Haven -- the joint health care venture by Amazon, Berkshire and JPMorgan -- is shutting down - CNN

Rich companies and investors with tremendous cash reserves often try to add health care to their book of companies.  Not many are successful.  Often their ventures last one to three years due to their unprofitability due to lack of demand for their services (often because there is much competition for others who have much more experience.   I try to be optimistic as to their intentions, thinking they are here to help, but more often than not there is a profit motive. These folks really do not have a clue about providing health care when they come at it from a consumer or business approach.  Those in health care already are more altruistic and continue to operate at a loss, until a financial backer, bank or otherwise begins to lose money on their own stake in the game.  

Haven, an ambitious health care company formed just three years ago as a partnership between Amazon, Warren Buffett's Berkshire Hathaway and JPMorgan Chase is shutting down.  The only thing the investors did correctly was to hire Atul Gwande M.D, a well-respected medical writer, researcher and surgeon. Always willing to have additional income he accepted the position as COO. However after 12 months, he recognized the perverse incentives and lack of forethought forming Haven, he bailed out.  His reputation remains only slightly blemished the brush with entrepreneurs. 

"Haven will end its operations at the end of February," said Haven spokesperson Brooke Thurston in an email to CNN Business. The news was first reported by CNBC.

Why Haven Healthcare Failed HBR

Insufficient Market Power

Perverse Incentives

Poor timing

The venture was created in 2018 with the goal of helping provide better health care services and insurance at a lower cost to workers and families at these three leading American firms -- and potentially to other US companies as well.

But Haven had struggled to make inroads beyond its three partners since its inception. Haven CEO Atul Gawande stepped down last May and chief operating officer Jack Stoddard also left the firm in 2019 after just a few months' tenure.

JPMorgan CEO Jamie Dimon wrote in an email to employees, "Haven worked best as an incubator of ideas, a place to pilot, test and learn -- and a way to share best practices across our companies. Thurston told CNN Business that "moving forward, Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. will...continue to collaborate informally to design programs tailored to address the specific needs of our individual employee populations and locations." Amazon was encouraged by it's foray into buying a pharmacy, relabelling it "Pillpak" and applying some of. its experience with unique packaging and mail orders. It probably did not require much capitalization to purchase an already existing pharmacy (mail order) and adopt their rich experience in software and shipping experience.

 The original three partners did not have a focused goal for the new entity. Operationally it was established as a tool for their own enterprises, and their own employees.  The plan was to throw money at the wall, and see if stuck, and go on from there. 

The risk became apparent when their easy money becomes hard and they withdrew.  Business people are averse to any loss in the short or long term unless they see profits within a reasonable time.  Knowledgeable people know healthcare is not a profit center.  It is there to maintain people's health, for better or worse. It is a never-ending struggle. 

Berkshire Hathaway, run by billionaire Warren Buffett, has recently been looking for bargains in the health care sector.

Berkshire disclosed in November that it bought shares of Covid-19 vaccine developer and Big Pharma leader Pfizer (PFE) in the third quarter. Buffett's firm also invested in AbbVie (ABBV), Bristol-Myers Squibb (BMY) and Merck (MRK).

Haven -- the joint health care venture by Amazon, Berkshire and JPMorgan -- is shutting down - CNN

Primary Care Doctors Look at Payment Overhaul After Pandemic Disruption

Three-quarters of the more than 500 doctors contacted in an online survey by McKinsey & Co. said they expected their practices would not make a profit in 2020.
A study in the journal Health Affairs, published in June, put a hard number on that. It estimated that primary care practices would lose an average of $68,000, or 13%, in gross revenues per full-time physician in 2020. That works out to a loss of about $15 billion nationwide.

The pandemic impacted an already festering economic climate for primary care physicians as well as specialty physicians. Surgical and other specialists such as Radiologists who depend upon referrals, and the ability to perform routine procedures also saw a precipitous decrease in volume and income.

The addition of telehealth worked well for patients, however, it did not offset the decrease in-office visits.  The saving grace was emergency authorization for reimbursement of telehealth visits by CMS, Medicaid, and private payers.

Primary Care Doctors Look at Payment Overhaul After Pandemic Disruption

The Silent Pandemic--Malaria

The general public knows little about this ongoing tragedy. The  World Health Organization knows about it, and some wealthy philanthropists (Bill and Miranda Gates Foundation) fund vaccine efforts for Malaria and HIV/AIDS.  Great progress has been made against HIV/AIDS when funds become available for these efforts.

Culex Larva growing in water, developing into mosquitoes

which transmits the Plasmodium parasite,

Malaria is a life-threatening disease transmitted to humans by infected mosquitoes. In 2018 alone there were 228 million cases and 405,000 deaths worldwide, affecting mostly children under five years of age. Scientists have long been looking for an effective vaccine, but haven’t yet been able to produce one.

Culex and Plasmodia have a complex life cycle, the mosquito, and a vector and warm-blooded animals as a host.

As weird as it seems, spit actually seems to play a big role in how blood-sucking bugs transmit infections to humans (or other animals) that they feed on.

Red blood cells with an intracellular plasmodium parasite. (see life cycle video above)

Malaria vaccines have been developed in the past, with varying results. 1,2,3,4

Malaria is predominant in Africa, however certain genetic mutations that cause sickle cell anemia afford resistance to the parasite. The gene is most prevalent in people of African descent.

A new malaria vaccine made from the rodent malaria parasite is effective in humans

Warnings about the Use of Dietary Supplements.

While the age of health and wellness and good nutrition are upon us, the marketplace is overrun about natural supplements. 

These supplements are regulated by the Federal Food, Drug, and Cosmetic Act (FDCA). It is enforced by the Department of Justice.  Despite the regulations, supplements are sold which do not meet the requirements, nor have ever been subject to regulation.  Many are imported from foreign countries and manufactured in uninspected facilities.

 The United States Court for the Eastern District of New York has permanently enjoined a New York company and its operators from manufacturing or distributing dietary supplements unless and until they comply with the law, the Department of Justice Civil Division’s Consumer Protection Branch, and the United States Attorney’s Office for the Eastern District of New York announced today.

A complaint filed May 23, 2019, alleged that defendants Confidence USA Inc., of Port Washington, New York, the company’s president Helen Chian, and manager Jim Chao violated the Federal Food, Drug, and Cosmetic Act (FDCA) by distributing adulterated dietary supplements. The complaint alleged that inspections conducted by the U.S. Food and Drug Administration (FDA) in 2016, 2017, and 2018 showed that the defendants repeatedly failed to verify that their finished dietary supplements met product specifications for identity, purity, strength, composition, and contamination limits, and failed to verify the identity of each dietary ingredient used in the manufacture of the supplements. The United States filed the complaint in U.S. District Court for the Eastern District of New York at the request of the FDA.

According to the complaint, the defendants made and distributed more than 50 dietary supplements under brand names that include Confidence USA, American Best, USA Natural, and The Herbal Store.

The current opioid addiction has stimulated the marketing of some herbal compounds alleged to aid withdrawal symptoms (Kratom)

“Despite our warnings, companies continue to sell this dangerous product and make deceptive medical claims that are not backed by science or any reliable scientific evidence,” Ned Sharpless, the current acting FDA chief, said in a statement. “As we work to combat the opioid crisis, we cannot allow unscrupulous vendors to take advantage of consumers by selling products with unsubstantiated claims that they can treat opioid addiction or alleviate other medical conditions.

Kratom, the herb of last resort was used by opioid users in the period 2011-2017 despite reports of illness, and deaths.   Investigations revealed troubling incidents, side effects, and deaths of people using Kratom

District Court Orders Long Island Company and its Operators to Stop Distributing Adulterated Dietary Supplements | USAO-EDNY | Department of Justice

OrCam Read - For theVisually Impaired

This is a well-designed device that converts text to speech.  It has been designed for all visually impaired people.  The video explains the OrCam Read.  It is expensive.  While there are other devices for the 'low vision' community, they are inadequate in many circumstances.

Many of these patients are in the senior group, covered by Medicare.  However Low Vision devices, magnifiers, or optical lenses are NOT covered by CMS.  In 2017 H.R. 2050 was proposed by Rep. Carolyn Maloney (D N.Y.). However, it was not passed.  CMS reimburses for other aids, such as wheelchairs, crutches, and other ambulatory aids.  Vision is certainly necessary to ambulate safely.

This a glaring discrimination again low vision patients.   It is expensive however it can be purchased over time at a reasonable rate.  CMS often leases expensive wheelchairs or another prosthesis.  Why not the Orcam.  I urge you to call your representative today to lobby for the legislation to be reintroduced and ask them to sign on to the bill.

Please consider signing the petition. You will find it at change.org.

OrCam Reader

Some Covid-19 Vaccines Are Effective After One Dose, Can Be Stored in Normal Freezers, Data Show - WSJ

In a win for global vaccination goals, the BioNTech-Pfizer (Moderna)vaccine is shown to generate a strong response with one dose and to maintain potency in standard freezers for two weeks.

The daily story of the covid19 vaccine is a story of poor logistics and outright lies.  The plan for distribution was not well thought out.  Perhaps it was written down in a "playbook" and it was not implemented as written.  Although the vaccine was developed in record time, the amounts to be produced were exaggerated to fit political ambitions during a year of a Presidential election.  It was delayed by political rhetoric, and the covid pandemic itself requiring distancing, masking, and sanitizing requirements.   It is an ongoing learning experience.

The Israel's seem to have a leg up with their process. This is no surprise, it is a small country of about 8-10 million, with a universal health care system. There is a centralized health information system

https://www.wsj.com/21e48f86-5968-47d4-b508-a418d0056e5f










Some Covid-19 Vaccines Are Effective After One Dose, Can Be Stored in Normal Freezers, Data Show - WSJ: In a win for global vaccination goals, the BioNTech-Pfizer vaccine is shown to generate a strong response with one dose and to maintain potency in standard freezers for two weeks.

Build a Revolutionary Healthcare Model

I hear many organizations bandying terms like Exponential Medicine, The Future of Medicine , Singularity, Precision Medicine, Personalized Medicine, and many others. Health care delivery has changed radically during the past ten years.  2020 presented a crisis that stimulated the use of already existing technology that had been under-utilized.

One of the most comprehensive patient-centered models of health care is that of "Forward" Forward is a revolutionary startup with offices in San Diego, San Francisco, Newport Beach, Glendale, and San Diego California.

It is funded by 24 private investors, initiated in 2015, with its headquarters in San Francisco.. Funding off 

Forward came inin January 2016 by former executives and engineering leaders from Google and Uber and led by serial entrepreneur Adrian Aoun. Forward was funded by some of the world's best

investors and entrepreneurs including First Round Capital, Eric Schmidt (Google/Alphabet chairman), Marc Benioff (Salesforce founder), Joe Lonsdale (Palantir founder), Joshua Kushner (Oscar co-founder), and Garrett Camp (Uber co-founder)

Forward Medical Lead, Dr. Nate Favini provides an in-depth tour of one of Forward's clinics, highlighting our biometric monitoring technology, rapid blood testing, genetic analysis, and more. Learn about how Forward's top-rated doctors leverage advanced technology to take a preventive approach to healthcare.

The video details the appearance of the clinic, it's examination rooms and the innovative means of gathering critical vital signs, as well as laboratory work, including genetic analysis.

Forward's stated goals are  Preventive primary care, powered by technology. On a mission to bring healthcare to the people who need it most.  Forward is a new approach to primary care that combines world-class doctors and leading-edge technology. Control the future of your health.

Forward Careers - Help Build a Revolutionary Healthcare Model

The methamphetamine crisis silently burns in the background. – Scientific Inquirer

Public attention has been drawn to the 'Opioid Addiction" drugs which are legally prescribed for pain management.  The misuse of these useful medications was fueled by overzealous prescribing by physicians and marketing by unscrupulous pharmaceutical companies. 

Several large previously reputable pharmaceutical companies (privately owned) were brought down by the opioid scandal (Purdue), and a rich philanthropic family's wealth destroyed by multiple large judgments (states) who sued for damages for medical treatments and therapy for addicted patients.  This will serve as a warning to those in the future who plan to profit from marketing dangerous and/or addicting drugs.

There are also many other non-opioid compounds that are used by patients who seek highs or other body experience, ranging from nitrous oxide to sniffing glue or other volatile compounds.  Many have serious effects on other body systems such as the heart, liver, and kidneys.

Methamphetamine, the chief ingredient for 'crack' is easily manufactured from some legal prescriptions including many over-the-counter cold remedies.  It became so well known that retail pharmacists no longer place them on open shelves, and although unregulated by the Drug Enforcement Agency (DEA) keeping them under lock and key elsewhere. The key ingredient, Sudafed is a main ingredient for nasal decongestants and is nonaddictive. Its main danger is the combination of readily available supply and dangerous side effects when concentrated into 'crack" 

 

Desoxyn Methamphetamine

Blu Crystal Meth

The methamphetamine crisis silently burns in the background. – Scientific Inquirer

Covid 19 vaccine was not a miracle...read more

Many politicians claim the vaccine is a miracle, however like magic the truth is in the science.

History of  CIRM

Over 15 years ago, in California, proposition 71 was presented to the voters to create the California Institute of Regenerative Medicine and funded it with a 3 billion dollar bond issue. This occurred when then President George Bush placed a ban on harvesting human fetal tissue for stem cell research. The reason was the hot topics of right to life and faith issues.  It was a political issue. 

The CIRM allowed stem cell research to continue using adult stem cells in lieu of fetal stem cells. Certain adult organs contained primitive and only partially differentiated stem cells. Tissues that rapidly multiply such as bone marrow and skin were likely candidates.  Fortunately, this hypothesis was true. 

This formed the foundation for the Moderna and Pfizer-Bionet covid 19 vaccines. CIRM  is an interesting story in itself and worth reading about. 

Had CIRM not been formed there would have been other significant delays in the basic science of stem cells.

To learn more and attend the Webinar

REGISTER

Patients

Researchers

About CIRM 

The Stem Cellar (blog)

Video Library

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Cancer patients and Covid 19 Vaccinations.

As two new COVID-19 vaccines become more widely available, patients with cancer and cancer survivors may wonder if it's safe to be vaccinated.

"Because cancer patients and survivors are at higher risk for severe effects from COVID-19 infection, we recommend they get vaccinated as soon as they can," says Robert McWilliams, M.D., a medical oncologist at Mayo Clinic. "Patients who are immunosuppressed due to active cancer treatment may not get the same effective response as someone without immune compromise, but it should still be safe for them to receive the vaccine."

There is no definitive data on the efficacy of the COVID-19 vaccines from Pfizer/BioNTech and Moderna in patients with cancer or cancer survivors. "However, the few patients with cancer who were studied as part of the clinical trials leading to the approval of these vaccines did not experience any unique side effects," says Joleen Hubbard, M.D., a medical oncologist at Mayo Clinic.

The good news for patients with cancer and cancer survivors is that the Pfizer/BioNTech and Moderna COVID-19 vaccines are not live virus vaccines. That makes them less likely to cause side effects in immunosuppressed patients. "Both vaccines are mRNA (messenger RNA) vaccines, which means they teach our bodies how to make a protein that will trigger an immune response without the use of a live virus that causes COVID-19," says Dr. Hubbard. "Once triggered by the protein, our immune system makes antibodies to protect us if we are exposed to the virus."

Now that the vaccine is becoming available in the United States, expect to see more cases of side effects, however, the incidence rate remains the same.

Average daily case rate of Covid 19 positive cases.  Many of these patients have mild, moderate, or no symptoms.

Moderna Vaccine

Pfizer-Bionet

Newsfeed Detail | Mayo Clinic Connect

The Relationship Between Alzheimer’s Disease and Diabetes

Society for Neuroscience - Inside Neuroscience: The Relationship Between Alzheimer’s Disease and Diabetes

Inside Neuroscience: The Relationship Between Alzheimer’s Disease and Diabetes

Regions of the “social brain,” including the medial prefrontal cortex (mPFC), temporoparietal junction (TPJ), posterior superior temporal sulcus (pSTS), amygdala, and anterior cingulate cortex (ACC). Source: Sarah Jayne Blackmore, Nature Reviews Neuroscience 2008.

Alzheimer’s disease is the most common form of dementia, affecting over 50 million people worldwide, with rates expected to triple in the next 30 years. The disease is characterized by aggregates of amyloid-beta outside neurons and tangles of hyperphosphorylated tau within neurons. More recently, evidence suggests a disturbance in glucose metabolism in the Alzheimer’s brain as well, although whether this is a cause or symptom of the disease remains unclear. Type 2 diabetes — in which blood glucose levels are elevated — increases the risk for Alzheimer’s disease about two-fold.

A better understanding of the relationship between these two diseases may yield novel therapies. At the Neuroscience 2019 press conference “Untangling the Link Between Diabetes and Alzheimer’s Disease,” researchers shared new insights into how glucose metabolism problems and Alzheimer’s pathology could be related, disrupted, and potentially fixed.

Test your knowledge about Viruses Quiz gone viral - Cold Spring Harbor Laboratory

Coronavirus (COVID-19) Self-Checker

John. Hopkins is one of the best sources for Covid 19.  Beginning in January 2020 JHU has reported daily on the extent of the pandemic with an interactive global map detailing the number of cases worldwide by country.

Covid Dashboard

COVID-19 has caused a sea-change for business, social activities, health care, education, and government. There have been few other cataclysmic events in our history such as Pearl Harbor, Nine-eleven, and the Civil War.  It unleashed public outcry for police reform, justice, and too many others to list here.

In order to understand what Covid-19 is all about we are going to point readers to credible references.

Covid-19 is the first recent pandemic to affect the globe. Several other epidemics such as Ebola, Zika, SARS and H1N1 influenza pale in the extent of global involvement.  Ebola, Zika was a regional disease that did not extend to a pandemic.

This brief discussion is expanded by clicking here

Dr. Vivek Murthy Champions the Power of Togetherness

In our youth and middle age, we all wish a long and healthy life to our family and friends, no more so than at this holiday season.  We pause now between Christmas and New Year during winter's annual break.

As we age and have expectancies of our golden years that may or may not be realistic, how many of us could not save for retirement due to illness, disability, never-ending family responsibility, catastrophic events such as floods, tornadoes, firestorms, or hurricanes, most Americans will come up short in their savings plans.  Very few people begin savings early.  Even well educated people with good incomes now service huge education debt in line with what used to be a mortgage payment.  Housing costs have become ridiculous, and despite recessions, the pandemic real estate values continue to outpace inflation. Add to this is a housing shortage.  The housing market is very much divided.  There seems to be no shortage in t he market for the wealthy. 

As we age if you are unfortunate enough to outlive family and friends our support group shrinks and may disappear.  We become dependent upon social organizations, assisted living and/or care at home.  Some cannot afford those 'luxuries' and must manage 'alone, with devastating effects on health and emotional wellness.  It is a gradual decline, sometimes not noticed by those around the aged.

I often hear people saying I don't want to outlive my bank account.

As a physician and as Surgeon General, Murthy found that loneliness was a profound problem that can lead to public health concerns from addiction to depression, yet it was rarely discussed.

Dr Murthy wrote,

Together: The Healing Power of Human Connection in a Sometimes Lonely World.

Dr. Vivek Murthy: What's really interesting is that there are many manifestations of loneliness in any age group. And this is why loneliness can often be so invisible, including among those who are older, because we stereotypically think about loneliness as the person who is living alone at home and has no one coming to visit, or the person who is living in an institution and no family ever stops by. 

"If there's a gap between the connections you feel you need and the connections you have in your life, then you can feel lonely regardless of how many people you have around you." 

But I call it the great masquerader because it can look like depression, it can look like anxiety. Loneliness can look like anger and irritability, which is often how it shows up among men in particular, but also sometimes among women. It can look like being socially withdrawn. It can look like being bored and disinterested. 

And when you start to think about that broader context then you start to realize, gosh, I might actually know a lot of people who might be struggling with loneliness. It doesn't mean that everyone who is depressed is lonely, it doesn't mean that everyone who has anger issues is lonely. But I have found more often than not that loneliness is contributing to many of these feelings. 

We need to define the difference between loneliness and isolation.  Isolation is an objective term that describes the number of people we have around us. Loneliness is a subjective term that describes how we feel about the connections we have in our life. And if there's a gap between the connections you feel you need and the connections you have in your life, then you can feel lonely regardless of how many people you have around you. 

A couple of studies have found that older adults are actually in general doing better emotionally during the pandemic.  

Dr. Vivek Murthy Champions the Power of Togetherness | Next Avenue