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Saturday, January 5, 2019

Digital Health Tech growth notwithstanding, we're "not any healthier?"

Intrepid CNBC journalist @chrissyfarr poses a core question.

Lots to address there, much of it perhaps above my pay grade (but, then, I no longer have a "pay grade"). First, can we accurately (scientifically) quantify (relatively) "healthier, as a society?" Might we find multiple dueling definitions, and/or differing trends within various socioeconomic strata (the latter likely the case, IMO)? apropos, see Beth Macy's riveting book "Dopesick" (review here, scroll down).

Second, all the noble, high-minded health digitech startup making-the-world-a-better-place rhetoric aside, Venture Capitalists' priorities necessarily remain profitable "exits" launching from the shortest feasible "runways."  Should that entail delivering "improved health" in the process, so much the better.
Also, as my medical economist friend JD Kleinke pointed out in a Facebook response, there's the "affluent worried-well early-adopter" self-selection bias. A lot of novel health digitech skews toward the already fit.
Third, see my recent post "Population health and an aging world."

Fourth, ironically, the more clinical (and consumer-facing) data to which we gain access, the more we realize how much more we really need to improve both dx accuracy and px/tx efficacy. Availability of "data" grows exponentially (much of it "noise," unfortunately). Available time for its effective clinical analysis and utilization remains fixed -- at best.

Finally for now, see my prior posts on "climate change and health impacts." Evidence accrues that the impacts are no longer hypothetical, far-off abstractions and theories.

Stay tuned. This post will likely accrue episodically across the next few days.

First, this STATnews piece is timely and interesting:

The pull of JPM may be irresistible, but will San Francisco’s problems push people away?
By ADAM FEUERSTEIN @adamfeuerstein, REBECCA ROBBINS @rebeccadrobbins, and DAMIAN GARDE @damiangarde JANUARY 4, 2019

SAN FRANCISCO — If you were to ask health-care and biotech executives where they want to be next week — where they truly want to be — they will not say San Francisco. Anywhere, they will say, but San Francisco.

There’s the garbage and the human excrement on the sidewalks. There’s the mad dash to try find available accommodations. There’s the panhandling, evidence of the city’s handling of its worsening homelessness crisis. Oh, and there’s the $14,000 meeting cubicles and the coffee, available (this is true) for $170 per gallon.

And yet everyone who’s anyone will be here during the four days of “JPM Week” — the biotech industry’s largest and most important business and networking meeting, headlined by the J.P Morgan Healthcare Conference…
Hmmm... It has not escaped my notice that there's no Health 2.0 WinterTech Conference this January (it ran concurrent with JPM Week). Neither did they put on a Technology for Precision Health Summit in December 2018 (both of them hosted in SF). Also, the AARP Innovation@50+ Pitch Conference has disappeared.



A dear long-time friend of ours (she's a a nuclear engineer who worked for my wife) turned us on to this documentary:


Just watched all of it. I find it at once very interesting and rather troubling. In any event, it coheres nicely with this book I'm now deep into:

Jan 6 update: I finished this book. He concludes,
Fighting the obesity epidemic will require a radical change in our attitude toward food and eating. We will need to view many types of food as potentially dangerous, requiring caution and regulation. We will need to think much more strategically about such life choices as our employment, housing, family structure, habits of daily living, locomotion, commuting, and recreational activities. There may come a time when we respond with horror to stories of friends spending the day on a couch watching television, just as we today look back in shock at nineteenth-century tales of multi-day binges in a local opium den. We will need to reconsider our education systems, our embracing of choice, and the limits of parental authority over children’s eating habits. We will need to redesign our built environments and reconsider our perceptions of appropriate automobile use. We will need to rethink the costs of tolerating overly long work shifts, over-scheduled children, and disrupted family mealtimes. That is, we will need to do all of this if we wish to lose weight and prevent our children from dying prematurely. 

If we continue on our current trajectory, we have every reason to believe that our present problem will grow worse. Given our natural inclination to sloth, our rapacious appetite for sugar and simple starches, our hyper-mechanized and unwalkable environments, our sedentary work styles, and our inadequate control over our own eating, there is little to stop us from growing ever fatter. Diabetes, heart disease, joint pain, physical discomfort, professional and social failure, and early death await us if we continue as we have been.

Engel, Jonathan. Fat Nation (Kindle Locations 2788-2800). Rowman & Littlefield Publishers. Kindle Edition.
Excellent scholarship and analysis, right down to the biochemical molecular level. Excellent writing. Jonathan is all over it.

BTW, Science-Based Medicine is not a big of fan of "What The Health." They have not (yet) reviewed "Fat Nation." There's a Slate review here.

Another relevant book I ran across over at Science Magazine:

"Is it shocking that many food companies do whatever they can in the name of fatter profits? Maybe, but it’s old hat for Nestle, who has spent five decades honing her expertise and is a leading scholar in the field of nutrition science. In this book, she details nearly every questionable food company tactic in the playbook, from companies that fund their own food science research centers and funnel media attention to nondietary explanations for obesity, to those that cherry-pick data or fund professional conferences as a plea for tacit approval..."


Meanwhile, the health of Ranger the 91 lb Rescue Puppy remains a mixed bag a year on (our son found him running loose late one night last January in the Delta just west of Sacramento, no tags, no chip, dirty piece of rope for a "collar").

Real piece of work, this dog. Estimate he's now about 4 yrs old. We've now had to resort to "compounding pharmacy" custom Rx ($$$) for those intractably infected ears. I joke that he's gonna need a veterinary GoFundMe page.

He is a joy, though. Mr Amiable. Nice family room leather sofa ya got there, Ranger.


Time to hang 'em up?

I've had a really good, fun run, just for the pro bono fun of it. What began as pretty much an ongoing photography-augmented online diary of my REC Meaningful Use job and health digitech conference coverage has simply continued on. 800,000+ hits later, people keep reading, so I keep posting. But, nearly six years out of the EHR trenches, my tech observations are increasingly viewed-at-a-distance speculative and theoretical. And, my chops are not all that robust as a "Futurist."

I've got some ideas on what priorities to segue to in the year ahead. Still pondering them. Still recovering from our searing 2018. Just grateful to be alive.

Speaking of conferences,

In 2012, on a lark, I applied for a press pass, given that they were in Las Vegas that year, where I was living and working in the Meaningful Use program.

To my complete surprise, they granted it.

This is the Biggie, the "Comdex / CES" of Health IT (though, the annual IHI Forum is no slouch). Estimating ~45,000 attendees this year at HIMSS19.

More to come...

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