THCB Gang Special: Episode 138, Thursday 30 November 2023 with Jen Goldsack

On #THCBGang today we have a special solo episode with Olympic rower for 2 countries and Digital Medicine Society CEO Jennifer Goldsack, (@GoldsackJen) joining Matthew Holt (@boltyboy). It’s at at 1pm PST 4pm EST on Thursday November 30. Find out about what DiME is and does, and what projects it is pushing forward in the future of health tech.

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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Health Innovation & Data: Five Common Missteps (and How to Interrupt Them)

By MARIE COPOULOS

I’ve had the great fortune of spending much of my career at the intersection of health care innovation and the underlying data that drives new models.

For those of us who’ve worked in this space for a long time, there’s a certain pattern recognition that comes with this work that is often immediate and obvious – both in terms of really cool developments but also gotchas. “Ah, you’re stumbling here. Everyone does that.”

The challenge, I’ve found, is that these ‘gotchas’ that can be so visible to the folx who’ve worked in health tech for the past few decades can be counterintuitive in the business and even met with resistance. Why?

I’m going to focus here on pattern recognition, with the goal of highlighting common stumbling blocks and, critically, ways you can interrupt them if you see them.

Pattern #1: Lacking a Clear-Eyed View of Market Data Gaps
Key Question: Do you understand how the market you’re in informs your ability to measure your work and use data to drive insight?

For those of you building models that change the status quo – this is for you. By nature these innovations break from existing care and financial models with the goal to improve them. We need this in health care. However, it’s common to overlook the fact that breaking with the status quo also breaks with the ways that we capture and serve up health data.

To this end, don’t assume you will be able to measure and show success, and that the data you need must be out there. The true differentiator is for both to align. Design with intention.

If you’re at the stage of thinking about a productized solution to a health care problem, then it is also the right time to look at the market with a lens toward data availability. In your problem space, what’s the data set you’re likely to lean on? Is it sufficient?

If the answer is that the data is not available or notoriously problematic in your market space for the problem you’re solving, this merits a pause. Can you find a way to survive in this reality? Can you create the data set you need? Can you adjust what you’re doing in some way to align with what is available? Is qualitative feedback ok?

Pattern #2: Accumulating Non-Technical Roadblocks Key Question: Do you have a good handle on the non-technical challenges impacting your data business?

A decade ago I would have approached this question differently. Technical challenges were often paramount as we tried to figure out how to solve the basics. Today, however, it’s often the opposite, in that business challenges are more likely to slow down technical progress than the other way around.

What do I mean by that? Most frequently I see organizations stumble on things like data acquisition, partnerships, and the right strategic vendor choices and these stumbles manifest in increasing technical debt that grind teams and reduce productivity.

In new models and approaches, in particular, there are often many players involved, eager to try something new. Because you’re doing something new, by design you won’t know all the stumbling blocks. What matters is not that you know what they are, but that you have good governance that allows you to work through these issues together.

It’s not that the problems are insurmountable, but the question of who is going to spend limited resources, in what order, on these very hard problems. Who owns that work and that risk? Who makes decisions? Think about this early.

Pattern #3: Lack of Focus
Key Question: Do you know what pieces of information provide disproportionate value?

There are many kinds of healthcare data (claims, EMR, ADT, pharmacy, labs, etc). Those different sources shine light on the same patient events–a single visit results in little bits of a story that are captured in many electronic systems.

Often talking about different data types feels wildly obscure. But, if there’s one concept to center on as a business leader, it’s getting to the bottom of this question: what are the pieces of information that are disproportionately valuable to run your business?

Some of the most value-add businesses in health care, in my view, have figured out how to narrow in on a piece of information (readmissions, medication fills) that is scalable and hyper focus on consistently improving on the patient and clinician experience, and outcome.

This reflects the reality of our industry today. Because health care data is messy and inconsistent, it takes a lot of work to get into usable forms. Absent that work, this information can be confusing, contradictory, and too frequently – noise.

Until we hit the point where this is not quite so hard, make sure you know what kind of business you are and where you want to invest your resources. From an infrastructure and product perspective, a business powered by a narrow insight looks different from a business powered by a holistic, normalized view of a patient. Which are you?

Pattern #4: Short-Term Wins that Don’t Build

Key Question: Do you feel comfortable with the tension between short-term wins and long-term wins and do you have an open conversation with your team on this topic?

This manifests in a couple ways. One is short-term wins that don’t build, and the other is a focus on long-term goals exclusively with unrealistic timelines. These problems are certainly not counterintuitive, but they are hard to interrupt and one of the reasons we see so much churn, burnout, and disappointment in major launches. My advice: aggressively look for ways to build in small, additive steps. 

An example: It’s really common in a new model to build a partnership to access information to provide a broader view of a patient population. Depending on the problem, you might find local, regional or national entities to support you in finding the right information.

A short-term win might have you build a partnership with a provider of that information with the goal of a quick win. However, these are the kinds of decisions that often weigh on technical teams in the long-term as they manage many partnerships and many interfaces, and in fact the cumulative effect can be devastating to productivity and innovation. It’s not just the weight of managing one-off work, but the sense of loss of having to rebuild again and again.

Building in an additive way takes a little extra time at the start, but reduces waste over time.  Consider how any small project will serve future efforts (i.e. is this a partnership that scales, contractually and technically?). These small wins build momentum and collective capacity.

Pattern #5: Siloed Technical Teams
Key Question: Do you have a good sense of what motivates your team to solve hard problems for you? 

Choosing to work in health care data means choosing to work in one of the most challenging technical segments – because of the weight of regulations, messy data, and old infrastructure. In my experience, a common motivator is mission. In the teams I’ve built, there is a palpable drive to help patients and improve systems for the better.

If I leave you with one point, it would be not to overlook this connection to mission and sense of belonging to the team that is helping improve patient lives. Yes, fair compensation and good benefits and work-life balance all matter. But, don’t forget ‘why’ these talented technical team members are sitting at your table, frequently doing work that is technically below their capabilities.

Ask them what makes them feel informed and connected to the whole. It will make it collectively easier to solve the messy, hard problems together.

Marie Copoulos, MS, is a public health professional and long-time health executive working at the intersection of analytics, population health, and climate. (She previously published on THCB under the name Marie Dunn).

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Amazon Can Still Surprise Me

By KIM BELLARD

It’s Cyber Monday, and you’ve probably been shopping this weekend. In-stores sales on Black Friday rose 2.2% this year, whereas online sakes rose almost 8%, to $9.8b – over half of which was via mobile shopping. Cyber Monday, though, is expected to outpace Black Friday’s online shopping, with an estimated $12b, 5.4% higher than last year. 

Lest we forget, Amazon’s Prime Day is even bigger than either Cyber Monday or Black Friday.  

All that shopping means lots of deliveries, and here’s where I got a surprise: according to a Wall Street Journal analysis, Amazon is now the leading (private) delivery service. The analysis found that Amazon has already shipped some 4.8 billion packages door-to-door, and expects to finish the year with some 5.9bn. UPS is expected to have some 5.3bn, while FedEx is close to 3bn – and – unlike Amazon’s numbers — both include deliveries where the U.S. Postal Service actually does the “last mile delivery.” 

Just a few years ago, WSJ reminds us, the idea that Amazon would deliver the most packages was considered “fantastical” by its competitors. “In all likelihood, the primary deliverers of e-commerce shipments for the foreseeable future will be UPS, the U.S. Postal Service and FedEx,” the then-CEO of Fed Ex said at the time. That quote didn’t age well.

Amazon’s growth is attributed in part to its contractor delivery program, whose 200,000 drivers (usually) wear Amazon uniforms and drive Amazon-branded vehicles, although they don’t actually work for Amazon, and a pandemic-driven doubling of its logistics network. WSJ reports: “Amazon has moved to regionalize its logistics network to reduce how far packages travel across the U.S. in an effort to get products to customers faster and improve profitability.”

It worked.

But I shouldn’t be surprised. Amazon usually gets good at what it tries. Take cloud computing.  Amazon Web Services (AWS) in its early years was considered something of a capital sink, but now not only is by far the market leader, with 32% market share (versus Azure’s 22%) but also generates close to 70% of Amazon’s profits. 

Prime, Amazon’s subscription service, now has some 200 million subscribers worldwide, some 167 million are in the U.S. Seventy-one percent of Amazon shoppers are Prime members, and its fees account for over 50% of all U.S. paid retail membership fees (Costco trails at under 10%). There’s some self-selection involved, but Prime members spend about three times as much on Amazon as nonprime members.

The world’s biggest online retailer. The biggest U.S. delivery service. The world’s biggest cloud computing service. The world’s second largest subscription service (watch out Netflix!).  It’s “only” the fifth largest company in the world by market capitalization, but don’t bet against it. 

I must admit, I’ve been a bit of a skeptic when it comes to Amazon’s interest in healthcare. I first wrote about them almost ten years ago, and over those years Amazon has continued to put its feet further into healthcare’s muddy waters.

For example, it bought online pharmacy Pillpack in 2018. “PillPack’s visionary team has a combination of deep pharmacy experience and a focus on technology,” said Jeff Wilke, Amazon CEO Worldwide Consumer. “PillPack is meaningfully improving its customers’ lives, and we want to help them continue making it easy for people to save time, simplify their lives, and feel healthier. We’re excited to see what we can do together on behalf of customers over time.”

PillPack still exists as an Amazon service, but has broadened into Amazon Pharmacy. PillPack focuses more on people with chronic conditions who like the prepacked pills, while Pharmacy offers home delivery to other customers.  At its introduction, Doug Herrington, Senior Vice President of North American Consumer at Amazon, said: “PillPack has provided exceptional pharmacy service for individuals with chronic health conditions for over six years. Now, we’re expanding our pharmacy offering to Amazon.com, which will help more customers save time, save money, simplify their lives, and feel healthier.”

Amazon Pharmacy has since introduced RxPass, a $5/month subscription service for many common generic drugs, but it still hasn’t cracked the top ten U.S. pharmacies, so there’s work to be done. One pharmacy analyst writes: “Perhaps one day Amazon will be a true disrupter. For now, Amazon is choosing to join the drug channel not fundamentally change it.”

PillPack’s co-founders have recently left.   

Earlier this year, after all the fumbling around with Haven and Amazon Care, Amazon bought One Medical. “We’re on a mission to make it dramatically easier for people to find, choose, afford, and engage with the services, products, and professionals they need to get and stay healthy, and coming together with One Medical is a big step on that journey,” said Neil Lindsay, senior vice president of Amazon Health Services.

Then this month Amazon sought to entice Prime members to join One Medical by offering membership for $9/month, or $99 per year. “When it is easier for people to get the care they need, they engage more in their health, and realize better health outcomes,” said Mr. Lindsay. “That’s why we are bringing One Medical’s exceptional experience to Prime members—it’s health care that makes it dramatically easier to get and stay healthy.”

Of course, One Medical is only in 25 metro markets, with some 200 doctors office, and it doesn’t contract with every insurance plan. Plus, One Medical CEO Amir Dan Rubin is already on his way out of the door. Scaling will not be easy.

Amazon’s success with its healthcare ventures is hard to tell.  HT Tech reports that monthly active users of the One Medical app are up 16% since the acquisition, and that Amazon claims Amazon Pharmacy doubled its active customers from 2022 to 2023. Still, Lisa Phillips, an analyst with Insider Intelligence, scoffed: “It really hasn’t made a big dent. I don’t think anybody is scared of it anymore.”

Maybe. Healthcare is hard, and usually confounds outsiders who aren’t familiar with its byzantine structures. But I look at it this way: Amazon has been delivering its own packages for less than 10 years, and now it is bigger than UPS and FedEx. That’s not nothing. So for the first time I’m starting to think that maybe Amazon can make its mark in healthcare. 

Amazon the biggest healthcare company in ten years?  Don’t bet against it.

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How Patient Activation Made It Possible to Thrive with Kidney Disease

By DAVE WHITE

It had been 10 years since I’d seen a doctor when I arrived at the Emergency Room at George Washington University Hospital in October 2009. I was able to climb the first flight of stairs, but after I froze on the second, they brought me in on a wheelchair.

That was the first time I heard the dreaded words, “Your kidneys aren’t working.” I was put on dialysis immediately, and my life transformed into a series of tests and procedures. But even after three weeks at the hospital, it didn’t sink in that there was no cure.

I checked most risk factors for kidney disease: I ate the wrong foods, smoked more than a pack of cigarettes a day, drank too much beer, and didn’t exercise much. But the biggest risk to my health was not getting regular check-ups. I didn’t think I needed them, or that I had a part to play in my own health.

I hated going to dialysis three times a week. Since I could no longer work, the $20 cab fare each way was an expense my wife and I struggled to afford, so I skipped often. When a nurse warned me that if I missed three sessions in a row I would have to be dialyzed at the hospital, I decided this meant I could get away with one session a week.

The care plan I received from my providers called me “non-compliant” seven times. I felt they had written me off as a lost cause and saw no point in working with them either.

Finally, I was called into a meeting with six nurses, social workers, and clinic staff. When I said I skipped dialysis because money was tight, the charge nurse said, “We’re going to get you resources for transit and help you plan good meals.”

I was shocked – I didn’t know how support services worked. The nurse continued “But you have to do your part or you’re not going to be around much longer.”

No one had said this in such blunt terms before. I left the room, went home, looked at myself in the bathroom mirror, and said, “They’re right. You can do better. You have to do better.”

Fourteen years later, I am lucky to be alive to see the Centers for Medicare and Medicaid Services (CMS) include measures that place the patient’s voice at the center of clinical care. CMS has recognized that supporting patient activation, building a person’s knowledge, skills, and confidence around managing their health, and addressing social needs is critical to helping people like me get the support we need to get and stay healthy.

Getting support to take a more active role in my care made a difference, and will for other people living with kidney disease and a range of conditions as CMS includes the Patient Activation Measure and screening for social drivers of health (SDOH) in the 2024 Merit-based Incentive Payment System (MIPS) Physician Fee Schedule which will be officially published on November 16.

I began my journey as a person with kidney disease angry and in denial. But when I realized I could take charge of my health and ask for help, things started to change.

Going to dialysis regularly wasn’t enough. I needed to know more about how to manage my condition when doctors and nurses weren’t around. My care team helped me read nutrition labels, so I could modify my diet to improve my kidney health. I quit smoking and started exercising: one push-up a day was all I could manage at first, but I kept going.

Once I was healthy enough to return to work, I realized this was hard while going to dialysis during the day. I started asking questions and found out I could switch to doing nocturnal dialysis or doing dialysis at home. Around the same time, I started advocating for myself so I could get a transplant and got on the list at three centers.

I was so proactive about managing my health, I can honestly say I didn’t spend a single day waiting for a kidney. It ultimately took four years to find a match and getting my transplant wasn’t easy, but when I heard the nurse say, “You can eat whatever you want now,” I began to feel like myself again.  

Treat the person, not the disease is a powerful axiom, but in my case and many others, it takes the patient and their doctors and nurses to make this work. Initially, my care team assumed I had resources to pay for healthy food, and transportation to dialysis, and I didn’t know I could get help. Only when the charge nurse asked me to do my part did I feel seen as a key player on my care team, as an equal rather than a patient being told what to do.

Our healthcare system focuses on medicine, and issues like housing, transportation, and what’s going on at home are pushed to the periphery. But supporting activation in patients, giving them the training they need in their new role, and creating the opportunity for them to ask questions are critical to providing whole-person care. When people like me get off dialysis and get a transplant, it’s not only better for our quality of life, but also reduces healthcare costs.  

I went from feeling hopeless about my future to thriving as a person living with kidney disease. When people see me speaking, advising other people about how to advocate for better care, they can’t imagine me then. But I tell my story because many others are judged as “non-compliant,” hopeless cases. They deserve a chance to attain their optimal health no matter which stage they have reached in the patient journey.

I’m optimistic that including patient activation and screening for SDOH as quality measures in MIPS will help engage more patients and open the door for them to ask for the resources they need to lead healthy and fulfilling lives. 

Dave White is  a proofreader for an international law firm and self described “Kidney Warrior” — a grateful kidney transplant recipient and an informed, engaged healthcare consumer and patient advocate

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Engage with Grace

Alex Drane started this movement in 2008 & named it Engage with Grace. What are your loved one’s wishes at the end of life? Are you with them this Thanksgiving weekend? This one slide can help you start the conversation

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(We Don’t) Trust The Science

By KIM BELLARD

I know the A.I. community is eagerly waiting for me to weigh in on the Sam Altman/OpenAI dramedy (), but I’m not convinced this isn’t all a ploy by ChatGPT, so I’m staying away from it.  A.I. may, indeed, be an existential issue for our age, but it’s one of many such issues that I fear we’re not, as a society, going to be equipped to handle.

Last week the Pew Research Center issued an alarming report Americans’ Trust in Scientists, Positive Views of Science Continue to Decline. Now, a glass half-full kind of person might look at it and say – no, it’s good news!  Fifty-seven percent of Americans agree science has a mostly positive impact on society, and 73% have a great deal or a fair amount in confidence in scientists to act in the public’s best interests.  For medical scientists it was 77%. Only the military (74%) also scored above 70%. That’s good news, right?

The glass half-empty person would point to the downward trend in just the past few years: at the beginning of the pandemic (April 2020) the respective percentages were 87% (scientists), 89% (Medical scientists), and 83% military.  The faith in them has continued to drop since.  Things are trending in the wrong direction, quickly.

If the glass was half full, it’s spilling now.

About a third (34%) of the public thinks that the impact of science on society has had an equally positive and negative impact, while 8% think science has had a mostly negative impact. Again, the trend has been negative since the pandemic; the 57% who think science has a positive impact was 73% in January 2019. That’s alarming.

The skepticism about scientists and the value of science has increased generally but is more pronounced among Republicans and those without a college degree.  E.g., only 61% of Republicans have a fair/great amount of confidence in scientists, versus 85% in April 2020 and versus 86% of Democrats now.  Fewer than half (47%) of Republicans think science has had a mostly positive impact on society, versus 70% on January 2019.

In the supposed most developed country in the world, 39% of Americans think the U.S. is losing ground in science achievement versus the rest of the world, and only 52% even agree it is important for the U.S. to be a world leader in scientific achievements.  10% didn’t think it was important at all. Young people, surprisingly, were most skeptical.

I wonder what they do think it is important for us to be the world leader in.

The problem may be that a third thought developments in science were changing society too quickly (43% among Republicans).  They want their new iPhones, they like fast internet speeds, they demand the latest treatments when they get sick, but somehow they don’t connect those to science.

I think about this when I read about the Texas board of education fighting about how science is taught in Texas schools.

This year climate change and evolution were, again, hot topics. Evelyn Brooks, a Republican board member, said: “The origins of the universe is my issue — big bang, climate change — again, what evidence is being used to support the theories, and if this is a theory that is going to be taught as a fact, that’s my issue. What about creation?”  

Ms. Brooks also declared: “There is no evidence that an entirely different species can come from another species,” which suggests she’s not keeping up with the fossil record or DNA analysis.

Never mind that evolution continues to be validated by finding after finding; some 40% of Americans believe in “creationism.” Never mind that the world has just passed the landmark 2 degrees Celsius above pre-industrial age global temperatures or that 97% of climate scientists agree humans are causing global warming and climate change. Never mind all that because, you know, an outspoken minority don’t believe in science or in scientists. And they’re determined to not help our children prepare for the world they’re inheriting. 

A recent study looked specifically at how climate change is – or isn’t – being taught in U.S. K-12 schools, and found that, indeed:

While planetary health education varies widely across the USA with respect to the presence and depth of terms, most science standards neglected to convey these concepts with a sense of urgency. Furthermore, state/territory dominant political party and primary gross domestic product (GDP) contributor were each predictive of the quality of planetary health education.

We’re worried that artificial intelligence may kill us off, but plain old human intelligence (or lack thereof) may do that first.

All that, of course, assumes that we’re teaching our kids generally, but the evidence is pretty grim on that point – again, especially since the pandemic. The pandemic led to drastic declines in math and reading scores (only 26% of 8th graders are proficient in math, only 31% are proficient in reading). The National Science Board warns: “U.S. student performance on standardized tests in science and math has not improved in over a decade, placing the U.S. in the middle of a long list of global competitors,” and urges: “the U.S. needs “all hands on deck” to modernize K-12 STEM education and to hold itself accountable with reliable, up-to-date data.”

Some of that poor performance is because absenteeism has soared since the pandemic started.  According to Attendance Works, in the 2021-22 school year chronic absence affected nearly 30% of students. Yes, it disproportionately impacted minority students and high poverty schools, but all schools and all demographics were impacted. Parents wanted schools to reopen in the early days of the pandemic, but evidently they weren’t as insistent that students actually attended.

————

Science is a self-correcting endeavor, which means it isn’t always right at first. Scientists are human, which means they sometimes act out of impure motives. The pace of change enabled by science is, indeed, getting faster; just look at use of A.I. in the past year. But the “solution” to all that isn’t to turn our backs on science or to distrust scientists; it is to improve science literacy among all of us so that we are better equipped to adapt to what science offers us.

Hug a scientist – or better yet, help your children become one.

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TOMORROW: ZS Impact Webinar on Digital Health

Join ZS’s Ahmed Albaiti with me, Matthew Holt, author and founder of The Health Care Blog, as we discuss the considerations and approaches that policy experts, regulators, clinical leaders and the venture capitalist community can take to affect a future for connected health technologies.

Date: Wednesday, November 22, 2023

Time: 12:00 PM Eastern Standard Time

Duration: 30 minutes

Register here

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Orange, Green, and Red – The Colors of Tribalism

BY MIKE MAGEE

As Thanksgiving Day approaches, let’s give thanks for the study of history, in part because it reminds us that Trumpian words like “vermin” have been used before and serve to alert the human race that we have entered danger zone

One President who understood the power of words more than many others was FDR. When he structured up “a series of programs, public work projects, financial reforms and regulations…to provide support for farmers, the unemployed, youth and the elderly”, he memorably packaged the plan under the label, “The New Deal.”

Seizing alliteration in 1933, he further defined his new policies as the “3 R’s – Relief, Recovery, Reform”, promising “…action, and action now.”

When his enemies began to coalesce against him in 1936, he chose his words carefully in the public defense. Seizing the largest venue he could find at the time –Madison Square Garden – he stood tall and erect, supported by heavy leg braces, and declared defiantly, “They are unanimous in their hate for me – and I welcome their hatred.”

With a heavy dose of humility and learned wisdom, he rose again eight years later, on January 11, 1944, fifteen months before his death, and delivered the State of the Union Address as a Fireside Chat from the Oval Office in the White House. 

His words once again were clear and ever lasting. He stated that the original Bill of Rights was “inadequate to assure us equality in the pursuit of happiness.”

 “Necessitous men are not free men.  People who are hungry and out of a job are the stuff of which dictatorships are made,” he said, proposing“a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed.”

In proposing this radical cultural shift, he was forecasting the words of Harvard-trained philosopher Susan Neiman PhD in her recent book, “Left Is Not Woke” celebrating a democracy that valued “a commitment to universalism over tribalism, a firm distinction between justice and power, and a belief in the possibility of progress.” Adding, “All these ideas are connected.” 

It is not surprising that Dr. Neiman highlights the work product of Eleanor Roosevelt who guided the creation of the UN’s “Universal Declaration of Human Rights” which she herself admits is to this day “a declaration that remains aspirational.” Signed  by 150 nations, and the most translated document in the world, not a single country has created a society that assures all the rights enumerated.

This Thanksgiving Day, I will encourage my children, and grandchildren and guests to read aloud the 30 short Articles in the Declaration. Embedded in the declaration is a broad and inclusive definition of health. It reads “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

I am motivated to take this action, not simple because the health of our democracy and others around the globe are under attack by Trump, and Putin, and their followers; nor only for the intentionally destructive behaviors of some of our elected officials; nor just as a reaction to the willingness of some leaders to undercut women’s autonomy and their rightful access to health professionals when medical danger is knocking at their doors.

Rather, I am driven to this action by last week’s March of Dimes report on maternal fetal health in America, and its incongruity with the second paragraph of Article 25 in the Declaration which reads:

“Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.”

As the March of Dimes reported, “the U.S. remains among the most dangerous developed nations for childbirth with early data from the CDC showing a 3% increase in infant mortality in 2022.” 10.4% of babies last year were born prematurely before 37 weeks gestation. Compare that with the U.K. (7.6%), Italy (6.8%), or Japan (5%). To make matters worse, U.S. numbers reveal remarkable racial disparity with 14.6% of Black babies born prematurely compared to 9.4% of White babies.

As for mothers heath in the post Dobbs era, the report states that “maternal deaths are on the rise, with the rate doubling between 2018 to 2021 from 17.4 to 32.9 deaths per 100,000 live births.”

Fintan O’Toole, the Leonard L. Milberg Professor of Irish Letters at Princeton, in a recent review of Susan Neiman’s book, suggested that results such as these are “rather intimate catastrophes” … and “the starkest manifestation of a tribalized society.” 

Such societies, and by inference our own, go well beyond “political partisanship.” As O’Toole explains, “Tribalism spills beyond the strictly political arena into parallel assumptions about history, geography, economics, and, of course, religion… neither side in this (typically binary) contest truly accepts the legitimacy of an electoral defeat. Being outvoted is understood not as a disappointment but as an existential threat.”

O’Toole, as an expert on “The Troubles” in Northern Ireland, knows the landscape, and is raising alarms.  “The throwback now feels like a foretelling,” he says. As he sees it, “the Troubles are now—and not in a good way—everybody’s trouble.  There are, in the United States and Europe, powerful forms of mass political identity that do not ‘adequately manifest’ themselves in loyalty to the institutions, laws, and values that make a democratic state possible…. suffering deepens the sense of victimhood… Self-harm and self-pity form a feedback loop of endlessly renewable political energy. And this perpetual motion machine is also driven by revenge.”

“The true colors of a community’s life may be a dazzling mosaic, but tribalism makes them monochrome: an orange sash, a green flag, a red MAGA hat.”

As a moral philosopher, Susan Neiman clearly channels an earlier Eleanor Roosevelt when she highlights the abandonment of philosophical values including “a commitment to universalism over tribalism, a firm distinction between justice and power, and a belief in the possibility of progress.”

Of course, societal progress, as O’Toole points out, almost always involves real trauma and human suffering. But with tribalism it is also accompanied by heavy doses of self-victimization. Trump’s White Nationalist followers believe they are being “tyrannized by poor immigrants and nonwhite people demanding to be treated as equals.” But as O’Toole points out, “The power of self-pity is that it does not require actual oppression—if you always travel first-class, being stuck in economy will make you feel very sorry for yourself.”

Neiman’s major point is that the vacuum left by an erosion of justice is always filled with power – and specifically, power over someone. As the March of Dimes report so well illustrates, that “someone” for Trump and followers, for whom (as O’Toole suggests) “the only truth is the eternal binary of friend and enemy,” and “politics, like war is a matter of the most extreme and intense antagonisms,” the enemies are clear. They are women and people of color in America.

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical-Industrial Complex.

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Paul Jaglowski, Feedtrail

Feedtrail is one of a new breed of customer experience companies. Most health care experiences are captured in paper surveys that end up in H-CAPS and Star ratings. These are very important for how providers and plans get paid but probably don’t actually reflect what happens very well and give very poor feedback to organizations and staff about what’s actually going on. They also don’t give a chance for patients to directly give positive feedback to staff who do a great job–which likely helps them feel good about their work. Feedtrail is working to fix all that. I got a full demo and explanation from founding CEO and chief strategy officer Paul Jaglowski–Matthew Holt

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Pin Me, Please

By KIM BELLARD

You had to know I’d write about the new Humane AI Pin, right?

After all, I’d been pleading for the next big thing to take the place of the smartphone, as recently as last month and as long ago as six years, so when a start-up like Humane suggests it is going to do just that, it has my attention.  Even more intriguing, it is billed as an AI device, redefining “how we interact with AI.”  It’s like catnip for me.

For anyone who has missed the hype – and there has been a lot of hype, for several months now – Humane is a Silicon Valley start-up founded by two former Apple employees, Imran Chaudhri and Bethany Bongiorno (who are married).  They left Apple in 2016, had the idea for the AI Pin by 2018, and are ready to launch the actual device early next year.  It is intended to be worn as a pin on the lapel, starts at $699, and requires a monthly $24 subscription (which includes wireless connectivity).  Orders start November 16.

Partners include OpenAI, Microsoft, T-Mobile, Tidal, and Qualcomm.

Mr. Chaudhri told The New York Times that artificial intelligence  “can create an experience that allows the computer to essentially take a back seat.” He also told TechCrunch that the AI Pin represented “a new way of thinking, a new sense of opportunity,” and that it would “productize AI” (hmm, what are all those other people in AI doing?).  

Humane’s press release elaborates:

Ai Pin redefines how we interact with AI. Speak to it naturally, use the intuitive touchpad, hold up objects, use gestures, or interact via the pioneering Laser Ink Display projected onto your palm. The unique, screenless user interface is designed to blend into the background, while bringing the power of AI to you in multi-modal and seamless ways.

Basically, you wear a pin that is connected with an AI, which – upon request – will listen and respond to your requests. It can respond verbally, or it can project a laser display into the palm of your hand, which you can control with a variety of gestures that I am probably too old to learn but which younger people will no doubt pick up quickly.  It can take photos or videos, which the laser display apparently does not, at this point, do a great job projecting. 

Here’s Humane’s introductory video:

Some cool features worth noting:

• It can summarize your messages/emails;
• It can make phone calls or send messages;
• It can search the web for you to answer questions/find information;
• It can act as a translator;
• It has trust features that include not always listening and a “Trust Light” that indicates when it is.

It does not rely on apps; rather, it uses “AI Experiences” – on device and in the cloud — to accomplish whatever goals smartphone apps try to accomplish.  The press release brags: “Instead, it quickly understands what you need, connecting you to the right AI experience or service instantly.”  

Ken Kocienda, Humane’s head of product engineering, contrasted the AI Pin with smartphone’s addiction bias, telling Erin Griffin of The New Times: “It’s more of a pull than pushing content at you in the way iPhones do.”

Health and nutrition is said to be an early focus, although currently it is mostly calorie counting.

Ms. Griffin summarizes the AI Pin thusly: “It was, like any new technology, equal parts magic and awkward.”  Inverse’s Ian Carlos Campbell was also impressed: “Added together, the Ai Pin is exciting in the way all big swings are, the difference being it seems like Humane could back up its claims.”  

Mark Wilson of Fast Company, on the other hand, was more reserved, noting: “In practice, the AI Pin reminded me of an Echo Dot on your chest,” and wondering: “Where was all the magical stuff?…The stuff where, because the AI Pin is so overtly planted on our person, the rest of its demands could disappear?”   

Mr. Chaudhri defended using a pin instead of another version of smartglasses, telling Mr. Wilson:

Contextual compute has always been assumed as something you have to wear on your face.  There’s just a lot of issues with that…If you look at the power of context, and that’s the impediment to achieving contextual compute, there has to be another way. So we started looking at what is the piece that allows us to be far more personal? We came up with the fact that all of us wear clothing, so how can we adorn a device that gives us context on our clothing?

Or, as Mr. Chaudhri said earlier this year: “The future is not on your face.”

Color Mr. Wilson unconvinced:

Humane’s issue in a nutshell isn’t that a wearable assistant is inherently a flawed idea, it’s that Chaudhri’s product doesn’t yet solve the problem he has diagnosed and set out to mitigate: that removing a screen will solve our dependence on technology… it appears Humane hasn’t unlocked the potential of AI of today, let alone tomorrow, nor has it fundamentally solved any significant problems we have with technology.

To be honest, it isn’t everything I’d hoped it’d be either. The AI is impressive but, at this point, still limited. The laser display is cool but not really ready for prime time. The pin is sleek, as would be expected from Apple alums, but I don’t want to even be aware of a device; I want it embedded in my clothes, maybe worn as a “smart tattoo.”  

But these are, really, quibbles. The AI will get exponentially more useful. The device will get much smaller. The display will get much better. As others have pointed out, the iPod was a revolution but was limited, and led to the iPhone, which itself was initially fairly limited.  Similarly, the AI Pin should get much, much powerful, and have even more awesome successors.

In the press release, Ms. Bongiorno and Mr. Chaudhri say:

AI Pin is the embodiment of our vision to integrate AI into the fabric of daily life, enhancing our capabilities without overshadowing our humanity. We are proud to finally unveil what we and the team at Humane have been working on for the past four years. For us, Ai Pin is just the beginning.

The introductory video closes with Mr. Chaudhri promising: “It is our aim at Humane to build for the world not as it is today, but as it could be tomorrow.”  We should all be designing for that.

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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