UC Irvine Medical School gifts Butterfly handheld ultrasounds to its whole class of 2023

The University of California, Irvine presented each member of the class of 2023 a handheld/smartphone portable ultrasound device.  This represents a considerable upgrade for the stethoscope treasured by so many neophyte physicians.  No longer would the treasured stethoscope hanging from the neck of students, nurses and nurse practitioners be the status symbol.

Ultrasound machines are usually those large instruments wheeled around from room to room with a large display.  It required a  physician order to have an ultrasound technician to perform the test.  Now the ultrasound will become ubiquitous.  For most diagnostic purposes it will be carried in a pocket by the physician for immediate use.  And for most studies, it will be adequate.  If a more advanced ultrasound is needed it can be ordered.  In 90 % of cases, it will be used to rule out serious problems in an emergency department, urgent care center, nursing home or even at home.

Normally $2,000, the devices were free for the 104 newly-minted members of the class of 2023.

In 1966 when I was a junior at George Washington University School of Medicine we were gifted a Welch Allyn Diagnostic set in a zipper case.  It was a moment like that I am sure the UCI medical students experienced.  This gift measures the strides we have taken since 1968. Very few would imagine a hand-carried ultrasound would take the place of the 'stethoscope' which had become an icon about physicians.

Nine years ago, the University of California at Irvine Medical School became the first medical school in the country to equip each of its 104 incoming students with their own iPads.

This month, at the same White Coat Ceremony where that announcement was made back in 2010, Dr. Michael J. Stamos, the school’s dean, surprised the class of 2023 with another gift: Butterfly handheld ultrasound devices.

The devices are the students’ to keep, and it's no small investment on the school’s part — each device retails for just under $2,000.

“When our faculty director caught wind of Butterfly coming into existence, we had talked about this being a big game-changer for us,” Dr. Warren Wiechmann, UCI’s associate dean, told MobiHealthNews. “Historically, we had been using a lot of laptops and cart-based ultrasounds, which are technically portable but they’re not handheld and they are still a little bit limiting for our students. So when we heard about Butterflies, that really opened up the possibility that we could move toward this idea of having every student with an ultrasound machine in their pocket.”

An additional important feature of this device is that images can be uploaded to a cloud and also interface with the electronic health record for permanence. Incorporated in the network software is a provision for reimbursement coding (CPT) and diagnostic information. (ICD)
WHY IT MATTERS

Butterfly Network’s device, which secured FDA clearance two years ago, uses a novel ultrasound-on-a-chip technology to make handheld portable ultrasounds cheaper and more accessible. The mission is not just to make it easier to use ultrasounds in the ways they are already used, but also to change the status quo — using ultrasounds in areas of medicine where they might be useful but formerly would have been impractical.

“From the very beginning, it’s an affirmation of this device and the role it could play in the transformation of healthcare,” Dr. John Martin, chief medical officer at Butterfly, said. “If you look across the practice of medicine, two-thirds of medical dilemmas can be solved with simple imaging devices. In the past, I had to order that test. Now, as a physician I don’t have to order that test; the test is in my pocket. I can communicate with my patients, I can share that information with them instantly, I can make rapid decisions, and that puts this school far out front of others across the country.”

Martin and Wiechmann hope that students will take the technology and treatment methodologies it enables with them after they graduate.

“The fundamental purpose of good medical schools and good residency programs is they help people develop the knowledge and skills and then seed the rest of the planet with those people and then they take that knowledge to those institutions,” Martin said. “I’m pretty confident that’s what’s going to happen.”

THEIR TAKE

Members of the class of 2023 said they are excited at the prospects of the device for patient engagement and for bringing care to lower-income, lower-infrastructure parts of the globe.

“I think it’ll help me connect with my patients, which is pretty much essential to establishing continuous care of a population,” Leonardo Alaniz, an incoming student, said. “It will enhance my abilities as a physician, and it will also give me the opportunity to share what I see. Patients aren’t always committed to sticking with the health plans we put them on, and I think that [better communication] ultimately can lead to better outcomes.”

“I’m looking at doing a program for ultrasound initiatives, global outreach around the world, in the summer between first and second year,” said Christina Grabar, another student. “I think having my own Butterfly and being able to use it well before the program starts is not only going to enhance my research but then when I’m going to teach other physicians about this technology, I’ll feel even more comfortable with it.”

THE LARGER TREND

UCI’s cultivated reputation for training the next generation of digital-savvy doctors goes beyond iPads and ultrasounds. The school has also experimented with Google Glass and AliveCor’s ECG device, as well as investing in high-fidelity simulations.

In 2013, the school boasted that the first class to receive iPads saw a 23% boost in their test scores.


“I think it’s important that we prepare our students to become the best 21st-century physicians and not necessarily be held to the classic constructs of how medicine is practiced and how medicine’s delivered now,” Weichmann said.

First hint that body’s ‘biological age’ can be reversed

In a small trial, drugs seemed to rejuvenate the body’s ‘epigenetic clock’, which tracks a person’s biological age.

A person’s biological age, measured by the epigenetic clock, can lag behind or exceed their chronological credit: Patrick McDermott/Getty

A small clinical study in California has suggested for the first time that it might be possible to reverse the body’s epigenetic clock, which measures a person’s biological age.

For one year, nine healthy volunteers took a cocktail of three common drugs — growth hormone and two diabetes medications — and on average shed 2.5 years of their biological ages, measured by analyzing marks on a person’s genomes. The participants’ immune systems also showed signs of rejuvenation.

The results were a surprise even to the trial organizers — but researchers caution that the findings are preliminary because the trial was small and did not include a control arm.

“I’d expected to see slowing down of the clock, but not a reversal,” says geneticist Steve Horvath at the University of California, Los Angeles, who conducted the epigenetic analysis. “That felt kind of futuristic.” The findings were published on 5 September in Aging Cell1.

“It may be that there is an effect,” says cell biologist Wolfgang Wagner at the University of Aachen in Germany. “But the results are not rock solid because the study is very small and not well controlled.”

Marks of life

“I’d expected to see slowing down of the clock, but not a reversal,” says geneticist Steve Horvath at the University of California, Los Angeles, who conducted the epigenetic analysis. “That felt kind of futuristic.” The findings were published on 5 September in Aging Cell1.

“It may be that there is an effect,” says cell biologist Wolfgang Wagner at the University of Aachen in Germany. “But the results are not rock solid because the study is very small and not well controlled.”

Marks of life

The epigenetic clock relies on the body’s epigenome, which comprises chemical modifications, such as methyl groups, that tag DNA. The pattern of these tags changes during the course of life, and tracks a person’s biological age, which can lag behind or exceed chronological age.

Scientists construct epigenetic clocks by selecting sets of DNA-methylation sites across the genome. In the past few years, Horvath — a pioneer in epigenetic-clock research — has developed some of the most accurate ones.

Steve Horvath, PhD

The latest trial was designed mainly to test whether growth hormone could be used safely in humans to restore tissue in the thymus gland. The gland, which is in the chest between the lungs and the breastbone, is crucial for efficient immune function. White blood cells are produced in the bone marrow and then mature inside the thymus, where they become specialized T cells that help the body to fight infections and cancers. But the gland starts to shrink after puberty and increasingly becomes clogged with fat.

Evidence from animal and some human studies shows that growth hormone stimulates regeneration of the thymus. But this hormone can also promote diabetes, so the trial included two widely used anti-diabetic drugs, dehydroepiandrosterone (DHEA) and metformin, in the treatment cocktail.

The Thymus Regeneration, Immunorestoration and Insulin Mitigation (TRIIM) trial tested 9 white men between 51 and 65 years of age. It was led by immunologist Gregory Fahy, the chief scientific officer and co-founder of Intervene Immune in Los Angeles, and was approved by the US Food and Drug Administration in May 2015. It began a few months later at Stanford Medical Center in Palo Alto, California.

Fahy’s fascination with the thymus goes back to 1986 when he read a study in which scientists transplanted growth-hormone-secreting cells into rats, apparently rejuvenating their immune systems. He was surprised that no one seemed to have followed up on the result with a clinical trial. A decade later, at age 46, he treated himself for a month with growth hormone and DHEA and found some regeneration of his own thymus.

In the TRIIM trial, the scientists took blood samples from participants during the treatment period. Tests showed that blood-cell count was rejuvenated in each of the participants. The researchers also used magnetic resonance imaging (MRI) to determine the composition of the thymus at the start and end of the study. They found that in seven participants, accumulated fat had been replaced with regenerated thymus tissue.

All of this work required the collaboration of many disciplines, genetics, statistics, biochemistry, immunology, and mathematics.

While the clinical evidence is still limited by the small size of the trial, the science is real. Perhaps soon there will be a test to measure your biological clock.

Rather than being viewed as a fountain of youth, there are other important motivating factors to research anti-aging. Source:  Reversal of epigenetic aging and immunosenescent trends in humans Population aging is an increasingly important problem in developed countries, bringing with it a host of medical, social, economic, political, and psychological problems

The first hint that body’s ‘biological age’ can be reversed: In a small trial, a cocktail of drugs seemed to rejuvenate the body’s ‘epigenetic clock’.

Cleveland Clinic Institutes Ambitious Plan to Double Patient Volume

by Greg Slabodkin Managing Editor, Health Data Management

Last year, the Cleveland Clinic cared for more than 2 million patients—an unprecedented number. However, president and CEO Tom Mihaljevic, MD, says it’s a small fraction compared with what the health system can and should be doing.

“The care that we deliver today is of paramount importance to those in need,” Mihaljevic told an audience this week at the Cleveland Clinic’s 2019 Medical Innovation Summit. “What we strive to do is to touch as many people as possible with the highest quality care.”

Mihaljevic said the Cleveland Clinic has an “ethical mandate to grow” and a moral obligation to relieve human suffering. However, he acknowledged that the provider organization “touches far fewer lives than what our brand recognition, our reputation would suggest.”

According to Mihaljevic, the Cleveland Clinic’s market share in the United States is only half a percent. As a result, the Cleveland Clinic has an ambitious plan to double the number of patients that the healthcare organization serves over the next five years—and health information technology is at the core of its strategy.

Adding more facilities and increasing the number of caregivers is not enough to meet this goal and the growing demand for the Cleveland Clinic’s services, according to Mihaljevic.

“We understand that we have to change the way that we deliver care—but we also have to change the tools that we use for care delivery,” he said.

As Centers for Excellence in many specialties both Cleveland Clinic see large numbers of patients.  Mayo Clinic is often compared to Cleveland Clinic in terms of excellence.  By comparison, Cleveland Clinic sees twice the volume of Mayo Clinic and appears to be hard-pressed to see this volume.  Yet they seek to double that volume.

By comparison, Cleveland Clinic is in a much more densely populated region with proximity to the east coast of major metropolitan areas and Pittsburgh.  Cleveland has a major international airport, a 19-minute drive to the clinic via Interstate 71.

The Mayo Clinic lies in a less populated region, and the airport is served by regional airlines with few connecting flights as compared to Rochester, MN. It can be accessed by Rochester's International Airpor (RST) or Minneapolis-St. Paul's Hopkin's (MSP) airport.

Adding more facilities and increasing the number of caregivers is not enough to meet this goal and the growing demand for the Cleveland Clinic’s services, according to Mihaljevic.

“We understand that we have to change the way that we deliver care—but we also have to change the tools that we use for care delivery,” he said.

Scaling an enterprise of this size can be daunting and requires methods of not just increasing or doing more with present facilities.  It will take a sea-change in facilities and technology to reach this very ambitious goal of 4 million patients a year. It will also require insurance companies, health plans transportation services and other support industries to match Cleveland Clinic's growth curve.

The Cleveland Clinic’s near-term plan calls for the implementation of digital platforms such as telemedicine, data analytics, and artificial intelligence, as the $8 billion healthcare organization looks beyond its core electronic health record system capabilities.

“The new digital and analytic tools and the new way that we process information for better servicing our patients will have a transformative effect on our industry,” added Mihaljevic, who noted that the Cleveland Clinic’s aspiration is to be the best place to receive care anywhere and also to be the best place to work in healthcare.

On Monday, at the Medical Innovation Summit, the Cleveland Clinic and telemedicine vendor American Well announced that they have formed a joint venture company—called The Clinic— which will offer virtual care by leveraging the Cleveland Clinic’s specialists through American Well’s digital health platform, providing patients with online access to care in their homes. American Well is focused on providing telehealth communications and also integrates with Cerner and Epic electronic health record systems.

“This new venture marks the first time that a major digital health technology platform has partnered with a globally recognized healthcare provider to deliver digital solutions for complex healthcare problems,” observed Mihaljevic. “This new digital health service will provide access to world-class Cleveland Clinic expertise and quality of care for patients in the U.S. and internationally.”

Cleveland Clinic's plan to expand its footprint using telehealth allows primary care doctors to access specialty knowledge as well as affording patients second opinions without traveling to Cleveland. 

Both Cleveland and Rochester are challenged by inclement weather restricting patient travel

Rather than a true partnership where both entities are at risk, it seems to be more of a client-vendor relationship.

Mihaljevic neglected to expand on internal functions for patient flow and reducing paperwork.  By comparison from personal experience, Mayo Clinic already implements patient registration, calendars for the patient on line, instructions for both pre-visit and post visit. The patient is aware of the plan and locations for their services.

Insurance companies aren’t doctors. So why do we keep letting them practice medicine? - The Washington Post

We know how important it is to have insurance so that we can get health care. As a physician, parent and patient, I cannot overemphasize that having insurance is not enough.

Physicians often prescribe expensive medications or tests for my patients. But for insurance companies to cover those treatments, I must submit a “prior authorization” to the companies, and it can take days or weeks to hear back. If the insurance company denies coverage, which occurs frequently, I have the option of setting up a special type of physician-to-physician appeal called a “peer-to-peer.”


Here’s the thing: After a few minutes of pleasant chat with a doctor or pharmacist working for the insurance company, they almost always approve coverage and give me an approval number. There’s almost never a back-and-forth discussion; it’s just me saying a few keywords to make sure the denial is reversed.


Because it ends up with the desired outcome, you might think this is reasonable. It’s not. On most occasions, the “peer” reviewer is unqualified to make an assessment of the specific services. They usually have minimal or incorrect information about the patient. Not one has examined or spoken with the patient, as I have. None of them have a long-term relationship with the patient and family, as I have.

 Some physicians dealt with this system from the patient side, as well. A daughter has a rare genetic disorder called Phelan-McDermid Syndrome, which causes developmental delay, seizures, heart defects, kidney defects, autism and a laundry list of other problems. She receives applied behavior analysis therapy, an approach often used for autism, and has been wildly successful in improving her skills and communication. But recently, our health insurer reduced the amount of therapy they thought she needed.

While I know what levers to pull from the physician's side, a patient’s options are completely unclear. I probably have better access than almost anyone else can get, yet the ability of my daughter’s providers to mitigate denials for services they deem appropriate is slow and often ineffective. A patient can languish for months or years not receiving care that every highly qualified person who treats her agrees she needs. While we wait, the window to give her a little bit more function, a little bit less suffering and a little better life get smaller.

Most likely the person evaluating the claim has a leaf book or now a computer with an algorithm that decides the decision by checking off any number of boxes in a flow diagram of yeses and nos to make a decision, without knowing the patient's history, or physical findings.

This sounds good, as most denials are related to specific provider choice or contractual issues, which are relatively easy to remedy (but a problem nonetheless). But other denials are a judgment of some test or treatment as “not medically necessary.”

Insurance companies know that many patients don’t bother to appeal at all. A smaller fraction asks for an internal review, and still fewer seek or even know about external review options available in most states. Of the cases that do end up under external review, almost a third of all insurer denials are overturned. This is clear proof that whatever process insurers have to determine medical necessity is often not in line with medical opinion. A study of emergency room visits found that when one insurance company denied visits as being “not emergencies,” more than 85 percent of them met a “prudent layperson” standard for coverage.

Some might argue that it makes sense to have two doctors discuss a case and then come to a consensus on the most cost-effective approach for an individual. That’s not what is happening. This is a system that saves insurance companies money by reflexively denying medical care that has been determined necessary by a physician. And it should come as no surprise that denials have a disproportionate effect on vulnerable patient populations, such as sexual-minority youths and cancer patients insurance companies will say this system makes sure patients get the right medications. It doesn’t. It exists so that many patients will fail to get the medications they need.  It also exists to save money for the insurance company. 
Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy.

Case-study: An IRB-approved retrospective medical record review (2014–2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization.

Results: Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9–18). Seventy-three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogs, only 8 (29.6%) received insurance coverage.

Conclusion: Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform.We can do better. If physicians order too many expensive tests or drugs, there are better ways to improve their performance and practice, such as quality-improvement initiatives through electronic medical records.

When an insurance company reflexively denies care and then makes it difficult to appeal that denial, it is making health-care decisions for patients. In other words, insurance officials are practicing medicine without accepting the professional, personal or legal liability that comes with the territory.

Insurance companies aren’t doctors. So why do we keep letting them practice medicine? - The Washington Post: To get access to health care, you don't just need insurance. You also often need to navigate all the hoops and hurdles of health plans.

Medicare to require new Medicare ID in lieu of Social Security number for Medicare Health claims

About a year ago CMS began mailing your new Medicare ID card with a unique identifying number.Due to increasing cyber intrusions in the health care records on many websites, Social Security numbers were increasingly being compromised.  The new ID number has a different format making it more difficult to crack using decryption algorithms.  Beginning January 01, 2019 health providers must use this number or your CMS claim will be REJECTED .


Depending on your age your current SS card will look like this

Your new Medicare ID card looks like this

Comparison of current card v. new card

Do not discard your current Social Security Card.  It will still be required for tax filing and all other financial documents, including IRS and state tax returns.  Other non-health related businesses, banks, credit cards, visas, passports, green cards, immigration forms, and many other applications, for employment, driver's license applications, social security benefits, veterans benefits, and many other things.


Other CMS and Medicare compliance announcements

Governor Signs Variety of Bills Affecting Californians’ Healthcare

HIV Prevention

California will be the first state to allow people to access HIV prevention drugs from pharmacies without a doctor’s prescription. Pre-exposure prophylaxis (PrEP) is a once-a-day pill for HIV-negative people that may keep them from becoming infected, and post-exposure prophylaxis (PEP) is a medication that can help prevent the virus from taking hold if they have been exposed to it. SB-159 by state Sen. Scott Wiener (D-San Francisco) will allow pharmacists to dispense a 60-day supply of PrEP or a 28-day course of PEP. Patients will need to see a physician to obtain more medication. The bill prohibits insurance companies from requiring patients to obtain prior authorization before obtaining the medication.

Abortion Pill

Students at California’s 34 California State University and University of California campuses will have access to medication-induced abortion — commonly known as the abortion pill — at on-campus student health centers by Jan. 1, 2023. Under SB-24 by state Sen. Connie Leyva (D-Chino), students who are up to 10 weeks pregnant will be eligible. Initial costs, such as the purchase of medical equipment, will be paid for with private, not state, dollars.

Maternal Health

Black women are three to four times more likely to die during childbirth and from other pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention. SB-464 by state Sen. Holly Mitchell (D-Los Angeles) will require perinatal healthcare providers to undergo bias training with the goal of reducing preventable maternal deaths among black women. “The disproportionate effect of the maternal mortality rate on this community is a public health crisis and a major health equity issue,” Newsom said upon signing the bill.

Some new moms returning to their jobs who want to pump milk at work will face fewer barriers. SB-142 by Wiener will require employers to provide new mothers with a private space that includes a table, chair, electric outlet and nearby access to running water and refrigeration. Businesses with fewer than 50 employees may be eligible for an exemption. “Too many new mothers are unable to express milk at work or are forced to do so in a restroom or other unsuitable space,” Wiener said.                                                 

 


 Financial Abuse of Older Adults



Investment advisers and broker-dealers will be required to report suspected financial abuse of an elder or dependent adults. SB-496 by state Sen. John Moorlach (R-Costa Mesa) allows these financial experts to temporarily delay requested transactions, such as stock trades and disbursement of funds, when they suspect potential abuse. “With growing Alzheimer’s and dementia concerns, it is critical that we provide safeguards to prevent financial abuse for those in the beginning stages of a difficult life journey,” Moorlach said in a statement.

               

 Ban Smoking in State Parks



Californians will be prohibited from smoking or vaping at state beaches and parks, except for paved roads and parking areas. Violations of SB-8 by state Sen. Steve Glazer (D-Orinda) will carry a fine of up to $25. Similar efforts were vetoed by former Gov. Jerry Brown.

     

                                                                           


Nurse Staffing



State health officials who make unannounced inspections of hospitals will start reviewing nurse staffing levels. Some California hospitals disregard the state’s current nurse-to-patient ratio requirements, Leyva, the bill’s author, argued. SB-227 establishes penalties for violations: $15,000 for the first offense and $30,000 for each subsequent violation.

Medical Marijuana on School Grounds



Even though medicinal cannabis has been legal for years in California, it has not been allowed on school grounds. SB-223 by state Sen. Jerry Hill (D-San Mateo), will allow school boards to adopt policies that authorize parents or guardians of students with severe medical and developmental disabilities to administer medicinal cannabis on campus, as long as it is not via smoking or vaping. This allows students to “take their dose at school and then get on with their studies,” Hill said.

Dialysis Industry Profits


One new law could disrupt the dialysis industry’s business model. Dialysis companies often get higher reimbursements from private insurers than they do from public coverage. One way low-income patients remain on private insurance is by getting financial assistance from the American Kidney Fund, a nonprofit that receives most of its donations from the two largest dialysis companies, Fresenius Medical Care and DaVita Inc. AB-290, by Assemblyman Jim Wood (D-Santa Rosa), will limit the private-insurance reimbursement rate that dialysis companies receive for patients who get assistance from groups such as the American Kidney Fund.

Healthcare in Jails and Prisons

County jails and state prisons will be prohibited from charging inmates copays — usually $3 to $5 — for medical and dental services with the passage of AB-45, by state Assemblyman Mark Stone (D-Scotts Valley). Some states already prohibit copays in prison, but California is the first to eliminate copays in county jails.

Cancer Patients

Some Californians undergoing cancer treatment such as radiation or chemotherapy will have insurance coverage for fertility preservation treatments. Under SB-600 by state Sen. Anthony Portantino (D-La Cañada Flintridge), private health plans regulated by the state must cover procedures such as the freezing of eggs, sperm or embryos for patients who want to try to have children in the future.

Big Pharma,

The Democratic governor also signed what health advocacy groups deem this year’s biggest effort to lower prescription drug costs. AB-824 will give the state attorney general more power to go after pharmaceutical companies that engage in “pay for delay,” a practice in which makers of brand-name drugs pay off generic manufacturers to keep the lower-cost generic versions of their medications off the market.

SOURCE: Story By Ana B. Ibarra | Kaiser Health News.

Moonshots for Health Care

It sounds a lot like Star Trek's iconic statement, "Go where no man has gone before"

Paradoxically that is where we are at with health care, financially, technically and for access to care.

A strange coalescence of increasing needs, increasing elderly patients, and conflicting needs for financial resources has attracted investors, entrepreneurs to apply known and developing technologies across many disciplines ranging from biochemistry, genetics, material engineering, and artificial intelligence.

A Moonshot is, in the technology context at least, an ambitious, exploratory and ground-breaking project, normally undertaken without any near-term expectation of profitability, and without the full investigation of all potential risks and benefits to come further down the road.

Current Moonshots from Startup Health include supporting the U.N. Sustainable Development Goals for health and wellbeing by 2030 and a mission to improve the health of everyone on the planet by 2040.

Access to Care Today, healthcare is for the few, for those who live near more developed cities or towns, and for those with money. Fully half of the world’s population goes without needed healthcare. Lack of access to quality healthcare is a problem affecting billions of people across diverse economies in every corner of the globe. Access to care is about geography – is it a four hour drive to the nearest hospital? But it’s also about being able to afford the care once you arrive. To solve the access problem we’re building radical new solutions that address delivery, cost, geography, and technology. We will need to leapfrog legacy systems and dream up brand new ways of doing business.

Cost to Zero About 800 million people spend at least 10% of their household budgets on medical expenses, according to a 2017 report by the World Bank and WHO. That’s expensive enough to send 100 million people into extreme poverty. Mobile technology internet connectivity are flipping the cost of care paradigm. Telemedicine has dramatically lowered provider overhead. New population health startups are upgrading the way patients battle chronic illnesses, slashing costs. We’re on a moonshot mission to take costs from poverty- inducing all the way to zero. The only way that is going to be possible is for us to dismantle our understanding of health and rebuild the machine from the ground-up.

Cure Disease Heart disease. Cancer. Stroke. Obesity. Diabetes. Six in 10 U.S. adults have a chronic disease. These diseases, which accounted for tens of millions of deaths in 2016, are already within our power to treat or cure. Through basic apps run on smartphones, people can follow healthy diets and schedule recommended screenings. The bottom line: If a cure exists, it should exist for all, and health tech has the potential to be that democratizing ingredient. A moonshot to cure disease is about access, but it’s also about discovery. Groundbreaking advances in machine learning are increasing our capacity to understand the drugs we’re making, and how they will affect our bodies. This, in turn, is opening the door to faster cures and targeted medicines for rare diseases.

End Cancer Cancer claims the lives of millions, shattering families across every bracket of age, geography and economic status. By 2030, the number of new cancer cases per year is expected to top 23 million. Chances are, you know someone personally who has battled cancer. And if you don’t, you unfortunately most likely will. To defeat cancer once and for all, it is going to take true moonshot thinking. A global cancer moonshot is built on a level of collaboration we’ve never seen before. It’s going to require breaking down data silos between academic institutions, reaching across political aisles, and even sacrificing personal egos.

Women’s Health Being born a woman shouldn’t be a health risk factor. But in much of the world, it is. Achieving the Women’s Health Moonshot means widening the aperture on the definition of women’s health, focusing on issues that move beyond the current litmus test — sexual and reproductive health — to a standard of living well. This includes a women’s right to physical and mental health and wellbeing. According to the WHO, self-harm, including suicide, was the second leading cause of death globally among females, aged 15–29, in 2015. It means creating a world where individual women no longer have to shoulder the burden of advocating for themselves in order to get proper medical care, a world where they can rely on the medical system

Children’s Health  On one hand, we have cause to celebrate. Global annual infant deaths have been cut in half between 1990 and 2017. At the same time, we see massive opportunity for improvement. Every year more than 1.4 million children under five die of preventable environmental hazards like air pollution, hazardous chemicals, inadequate water, sanitation and hygiene. Nearly 100,000 kids under 15 die of cancer even though the vast majority of childhood cancers are potentially curable with existing treatments.

Nutrition & Fitness If we are what we eat, we’re a world of extremes, desperate for a healthy middle. On one end is hunger. According to UNICEF, in 2017 approximately 200 million children under the age of five suffered from malnutrition. Where malnutrition has been abolished, we’ve created an epidemic of excess. Obesity is now a primary cause of some of the world’s biggest killers, like heart disease, stroke and diabetes. Billions of people the world over are overweight, and 650 million are obese. Together we can create a world where all people have access to the foods they need to thrive, prevent disease, and stay healthy regardless of where they live. We also can build communities of support to help people control their weight and live healthy lifestyles.

Brain Health  With every new age has come startling, beautiful revelations about the human brain. How, like an intricate map, sections of the three pound mass can be tied to everything from speech to memory to personality. Yet the more we understand it, the less it appears like a map, and the more it opens up like an unexplored galaxy, full of mysteries and new frontiers. The Brain Health Moonshot means dismantling the old, siloed notions about basic neurology and searching its great depths to unlock its mysteries. No longer will we merely treat health challenges without connecting the brain to the solution. We will master the mechanisms of the brain in ways that will create new opportunities for health and wellness and then share them with the world.

Mental Health & Happiness  The DSM-5 tells us that there are approximately 300 mental disorders. We live in a world where 600 million people suffer from depression and an epidemic of loneliness threatens our elderly population. Advances in mental health research have shown us deeper and more nuanced ways of understanding how our chemistry and environments affect our brains, and our behavior. The Mental Health and Happiness Moonshot reimagines what it means to thrive, feeling whole inside and out. It means using telemedicine and smartphones to expand the reach of mental health services. It means gamifying healthy habits in a community of peers. And it means expanding our definition of happiness in ways that we can’t even fathom yet.

Addiction According to the National Survey on Drug Use and Health, close to 20 million American adults (aged 12 and older) battled a substance use disorder in 2017. What’s clear is addiction is no longer anonymous, like the sign at meetings suggests. Its cords are reaching into families everywhere, ripping at the fabric of our communities. The time is now to fight back, to radically alter our thinking about treating addiction and ending the opioid epidemic. It starts by rethinking what’s possible. Together, with a unified will, global collaboration, and innovative health treatments, we can create a world where addiction is a crisis of the past.

Longevity  The Longevity Moonshot is just as personal as it is technical. Where you live greatly impacts how long you live. What public health experts refer to as social determinants of health—think housing quality, access to fresh food, water and air quality—are thought to be among the most powerful influences on a person’s health. As more people live longer, we need the ability to scale senior care in a way that addresses both medical and mental health needs in this older population. We need smart solutions to improve injury recovery. We need support and accountability to adapt a preventative mindset when it comes to our health in order to detect diseases earlier.


The groups are not listed in terms of priority.  Behind each of these goals are people and companies already on their moonshot.

Present and previous moonshot companies have videos explaining their goals.


What is your Moonshot ?

   For those of us who like meetings, Startup Events are listed here





Startup Health is an internet driven organization whose purpose is to attract other high-minded entrepreneurs to health care as an investment opportunity.   We are all invited to join the effort.

Using CRISPR to edit eggs, sperm, or embryos does not save lives

Some scientists hail reproductive applications of CRISPR as potentially lifesaving and curative. That claim for CRISPR is mistaken and misleading.


This startling announcement by He Jiankui almost one year ago that he had created the first genetically modified human beings unleashed a torrent of criticism. It also brought to the surface common misunderstandings — even among scientists and ethicists — that reproductive uses of this genome-modifying tool have therapeutic value, will treat people with genetic disorders, will save lives, and will eradicate disease. None of those are true.

The twin girls that He helped create are publicly known as Lulu and Nana. Their father is HIV-positive. The scientist said he used CRISPR-Cas9 genome editing technology to disable a gene called CCR5 to mimic a naturally occurring gene deletion that appears to confer immunity against HIV.



In a recent publication, The  Journal of Bioethics the ethics and thinking behind this ill-advised experiment are viewed by another expert.

A major criticism from the scientific community, which has otherwise been generally supportive of advancing gene technologies, was that He did not use the technology to address a serious medical need. That criterion stems from a 2017 report by the U.S. National Academy of Sciences and the National Academy of Medicine recommending that, once the technology is ready and safe, genetic modification of embryos could be allowed when there is a “serious disease or condition” to be addressed and no “reasonable alternatives” exist.

IVF with pre-implantation genetic diagnosis is an existing alternative to CRISPR for preventing the transmission of genetic disease.

PHILIPPE LOPEZ/AFP VIA GETTY IMAGES

This scientific criticism of He’s experiment was on target: Although HIV infection is a serious disease, there are proven ways to prevent transmission of the virus from an infected father to his offspring, and later in life to prevent or treat the infection.

This act can be compared to the young child finding a gun and shooting itself because it did not understand what a gun does.  It's actions cannot be reversed....the genie is out of the bottle.

Careful consideration must be taken when designing and proposing gene editing using CRISPR or any other techniques which alter the 'germ line' of human and mammalian cells. We know so little about the long term effects of clipping out parts of the gene or adding snippets.  If there are other methods of treatment with known risks, they should always be used first. "primum non nocere" is one of the first things that medical trainees are taught.

Although we 'think' we know how genetics works and how DNA fits into programming protein manufacturing each year that goes by new surprises appear to disprove our theories.

CRISPR does offer a new tool for research in laboratory animals, bacteria, viruses.  Unique genes  can be inserted to use microorganism's machinery to manufacturer new drugs.

"Prime editing" is more precise and more efficient than CRISPR and could herald a new era of genetic manipulation.




Using CRISPR to edit eggs, sperm, or embryos does not save lives - STAT:

CMA to tackle four major issues at annual meeting

CMA physician delegates meet annually to establish broad policy on current major issues that have been determined to be the most important issues affecting members, the association and the practice o...

The 148th Annual Session of the California Medical Association (CMA) House of Delegates (HOD) will tackle four major issues when it convenes October 26-27, 2019, in Anaheim.

This year’s major issues are:

Augmented Intelligence: Technology continues to transform the way physicians serve patients, creating opportunities and exposing challenges that prevent quality, timely and affordable care. While CMA has adopted policies addressing telemedicine, electronic health records and interoperability, it’s time to explore pragmatic solutions that address medical decision-making, new liabilities and privacy concerns inherent with augmented and artificial intelligence. With few laws and regulations on the books, CMA needs to proactively develop new policy that keeps physicians at the center of health care delivery.

Cannabis: CMA has adopted extensive policies concerning cannabis use and regulation, including our 2011 white paper, “Cannabis and the Regulatory Void.” As the state’s legal cannabis industry continues to grow and evolve, CMA must continue to weigh in on pressing issues, including health impacts associated with cannabis use, public health protections, federal legalization, data and surveillance efforts, high-quality research, marketing and advertising practices, cannabis equity programs and more.

Homelessness: Physicians witness the homelessness crisis in emergency rooms, clinics and on the streets of our communities. The multi-faceted challenges of housing, case management, intervention programs and public health considerations require California’s physicians to weigh in on evidence-based solutions that address the health care and social needs of those at risk of or experiencing homelessness.

Adverse Childhood Experiences: When it comes to trauma-informed care, CMA supports efforts for data collection, research, and evaluation of screening for Adverse Childhood Experiences (ACEs), recognizing there is a growing need to increase familiarity on the what, when and how to incorporate ACE screening practices into routine care. California physicians need tools, resources and funding to address their patients’ cumulative ACEs, which has a strong correlation to numerous health, social and behavioral problems throughout their lives.







CMA to tackle four major issues at annual meeting: