As a scientist, I question the efficacy of paper surgical masks in preventing the transmission of COVID-19, as my hospital reintroduced a mandate for healthcare providers to wear them.

Although many debate the effectiveness of paper masks, I am more interested in the evidence supporting wearing one rather than the politics surrounding masking.

Mixed Feelings

I remember wearing a paper surgical mask during a particularly busy shift at the hospital last winter.

As I moved from one patient’s room to another, I couldn’t help but notice the discomfort caused by the mask’s straps constantly tugging at my ears.

Despite the inconvenience, I also couldn’t ignore the sense of protection and responsibility that came with wearing it.

I work in cancer medicine, after all.

It’s a strange juxtaposition — the physical discomfort versus the mental reassurance.

Moreover, my patients prefer to see my face.

Moments like these make me reflect on the true effectiveness of these masks and whether they are truly making a difference in preventing the transmission of viruses.

Overview

While we adopted widespread mask use as a public health measure, the evidence supporting their effectiveness remains contested.

Observational studies (and even some randomized controlled trials) suggest a benefit, but there is no high-level, conclusive evidence that masks reduce COVID-19 transmission.

You may be surprised to hear this doctor admit that.

Today, I want to examine a recent study that hails the effectiveness of masking.

The big reveal: We need more rigorous investigations to determine the precise role of paper surgical masks in mitigating the spread of the virus.

A New Study

Atle Freithem and colleagues report the results of a pragmatic randomized control trial in the British Medical Journal:

Personal protective effect of wearing surgical face masks in public spaces.

www.bmj.com.

The take-home message is this:

Wearing a surgical mask for two weeks during the winter of 2023 reduced the spread of self-reported viral illness.

This research proves that paper masks work, right?

Study Details

Purpose: This study aimed to see if wearing a surgical mask in public places like stores, streets, and public transport for two weeks could protect people from getting sick with respiratory infections like colds or the flu.

How the study worked: Researchers randomly divided almost 4,700 adults in Norway into two groups. They told one group of participants to wear surgical masks in public for two weeks while asking the other group not to.

What researchers examined: The scientists were mainly interested in whether people got sick with respiratory infections. They also looked at whether people reported getting COVID-19 or had it confirmed by a doctor.

Important note: The investigators did not tell subjects to wear masks at home or work, only when in public.

Study Results

Here are the study results:

Over the study period, about 9 percent of those who wore masks reported cold or flu-like symptoms, compared to 12 percent of those who didn’t.

This finding suggests that wearing masks might slightly lower your chances of contracting a respiratory infection.

My Take

First, kudos to the researchers for completing a practical, randomized clinical trial evaluating paper mask effectiveness.

We can do randomized clinical trials in the COVID-19 realm.

Second, the study does not prove that paper masks reduce COVID-19 transmission.

Many people believe masks are effective, and this study didn’t use a placebo or fake mask to account for that belief.

The results may reflect that people feel better because they wear a mask rather than a mask that prevents illness.

We Need Studies With Objective Measures

I hope we get a study that uses objective measures of infection.

I wish the authors had used regular virus tests or blood tests checking for COVID-19 antibodies.

And mandated mask wearing for more than a couple of weeks.

The study, as conducted, tells us that people wearing masks reported fewer illnesses, not that they were actually sick less often or felt better overall.

While the study didn’t find a benefit in confirmed COVID-19 cases, it might not have been large enough to detect a small difference.

Bottom Line

This study does not prove masks reduce COVID-19 transmission; the study’s primary endpoint was self-reported illness.

After so much trumpeting of the value of paper masks to reduce COVID-19 contagiousness, we still need high-level evidence to convince me.

Per my hospital’s mandate, I will continue to don my paper mask faithfully in designated places in my workplace.

But am I better off donning a mask year after year for a virus that has diminished in lethality for healthy individuals like me?

If I had a big upcoming event, I would wear an N-95 mask.

Many counterfeit N-95 and K-95 masks are out there, and many don’t fit them properly.

But that is another story.

Do you regularly wear a paper surgical mask? What motivates you to do so?

Effectiveness of Face Mask or Respirator Use.

This report describes face mask or respirator effectiveness in helping protect against COVID-19 infection.

www.cdc.gov.

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Filippo Maria Stefania of Generali thought consent would always be needed, but it would become a cultural norm. “A decade ago, if you took a picture of your main course in a restaurant, the owner would come out to ask what was wrong,” he said. Agreeing to share health data with insurers and providers will be part of an overall move toward individuals taking more responsibility for their health. That cultural shift will be supported by incentives, discounts, and nudges based on behavioral economics.

The technology is ready. Inge Thijs, a remote clinical monitoring coordinator, explained that a hybrid care system is already in place for heart failure patients in northwestern Belgium. They tend to have repeat admittances to the hospital. Health professionals can intervene before hospital care is needed by tracking measurements such as the build-up of fluids. This not only improves patient outcomes but also reduces the financial burden on the healthcare system. Belgium has a new pathway for reimbursement of M Health, and one of the first areas to be considered was heart failure.

The same technology can be used for rehabilitation after major surgery, reducing hospital stays while improving outcomes — data clearly show that patients recover better at home.

Elie Lobel, the CEO of RDS, a company that develops biosensor technology that can be worn comfortably at home, said that just discharging patients a day or two early can make an enormous difference to hospitals’ viability. Most hospitals in Europe are paid for the procedure performed, not the days spent in the hospital, and most have waiting lists. Discharging each patient even a little earlier will control costs and improve access.

Technology may also make prevention more cost-effective and better targeted, said Todor Jeliaskov, the CEO of In Heart. At the moment, for example, most implanted defibrillators – designed to restore the regular rhythm of the heart after an abnormal heartbeat – are never used. Large data sets may predict who should receive them better than current clinical guidelines can. Those same data sets may be able to target patients most at risk for a blood clot in the heart; these clots cause about a third of strokes, many of which can be prevented by medicines if health systems can identify who needs treatment.

This progress depends not just on wearables and sensors to collect data but on massive computational power to detect patterns unrelated to the disease. Some of these digital biomarkers will seem improbable: in multiple sclerosis, for example, symptoms of depression are predictive of a disease flare-up. It may well be that speech patterns or subtle shifts in activity can warn of cardiovascular problems. Risk factors may be synergistic, too, Dr Nathan Malka said. As a cardiologist, he could never accumulate the data to see which risk factors might augment others, but quantum computer power can unveil these patterns.

Remember the human factor, cautions care coordinator Inge Thijs. The same patients reluctant to come to clinics in hospitals are resistant to home rehabilitation monitoring and help. The technology will require health professionals who can turn its findings into advice that patients will follow. This transition may not be easy, and it’s important to acknowledge and address these concerns to ensure a smooth integration of digital monitoring in healthcare.

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Health system CFOs across the country face a unique quandary. Operating margins remain low, staffing shortages restrict services, industry-wide buying power is waning, organizational credit ratings are at risk, and inflation rapidly affects reimbursement and patient affordability. From the CFO’s point of view, it is prudent to look toward other industries and adopt a holistic approach to managing their organizations’ financial health.

The following seven habits can be employed by health system CFOs leading through turbulent economic times:

Embrace Adaptation in the Post-Pandemic Era

The pandemic disrupted traditional operations, requiring a departure from established norms. In this post-pandemic era, CFOs must acknowledge that returning to the pre-pandemic status quo is not feasible. Rising labor costs and supply chain challenges in the face of capped payor contracts demand fresh strategies. Relying solely on traditional approaches and partners in this new environment will not work. To remain effective, CFOs and their operational leaders must lead their organizations in adapting to the new post-pandemic reality.

Repurpose Savings for Clinical Impact

Non-clinical departments often struggle to inspire clinicians, but CFOs can bridge this gap by strategically connecting clinical goals with repurposed savings from overhead departments. Healthcare leaders should embrace innovative cost-saving approaches, such as considering non-clinical spending as a strategic category of costs to negotiate. CFOs can funnel those savings back into the clinical environment, easing pressure on physicians and nurses and enhancing patient care. An annual habit of exploring non-clinical spending to fund clinical initiatives can pay off for both resources and morale.

Shift from Volume to Efficiency

The age-old adage “volume is everything” in healthcare may not go away entirely, but it is evolving. CFOs increasingly steer their organizations toward cost-efficient practices rather than merely focusing on volume growth. Shifting performance measures from volume to efficiency is worthwhile, even if it is a departure from traditional thinking. This habit is needed as the industry acknowledges the importance of cost-effective care delivery—and the value within risk-based payment programs.

Execute Beyond Technology

Technological solutions typically rely on business cases and aim to provide essential tools for modern operations. However, this technology assessment must go beyond adoption and implementation. The true value lies in the execution of the solution and the insights gained from its use and performance. Sound systems require good data to meet their potential. As an example, a national home goods retailer conducted an RFP and needs assessment for its 1,200-truck delivery fleet. The organization derived information to extend the contract with a current vendor. The negotiation resulted in over $1.8M in savings through invoice credits, cash retention bonuses, and contracted cost savings. Most notably, the negotiation never disrupted distribution. The habit of “focus and finish”—connecting technology with non-tech performance measures—ensures that insights are effectively translated into actionable strategies. The discipline to perform a rigorous “look back” analysis on major technology investments is essential to achieving the promised ROI.

Embrace Data and Strategies Beyond Your Four Walls

There is a world of insights and opportunities beyond the healthcare industry. Although healthcare is unique compared to other industries, there are insights and lessons to be learned from looking at how business is conducted outside of healthcare. For example, wouldn’t a hospital want to know what the local university pays for groundskeeping in the same city? What about bank processing and other financial fees? In one case, the CFO of a big-box retailer looked beyond the industry for insights and saved over $10M by uncovering overcharged credit card processing fees that had slipped past their internal process for more than four years. With this information, the CFO and team negotiated a refund of the fees and all credit card agreements.

Knowledge sharing across industries can be valuable for all organizations. The habit of expanding a network of partners and collaborating with businesses outside the industry can provide fresh perspectives and solutions, which ultimately benefit the health system’s financial performance.

Question the Status Quo

CFOs should embrace the habit of challenging industry norms and targets. It’s a requirement to push change management boundaries in pursuit of effective solutions. One industry norm worth challenging is the singular reliance on group purchasing organizations (GPOs) to aid in spend analysis and negotiations. With GPOs addressing only 25% of non-clinical spending, there is an excellent opportunity to address cost savings in these categories. Unlike direct clinical spending, health systems compete with all industries to secure optimal non-clinical product and service contracts. Leading companies outside healthcare often devote more time and resources to secure better contracts. Continually setting the bar higher—to renegotiate contracts, adopt cutting-edge technology, or pursue innovative partnerships—can drive tangible results and transform the financial trajectory of health systems, no longer leaving money on the table.

Manage Non-Clinical Costs Proactively

Non-clinical cost allocation, akin to investments in a personal portfolio, requires constant monitoring and adjustment. CFOs should adopt a proactive habit of managing non-clinical costs that consume approximately 20% of revenue. By acknowledging the dynamic nature of healthcare finances, CFOs position their organizations for financial success. Also, the CFO can no longer assume that existing structures and partners are sufficient to control these non-clinical costs. Research shows that 75% of non-clinical spending falls outside GPO and procurement contracts. With today’s financial challenges, this leaves a gap in controls that must be addressed. The habit of managing non-clinical costs proactively pays off.

Proactive management of v costs has been proven to result in favorable contracts and significant savings in both annual direct costs and signing bonuses. This outcome was demonstrated by a discount retailer that conducted an RFP and needs assessment with their 10-year incumbent Warranty provider. The proactive assessment resulted in a more favorable contract with higher vendor engagement and training support from a new vendor. Beyond the service value, the resulting savings were $4M in annual direct costs and a $4M signing bonus in the contract’s first year, with the new vendor covering all transition costs.

Today, the role of a health system CFO extends beyond traditional financial management. CFO leadership requires a blend of strategic vision, adaptability, and innovative thinking about benchmarking and managing change. CFOs who embrace these seven habits can navigate the healthcare industry’s challenges in a post-pandemic economic climate, foster financial resilience, and ultimately contribute to enhanced patient care, organizational success, and highly competitive service delivery.

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Special thanks to co-author Mark Van Sumeren, who has more than 40 years of experience in healthcare strategy, operations, and supply chain management. As the General Manager of the healthcare practice at LogicSource, he spearheads cost-savings initiatives within nonclinical healthcare supply chains. Previously Mark held senior executive positions at Owens & Minor, Ernst & Young, and Detroit Medical Center, collaborating with major integrated delivery networks and academic medical centers to enhance operational efficiency and supply chain practices. 

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Hospital systems are experiencing increased cost of care due to workforce shortages, constrained bed capacity and increasing readmission rates.^i,ii Care-at-home programs, which typically include a virtual component, have proven to be effective in decreasing the length of stay and readmission rates which can result in the overall cost of care being reduced.^iii,iv Additionally, care-at-home programs can also support patient recovery and safety, with a potential reduction in fall risk and hospital acquired infections.^v Patients using remote solutions in their homes are three times more likely to be satisfied with the overall care experience.^vi

The goal of the GE HealthCare-Biofourmis collaboration is to enable more patients to go home earlier, and offer an alternative to facility-based care with the comfort and peace of mind that they are receiving high quality care at home with the intent of driving healthy behaviors in patients by managing them remotely. Moreover, insights from Biofourmis’ FDA-cleared, AI-guided algorithms can help care teams deliver efficient, personalized care at home.

“Biofourmis’ demonstrated success with care-at-home solutions will extend GE HealthCare’s current inpatient monitoring portfolio to support patient care from the hospital to home,” said Ashutosh Banerjee, GE HealthCare. “Combining our companies’ demonstrated capabilities will help revolutionize the way we approach the patient care journey as well as help address current challenges faced by health systems including hospital capacity issues and clinical staffing shortages.”

Biofourmis offers care-at-home solutions to deliver and enable care both virtually and in person using its digital platform, with FDA-cleared AI-guided algorithms, clinical-grade wearable devices, in-home services orchestration technology, and nursing services. The solutions provide numerous dynamic care pathways with questionnaire-branching logic to provide enhanced clinical context for care teams.

GE HealthCare’s FlexAcuity™ monitoring solutions in combination with GE HealthCare’s virtual care solutions like Mural ICU, Command Center and Digital CMU adapt to rapidly changing patient needs in the hospital and are built on a legacy of innovation. By offering Biofourmis’ virtual care-at-home solutions to customers, GE HealthCare can extend the care continuum beyond the hospital, and care teams can have a longitudinal patient view beyond the hospital setting.

Ross Armstrong, General Manager of Biofourmis Care, said: “Our collaboration will enable health systems and hospitals to leverage the power of technology and data in order to shape patient-focused solutions across the care continuum, no matter where the site of care is.”

GE HealthCare will begin distributing Biofourmis solutions to customers in the United States starting Q1 2024.

About Biofourmis

Biofourmis delivers technology-enabled solutions that bring the right care to any person anywhere. Biofourmis’ innovative solutions provide people everywhere with connected access to hospital-level services, virtual provider networks for remote care, in-home services, and life-changing clinical trials—all without leaving their homes. The company’s FDA-cleared AI-enabled analytics collect and analyze patient data in real time and identify shifts that can assist in supporting proactive interventions. Trusted by leading health systems, payers, biopharma companies and patients alike, Biofourmis’ connected platform improves patient outcomes, prevents hospital readmissions, aims to accelerate drug development, and closes critical gaps in care—ultimately making science smarter, healthcare simpler, and patients healthier. Biofourmis is a global technology company enabling care delivery, with headquarters in Boston and offices in Singapore and India.

About GE HealthCare Technologies Inc.

GE HealthCare is a leading global medical technology, pharmaceutical diagnostics, and digital solutions innovator, dedicated to providing integrated solutions, services, and data analytics to make hospitals more efficient, clinicians more effective, therapies more precise, and patients healthier and happier. Serving patients and providers for more than 100 years, GE HealthCare is advancing personalized, connected, and compassionate care, while simplifying the patient’s journey across the care pathway. Together our Imaging, Ultrasound, Patient Care Solutions, and Pharmaceutical Diagnostics businesses help improve patient care from diagnosis, to therapy, to monitoring. We are a $19.6 billion business with 51,000 colleagues working to create a world where healthcare has no limits.

ⁱ Fleron, A., Krishna, A., & Singhal, S. (2022, September 19). The gathering storm: The transformative impact of inflation on the healthcare sector. McKinsey & Company. https://www.mckinsey.com/industries/healthcare/our-insights/the-gathering-storm-the-transformative-impact-of-inflation-on-the-healthcare-sector

ⁱⁱ Massive Growth in Expenses and Rising Inflation Fuel Continued Financial Challenges for America’s Hospitals and Health Systems. American Hospital Association. (2022, April). https://www.aha.org/system/files/media/file/2022/04/2022-Hospital-Expenses-Increase-Report-Final-Final.pdf

ⁱⁱⁱ Levine DM, Ouchi K, Blanchfield B, Saenz A, Burke K, Paz M,Diamond K, Pu CT, Schnipper JL. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020 Jan21;172(2):77-85. doi: 10.7326/M19-0600. Epub 2019 Dec 17. PMID: 31842232.

^iv Leff B, Burton L, Mader SL, Naughton B, Burl J, Inouye SK, Greenough WB 3rd, Guido S, Langston C, Frick KD, Steinwachs D, Burton JR. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med.2005 Dec 6;143(11):798-808. doi: 10.7326/0003-4819-143-11-200512060-00008. PMID: 16330791.

^v Telehealth: Helping hospitals deliver cost-effective care.American Hospital Association. (2016, April 22). https://www.aha.org/system/files/content/16/16telehealthissuebrief.pdf  

^vi Leff B, Burton L, Mader S, Naughton B, Burl J, Clark R, Greenough WB 3rd, Guido S, Steinwachs D, Burton JR. Satisfaction with hospital at home care. J Am Geriatr Soc. 2006 Sep;54(9):1355-63. doi:10.1111/j.1532-5415.2006.00855.x. PMID: 16970642.

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Last year, Medika Life published a piece titled The Top 20 AI Voices to Watch, and most of the thought leaders, influencers, and theorists featured continue to demonstrate why they lead the AI conversation. Among those key voices – Tom Lawry and John Nosta – have focused on why conversation must center around “not will be” rather than what is!  What is happening with this technology right now to improve the system and human health?  Nosta points to how AI is an extension of the health professionals’ cognitive abilities, and Lawry reinforces that health systems that adapt and implement remain ahead of the care curve.

Too much of the side conversation distracts from the reality that AI isn’t a future shock; it’s happening – it’s been happening – now and for decades and is impacting health professionals’ abilities to rise to higher levels of performance and contribution within their communities. 

We had a chance to sit down with one of those market leaders whose ideas and organization are demonstrating the efficient value of AI to make medical diagnoses more timely, efficient, and effective.  Joseph Mossel, Co-founder and CEO of Ibex Medical Analytics is an engineer, entrepreneur, and supply chain workflow expert and has been partnering with pathologists, health systems, and pharmaceutical companies to add speed and reduce the human stressors around accurate diagnosis.

Medika Life sat down with Mossel to explore how he and his team at Ibex bring real-time practical value to the pathologist’s workflow and world and, in doing so, bring an authoritative voice and application to their output.

Conversation with Joseph Mossel – Ibex Medical Analytics

Gil Bashe, Editor-in-Chief, Media Life: People often discuss augmented intelligence – AI – as “futuristic” or theoretical technology. Then, there is abundant conversation about AI’s pros and cons. Can it replace skilled medical professionals?  But, as you and Ibex AI demonstrate, it accelerates critical analysis – sustains human life, and enhances research decisions. Your company’s customers embrace this “thinking” technology to improve workflow and reduce throughput stress. Perhaps most important is its ability to amplify critical thinking skills to provide deeper understanding. 

People want to understand how leaders take this technology, manage vast amounts of information, and operationalize it. You turn a wealth of information into practical business and clinical solutions that sustain and save lives. Do you agree with that basic premise?

Joseph Mossel, CEO, Ibex: Yes, I do. When we looked at this field, we saw a huge opportunity to do something that had not been done before by applying AI to pathology. While it’s been done successfully in radiology, digitization in pathology is far more recent, presents unique challenges, and offers significant opportunities for the research and clinical care communities. For us, it was crucial to feel that we were doing something meaningful and helping improve people’s health globally.

What’s interesting about Ibex is that our founders come from a computer science background. We set out to harness the technology within a clinical environment. But we were true to the goal of helping patients and physicians. This singular focus guided us throughout our journey to do something meaningful and, as you note, practical.

Bashe: Pathology, traditionally involved in examining wet slides under a microscope, now embraces digitization. You were applying computer science and thinking through an idea that would transform an insight-driven medical profession that navigates within a larger physician community.

When you and your co-founder began this journey, did you study the entire process, from sample collection to the pathology lab’s inner workings to how patient-centered professionals use these data? What was your approach to understanding and improving this sector?

AI Isn’t Only About Data – It’s Also Work Flow Change

Mossel: More than that. We come from a background that requires understanding how to build products that improve throughput and output. It’s in our DNA. This isn’t just about analyzing data; it’s about having products running in the market, accomplishing an engineering feat and a successful user experience. A lot of sector knowledge is core to the company’s DNA.

As we looked at pathology, three questions drove what we were doing:  

1. The pathology lab resembles a sophisticated factory with advanced machinery and highly trained technicians.  We wondered how to improve this (life-sustaining) factory—even considering how the experts’ experience improved.
2. How do we capture mistakes early to reduce professional anxiety?
3. How do we ensure the right cases get the right priority? We explored the steps, bottlenecks, challenges, and the IT status and infrastructure of the pathology lab.

The next set of questions is clinical. We needed to understand what happened after this sophisticated “factory” had completed its initial work. How is the information used in patient care or research?  How can it be prepared and offered so that it continues to advance within the decision-making process?

The slides are already there, and a pathologist is looking through, historically, the microscope, now on a computer screen, and conducting the analysis. The key is understanding the clinical questions pathologists must answer and having confidence in their observation beyond a black-and-white diagnosis. That is much more complex than just saying whether cancer cells are present or not.  It adds value to this professional’s presence in the care or research process.

Our goal is to identify tasks where AI excels, like counting cells, and tasks where human expertise shines, such as spotting very small, suspected regions. AI can ensure that everything is scanned and nothing is missed, highlighting interesting areas and ensuring the pathologist can confidently examine.  Augmented Intelligence, in this case, is not replacing the pathologist; it’s helping them do their job – the function that makes them essential in clinical care – even better.

If the Benefits Are Clear Change Is Possible

Bashe: No matter how valuable the idea or technology is, sometimes the culture of a community can create roadblocks to change. As an engineer with computer science and product development expertise, you understand the pathologist’s role as an ally to allied health professionals and as your customer. You have the keen ability as an engineer who understands computer science and building products, which means you understand customer expectations.

There is often a feeling that physicians feel threatened by AI; what was your experience sitting down with your advisors? What comments or feedback were you getting from those people?

Mossel: My view might be biased as I primarily meet with people already inclined toward using AI. The main reason I hear from early adopters is that pathologists are struggling to cope with their field’s increasing complexity, and they are genuinely open to help.

One of the things that we hear from many of our users is that it reduces stress levels. It also just helps them get through the cases faster. There’s less buildup of what they physically have on their desk – slides waiting to be made, for example – which adds stress.

But there’s an even deeper element: they don’t need to go home with this feeling at the end of the day. ‘What did I miss today? Was there something I didn’t see?”

So there’s always these remaining questions, and I think we’re helping them sleep better at night. In general, we make the experience of being a pathologist meaningful – even crucial to the next part of the patient’s journey. We’re not at all considering replacing pathologists. We’re focused on making their experience and clinical voices more authoritative.

Bashe: Technology augments the skills of health professionals; it doesn’t replace them. The human deploys or calls upon the technology to provide a greater value to the system, the patient, and the referring physician, and it becomes a much more authoritative voice because they’re championing it. They’re channeling their wisdom through technology.

Ibex chose to focus specifically on cancer diagnosis. Was that a personal, strategic, or market-driven choice? Because of the ability of the technology? Can we say, ‘Wow, it’s not that they have this type of cancer, from the molecular structure in the staging, it’s this type of cancer, and therefore, we’re best to go with this type of clinical approach’?

Paving the Pathway for Precision Medicine

Mossel: Yes, we are paving the way for precision medicine. I think that’s the third driving question for what we’re doing. One revolves around efficiency and the other concerns clinical quality. We primarily do that with our partnerships; we partner with pharmaceutical companies to use this information. 

Data coming out from pathology drives new insights that pathologists can’t do alone. We are finding these important clinical questions that guide treatment. The key here is getting your hands on the correct data sets that allow you to build what we like to call AI markers, like biomarkers, by analyzing these slides quantitatively, which is different from how a human pathologist does it, and putting this into a machine learning framework, generating novel predictions, creating novel tests.

Why cancer? First of all, you’re right. It doesn’t have to be about the technology. Pathology is not just about cancer; technology lends itself to anything. I think that the answer to your question is all of the above; some of it has to do with firsthand experiences with family members who had cancer. Cancer isn’t everything pathologists do, but it’s undoubtedly the most critical, meaningful, and at the heart of the profession.

If you tie it back to therapeutics, determining the right therapy is where the most significant need and opportunity resides. I see us expanding to other disease areas. Clinical diseases also vary. The diagnosis is a determinant of pathology, and we can certainly go into those domains. We are not limited just to cancer, but still, we think of ourselves as a cancer diagnostic.

Bashe: Cancer is the third major cause of death in the world. 72% of disease deaths relate to what they call noncommunicable diseases. Cancer has a substantial economic impact. If we could get to a correct diagnosis earlier, we could deploy treatments earlier; the fastest or quickest institutions to deploy technologies that make their people smarter, faster, more effective, and more efficient are often major academic medical centers.

Does this type of technology make academic medical centers more important to the biopharmaceutical industry because the quality of the data the department shares is more specific?  Will it make the data more valuable to pharmaceutical companies when submitting new medications?

Mossel: The way to think of it is that AI is, in a way, creating a new modality of data: the ability to extract quantitative objective features from vast information. When you work with human pathologists in a clinical trial, they’re much more limited in the amount and objectivity of the data they can get on the site. So yes, you create this new, much richer, more objective information set. You can do more sophisticated machine learning AI on this data and introduce new insights.

Interestingly, the most significant successes are from academic centers. We work with many, though much of our work is with community commercial pathology labs. These are the backbone centers that oversee high volumes. People in the community commercial pathology labs feel the most pain and stress.  Most of our success is in this domain.

AI Can Advance Health Equity

One of the biggest motivators for our actions is how we help promote health equity. If you’re a pathologist at one of these academic centers, you are well-trained with particularly good colleagues surrounding you. You have a fellow doing all your cases in advance of your searches. There’s a strong support network around you. If you’re a pathologist in a commercial lab, you work alone and don’t have the same level of support. We bring this lab our technology, which was trained by some of the world’s best pathologists and help drive up the quality. Most pathology cases go through these labs, and we are helping them—most people who don’t get their pathology sent out to Brigham and Women’s here in Boston.

Bashe: This is a two-pronged health equity front. Ibex enables the community-based or private lab pathologist to share equality with the state-of-the-art academic medical center’s pathology department. So, David equals Goliath when it comes to clinical output or throughput.

There is also the potential that people who often receive sub-optimal care, the Black, Indigenous Americans diagnostic, can get the same quality oversight as someone who has the private resources to go to Mass General or New England Deaconess or Dana Farber Cancer Center; they’re going to get the same quality review of their pathology data. This type of technology, deployed widely, can be a great equalizer in terms of both the ability of the pathologist to perform and feel comfortable about that, but also the ability of people who may have significant health risks to think that their data had the same oversight as someone from a different zip code. Is that accurate?

Mossel: Yes. This works within a specific country where you have a huge demand. This is not theoretical; we have actual numbers backing it up. But you see it within a specific country, the difference between the top academic centers and the periphery. It’s a dichotomy that exists both on a domestic and international level. If you go to the developing world, there is a massive shortage of pathologists, and there is opportunity there. That’s another part of our vision.

Our mission is to ensure that every patient gets the correct diagnosis. Everyone takes it as a given that cancer diagnosis is often wrong, and we do the best we can do. But we are now in a position where technology allows us to go beyond that, overcome these barriers, and make diagnostic errors exceedingly rare. But it’s not just a technological question, right? It’s a question for the healthcare system. For the technology companies, the providers, the payers, and the regulators – everyone needs to get together and solve this problem.

Bashe: You are a CEO, a founder. You’re an operational leader. You’re listening to the customer’s needs; you’re listening to the response. You talked about how you and your colleagues have created products before, and you understand that it has to be packaged, deployed, and used to assess market success. Could you share two or three measures of success from where you sit? What do you think the success measure should be?

Accuracy Decreases Workplace Stress

Mossel: We have one straightforward measure of success for Ibex that can be extended for the entire industry: the number of biopsies that go through our system. We have hard data showing that Ibex knows what we are doing and has proven that the more cases that go through our system, the fewer the diagnostic errors and the greater the efficiency for pathologists. And for us as a company, that’s what we rally around: driving up the usage. Everything will cascade from both the clinical and economic impacts and the success of Ibex as a company.

Bashe:  Joseph, thank you for your insights – practical guidance on how AI accelerates decisions that save lives. You and your colleagues are drilling down into an area that is one of the most expensive areas of health: managing people with cancer. It’s one of the most terrifying diseases, where people want to know that they have an authoritative diagnosis and where pathologists and oncologists don’t want to screw it up. You are enabling people to be much more confident that the information they’re sharing with their patients and their clinical decisions is on point, not because of their own life experience or clinical experience. But the data is there to back them up. It doesn’t get much more practical than that.

Futurists have the advantage of rarely being wrong.  Long after they’ve shared their predictions, the world moves along. People forget, and the edgy on-stage comment is forgotten.  Pathologists can never be wrong. When they are, it’s considered an error – sometimes with dire consequences.  The possibility of combining knowledge – trained and honed – with the aggregated intelligence of pattern recognition offers pathologists and their health professional community an added advantage.  Ibex AI demonstrates not what is possible – what is happening now. 

The concept of the future is always inviting and exciting.  The difference between invention and innovation is scaled application.  AI, ChatGPT and GenAI applied play to the strength of the curious and bold. Using these technologies can democratize information for humanity’s benefit.

The post Don’t Crystal Ball Patients’ Futures – AI Delivers Accuracy Right Now appeared first on Medika Life.

Kevin Stansbury, the CEO of Lincoln Community Hospital in the 800-person town of Hugo, Colorado, is facing a classic Catch-22: He could boost his rural hospital’s revenues by offering hip replacements and shoulder surgeries, but the 64-year-old hospital needs more money to be able to expand its operating room to do those procedures.

“I’ve got a surgeon that’s willing to do it. My facility isn’t big enough,” Stansbury said. “And urgent services like obstetrics I can’t do in my hospital, because my facility won’t meet code.”

Besides securing additional revenue for the hospital, such an expansion could keep locals from having to drive the 100 miles to Denver for orthopedic surgeries or to deliver babies.

Rural hospitals throughout the nation are facing a similar conundrum. An increase in costs amid lower payments from insurance plans makes it harder for small hospitals to fund large capital improvement projects. And high inflation and rising interest rates coming out of the pandemic are making it tougher for aging facilities to qualify for loans or other types of financing to upgrade their facilities to meet the ever-changing standards of medical care.

“Most of us are operating at very low margins, if any margin at all,” Stansbury said. “So, we’re struggling to find the money.”

Aging hospital infrastructure, particularly in rural areas, is a growing concern. Data on the age of hospitals is hard to come by, because hospitals expand, upgrade, and refurbish different parts of their facilities over time. A 2017 analysis by the American Society for Health Care Engineering, a part of the American Hospital Association, found that the average age of hospitals in the U.S. increased from 8.6 years in 1994 to 11.5 years in 2015. That number has likely grown, industry insiders say, as many hospitals delayed capital improvement projects, particularly during the pandemic.

Research published in 2021 by the capital planning firm Facility Health Inc., now called Brightly, found that U.S. health care facilities had deferred about 41% of their maintenance and would need $243 billion to complete the backlog.

Rural hospitals don’t have the resources of larger hospitals, particularly those in hospital chains, to fund billion-dollar expansions.

Most of today’s rural hospitals were opened with funding from the Hill-Burton Act, passed by Congress in 1946. That program was rolled into the Public Health Service Act in the 1970s and, by 1997, had funded the construction of nearly 7,000 hospitals and clinics. Now, many of those buildings, particularly those in rural areas, are in dire need of improvements.

Stansbury, who is also board chair of the Colorado Hospital Association, said at least a half-dozen rural hospitals in the state need significant capital investment.

Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, a think tank in Pittsburgh, said the major problem for small rural hospitals is that private insurance is no longer covering the full cost of providing care. Medicare Advantage, a program under which Medicare pays private plans to provide coverage for seniors and people with disabilities, is a major contributor to the problem, he said.

“You’re basically taking patients away from what may be the best payer that the small hospital has, and pushing those patients onto a private insurance plan, which doesn’t pay the same way that traditional Medicare pays and ends up also using a variety of techniques to deny claims,” Miller said.

Rural hospitals also must staff their emergency rooms with physicians round-the-clock, but the hospitals get paid only if someone comes in.

Meanwhile, labor costs coming out of the pandemic have increased, and inflation has driven up the cost of supplies. Those financial headwinds will likely push more rural hospitals out of business. Hospital closures dropped during the pandemic, from a record 18 closures in 2020 to a combined eight closures in 2021 and 2022, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill, as emergency relief funds kept them open. But that life support has ended, and at least nine more closed in 2023. Miller said closures are reverting to pre-pandemic rates.

That raises concerns that some hospitals might invest in new facilities and end up shutting down anyway. Miller said only a small portion of rural hospitals might be able to make a meaningful difference to their bottom lines by adding new services.

Lawmakers have tried to help. California, for example, has loan programs charging low to no interest that rural hospitals can participate in, and hospital representatives are urging Colorado legislators to approve similar support.

At the federal level, Rep. Yadira Caraveo, a Colorado Democrat, has introduced the bipartisan Rural Health Care Facilities Revitalization Act, which would help rural hospitals get more funding for capital projects through the U.S. Department of Agriculture. The USDA has been one of the largest funders of rural development through its Community Facilities Programs, providing over $3 billion in loans a year. In 2019, half of the more than $10 billion in outstanding loans through the program helped health care facilities.

“Otherwise, facilities would have to go to private lenders,” said Carrie Cochran-McClain, chief policy officer for the National Rural Health Association.

Rural hospitals might not be very attractive to private lenders because of their financial constraints, and thus may have to pay higher interest rates or meet additional requirements to get those loans, she said.

Caraveo’s bill would also allow hospitals that already have loans to refinance at lower interest rates, and would cover more categories of medical equipment, such as devices and technology used for telehealth.

“We need to keep these places open, even not just for emergencies, but to deliver babies, to have your cardiology appointment,” said Caraveo, who is also a pediatrician. “You shouldn’t have to drive two, three hours to get it.”

Kristin Juliar, a capital resources consultant for the National Organization of State Offices of Rural Health, has been studying the challenges rural hospitals face in borrowing money and planning big projects.

“They’re trying to do this while they’re doing their regular jobs running a hospital,” Juliar said. “A lot of times when there are funding opportunities, for example, the timing may be just too tight for them to put together a project.”

Some funding is contingent on the hospital raising matching funds, which may be difficult in distressed rural communities. And most projects require hospitals to cobble together funding from multiple sources, adding complexity. And since these projects often take a long time to put together, rural hospital CEOs or board members sometimes leave before they come to fruition.

“You get going at something and then key people disappear, and then you feel like you’re starting all over again,” she said.

The hospital in Hugo opened in 1959 after soldiers coming back from World War II decided that Lincoln County on the eastern Colorado plains needed a hospital. They donated money, materials, land, and labor to build it. The hospital has added four family practice clinics, an attached skilled nursing facility, and an off-site assisted living center. It brings in specialists from Denver and Colorado Springs.

Stansbury would like to build a new hospital roughly double the size of the current 45,000-square-foot facility. With inflation easing and interest rates likely to go down this year, Stansbury hopes to get financing lined up in 2024 and to break ground in 2025.

“The problem is, every day I wake up, it gets more expensive,” Stansbury said.

When hospital officials first contemplated building a new hospital three years ago, they estimated a total project cost of about $65 million. But inflation skyrocketed and now interest rates have gone up, pushing the total cost to $75 million.

“If we have to wait another couple of years, we may be pushing up closer to $80 million,” Stansbury said. “But we’ve got to do it. I can’t wait five years and think the costs of construction are going to go down.”

The post Rural Hospitals Are Caught in an Aging-Infrastructure Conundrum appeared first on Medika Life.

[Though now out of print, used copies are available on Amazon at an incredible price range of $599 to $9.99. The full text is a free-of-charge Google download, Branding Health Services.]

Today’s Leaders Continue to Grapple with the Broken System

It is almost impossible to imagine that when the book’s 18 contributors penned their chapters, the Internet of 2000 was a novelty used by early adopters. The Office of the National Coordinator for Health Information Technology, which outlined a plan to ensure that most Americans had electronic health records, didn’t exist. “Dr. Google” had yet to become a code word for consumers looking up information for “self-diagnosis.” The world Eric Topol envisioned in the bestseller “The Patient Will See You Now” was pure science fiction. The system’s customer — the patient — was left out of the picture. Terms defined in Tom Lawry’s Hacking Healthcare and the potential of AI and ChatGPT outlined by John Nosta were not even on the big tech brainstorming whiteboard.

Fast forward 24 years. Medical information and innovation accelerate the possibilities of improved care, but health institutions still grapple with many of the same challenges. Many have been folded into others to create networks, gobbling each other up or finding that partnerships are better than head-to-head direct competition. Those arrangements have likely been driven by cost containment and more substantial negotiating power around private and public payer reimbursement. Yet, the importance of patient experience and engagement remains largely lip service.

You Can Order a Pizza Online — But Make A Doctor Appointment?

You can order a pizza with a few strokes of an app. Try scheduling or changing a doctor’s appointment. Frustrating. In Psychology Today, John Nosta writes about one of the health system’s biggest challenges, “Culture squashes innovation.” What was true 24 years ago remains much the same — even as hospital and care systems rush to perfect their digital front door and make it easier for patients to access care.

The institutions that chose to contribute to this prescient book on branding evolved into national health-sector leaders. Unsurprisingly, most are icons of clinical excellence by securing high levels of patient satisfaction. They are among the top-rated hospitals in the US News and World Report rankings. All make “brand building” relationships with their stakeholders — board members, employees, consumers, patients, caregivers, policymakers, product innovators, and payers — a C-Suite priority.

However, others continue to see sustained brand-building efforts as a cost center rather than core to attracting and retaining the best health talent, securing solid reimbursement rates, and, most importantly, making consumers, as they enter its portals and doors, feel confident their clinical concerns will be addressed with expertise and customer-centered convenience. The experience around care defines the power of the brand in health care.

Medicine is for the People — Still a Futuristic Calling

In the closing pages of the chapter, I contributed a reminder that we are still — even as enlightened — committed health professionals — struggling to create space for the consumers’ voices to be heard. Today, I am reminded that pharma pioneer and visionary George W. Merck, speaking at the Medical College of Virginia at Richmond in 1950, said, “We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we remember that, they have never failed to appear.” Constantly, we must look back to press forward.

Health care is for the people! The system is supposedly designed to provide care — not withhold it. But, when consumers look back at the 24 years since Branding Health Brands was published and look at their situations, today, health care seems to be created by and for the system. Institutions and drug innovators are inspired to help and heal, but that is not how the public and policymakers perceive them. Now, as we look to Election 2024 and the upcoming presidential debates that will chastise the sector, we anticipate the brutal attacks that will be coming. But not one segment of the system is at fault — The most significant cost sink results from fragmented information and economic systems.

(Health) Information is Power

Do not judge this old jug of a book published two decades before Topol’s bestseller, The Patient Will See You Now, as out-of-sync. Its pages contain actionable historical insight:

“Once even the ablest of patients played a version of ‘Mother May I?’ with their doctors — no more. Information in the hands of the lay public has become part of the cure. Even many health care providers now feel, in a twist on the retailing come-on, that an educated health care consumer is their best patient. Indeed, for every provider irked at the second-guessing of amateurs, others [physicians and pharmacists] are grateful not to have to explain the difference between bacterial and viral infections…

“More and more, information is the weapon of choice of today’s health care consumers, who are shedding light where bureaucratic stonewalling and professional secrecy once ruled. Empowering the ‘end users’ of health care as never before.”

The passion to continue this journey is more vibrant than ever. Today, health communication colleagues worldwide must champion the call that embracing health brands leads to closer connections between product innovators, physicians, payers, policymakers, and, most certainly, patients. They must be encouraged to realize that — while too often messaging C-Suite leaders to pass along blame on why the US health system is broken — they must also find ways to collaborate and center efforts around a shared passion for healing that outweighs who comes out on top on a given day.

Will AI, ChatGPT and Telehealth Make Things Better

In the face of many health brand-building reputation challenges, power brands solve people’s health problems. With new platforms to reach audiences, including AI, ChatGPT, and Telehealth, in truth, brands streamline decision-making. Excellence and hope are not disparate concepts. Together, they send a message to consumers, caregivers, and patients — you have come to the right place.

Since its publication, 24 years have passed, yet the challenges and call-to-action presented in “Branding Health Services” have not changed. “Products and services that can rise above the clutter withstand the klieg lights of exposure and are elevated above others in the hype-competition for consumers’ attention.” Health brands resolve people’s fears and aggregate their hopes and dreams, helping them navigate the clutter to enhance their lives.

Twenty-four years have passed since Branding Health Services — Defining Yourself in the Marketplace hit the bookshelves. We have to ask ourselves candidly, how far have we gone to address the patients’ pressing needs to be a partner in their care? Not far enough!

The post Patient Engagement Goes Back to the Future — How Far Have We Gone to Answer Consumers’ Needs? appeared first on Medika Life.

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In the first Medika Life analysis of the always insightful Galen Growth data offering insight into the state of affairs of digital health – from partnerships to its practical application to the category’s financial health – we described the global environment as promising yet filled with “trepidation”:

Trepidation. That one word describes the uncertain economic climate that gripped corporate and investment decision-makers. If we are to believe the headlines, wallets have tightened – almost closed – and investment in life science and digital health, as a result, has declined. That go-to conclusion takes a simple approach to a complex investment strategy for the digital health sector that has shown great resilience year-after-after.

Now, the word to describe this new report is “Potential.” There is incredible potential for digital health to find its way within the US health system in multiple ways – from AI to ChatGPT to digital therapeutics – it’s potential remains great. Its path arduous.

The special report prepared for ViVE2023 shifts from its usual global 30,000 feet analysis to a special meeting theme – digital health and the US health system – particularly on the provider side.  The data released during the first full day of ViVE as an analysis of hospital activities around digital health –where the rubber meets the road for many of these ventures – practice application of innovation. Galen Growth of their FINN Partners has mined the insights that entrepreneurs, their investors, health system chief information, and innovation officers need to study closely! 

The data are essential for ventures, incubators and accelerators to mine, determining whether the digital health category and the massive US health provider system are working together to evaluate their activities’ effectiveness and advance the nation’s wellbeing.

Galen Growth is among the world’s trusted digital health private market data, intel and insights firms for industry and investors. They remain the only specialist digital health innovation partner, able to bring together private market venture data, intel and insights platform giving its clients more applicable information than any other platform

In the US, some 417 Health Systems account for nearly 3,500 hospitals. More than 1,600 independent hospitals are the backbone of healthcare delivery in the country and – in addressing in-patient care — a significant contributor to health outcomes.  But, many of these institutions – particularly those in remote and rural communities – are ailing. They need a bolus infusion of health innovation to access patient data, reimbursement and basic diagnosis and treatment priorities.  Digital health – from EMRs to remote access technologies is part of the critical-care, system-wide treatment.

“More than 50% of the 417 US health systems are struggling financially, impacted by the rapidly rising labor cost and shrinking HCP workforce. Meanwhile, demand from consumers and patients continues to increase,” says Julien de Salaberry, founder and CEO of Galen Growth. “Health systems and hospitals have to make increasingly difficult decisions about their healthcare delivery capabilities and seek technology solutions to increase productivity and build capacity while retaining high standards of care,” he adds.

Unless otherwise stated, all data are exclusively sourced from the Galen Growth proprietary

database HealthTech AlphaTM – the leading global digital health intelligence and analytics on-demand platform. HealthTech Alpha now tracks more than 300 million data points and has coverage exceeding 13,000 digital health ventures across the globe.

Here are the core takeaways from the Galen Growth/FINN Partners – ViVE2023 Report – but read the entire report to mine its full value:

Partnerships

In 2022, 31% of all global partnerships with Digital Health ventures founded in the United States were built within the U.S. Health Systems and hospitals– more partnerships than any other industry vertical engaged with Digital Health.

Clinical Evidence

Among the ventures that are partnering with the U.S. Health Systems ventures focused on Research and Clinical Trials take the top strategic area spot, with 69% of the ventures having Evidence Signal > 40, indicating significant Clinical Evidence. Ventures in the strategic areas of Diagnosis and Treatment captured 40 and 36% shared, respectively.

Health Systems

Galen Growth has recorded more than 1,400 partnerships globally between Digital Health ventures and Health systems in the United States since 2012, with only 10 Health Systems recording a Digital Health portfolio larger than 15 ventures. More than 560 hospitals and Health Systems are active, but only the top 65 most active Health Systems are accountable for 50% of all recorded partnerships.

Oncology

Oncology takes the top position across the therapeutic areas, with more than 30% of U.S. Health System is partnering with ventures in this area—cardiovascular Diseases are in second place, with 20%. Looking across the top 25 most active Health Systems, the top 13 therapeutic areas were represented in more than half of the Digital Health portfolios.

Portfolio Size

Across the U.S., there is a 2.1x difference in the Digital Health portfolio size between the most active Health Systems and the most extensive Health Systems. While the largest Health Systems focus on infrastructure improvement and treatment partnerships, the most active systems are partnering more in diagnosis and have a higher share of digital tools for research (incl. clinical trials). Both groups have significant activity in Digital Health tools for Prevention and Wellness.

How is the digital health sector doing overall despite the energy and buzz?  According to today’s Galen Growth report, its most significant potential awaits to be fully realized. Julien de Salaberry summarizes:

“Since 2012, US health systems have disclosed more than 1,400 partnerships globally with digital health ventures, with only 10 Health Systems recording a digital health portfolio larger than 15 ventures. More than 560 hospitals and Health Systems are active, but only the top 65 most active Health Systems are accountable for 50% of all recorded partnerships.”

Once again, Galen Growth has given us a wealth of data to mine and contemplate. The potential for digital health – as a tool to accelerate access to life-saving information and care remains incredibly promising.

The post Galen Growth Issues Special ViVE2023 US Health System Digital Health Report appeared first on Medika Life.

In the classic rat sleep deprivation trials, total sleep deprivation ended up killing the rats in 11-32 days. When the researchers deprived the rats of REM sleep, or commonly known as “dreaming sleep,” the rats also died, although they did survive for a longer time period, 16-54 days. Nevertheless, sleep deprivation is very detrimental, and when I was training as a sleep specialist, I learned about myriad health problems when people become sleep deprived.

So, when patients are admitted to the hospital, why do we wake them up in the early morning to draw blood tests? Yale University researchers studied this, and they found that nearly 40% of laboratory studies occurred between 4:00 AM and 6:59 AM:

The traditional thinking behind this is that, by the time the physicians and APPs come in to see their patients in the morning, usually at 7:00 AM, the blood tests are ready for them, and they can act on the findings of those blood tests to help care for the patients.

Yet, this begs the question: do we really need to get blood tests that early in the morning? Would care suffer significantly if those blood tests were drawn at, say, 8:00 AM? There should be enough time to act on any abnormal test results in the morning and before morning rounds. At my hospital, we round at 10:00 AM, and so if blood tests were drawn at 8:00 AM, they should be back by the time I round with the rest of the team.

As far as I can remember – and into today – “AM Labs” are usually drawn at 4:00 or 5:00 AM by default or even tradition. Unless the patient is comatose in the ICU, getting a blood test at 4:00 or 5:00 AM can disrupt the sleep of our patients, which can be very detrimental and can hinder their recovery from illness.

It can also precipitate delirium in our patients due to the sleep deprivation, the effects of which can also be very detrimental to the recovery of our patients. Moreover, it can also disrupt the sleep of the clinicians caring for those patients at night, who have to be awakened also at 4:30 or 5:00 AM to receive notification of critical results and act on them. This sleep disruption can also affect clinician well-being and burnout.

Good sleep is often the elusive treasure of a hospital stay. Many clinicians chuckle when they hear this, but it really is no laughing matter. It may be time to rethink the necessity of getting blood tests so early in the morning, so that our patients can actually get a good night’s sleep and be well on their way to a good recovery from illness.

The post Are Early Morning Laboratory Studies Really Necessary in Hospitalized Patients? appeared first on Medika Life.

Elected officials quickly point fingers and prefer debating settled science for fear of antagonizing their base.  All in the interest of self-preservation or self-interest.  When it comes to public health, we need a bolus dose of radical purpose and a stiff shot of courage. We seem overwhelmed by health and ecohealth problems.  Yes, engaging and solving the endless list of issues appears impossible.  However, avoiding these “big three” – obesity, mental health, and plastics – only compounds the significant societal and business woes we’re already facing.

“Let’s start at the very beginning, a very good place to start…” as Julie Andrews sang Rodgers and Hammerstein’s uplifting Do-Re-Mi in The Sound of Music. It’s time we begin to rally to the beat of three public health priorities where investment of time and money will deliver outcomes:

Weight

1. America’s Expanding Waistline:  Some 40% of American adults aged 20 and older are considered obese. The domino effect of obesity-related conditions includes heart disease, stroke, type 2 diabetes, and some cancers. These are leading non-communicable causes of costly, premature death. According to the Centers for Disease Control, the estimated medical cost of obesity in the US reached $173 billion in 2019. Medical expenses for obese adults annually are almost $2,000 higher than medical costs for people with a healthy weight.

It’s simple to point the finger at the fast-food industry as a leading cause of the nation’s obesity problem. It’s also popular to blame overweight people for inflicting the problem upon themselves.  That’s not a good use of time or effort. It’s not even accurate,  Five contributors tip the scales: 

• Caloric intake
• Poor diet
• Lack of exercise
• Stigma
• Access to expert care

Social determinants of health influence obesity rates among adults and children. Poverty, racism, geography, and lack of access to preventive and expert medical care contribute to our ever-expanding waistlines.  Structural racism is baked into our institutions, policies and practices—from defining where people (are often forced to) live to how food is produced and priced. 

We also need to take obesity seriously as a medical condition.  Physicians such as Katherine Saunders, MD, and Louis Aronne, MD, at Weil Cornell are at the forefront of this emerging discipline. But fewer than 6,000 physicians like Saunders and Aronne are certified in Obesity Medicine.  The millions of people confronting obesity need continued medical intervention and support beyond losing pounds.

Marshaling public health and medical expertise to address obesity – access to care, greater public education, access to healthier, affordable food options and reinvestment in primary and secondary school physical exercise programs will produce results that slow the obesity-related non-communicable disease cascade, sustain lives and reduce costs.

Mental Health

• Mental Health is Health:  We must stop ignoring the realities and stressors of life that contribute to other health problems.  “You’ll get over it,” is not a curative response. There is universal acceptance that the pandemic unleashed the mental health problem. It merely made mental health an inescapable issue.  Removed from distractions and living, learning, and working in isolation from others, what was beneath the surface quickly bubbled up to the visible top.

It’s time we face the music and accept that depression and other mental illnesses are manageable medical conditions when diagnosed promptly and treated. Likely the biggest obstacle to care is societal bias and stigma.  In recent years, rates have shown a marked increase in reported cases.  Young adults aged 18-25 years have the highest prevalence of serious mental illness (9.7%) compared to adults aged 26-49 years (6.9%) and aged 50 and older (3.4%).

“As more of us share our experiences, then the stigma starts to reduce, as we understand that this is a shared experience, and this is what is part of being human,” said John McPhee, CEO of the JED Foundation.

Worse than the statistics around mental health-related conditions are deaths by suicide and the endless trauma survivors – parents, partners and children endure.  Globally, one person every 40 seconds takes their life. The World Health Organization and the Global Burden of Disease study estimate that almost 800,000 people die from suicide annually. With timely, proven intervention, many suicides can be prevented.

According to the JED Foundation, mental health in teens and young adults is pressing. More than half of college students will go through a period of high anxiety and one-third of college students will experience some level of depression. The data are frightening.  Suicide ranks the second leading cause of death among ages 15 to 24.

Public and self-stigma is the primary disease we must overcome to set the groundwork to better assist people with mental health needs.  Along with expected basic vitals tracked during a primary-care check-up, health professionals can make a difference by conducting mental health screens and conversations.  Remove the embarrassing obstacles to diagnosis and treatment so that more people step forward to ask for and receive care.  It’s a start that likely will save lives.

Plastics

• Plastics – Reduce Use in Healthcare Settings:  Microplastics have been detected in human breast milk for the first time, according to a new study published in Polymers and shared in WebMD. The researchers shared that they are worried about the potential health effects on babies. Shouldn’t elected officials share that concern? Shouldn’t the global medical community? Most definitely expectant parents!

US hospitals produce more than 5.9 million tons of waste yearly.  There is no escaping the reality that the planet’s health and our own are joined, and the medical community must work closely with environmental affairs experts on what must be done to keep the planet sustainable.

World Health Organization Director-General Tedros Adhanom Ghebreyesus, Ph.D., wrote in the Healthcare Without Harm report, “Places of healing should be leading the way, not contribute to the burden of disease.”  The health industry can start by using alternative plant-based packaging and products whenever possible rather than plastics. It’s an essential start to supporting clean innovation.

Is this even possible?  Absolutely! There are market leaders that are role models and sharing sustainability data. Kaiser Permanente, the nation’s most extensive integrated, nonprofit health system, reports its efforts to prioritize environmental health and patient care have enabled it to become the first health system in the US to achieve carbon-neutral status. Mega not-for-profit health systems such as CommonSpirit are partnering with vendors to reduce the use of plastics in operating rooms. These efforts must become a social impact metric that defines the business sector that commands almost 20% of the national GDP and is dedicated to sustaining our health. 

Health standard bearers such as Kaiser and CommonSpirit have proven that change is possible.  These centers of healthcare excellence – caring for people and the planet – lay the groundwork for Federal and state policies that can protect our short- and long-term well-being.

The clock is ticking.  These problems cannot be wished away.  Weight, mental health and plastics are three priority health concerns contributing to a deadly domino effect where one crisis leads to another.  Of course, these are not the only public health issues of import we face.  At the foundation of these problems are poverty, racism and economic systems rooted in an unsustainable status quo.  Eventually, there will be no choice but to engage and change.  By then, what will the state of people’s health be?  I’d prefer we commit to taking the necessary action sooner to spare us from having to face that bleak future.

The post Let’s Kick the Can Down the Road Again. Or Not! appeared first on Medika Life.