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Thursday, January 11, 2018

WinterTech 2018 in San Francisco



Conference recap coming shortly. I have about 100 photos to triage. Had a surgical consult this morning, and my daughter started a new chemo regimen as well. Plus, our son Nick rescued a chocolate lab mix dog who was out running loose on the road somewhere west of Sacramento. He seriously needed (and got) a bath. We're gonna go to the shelter and get him scanned for a chip.

 Busy day.

This marks my 4th year of being invited to participate in coverage of WinterTech, following 2015, 2016, and 2017. Definitely an honor to be included.

WEEKEND UPDATE

Between adverse developments on our daughter's dire medical situation, my doc visits for my own upcoming major px, and our newly "fostered"rescue dog (no chip, no online "lost dog" notices), I've just now gotten to triaging my WinterTech photos.

Let me begin with morning Keynoter Mark Ganz, President and CEO of Cambia Health.


You coulda heard a pin drop. Mark had to pause a couple of times, fighting back tears as he recounted his Georgetown U Law School interactions with the late Father Tim Healy. About to have to withdraw from law school over finances, Mark was told by Father Healy "don't worry, we'll cover it," and went on to clarify that he meant that it was not a "loan" to be repaid, but that Mark's subsequent obligation would be to "pay it forward" by doing good works in the world.

Mark asked of the audience: "Why do you do what you do? Is it born of hope? To make the world a more just place? Or is it just to make money, to bring in hefty 'exit' returns?" He went on to exhort "Challenge your VCs," and admonished attendees to "ask yourselves three questions every day" -- 
  1. Do I have hope?
  2. Do I believe I can be the catalyst for real change?
  3. Am I willing to risk it all?
Absent affirmative responses to all three, Mark advised "you need to reconsider."

It was compelling.He offered us a slide:
“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.” - Elisabeth K├╝bler-Ross
Stay tuned. Gotta take the stray rescue to the vet. More later.


OK, looks like he's only 2-3 years old. He weighed in at 73 lbs. Given the size of those paws, he may have another 10-20 lbs to go. Lordy.


$280.17 later he's had a full workup and now has a rabies tag.

FDA'S BAKUL PATEL


"Software as a Medical Device?" A new area for FDA oversight and certification. Interesting.
"Software intended to be used for one of more medical purposes that perform [sic] these purposes without being part of a hardware medical device."






Click to enlarge. Difficult to read.

Part of FDA's "Pre-Cert Pilot Program." This is good, given that the future of digitech will be increasingly comprised of software applications that are independent of fixed, dedicated hardware.

Bakul Patel here on YouTube.

ANOTHER THEMATIC SLIDE






"Digitization Across the Health Care Continuum." Yeah, this has been a major theme across the past couple of years. Progress seems still to be spotty, but, perhaps we're getting close to a "tipping point." Click to enlarge, also difficult to read.
It's interesting to me, I should honestly say at this point that my schtick may be getting somewhat dated (DSLR photo-heavy visual reporting necessarily uploaded post-conference). All you really need to do any more is follow the Twitter event hashtag "#WinterTech" and click "Latest" for near-real time participant documentation of the proceedings. While smartphone photos are not as sharp as mine (and there are character-count limitations), the immediacy trade-off is, well, in a word, one of "satisficing," 'eh?
A RANDOM PHOTO SET

I've told Lisa Suennen repeatedly that she could be a star at stand-up.
What a combination of smarts and humor!




Again, I can't caption ID all of the people I shot. Stuff goes by too fast. You can see the WinterTech page to link a lot of faces and names ("Our Speakers").

Of particular personal interest to me was the panel segment "Four CEOs and their VCs," in light of developments for my niece's husband Dr. Jeff Nyquist and his recently funded startup "NeuroTrainer."

Also on the agenda, the "FICO Score for Health" was back.
Dacadoo is the "Health Score" company - providing a mobile-first digital health platform that helps people live healthier, more active lives. The dacadoo platform allows organizations to offer a fun, engaging experience that measures, coaches and improves people's health across three key dimensions: lifestyle, biometric and emotional wellbeing. Dacadoo takes inputs from a variety of tracking devices, as well as its own app and applies a research-backed, patented process to calculate a single, composite health score for each individual. Dacadoo's customers include large and mid-sized companies, health and life insurance companies, and health & wellbeing service organizations.
I used to work in credit risk modeling and management (large pdf). Would love to see this algorithm.

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FYI, over at Medium, there's a recently updated six-part series:

 
Understanding Venture Capital
Our new series takes a hard look at how venture capital works, and finds positives — and plenty of negatives.
There's now audio transcription. Nice.

Member paywalled. I finally joined a while back. Only $50 a year. Lots of good stuff there. I use Medium every now and then, but I find the authoring platform rather stiff and weak. Limited functionality.

One prediction from the WinterTech stage was that of a record year in 2018 for VC investing in the digital health space. I hope so. I guess we'll see.

I have more stuff in my notes, but I'm gonna pop the clutch and upload the foregoing for now.

Stay tuned.

UPDATES OF RELEVANCE

"Science Fiction Coming to Life," by Dr. David Shaywitz over at THCB.

And, at the take-no-prisoners Naked Capitalism:
CES Shows That the Future Will Not Work
Posted on January 15, 2018 by Yves Smith


A new article by Taylor Lorenz in the Daily Beast, CES Was Full of Useless Robots and Machines That Don’t Work, by virtue of doing what tech writers are never supposed to do, namely report as opposed to cheerlead, is being buried despite its importance.

Lorenz went to the what is the biggest, most important consumer tech trade show in the US, and arguably the world, and found that tons of the great new gotta-have-them wares in the pipeline don’t work. As in unabashedly, obviously don’t work or are so ludicrously not fit for purpose as to be the functional equivalent of not work…
"Silicon Valley is no longer about products. It’s about VC hype and pump and dump..."
Excessively broad-brush and harsh?
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More to come...

Tuesday, January 9, 2018

Blockchain and health care?


Ran across a post over on Medium, "Can Blockchain Help Us Improve Health?"
“There’s great excitement and huge investment around what blockchain technology can do to improve the delivery of health care...” BUT “...not everyone is equally optimistic that this technology is more than a passing fad”
I commented thereunder:
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My concern goes to Gartner Hype Cycle conflation. Crypto financial transactions need, minimally, only four data elements, short and sweet:

  1. Payor_ID;
  2. Payee_ID;
  3. Amount;
  4. DateTimeStamp.
(And, of course, implicit in the foregoing are the (often pseudonymous) “Private Key” ID linkages to the transactors’ “Public Keys” that are used to validate the transaction, reflected via the DateTimeStamp. (Oh, and, gotta mention the “security hash” code linking the blocks.)




In contrast,
  1. The typical ambulatory EHR houses between 3,500 and 4,000 variables in its RDBMS schema (to say nothing of huge inpatient systems). A typical patient encounter may reflect hundreds of them (or more, comprising structured alphanumeric data, imaging, and open-ended text narratives). There were 60 vars in my most recent bloodwork alone. A typical “ROS” (Review of Systems data) houses 140 or so variables. And, all of these are typically “1 to n,” i.e. one-to-many longitudinal per patient (i.e., “progress note” stuff);
  2. Given that the ostensible “virtue” of the blockchaining architecture is its “immutability” (i.e., validated blocks cannot be modified once added), how do we handle the inevitable errors that plague all database systems? Find mistake(s)/omission(s), have to “append” execute a new block transaction (which is again “distributed” to everyone in the aggregate “ledger”/”wallet” population)?
  3. HIPAA 45.CFR.164.3,4,5 et seq data security, breach notification, and privacy requirements governing CE’s and their BA transactors (and also 42.CFR.2)?
  4. What of the continuing (lack of) “interoperability” problem (which I often irascibly refer to as “interoperababble”)? What of the clinical workflow implications? Clinicians are already drowning in data as they traverse the never-ending “productivity treadmill.”. How will the data variables in the validated new ‘blocks” be viewed by recipients? Will we need new, custom “download APIs?”
  5. Blockchain transactions are not “free,” they require payment of “transaction fees.” Crypto transaction fees have been on a steady, significant rise. Will they be reasonable (and stable) for health data transactions? Will such fees be bandwidth-consumption based?
Dunno. I have concerns. More inefficient IT Geek playground stuff w/respect to Health IT?
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'eh?


Currently, there are some 20 million crypto "wallets/accounts" (many of them anonymous duplicates), each a recipient of every accruing block addition transaction (the core peer-to-peer "distributed ledger" concept). I have to question the "bandwidth and data footprint efficiency" of this model -- beyond other reservations (some of them related).

Just some initial reactions.

 LOL.
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More to come...

Monday, January 8, 2018

On Deck, Health 2.0's #WinterTech 2018, January 10th

Registration link
"WinterTech is up next, and we're extremely excited about the final agenda. The 2018 edition of WinterTech will be not only be focusing on the new investment treads in digital health, but will take a in-depth look into the revolution in choice within the consumer landscape and the rapid development of digital therapeutics.

Our jam-packed 1-day conference includes:

    •   Keynote presentation on how to create seamless health care experiences to meet the needs of consumers by Mark Ganz, CEO of Cambia Health.
    •   Panel discussion on the opportunities, roadblocks, and regulations within the field of digital therapeutics by Bakul Patel, Associate Director for Digital Health at the FDA.
    •   Investment Strategies Past and Present: a look into 2017 trends, surprises, and flops. plus predictions for 2018 by VC firms GE VenturesCanaan, Fifty Years, NEA, and B Capital Group.
    •   Fireside chat between 4 VCs and their CEOs on their relationship and investment models
    •   Access to the Investor Breakfast where start-ups and investors discuss business models and explore portfolios. Start-ups apply here.
    •   Live demos from some of the most innovative companies in the digital healthcare space.
Don't miss out the hottest digital healthcare event focusing on investment in the space. Register today."
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See you there. I'm bringing with me Jeff Nyquist, PhD, founder and CEO of NeuroTrainer.com.

OFF-TOPIC ERRATUM


Pretty cool graphic.

He's, like, a Very Smart Person.
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More to come...

Thursday, January 4, 2018

Robert L. DuPont is a quack and a fraud


From The Daily Beast.
An adviser on marijuana policy to Attorney General Jeff Sessions wants to see doctors make drug testing a routine part of primary-care medicine and force some users into treatment against their will, he told The Daily Beast.

Dr. Robert DuPont was among a small group of drug-policy experts invited to a closed-door meeting with Sessions last month to discuss federal options for dealing with the rapid liberalization of state marijuana laws. California became the sixth state to allow the sale of marijuana for recreational use on Jan. 1…
Newsweek has the story as well.
A JEFF SESSIONS ADVISER THINKS DOCTORS SHOULD FORCE SUSPECTED ADDICTS INTO REHAB AND DRUG TEST ALL PATIENTS

Attorney General Jeff Sessions received marijuana policy advice from a seasoned veteran of the War on drugs, who helped popularize the phrase "Gateway Drug" and has proposed that doctors force some patients whom they suspect may be drug addicts into rehabilitation against their will…
"Good people don't use marijuana." - Trump Attorney General Jeff Sessions
This mendacious crap makes my blood pressure spike. From a rational public health perspective, how about we have docs order assays looking for the many dangerously enervating environmental toxins that increasingly impact all of humanity?

I did my graduate thesis on the scam of mass illicit drug testing 20 years ago. Nothing much has changed. My iterative online draft, which contains about 3/4ths of my final cut, remains available here (albeit with a good bit of "link rot" by now).
ABSTRACT: For an increasing breadth of organizational domains, a negative illicit drug screen result has become the final and paramount criterion for admission and/or continuing participation. Such a policy is vigorously promoted to the private sector by government and vendors of testing services as an inexpensive and vital tool for suppressing drug abuse. This policy, however, can be shown to be at once ineffective, wasteful, Constitutionally noxious, and ethically unsustainable. Reducing the harm attributable to illicit intoxication is a legitimate and worthy social goal. The ends, however, cannot justify such means of indiscriminate and intrusive surveillance.
DuPont et al therein:
Reagan Administration Attorney General Edwin Meese, long an opponent of crime-fighting restrictions like the Miranda Rule, saw great potential in enlisting employers in the fight against illicit drug use through mandatory screening: “Since most Americans work, the workplace can be the chokepoint for halting drug abuse.” (Gilliom, p. 35, Meese quoted originally in NY Times, October 31, 1986)

Two additional key administration operatives also added their efforts to the Reagan drug war. First, Dr. Robert L. DuPont, a psychiatrist and Reagan “Drug Czar” who would go on to become a tireless advocate for the commercial drug testing industry (more on Dr. DuPont elsewhere in this thesis). Second, the highly visible and forceful Dr. William Bennett, also to become a Reagan “Drug Czar,” despite his lack of training and experience in areas such as law enforcement and public health. Dr. Bennett saw illicit drug use in simple black and white: it was a moral issue, one bound to the dictates of authority. Once authority had spoken on drug use by declaring certain substances off-limits, users should suffer the penalties for transgressing. Bennett would brook no discussion of social or epidemiological “root causes” and “victimless crime” concepts. Drug users should pay dearly. Pay with their freedom, pay with their jobs.

Compliance, not health, was the real issue. “Now that the government has spoken to the subject that drugs are unlawful,” said Paul McNulty, a Bennettista soul-mate directing communications at the Justice Department, “a person who disobeys the law has made a moral choice and should be dealt with appropriately.” Bennett freely admitted drug enforcement was but an instrument of a wider agenda, calling for “the reconstitution of legal and social authority through the imposition of appropriate consequences for drug dealing and drug use.” “The drug crisis,” he told the Washington Hebrew congregation, “is a crisis of authority, in every sense of the term, 'authority'.” (Baum, p. 266)
While Bennett disdained any epidemiological analyses or addiction disease-model theories of drug use, he was not against using the epidemiological model when it suited his purpose. Dan Casse, a Bennett assistant, one day proposed a “contagion” model that might prove useful:
I studied under James Q. Wilson at the Kennedy School...He posits a contagion model. It isn’t hard-core users that spread drug abuse, because everyone can see that they’re a mess and nobody wants to be like them. Instead, it’s the casual user, the one whose life hasn’t fallen apart that is the vector for drug abuse, because he makes it look like you can use drugs and not pay a price. (Baum, pp. 272-3)
In epi-speak a “vector” is an organism that transmits a pathogen through the environment. The mosquito is the principal malaria “vector,” and so on. So, the otherwise prosperous and productive casual drug user could be targeted as a disease “vector” that had to be “quarantined” through tactics like drug screening and harsh economic legal sanctions. “I like it,” Bennett said. (Baum, p. 273)

In other words, don’t set a bad example, or we’ll ruin your otherwise nice life for you... (from Chapter 1)
From my Chapter 3:
Dr. DuPont was once awarded a Department of Energy grant for “a study described as ‘an attempt to demonstrate that opponents of nuclear power are mentally ill.’ DuPont [says] that he will study unhealthy fear, a phobia that is a denial of reality.” (see K.S. Schrader-Frechette, Risk and Rationality, p. 14) Psychiatrists are frequently big on Denial. Dr. DuPont seems to imply that since “the cardinal symptom of drug abuse is denial,” ( DuPont, op cit ) if you use illegal drugs and claim to do so without adverse consequences, you are by definition in Denial; your very dissent proves you to be an addict. And, before we can help you (given that you manage so well to not evince any overt symptoms), we must identify you through inexpensive mass drug screening.

You might as well just confess on the basis of the “clinical” screen result; after all, where there’s smoke, there’s fire, no?

In 1995 the U.S. Supreme Court handed down a major drug testing decision in the case of Vernonia School District 47-J v. Acton et ux., (Docket 94-590, suspicionless drug testing of Vernonia, Oregon high school athletes), ruling that the institution’s interest in combatting drug abuse outweighed any right to privacy on the part of student-athletes. The “scientific expert” for the school district, noted in the ACLU’s Amicus Brief, is none other than Dr. Robert L. DuPont. Dr. DuPont first came to my attention when his paper cited above came in a two-inch thick bound volume of “scientific”papers I received from Psychemedics Corporation. In his paper Dr. DuPont waxes rhapsodic with respect to the virtues of the RIAH® drug test, and enthusiastically supports its expanded utilization. Is this man a disinterested and principled scientist or a partisan advocate of mass drug testing with a financial stake in its spread to all sectors of society?
"Is this man a disinterested and principled scientist or a partisan advocate of mass drug testing with a financial stake in its spread to all sectors of society?"
Asked and answered.

Inane views further soiled by conflicts of interest? Well, that's practically a Trump administration job requirement. Perhaps DuPont could be appointed Jeff Sessions' Deppity Fer Drug War 2.0.

In today's news (Newsweek again):
CAN JEFF SESSIONS END LEGAL MARIJUANA? KEY OBAMA-ERA POLICY TO BE REVERSED
Attorney General Jeff Sessions is rescinding a key Obama-era policy that allowed states to regulate their own legal marijuana, right on the heels of the historic kick-off to legalization in California this week.

The policy, known as the Cole Memo, will be rescinded in an announcement on Thursday, according to the Associated Press, citing two anonymous sources with knowledge of the decision. The 2013 policy laid out the precedent that the Department of Justice would not prosecute marijuana businesses and users in states where it was legal, and would focus on more serious drug offenses instead –– like organized crime and sales to minors.

Sessions had already announced in November that he would be cracking down on these kinds of guidance memos…

Again, notwithstanding that my "recreational intoxicants" any more are limited to some good Cabernet and Courvoisier VSOP, this kind of ignorant Soviet-esqe Authoritarianism raises my BP.

DuPont would have "doctors make drug testing a routine part of primary-care medicine?"

If he still holds a medical license, it should be revoked. I'd like to know where his little "Institute for Behavior and Health" gets its money [Update: stay tuned, I have their latest available Form 990 -- they're a "501(c)(3)"].



A tax-exempt 501(c)(3) "charity" advocating clearly unconstitutional legislation? Using (from Schedule A) public "gifts, grants, contributions, and membership fees." totaling $2,420,017 spanning the most recent available period of 2011-2015? No info I can see on the precise sources of the funding.

Hmmm... let me guess.

Relatedly,
From the IRS: "To be tax-exempt under section 501(c)(3) of the Internal Revenue Code, an organization must be organized and operated exclusively for exempt purposes set forth in section 501(c)(3), and none of its earnings may inure to any private shareholder or individual. In addition, it may not be an action organization, i.e., it may not attempt to influence legislation as a substantial part of its activities [emphasis mine] and it may not participate in any campaign activity for or against political candidates..."
Read up on DuPont's many efforts to lobby for harsh (and unconstitutional) anti-drug legislation via his "Institute" and prior organizations. The foregoing cited and linked Daily Beast article is a good place to start.

UPDATE: check out this beaut. A private 501(c)(3) "Creating Tomorrow's Drug Policy"?


From page 3:
"Because there is no clear level at which most people are impaired by marijuana as there is with alcohol, the best solution is to set the illegal per se limit at zero or near-zero for THC."
Let that sink in for a moment. Review Chapter 3 of my thesis draft to ponder the analytic methodological idiocy of such a sentiment (its Constitutional noxiousness aside). I know that the imprecise weasel phrase "as a substantial part of its activities" will give the IRS an excuse for not acting, but, it's rather clear that DuPont is a tireless testing industry shill, apart from being a messianic Anti-Drug Warrior True Believer.
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Again, see the breadth of my old 1998 thesis draft. Decide for yourself whether I got it right. Groundhog Day...

"OH, AND, ONE MORE THING" 
"We're losing badly the war on drugs. You have to legalize drugs to win that war." - Donald J. Trump, 1990
UPDATE

Just ran across this organization.

"About Us"
Interesting.

FRIDAY UPDATE
Is This the End of Legal Medical Marijuana, Too?
Jeff Sessions changed an Obama-era policy on cannabis, and it could affect medical use.


On Thursday, Attorney General Jeff Sessions rescinded the Cole Memorandum, an Obama-era policy that took a hands-off approach to marijuana in states where it was legal. Instead, federal prosecutors, Sessions wrote, should decide for themselves whether to crack down on marijuana businesses.

This likely spells trouble for recreational marijuana, which is now legal in eight states and Washington, D.C. The move prompted an outcry from legalization advocates. “Enforcement is up to individual U.S. Attorneys, but this is a clear directive from their boss to start going after legitimate, taxpaying businesses,” said Morgan Fox, the communications director for the Marijuana Policy Project, via email.

What’s not as clear is how this might affect medical marijuana, long considered the more acceptable cousin to recreational weed.

A provision called the Rohrabacher-Blumenauer amendment protects medical-marijuana programs in states from federal interference. But that provision expires January 19, unless the new federal spending bill renews it. It’s not clear whether it will be included in however Congress decides to fund the government next. Justice officials told the Associated Press they “would follow the law, but would not preclude the possibility of medical-marijuana-related prosecutions.”…
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More to come...