusion. The doctor and nurse assured my relative that no harm had been done.

Unmentioned by the clinicians was the avoided threat of magnesium toxicity, which the National Library of Medicine says can cause “fatal complications such as hypotension, respiratory paralysis, and cardiac arrest.”

More than 200,000 Americans lose their lives to preventable medical error every year, according to an estimate by the Department of Health and Human Services (HHS). Medication errors are the most common “adverse event,” occurring as often as one out of every 13 hospital admissions, according to the HHS Office of the Inspector General (OIG). My relative was lucky her infusion wasn’t a more toxic drug.

Overall patient harm is startlingly common. An OIG report in May found that a little over one quarter of hospitalized Medicare patients experience some sort of harm, whether permanent or temporary. Unfortunately, there’s no national reporting system, although there is a growing effort to get Congress to establish a National Patient Safety Board. The current hodgepodge of reporting too often leaves all but the worst mistakes invisible. At first, that’s what happened here.

After my relative contacted me, I tried via a respectful email to get Famous Name Hospital’s patient safety director to launch what’s called a root cause analysis. She replied that my relative might have misunderstood “normal level” and should talk to her doctor. (The reply ignored that the doctor had immediately stopped the infusion.) Alas, denial, even with no lawsuit threat, remains an all-too-common response. A serious investigation commenced only when I utilized my professional contacts to get attention further up the chain of command, and my relative filed a formal grievance.

Famous Name Hospital prides itself on a “safety culture.” However, the veteran nurse on my relative’s floor had not filed an incident report about this “near miss.” Invisibility means no opportunity to learn. When an investigation was undertaken, it found that the infusion order in the Epic EHR, the platform used by many of the nation’s leading hospitals, was entered when my relative was admitted two weeks before. When she was transferred to a different floor, Epic required the doctor to uncheck the box for each test ordered; someone had missed a box.

It was also a holiday weekend in July, when a new group of medical residents takes over. Moreover, my relative’s veteran nurse was distracted, dealing with questions from other nurses while trying to double-check the EHR. As a result, she didn’t see the normal magnesium level.

As thorough as the investigators were in some respects, one omission stood out. The World Health Organization (WHO), the sponsor of World Safety Day, lists six principles in its global patient safety action plan. The very first is “engage patients and families as partners in safe care.” At Famous Name Hospital, clinicians interviewed other clinicians but not my relative, even after I prodded them to do so.

Lacking patient input, the report stated that the medication error was discovered by two doctors. And though a 100-cc bag of fluid was in my relative’s arm for two hours, the investigators reported that only a quarter of the liquid had been infused; my relative’s estimate was half to two-thirds.

In sum, the hospital’s version of events was that they found the error and did so at an early enough point that no harm could have been done. They did apologize, however, and assured my relative they were implementing changes to prevent a recurrence – which was why we insisted on an investigation.

Along with invisibility, provider inertia is another enemy of improvement. It’s typically not malevolent, just the heavy weight of “we’re busy” and “this is how we do things here.” Famous Name Hospital said their procedure was to have Patient Relations interview patients, a rational policy for complaints about food or noise, but a wholly inadequate response to a situation demanding clinical expertise.

Earlier this year, a group of senior government physicians wrote in a blunt commentary in the New England Journal of Medicine that “health care safety has declined” during the Covid pandemic, illustrating lack of “a sufficiently resilient safety culture and infrastructure.” Allowing patients to report medical errors as “partners in safe care,” in the WHO’s words, could help restore that resilience. This idea was actually considered by the Obama administration in 2012, but quickly shot down by providers.

We can do better. Again, to their credit, Famous Name Hospital recognized the medication error represented a system flaw, not a “bad” doctor or nurse problem. However, since the book that I wrote was entitled Demanding Medical Excellence: Doctors and Accountability in the Information Age, I was interested to see what role information technology might play.

A 2020 article in the Joint Commission Journal concluded that 68 percent of the alerts about medication issues issued by a machine learning system from a company called MedAware spotted problems not discovered by conventional tools. So I reached out to MedAware’s CEO, Dr. Gidi Stein, about my relative’s situation. He replied that if the EHR showed that the blood level of an electrolyte was within normal range before or during the infusion, the clinical team would have received an alert.

Which brings us to the third factor mitigating against a “zero harm” environment: “income.” I don’t know the cost of MedAware or similar products, but I’m certain it’s less than the cost of revenue-generating medical devices hospitals are routinely eager to purchase. Unfortunately, even at institutions prone to boasting about high-quality care, physicians and nurses advocating for systems and staff to make care safer are constantly asked to make “the business case for patient safety.”

As I’ve written about beginning in 2010 and repeatedly since, the ugly truth is that medical error can be profitable for hospitals. For instance, in a Journal of Healthcare Management article entitled “Does Patient Safety Pay?”, researchers advised hospital executives that “targeted” improvement in patient safety performance could improve financial performance.

My relative asked the Patient Relations department to make sure to remove the infusion charge from the bill.

In his recent book Making Healthcare Safe: The Story of the Patient Safety Movement, patient safety pioneer Dr. Lucian Leape scathingly concluded that “most health-care organizations fall woefully short of achieving a culture of safety,” including “most highly regarded academic medical centers.” Despite decades of effort, wrote Leape, a pediatric surgeon and adjunct professor at Harvard’s T.H. Chan School of Public Health, “there is no sense of commitment, no goal of zero harm.”

We can do better. And some hospitals quietly are. For a doctoral thesis exploring how to reduce the cost of medication errors, Walden University’s Janice Chobanuk conducted semi-structured interviews with 10 high-reliability U.S. hospitals and reviewed documents related to medication management. A high-reliability approach, she found, depended upon leadership support, open communication with feedback loops, sustaining a culture focused on error prevention and patient partnerships. That last factor affected all the others.

“The active engagement of patients…in error prevention and safety in hospitals can prevent errors, improve patient satisfaction, reduce litigations and reduce costs associated with medication mistakes,” Chobanuk wrote.

If Famous Name Hospital clinicians had interviewed my relative, they might have reached the same conclusion. No matter how skilled, dedicated or well-intentioned the care provider, errors will occur. It’s crucial to have an alert and informed patient as a partner in order to help prevent harm.

Medical error is a painful experience for patients and families even without physical harm ­– as my relative and I experienced – and yes, also for the providers involved. To prevent harm, everyone involved in care must constantly use all the information available to them to demand medical excellence.

Michael Millenson is a consultant specializing in quality of care, patient empowerment, and web-based health.

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Goliath, Meet David

BY KIM BELLARD

I’m a sucker for underdog stories.  I love unconventional wisdom overthrowing conventional wisdom. I’m deeply suspicious of Big Tech, Big Oil, and big health.  I know unfettered competition is not always to my benefit but get nervous when I don’t really have many options.  

So when I read that Google is starting to worry about a threat to its search dominance and that TikTok and other social media giants are scared of a rival start-up, well, count me in. I just wish it was health care goliaths that were worried.

————–

You probably use Google to search online.  “Google” has become a generic term for search, like Xerox was for photocopying.  Depending on the source, it’s share of search is north of 80%, probably closer to 90%, and it’s been that way for a long time. Larry and Sergey built a better mousetrap and the world, indeed, build a path to their door. 

TikTok might change that.

Yes, TikTok again.  Face it, it’s hard to keep a finger on today’s culture without that finger pointing to TikTok. Last month the finger pointed directly to healthcare, this month it is pointing to search, and that’s what has Google nervous. 

“In our studies, something like almost 40 percent of young people, when they’re looking for a place for lunch, they don’t go to Google Maps or Search. They go to TikTok or Instagram,” Prabhakar Raghavan, a Google senior vice president, said at Fortune’s Brainstorm Tech 2022.  

The New York Times proclaimed: For Gen Z, TikTok Is the New Search Engine.  The article discerns a sea change in search:

TikTok’s rise as a discovery tool is part of a broader transformation in digital search. While Google remains the world’s dominant search engine, people are turning to Amazon to search for products, Instagram to stay updated on trends and Snapchat’s Snap Maps to find local businesses. As the digital world continues growing, the universe of ways to find information in it is expanding.

The article describes how search on TikTok is different than on traditional search engines:

Instead of just slogging through walls of text, Gen Z-ers crowdsource recommendations from TikTok videos to pinpoint what they are looking for, watching video after video to cull the content. Then they verify the veracity of a suggestion based on comments posted in response to the videos.

That doesn’t mean, of course, that the videos are factually correct – not that other search engines are either – but Francesca Tripodi, an information and library science professor at the University of North Carolina, warned The Times: “You aren’t really clicking to anything that would lead you out of the app.  That makes it even more challenging to double-check the information you’re getting is correct.”  Lee Rainie of the Pew Research Center added that TikTok “is becoming a one-stop shop for content in a way that it wasn’t in its earlier days.” 

Google should worry.

————-

Lest anyone think the world is just going to become all TikTok all the time, TikTok is scared of a two-year old French start up: BeReal.  BeReal, in case you hadn’t heard of it either, is a photo-sharing app whose key feature is that it randomly prompts users to take and share a photo, within two minutes.  It uses both front and rear camera to show both a selfie and where the user is.  

As BeReal describes it:

Everyday at a different time, everyone is notified simultaneously to capture and share a Photo in 2 Minutes. 

A new and unique way to discover who your friends really are in their daily life. 

BeReal was Apple’s #1 download this summer, and has some 56 million downloads, with the US its biggest market. It even riffed on Facebook’s initial strategy of going after college campuses, through its ambassador program.  

TikTok and other platforms have noticed. “The fear of the incumbents is that this becomes the next TikTok,” said Mark Shmulik, an analyst for Bernstein, told The Washington Post. “So they’ve all scrambled to launch their own version.”

Just last week TikTok announced TikTok Now – “a daily photo and video experience to share your most authentic moments with the people who matter the most” – and Instagram is working on IG Candid Challenges, which The Verge labeled a “murder clone,” since its sole purpose is to replicate BeReal.  Snapchat was quicker off the mark, rolling out its Dual Camera feature last month, “a new way for Snapchatters to capture multiple perspectives at the same time – so everyone can be part of the moment, as it happens.”

It remains to be seen if the goliaths can crush BeReal by simply cloning its features, or if one of them will simply acquire it, as Meta did with one-time rivals Instagram and WhatsApp.  But, as Mr. Shumulik told WaPo, “They’ve certainly caught lightning in a bottle with an idea.”  

As WaPo put it:

BeReal’s success reveals an appetite among social media users for more authentic, intimate forms of expression, and shows that Davids can still shake up a sector dominated by global Goliaths. At the same time, the scramble by those Goliaths to copy core features of an app that doesn’t even have a way to make money yet underscores the uphill battle that upstarts face just to survive.

BeReal claims: “We want an alternative to addictive social networks fueling social comparison and portraying life with the goal of amassing influence.” Perhaps that will be enough.  

____________

Healthcare is full of Goliaths; pick your favorite (or, rather, your most hated): e.g., pharma, med device manufacturers, national health insurers, EHR vendors, for-profit hospital chains or even your local non-profit hospital monopoly/duopoly.  They’re entrenched, they’ve been entrenched for a long time, and their dominance is, if anything, growing.  Health care is big business, and that business is full of big players.  

It also isn’t like Tech, much less like social media, where an entrepreneur with a good idea and some cool tech can capture that lightening in a bottle and shoot to dominance quickly. It’s too fragmented, too byzantine, too regulated, skeptics and insiders would both say.  A David would have no chance.  

Well, I’m not giving up hope. I’m looking for the thing that will make current EHRs look like the clunky billing engines they are. I’m looking for the thing that will prove hospitals to be vastly oversized.  I’m looking for the thing that will break the physician monopoly.  I’m looking for the thing that will democratize prescription drugs.  I’m looking for the thing that will rewrite healthcare’s financing.

I’m rooting for the underdog.

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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#HealthTechDeals Episode 46 | Redesign Health, Theranica, Soda Health, and Kyruus

It’s that time of the year! Summer is over and it’s conference season! The Rock Health Summit was a fun session, the highlight of which was diversity, equity, inclusion, and representation. Tune in for Jess’s and my thoughts on the summits, the end of the world, and new deals: Redesign Health raises $65 million, Theranica raises $45 million, Soda Health raises $25 million, and Kyruus buys Epion Health.

-Matthew Holt

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