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Thursday, December 27, 2018

2019 in the health care space?

"I never make predictions, especially about the future." - Yogi Berra
"The great thing about being a health care futurist is that you never have to update your slides." - Health Care "Futurist" Ian Morrison
LOL. Ian also once quipped during a Health 2.0 Conference Keynote "I've got slide decks older than some of my clients."

Below: this is an actual thing.

"APF." Not kidding. Hmmm... Wonder if Ian is a member? (As well as my equally cool Futurist friend Joe Flower? And, how about Jacob Ward?)
From the APF website: "What is a Futurist? A professional futurist is a person who studies the future in order to help people understand, anticipate, prepare for and gain advantage from coming changes." Okeee-dokee, then. "studies the future"? (Wiki page on "Futurist.")
Michael Burry MD, now there was "Futurist" ("The Big Short" guy).

Stay tuned. Just got home from a Christmas trip back to the Baltimore area to see our son Matt. Met the most gracious, spectacular people in his circle. Stayed silent about being gone on social media, for what should be obvious reasons.

First, some random stuff in the waning 2018 days.

Finished this book while gone:

Highly recommended. A comprehensive, scholarly, accessible (and non-partisan) history of the evolution of the space. From the Amazon blurb:
Written for nonexperts, this is a brisk, engaging history of American healthcare from the advent of Medicare and Medicaid in the 1960s to the impact of the Affordable Care Act in the 2010s. Step by step, Jonathan Engel shows how we arrived at our present convoluted situation, where generic drugs prices can jump 1,000 percent in a day and primary care physicians can lose 20 percent of their income at the stroke of a Congressional pen.

Unaffordable covers, in a conversational style punctuated by apt examples, topics ranging from health insurance, pharmaceutical pricing, and physician training to health maintenance organizations and hospital networks. Along the way, Engel introduces approaches that other nations have taken in organizing and paying for healthcare and offers insights on ethical quandaries around end-of-life decisions, neonatal care, life-sustaining treatments, and the limits of our ability to define death. While describing the political origins of many of the federal and state laws that govern our healthcare system today, he never loses sight of the impact that healthcare delivery has on our wallets and on the balance sheets of hospitals, doctors' offices, government agencies, and private companies.
I'm already rather well-read up on this type of material, but Jonathan's was thoroughly enjoyable and instructive nonetheless. I would encourage everyone to read it, health care professionals and lay people alike.

Gonna be starting his latest release shortly.

Again, the Amazon blurb:
The diet and weight-loss industry is worth $66 billion – billion!! The estimated annual health care costs of obesity-related illness are 190 billion or nearly 21% of annual medical spending in the United States. But how did we get here? Is this a battle we can’t win? What changes need to be made in order to scale back the incidence of obesity in the US, and, indeed, around the world? Here, Jonathan Engel reviews the sources of the problem and offers the science behind our modern propensity toward obesity. He offers a plan for helping address the problem, but admits that it is, indeed, an uphill battle. Nevertheless, given the magnitude of the costs in years of life and vigor lost, it is a battle worth fighting.

Fat Nation is a social history of obesity in the United States since the second World War. In confronting this familiar topic from a historical perspective, Jonathan Engel attempts to show that obesity is a symptom of complex changes that have transpired over the past half century to our food, our living habits, our life patterns, our built environments, and our social interactions. He offers readers solid grounding in the known science underlying obesity (genetic set points, complex endocrine feedback loops, neurochemical messengering) but then makes the novel argument that obesity is a result of the interaction of our genes with our environment. That is, our bodies have always been programmed to become obese, but until recently never had the opportunity to do so. Now, with cheap calories ubiquitous (particularly in the form of sucrose), unwalkable physical spaces, deteriorating rituals and norms surrounding eating, and the withering of cooking skills, nearly every American daily confronts the challenge of not putting on weight. Given the outcomes, though, for those who are obese, Engel encourages us to address the problems and offers suggestions to help remedy the problem.
Hmmm... this quote comes to mind:
“Medicine is supposed to be about helping you through the accidents — the misfortune of a genetic disease, the misfortune of a trauma, the misfortune of some pathogen. Nobody went to medical school to babysit someone through a life of self-inflicted misery because of two deadly habits: sedentarism and excessive consumption of refined carbohydrates.”Greg Glassman, CEO, CrossFit Health
Glassman has a point, but I think things are a good bit more complex than that.

Like I said, stay tuned. lots to ponder and write about (still dragging my butt finishing up several other books in chronic, halting progress). We got home about 1 a.m. Gotta go fetch the dogs from vet/boarding. Can't wait to see that bill. Ranger is still having persistent ear infection problems.


From my latest hardcopy snailmail edition of Science Magazine:

apropos of my prior riffs on climate change,
…[T]he deeper cause of the ecological crisis: a pervasive worldview that imbues the trends of more with a cachet of inevitability and legitimacy. This worldview esteems the human as a distinguished entity that is superior to all other life forms and is entitled to use them and the places they live. The belief system of superiority and entitlement—or human supremacy—manifests in a range of anthropocentric commonplace assumptions, linguistic constructs, institutional regimes, and everyday actions of individual, group, nation-state, and corporate actors. For example, the human is invested with powers of life and death over all other beings and with the prerogative to control and manage all geographical space. The all-encompassing manifestation of the belief system of human supremacy is precisely what constitutes it as a worldview…
From "Reimagining the human."
Beyond Human Dominance
The dominant framework of tech
nofixes, technological schemes, and fine-tuning efficiencies is by itself no match for the tidal wave of human expansionism expected in this century. Looming before us is the imminent escalation of food, energy, materials, and commodities production, and resulting increases in wildlands destruction, species extinctions, wildlife extirpations, freshwater appropriation, ocean degradation, extractionist operations, and the production of industrial, pesticide, nitrogen, manure, plastic, and other waste—all unfolding amid climate-change ordeals.

In the face of this juggernaut, a singular focus on a techno-managerial portfolio seems fueled by a source other than pragmatism alone. That portfolio—which would include such initiatives as climate geoengineering, desalination, de-extinction, and off-planet colonization—is in keeping with the social rubric of human distinction. The prevalent corpus resonates with a Promethean impulse to sustain human hegemony while avoiding the most expeditious approach to the ecological predicament—contracting humanity's scale and scope by means that will simultaneously strengthen human rights, facilitate the abolition of poverty, elevate our quality of life, counter the dangers of climate change, and preserve Earth's magnificent biodiversity.

To pursue scaling down and pulling back the human factor requires us to reimagine the human in a register that no longer identifies human greatness with dominance within the ecosphere and domination over nonhumans…
 Good luck scaling back our speciocentric hubris.

See all the articles under Tomorrow's Earth.



Interesting, in light of the foregoing on "reimagining the human." From The Atlantic:
An Elephant’s Personhood on Trial
A legal case involving a famous solitary elephant poses a fundamental question about animals’ rights.
"Personhood?" Yeah. Some of us want to bestow it on human zygotes.

BTW, see EO Wilson's "Half Earth."


This issue is jammed with great stuff. to wit,

Revealing the brain's molecular architecture
The PsychENCODE Consortium

The brain, our most complex organ, is at the root of both the cognitive and behavioral repertoires that make us unique as a species and underlies susceptibility to neuropsychiatric disorders. Healthy brain development and neurological function rely on precise spatiotemporal regulation of the transcriptome, which varies substantially by brain region and cell type. Recent advances in the genetics of neuropsychiatric disorders reveal a highly polygenic risk architecture involving contributions of multiple common variants with small effects and rare variants with a range of effects. Because most of this genetic variation resides in noncoding regions of the genome, establishment of mechanistic links between variants and disease phenotypes is impeded by a lack of a comprehensive understanding of the regulatory and epigenomic landscape of the human brain…
Man, I've been reading all day. My brain is tired...

Developments in the neuroscience area will likely enhance progress in AI/ML, I would think. Expect significant advances in the coming year.


This book was reviewed in this foregoing cited issue of Science Magazine:

"Off topic?" Nah.
...Maybe it’s a tinkerer’s curiosity that turned me into a scientist. Early on, physics allowed me to explore the sprockets and gears of the universe and the very forces that control our lives. Looking for more challenges, I turned later to the complexities of networks and data. For a vigilant asker-of-questions, I’ve chosen the right corner of the scientific world to call home. As long as a line of inquiry is based on numbers—the more the merrier—I can pursue it doggedly, following its scent through the maze of data now available to researchers in our hyper-connected, technological world. Hunting down an answer inevitably leads to more questions, new possibilities that hover like gnats on the periphery of any research I conduct. I try to swat them away and stay focused on the task at hand, but I’m not that different from the kid I once was, stubbornly asking “Why?” in response to… well, pretty much anything. It is the quest for answers that gets me up in the morning and keeps me up at night.

These days I run the Center for Complex Network Research, in Boston, where my job is exploring the “why” behind topics as varied as how people or molecules interact, where and how links form, and what our interconnectedness can tell us about society or our biological origins. We’ve examined the topology of the World Wide Web. We’re looking at how tiny hiccups in our genetic networks lead to disease. We’re exploring how our brains control their billions of neurons and how molecules in food attach to our proteins, ensuring our long-term health.

I love this kind of stuff—the math behind our social fabric, the way numbers provide a framework for understanding the essence of our connectedness. When I use models and tools to delve into unlikely topics for scientific analyses, these frameworks inevitably deepen our knowledge…

Barabási, Albert-László. The Formula (pp. 4-5). Little, Brown and Company. Kindle Edition.
So much to learn, so little time.


Stay tuned. For openers, Forbes' "Top 8 Healthcare Predictions for 2019." Not sure that I'm buyin' a lot of that at first blush.

Erratum: BobbyG on "The Future of Science" in 2016.

It’s December 30, 2018.

Healthcare is complex. Simple solutions are useless. Any simple picture of the future is a lie. Simple techno-optimism or innovationist neophilia get us nowhere…

Simple futurism is entertainment. It points at each shiny thing—AI, contractual blockchain, virtual worlds, augmented reality, cell transformation, haptic rebuilds—and says, “Wow! Look at this.” It’s a Jetsons way of looking at the future, as real as using the Flintstones as a guide to the past.

Thinking about the future is a complex business. It requires clarity, penetration, a broad view, and the insights of complexity science. Futurism based on the insights of complexity is a tool for thinking, planning, strategizing…

These skills can be learned…

A futurism based on complexity looks at every element, shiny, dull, or invisible, and asks:

  • “What is it for?”
  • “How does it get its energy?”
  • “How does it affect other elements?”
Complex futurism can connect the dots and the 3-D networks of dots building out over time to paint the pictures of future scenarios, of ways the future could really turn out, what will take us there, and what strategies we might employ to meet them…

Healthcare is changing — consolidation, new tech, political chaos, a vast and growing IT overburden, shifting rules, ever-rising costs, new solutions, business model experiments. And it will continue to do this for some time...


Via STATnew:
What will 2019 bring for science and medicine? We asked the experts

Just got what will likely be my last 2018 Humana EoB statement in the mail. Year-to-date (thru 12/24) "total billed charges," just a tad more than $544,000 (those BS "chargemaster" prices). Mostly evrything having to do with a minor surgery (large inguinal hernia) and a major one (open heart aortic valve replacement).

I have no way to know which providers actually got how much (the Medicare, Humana, and Silverscripts EoBs across the year each run to many pages of obtuse FFS detail). And, I've not really tallied up my own 2018 OoP (out-of-pocket). It was plenty.

Suspect that in the aggregate, reimbursements have been on average perhaps ~25% of "list." Fair?

More to come...

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