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Thursday, September 25, 2014

A Health 2.0 2014 Conference reflection

So, beyond the always-dazzling parade of cutting-edge, beautifully rendered tech stuff (mostly software, but, yeah, some hardware gizmos, mostly mated with smartphones), there was an enormous, significantly increased amount of buzz at @Health2con regarding our imperative to all move toward broadly defined "wellness" -- in contrast to the prevailing, problematic paradigm of our evolved, bankrupting "Sickcare System." Recall, from my citation in a prior post, the estimation that only ~10% of health is attributable to clinical interventions?

Yeah, we're all gonna productively live to 150 in the wake of our having effectively addressed all of the Upstream issues, via full mobile personal digital quantification and recursively aggregated Big Data "Predictalyics," eh?

Went to my mailbox today. My new Atlantic Magazine had arrived. [Bleep]. Like I don't have enough to do today. Grrrrr... I gotta get up at 4 to have my daughter to BART before 5 a.m. for her trip back east, and laundry and housecleaning loom nigh. An old friend of mine (and former bandmate) is gigging at Yoshi's in Oakland tomorrow night; I gotta go shoot the show. The cats have to go to the vet on Saturday for overdue exams and shots, and then Cheryl returns on Sunday from Alabama where she's been taking care of her ailing Mom. Fresh roses, clean sheets and pillowcases...

Reading is my crack cocaine. I am an addict. Had to stop and read.

For millennia, if not for eons—anthropology continuously pushes backward the time of human origin—life expectancy was short. The few people who grew old were assumed, because of their years, to have won the favor of the gods. The typical person was fortunate to reach 40.

Beginning in the 19th century, that slowly changed. Since 1840, life expectancy at birth has risen about three months with each passing year. In 1840, life expectancy at birth in Sweden, a much-studied nation owing to its record-keeping, was 45 years for women; today it’s 83 years. The United States displays roughly the same trend. When the 20th century began, life expectancy at birth in America was 47 years; now newborns are expected to live 79 years. If about three months continue to be added with each passing year, by the middle of this century, American life expectancy at birth will be 88 years. By the end of the century, it will be 100 years.

Viewed globally, the lengthening of life spans seems independent of any single, specific event. It didn’t accelerate much as antibiotics and vaccines became common. Nor did it retreat much during wars or disease outbreaks. A graph of global life expectancy over time looks like an escalator rising smoothly. The trend holds, in most years, in individual nations rich and poor; the whole world is riding the escalator.

Projections of ever-longer life spans assume no incredible medical discoveries—rather, that the escalator ride simply continues. If anti-aging drugs or genetic therapies are found, the climb could accelerate. Centenarians may become the norm, rather than rarities who generate a headline in the local newspaper...
Full article link.
We all come and go unknown
Each so deep and superficial
Between the forceps and the stone
Well I looked at the granite markers
Those tribute to finality to eternity
And then I looked at myself here
Chicken scratching for my immortality
In the church they light the candles
And the wax rolls down like tears
There's the hope and the hopelessness
I've witnessed thirty years
We're only particles of change I know I know
Orbiting around the sun ...

-Joni Mitchell, Hejira


That’s how long I want to live: 75 years.

This preference drives my daughters crazy. It drives my brothers crazy. My loving friends think I am crazy. They think that I can’t mean what I say; that I haven’t thought clearly about this, because there is so much in the world to see and do. To convince me of my errors, they enumerate the myriad people I know who are over 75 and doing quite well. They are certain that as I get closer to 75, I will push the desired age back to 80, then 85, maybe even 90.

I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.

But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic...
Full article link.

My favorite "afterlife" speculation is here.

COLLEGE PARK, Maryland—Kira Adam was tired of waiting. When she first noticed the cavity about six months ago, she tried to book a dentist’s appointment, but she had trouble finding a practice that would take her Medicaid insurance.

“Every time I tried to schedule it, it was a two to three month wait” for an appointment, she told me.

The cavity got worse. When she finally did get seen, the dentist told her she would need a root canal. It would cost $1,000, and her insurance would pay nothing.

“He told me to come back when I had the money,” she said. As a baker at Panera Bread, she knew it would be a while before she did. She applied for and received a loan through CareCredit, a medical financing company, but it was a few hundred dollars short. So she waited some more—and tried to ignore the pain that was now shooting through her jaw...
Full article link.

The latter one reminds me of a New Yorker piece, one I cited years ago on one of my other blogs.
The Moral-Hazard Myth
The bad idea behind our failed health-care system.


Tooth decay begins, typically, when debris becomes trapped between the teeth and along the ridges and in the grooves of the molars. The food rots. It becomes colonized with bacteria. The bacteria feeds off sugars in the mouth and forms an acid that begins to eat away at the enamel of the teeth. Slowly, the bacteria works its way through to the dentin, the inner structure, and from there the cavity begins to blossom three-dimensionally, spreading inward and sideways. When the decay reaches the pulp tissue, the blood vessels, and the nerves that serve the tooth, the pain starts—an insistent throbbing. The tooth turns brown. It begins to lose its hard structure, to the point where a dentist can reach into a cavity with a hand instrument and scoop out the decay. At the base of the tooth, the bacteria mineralizes into tartar, which begins to irritate the gums. They become puffy and bright red and start to recede, leaving more and more of the tooth’s root exposed. When the infection works its way down to the bone, the structure holding the tooth in begins to collapse altogether.

Several years ago, two Harvard researchers, Susan Starr Sered and Rushika Fernandopulle, set out to interview people without health-care coverage for a book they were writing, “Uninsured in America.” They talked to as many kinds of people as they could find, collecting stories of untreated depression and struggling single mothers and chronically injured laborers—and the most common complaint they heard was about teeth. Gina, a hairdresser in Idaho, whose husband worked as a freight manager at a chain store, had “a peculiar mannerism of keeping her mouth closed even when speaking.” It turned out that she hadn’t been able to afford dental care for three years, and one of her front teeth was rotting. Daniel, a construction worker, pulled out his bad teeth with pliers. Then, there was Loretta, who worked nights at a university research center in Mississippi, and was missing most of her teeth. “They’ll break off after a while, and then you just grab a hold of them, and they work their way out,” she explained to Sered and Fernandopulle. “It hurts so bad, because the tooth aches. Then it’s a relief just to get it out of there. The hole closes up itself anyway. So it’s so much better.”

People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn’t, of course. The loss of teeth makes eating fresh fruits and vegetables difficult, and a diet heavy in soft, processed foods exacerbates more serious health problems, like diabetes. The pain of tooth decay leads many people to use alcohol as a salve. And those struggling to get ahead in the job market quickly find that the unsightliness of bad teeth, and the self-consciousness that results, can become a major barrier. If your teeth are bad, you’re not going to get a job as a receptionist, say, or a cashier. You’re going to be put in the back somewhere, far from the public eye. What Loretta, Gina, and Daniel understand, the two authors tell us, is that bad teeth have come to be seen as a marker of “poor parenting, low educational achievement and slow or faulty intellectual development.” They are an outward marker of caste. “Almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow,” Sered and Fernandopulle write, “the immediate answer was ‘my teeth.’ ”...
So much to dwell upon. Glad I'm now "retired."

The Atlantic is wrong about aging: Why our anti-elderly bias needs to change
In an Atlantic cover story, Dr. Ezekiel Emanuel says life after 75 isn't worth living. Here's why he's very wrong


Dr. Emanuel, now 57 years old, is smart, mature, productive and provocative in his ideas about avoiding aging. He is the age of my son, who was a colleague of his at the National Institutes of Health. At 86, I look at them both as “young” and still growing up. Unfortunately, Emanuel’s recent essay in The Atlantic — titled “Why I hope to die at 75″ — has contributed tremendously to the negative views of aging that plague our society today. I am as passionate about changing these attitudes as Dr. Emanuel is about dying less than two decades from now. So is my 51-year-old colleague and co-author, psychologist Mindy Greenstein. Why?

Dr. Emanuel’s image of life after 75 is bleak indeed: a time of deprivation and loss of creativity, a time when we are sluggish and no longer able to contribute to the world around us. He especially fears being remembered as “feeble, ineffectual, even pathetic.”

I am an elder who has treated older patients with cancer for over 35 years at Memorial Sloan Kettering Cancer Center, helping them cope with the challenges of being ill. Dr. Greenstein is a clinical psychologist and consultant to my geriatric psychiatry group. Clinical experience and much social science research refute many of Dr. Emanuel’s assumptions about life after 75. Large population studies by economists and psychologists asked adults of all ages, and from different countries, to rate their sense of well-being on a scale of 1 to 10. When they looked at the data by age, they found it had a fascinating shape: a “U.”

Self-reported well-being starts relatively high for people in their early twenties, after which time it starts to steadily decrease, particularly for the “sandwich generation.” Well-being plummets to its lowest level for people in their early fifties. After this trough, well-being starts to increase again, and keeps increasing over the years, until, by age 85, it’s even higher than it is for those in their twenties...

One more, apropos of this whole (naively cherubic, IMHO) "population health" mantra, also effusively on display at @Health2con.
Could Population Health Be Considered Discrimination?

...When the government talks about population health, they mean the entire population. When you start paying organizations based on the health of their patient population, it changes the dynamic of who you want to include in your patient population. Another possible opportunity for discrimination...
AKA "Business Intelligence," no? This issue came up briefly during one of the late day three sessions, wherein one of the panelists posed the question regarding the extent to which health care systems should be required to convey to public authorities de-ID'd patient data useful for population health analytics. Contentious, to be sure.


On "Empathy," (from an "Unmentionables" panel slide). "Broken People." Lyrics ensue at 0:30. Listen carefully. Spiritual, empathetic, compassionate. Beautifully stated. Sure to be scoffed at by the Ayn Randianistas.

When we open up our eyes,
Are we prepared to see the world with no disguise?
Will we listen to the call
Coming from a distant cry,
From a truth that we've denied,

Coming from all the broken people,
Do we even dare
Look at all the hurting people,
And show them that we care?...
It's called Health CARE, we must always remember.

Ole Borud. Magnificent young Norwegian R&B cat. Sat in with my Vegas pals. Recorded a live DVD that night. I did the cover art and photography. A great show.

More on "empathy":
Many African traditions speak of a concept known as ubuntu: “a person is a person through other persons.” Your humanity comes from the way you treat others, the idea goes, not the way you behave in isolation. Humanity comes from treating others as human beings, not in the biological sense of having a fully human body but in the psychological sense of having a fully human mind.
From the book Mindwise, cited in one of my recent posts (scroll down). The way you treat others is to a material degree a function of the extent (and accuracy) of your empathic view of them. How well can you put yourself "in another's shoes"? How much do you even care to try to do so?


That presentation blew my mind. Restoring long-term memory via digital hippocampus implants? Recall my goofy Photoshop from one of my prior posts?

Military's Tiny Implant Could Give People Self-Healing Powers
The Huffington Post, By Dominique Mosbergen, 09/26/14

If a tiny device could be implanted in your body to give you self-healing powers, would you want one?

That question is on many minds now that the Defense Department's Advanced Research Projects Agency (DARPA) has announced that just such a device is in the works: an electronic implant, injected via a needle, that would monitor the health of internal organs and help the body heal itself when illness or injury strikes.

The implant -- being developed as part of the agency's ElectRx (pronounced “electrics”) program -- would “fundamentally change the manner in which doctors diagnose, monitor and treat injury and illness,” DARPA program manager Doug Weber said in a written statement.

“Instead of relying only on medication -- we envision a closed-loop system that would work in concept like a tiny, intelligent pacemaker," Weber continued. "It would continually assess conditions and provide stimulus patterns tailored to help maintain healthy organ function, helping patients get healthy and stay healthy using their body’s own systems."

There's no word yet on when such a device might become available, but a spokesman for the agency said clinical trials might begin within five years.

DARPA says the ElectRx implant would work via a process akin to neuromodulation. That's the body's built-in biological feedback system in which the peripheral nervous system -- the nerves linking the brain and spinal cord to the rest of the body -- monitors and regulates the body’s response to injury and infection...

'eh? Lurching toward "Singularity" piecemeal?

Below: Recently read this (mostly firewalled) article in my Harper's:

Neuroscientists who work on the human brain seldom mention free will. Most consider it a subject better left, at least for the time being, to philosophers. Meanwhile, their sights are set on discovering the physical basis of consciousness, of which free will is a part. No scientific quest is more important to humanity. Everyone — scientists, philosophers, and religious believers alike — can agree with the neurobiologist Gerald Edelman that “[c]onsciousness is the guarantor of all we hold human and precious. Its permanent loss is considered equivalent to death, even if the body persists in its vital signs.”

The physical basis of consciousness won’t be an easy phenomenon to grasp. The human brain is the most complex system, either organic or inorganic, known in the universe. Each of the billions of nerve cells (neurons) composing its functional part forms synapses and communicates with an average of ten thousand others; each launches messages along its own axon pathway using an individual digital code of membrane-firing patterns. The brain is organized into regions, nuclei, and staging centers that divide functions among them. These regions respond in different ways to hormones and sensory stimuli originating from outside the brain, while sensory and motor neurons all over the body communicate so intimately with the brain as to be virtually a part of it...
Philosophers have labored for more than two thousand years to explain consciousness. Innocent of biology, however, they have for the most part gotten nowhere. I don’t believe it too harsh to say that the history of philosophy when boiled down consists mainly of failed models of the brain. A few contemporary neurophilosophers, such as Patricia Churchland and Daniel Dennett, have made splendid efforts to interpret neuroscience research as it has become available. They have helped to demonstrate, for example, the ancillary nature of morality and rational thought. Others, especially those of poststructuralist bent, are more retrograde. Theydoubt that the “reductionist” or “objectivist” program of brain researchers will ever succeed in explaining the core of consciousness. Even if it has a material basis, subjectivity in this view is beyond the reach of science. To make their argument, the mysterians (as they are sometimes called) point to the qualia—the subtle, almost inexpressible feelings we experience about sensory input. For example, “red” we know from physics, but what are the deeper sensations of “redness”? And if we can’t answer that, then what can scientists ever hope to tell us on a larger scale about free will or about the soul?

Neuroscientists, to their credit, have no illusions about the difficulty of the task. They agree with Darwin that the mind is a citadel that cannot be taken by frontal assault. They have set out instead to break through to its inner recesses with multiple probes along the ramparts, opening breaches here and there; by technical ingenuity and force they hope to enter and explore wherever they find space to maneuver. 

You have to have faith to be a neuroscientist. We don’t know where consciousness and free will may be hidden—assuming they even exist as integral processes and entities. Meanwhile, neuroscience has grown rich, primarily because of its relevance to medicine. Its research projects are growing on budgets of hundreds of millions to billions each year (in the science trade it’s called Big Science). The same surge has occurred in cancer research in designing the space shuttle, and in experimental particle physics.

Perhaps, then, a direct assault is possible after all. The Brain Activity Map (BAM) Project, led by the National Institutes of Health, has the goal of generating a map of the activity of every neuron in real time. The program, if successfully funded, will parallel in magnitude the Human Genome Project. Much of the technology will have to be developed on the job.

The basic goal of activity mapping is to connect all of the processes of thought—rational and emotional; conscious, preconscious, and unconscious; held still and moving through time—to a physical base. It won’t come easy. Bite into a lemon, fall into bed, recall a departed friend, watch the sun sink beyond the western sea. Each episode comprises mass neuronal activity so elaborate we cannot even conceive of it, much less write it down as a repertory of firing cells...

Edward O. Wilson is the author of more than thirty books, including two Pulitzer Prize winners. His new book, The Meaning of Human Existence, will be published in October by Liveright. 

I seriously look forward to that book.

Note on the word "philosopher." It derives from the ancient "philo" (love) "sophia" (knowledge). "Lover of knowledge," not the inscrutable, pedantic, hyperpseudoerudite ivory tower MEGO babbler we frequently conjure up upon encountering the term.



THCB comment today (Friday)


From the always astute Neil Versel:
Health 2.0 grows up to fight silos
Gone are the 'flighty, flaky' ideas of 2007, in is focus on connecting disparate systems.
SANTA CLARA, CA | September 26, 2014

Now in its eighth year, the annual Health 2.0 Fall Conference has evolved from a showcase for not-ready-for-prime-time apps that wouldn't exist a year later to a self-congratulatory Silicon Valley pep rally to a more mature event that seems to be addressing real-world healthcare problems.

Health 2.0 Conference co-founder and CEO Indu Subaiya, MD, opened the conference by saying that in her mind, there are four stages of health 2.0. The original definition of health 2.0, now considered stage 1, is user-generated care. From there, users connect to providers to send their data; form partnerships to reform care delivery; and, ultimately, data drives healthcare decisions and discovery, Subaiya said.

Like the rest of the healthcare industry, the health 2.0 movement is hard at work on the second stage, namely connecting disparate systems so data flows where patients and clinicians want it to. As with everyone else, it appears to be a formidable task, plus, so many new apps risk creating new data silos...
Good assessment of @Health2con, IMO. My "Interoperababble" concerns persist, though.


If It Looks Like A Bubble, And Quacks Like A Bubble ...
Todd Hixon, for Forbes
Then it’s best not to build your house on it. Silicon Valley sure looks like a bubble to me, and many others think so too. While these are heady times, it’s actually very difficult to start new investments. Some back-to-basics thinking is the best way to mitigate the risk.

I spent several days at a conference in Silicon Valley recently and then visited venture capital friends on Sand Hill Road. The venture capital market there is dramatically different from the rest of the U.S., even New York, which is having a good run...

At the Health 2.0 conference, which I attended, there was much moxie on display, including a digital health wearables fashion show complete with a runway and a custom music mix. I heard comments, however, that digital health investors are starting to see a lot of me-too offerings: if you closed your eyes and walked 100 feet, you’d bump into three companies selling systems to reduce hospital re-admissions.

Many VCs are wondering, how do you invest into this market with a decent chance of success? If you are chasing the companies that have visibly achieved “escape velocity” in their markets, you are competing with the great names and greater check books. Only a handful can succeed in that game. And then you pay a price based on perfection and bet on continuation of aggressive growth financings and a hot IPO market.

If you play at the seed level, you compete with the host of angels, accept weak terms, and invest in companies in which entrepreneurs may be on their own because seed investors often can’t help, don’t spend the time, or lack governance levers when the going gets tough. And occasionally the big funds reach down and take over an early financing with a big check at a high price, squeezing other investors out. One VC blogger calls this a “piggy round”.

Burn rates are running $500k to $1 million per month and up, in many cases (more). This presumes the ability to keep financing on favorable terms. If not, the blood quickly gets ankle-deep.

This market dynamic looks delicate to me. While the Internet continues to grow and entrepreneurs keep finding new opportunities, the sources of money fueling much of the boom are fickle. The scope of the hot segments market is narrow: largely confined to Silicon Valley and a half-dozen sectors. If the end comes fast, many companies will quickly be in mortal jeopardy: burn rates, valuations, and capital structures will be crushed...
Ouch. "[I]f you closed your eyes and walked 100 feet, you’d bump into three companies selling systems to reduce hospital re-admissions." LOL. My first assignment in 1993 with the Nevada Peer Review (QIO) involved running Stata code against HCFA claims data (pdf), mining for, among other things, 5- and 30-day acute care readmit causally inferential associations.

More to come...

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