Category: Future of Healthcare and Medicine

COVID “Treatment” is About to Get Interesting

Check this out. What you will see is a write-up that is interesting in several different ways. First, as the writer tells the story, the interest surrounding Molnupiravir, Merck’s much anticipated therapy for COVID-19, has captured analysts’ focus far more than the overall quarterly performance of the giant drug company. How those two factor will converge in quarters to come will be fascinating to watch.

Second, intervention decisions related to COVID-19 will get more complicated, and thus more interesting, when this product is approved. Sure, frontline for the foreseeable future will remain the vaccines. Molnupiravir’s role would seem fairly straightforward, i.e., in the treatment of compromised patients with mild to moderate disease. BUT. The possibility of using the product for postexposure prophylactic therapy could substantially increase the patient pool. 

And where will the monoclonal antibodies fit in as all of this gels? And what other forms of therapy will become available that will need to find their way into the mix?

Bottom Line. The general take on the situation is that COVID-19 and its variants will be around for a long, long time. Expect that the armamentarium of agents available to prevent and to fight the infection will continue to evolve. And for the developing pathways through that armamentarium to have a substantial impact on the economic fortunes of the companies that develop and market them. 

The Impact of “Full Ride” Medical School

Want a good smack in the face with some good old-fashioned common sense? Check this out. What you will see is an article that reviews the impact of NYU’s Grossman Medical School giving, starting in 2018, all current and future medical students free tuition. A generous move for sure, and one likely to attract medical students who otherwise might have gone to the Harvard’s and Georgetown’s of the world. But how about the expressed purpose of the move, i.e., to attract more students who will feed into primary care, and to attract a more ethnically and socially diverse student body? 

Read the piece and think about it. A free ride looks just as good to me if I am going into one of the lucrative specialties, like dermatology or radiology, as it does if I am headed for primary care. Free tuition did nothing to shape the direction of NYU graduates’ specialty choice. Zero. Nada.

Similarly, as long as metrics like GPA and MCAT scores are the primary selection criteria used nationwide, and minority applicant pools remain stagnant, free tuition does little to increase the diversity of the medical profession overall. Sure, more minority students may be drawn to the free tuition at NYU, but only at the expense of other schools. 

Bottom Line. Much talk is heard about “unintended consequences.” Civilians killed in air raids on military installations, etc. But how about “intended consequences?” Shouldn’t somebody be looking at a generous but expensive program like free medical school at NYU and ask the question, “How is that going to make happen what we want it to make happen?” 

How indeed?

Telehealth Use Up, Patient Satisfaction Down!!!

Check this out. What you will see is common sense as it applies to telehealth. Quite simply, the pandemic hastened the proliferation of telehealth platforms and of physicians ready, willing and able to use them. The fact that third-party payers, in many cases for the first time, compensated doctors for telehealth visits was a significant driving factor here. Just so, patients seeking safety and convenience stood ready to try telehealth visits during the pandemic.

BUT. Challenges in actually using the telehealth technology reduced patient satisfaction, as did confusion about treatment costs and lack of a “provider details.” Also, rather common sensical is the fact that telehealth is seen as being more satisfactory by the relatively well than by those in poorer health, who are looking for more support from their physician interactions. 

Bottom Line. All of these J.D. Power findings line up rather nicely with the results of my On Doctors’ MindsSM conversations, wherein doctors are telling me month after month that it is the less complicated, follow up patients, and those demanding special handling in terms of safety and convenience, who are now the only ones getting serviced through telehealth platforms. Especially for specialists, the loss of direct physical examination and patient relationship management inherent in telehealth visits causes most doctors to far prefer in-office patient visits. 

Surgical Concierge

Check this out. Press the Eye On Health SurgiQuality button and watch a fascinating video with an interesting premise. More specifically, the point of the video is that when patients are told that they need surgery, they are “shocked”, “nervous”, “scared” and “they don’t know what questions to ask.” Sounds right. Follow through the video and scroll around the SurgiQuality site, and you will see a service designed to deal with all these issues.  A service that will gather all of the paperwork necessary to approach surgery intelligently, or even to pursue non-surgical options which might be recommended by other clinicians. Case materials will be distributed to multiple providers to determine, if a patient elects to proceed with surgery, the highest quality and most cost-effective provider to employ.

Bottom Line. This approach is a very different one from what usually happens in real life. When a patient is told she needs surgery, the usual response is to proceed with the surgeon who has made the diagnosis, and to assemble as much paperwork as necessary to get the procedure scheduled and paid for. 

Does the SurgiQuality approach appear to be more rational than this? Absolutely! But I have two questions. First, to what extent will patients actually seek out this service rather than simply relying on the surgeon who has made the diagnosis and who has at least the beginnings of a viable patient relationship? Second and perhaps even more importantly, to what extent will surgeons repeatedly review cases, offer opinions and make bids for surgeries that they know that they will most likely not wind up being compensated for in most cases? This “competition,” which is described by SurgiQuality as being healthy, might seem less so to a doctor who is asked repeatedly to spend precious time without the guarantee of remuneration.

This will be an interesting one to watch!

Cannabis M.D.

Check this out. What you will be led to is the web presence of Jill Becker, M.D.  Trained in Ob/Gyn, Master’s Degree in counseling psychology, ordained Minister, etc.  BUT. Her main claim to fame is that she has extensively studied the use of cannabis used to deal with a large variety of medical problems. She will “work with your care team” to figure out the right cannabis program to cure what ails you. AND. Talk about a practice that is perfect for using telemedicine! She can work with patients nationwide using telemedicine platforms and can also help patients avoid any stigma that might accrue to being seen sitting in her waiting room. 

Bottom Line. Got me to wondering. How many other doctors have figured out this schtick??? Do the Google search and roam around like I did and you will know what I know. LOTS!!! All doing it via telemedicine.

Smart. I can see this specialization filling a real and important need that many (most?) doctors wouldn’t touch with a ten-foot pole!

Digital Therapeutics

Check this out. What you will see is the announcement of the launch of the first FDA-approved video game designed for the treatment of ADHD. Being marketed through, you guessed it, digital media. 

Go to their website and watch the trailer

One wonders how many more videogames will come onto the market, FDA approved, requiring an Rx and costing $100 per month, to compete with this initial offering. Or will this be a monopoly? 

Lots of other questions come to mind. What will the receptivity of healthcare practitioners be for this offering in particular, digital therapies in general? Will parents pony up the $100 a month for three months of initial therapy? How effective will the therapy be? Will parents reup after the initial trial? 

Bottom Line. Don’t you just love it when something genuinely new like this comes along? All the new research avenues that one gets to pursue! 

Industrialized Medicine

Check this out. What you will see is a psychiatrist, who specializes in helping physicians and their organizations deal with “complex personal challenges,” asking his colleagues a question. Are they “healers” or are they “widgets.” According to Dr. Adelman, the trend over the last 50 years toward “industrialized medicine,” where doctors’ workflows are controlled by corporations rather than by their own wills, has caused there to be so much “coming at them” that they are like Ethel and Lucy in the chocolate factory. They just can’t keep up. They become unable to do “their best work.”

A powerful quote from Adelman’s post:

Malaise sets in when you realize that you have become an almost inanimate object.  This is ‘physician burnout,’ which has been conceptualized by some as a form of moral injury visited upon us by industrialized medicine.

Bottom Line. The move away from being a healer and toward being a widget seems inexorable. This is not likely to get better in coming years.

My question? Then what will “worse” look like in years to come???

Too Many Cooks (Docs) In The Kitchen??

Check this out. What you will see is a comment on a very important trend in medicine today. Quite simply, patients used to be treated by their own doctors. Period! Now, due to after- hours “doc in a box” facilities, the growing reliance on Hospitalists for the care of hospitalized patients, the use of NP’s, PA’s, etc., a single patient is often confronted by a plethora of HCP’s. As pointed out in this article, continuity, efficiency and other desirable parameters wind up being significantly reduced by this trend.  

Bottom Line. The truly amazing part here is that the introduction of all of the various HCP types listed above was, in no small part, motivated by the desire to increase efficiency of medical care.  

Once again I say, “Beware of unintended consequences!”

Still Willing To Die At Age 75???

Check this out. A really bothersome and thought-provoking little ditty about the guy pictured above. Ezekiel Emanuel, MD. Brother to Rahm Emanuel, recent two term mayor of Chicago. Head of the Bioethics Department at the University of Pennsylvania, and chief architect of Obamacare. Not an intellectual lightweight.  

“Way back” in 2014, Dr. Emanuel penned a controversial article entitled “Why I Hope To Die at 75.” The URL I am sending you to today provides excerpts from an interview recently conducted with Ezekiel, basically asking him if he still believes what he believed five years ago, and asking if he has any further thoughts on the topic.  

Read this piece and ponder the points being made. Basically, there are two. First, Ezekiel believes that beyond the age of 75, people consume so many scarce healthcare resources that they wind up depriving others, children for example, of appropriate access to care which would be more beneficial to them than it is to the oldsters. Second, and somewhat scarier, is his notion that since even vital people beyond the age of 75 are spending their time “playing” instead of working, their lives are not worth extending anyway.  

No, Dr. Emanuel is not planning on “offing” himself on his 75thbirthday. BUT. He is planning on refusing medications and other treatments specifically designed to prolong his life as of that date, and believes that others reaching the 7.5 decade mark would be well served by doing the same thing.

I gotta tell ya! When I first read the Atlantic article, I was a mere child, aged 66. I had just really hit my senior years, and his article struck me as more of a curiosity than something that I should spend a lot of time pondering. Scroll forward 5 years, and December 5, 2019 will be my 72ndbirthday. Yikes. Only three years left for me in the Emanuel manual, so this time around I gave the doctor’s thinking some serious attention. BUT. I am still enjoying exercising several hours a day and working with Dr. Neale Martin on Habit EngineeringSMas an entirely new paradigm for pharmaceutical marketing and marketing research is some of the best and most important work I have ever done. SO…

Bottom Line. Although I understand where he is coming from, I believe that the variations in vitality, including both activity and productivity, make his theoretical end point of “health span” arbitrary enough to be declared incorrect.  

At least I hope so!

Visits To Primary Care Physicians Are On The Decline

Check this out. What you will see is a report indicating that office visits to PCP’s have dropped significantly over the last several years. So, you think, the patients are showing up to see NP’s and PA’s? Not so fast. This report also indicates that the rise in visits to the non-physician providers, as the chart above demonstrates, accounts for only half of the lost PCP visits. As another surprise, you will also see commentary indicating that any shift from physician to non-physician providers is NOT providing the cost savings that one would anticipate. Bottom Line. While I found these statistics to be interesting, this report left me with three questions.  First, if only half of the PCP shortfall is accounted for by non-physician providers, where the heck did the rest of the visits go?  Second, how can there be no cost savings if visits shift from physicians to non-physicians? Third, what does this trend mean for our businesses?    Inquiring minds want to know!