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      string(53) "We Need to Build Post COVID Sick Care System Immunity"
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    Patients, sick care workers and organizations in our dysfunctional sick care system of systems were left vulnerable to the pandemic, something many experts predicted, but whose warnings went unheeded.

    " ["fulltext"]=> string(4570) "

    But, eventually, the parts of the biomedical industrial and educational complex will either die or recover to some degree and need weeks, if not months, of post-discharge care and rehabilitation to rebuild their immunity as things gradually come back to some semblance of the new normal.

    Public policy experts are already planning for how cities should recover.

    Here are some places where we need post acute care discharge care pathways now to accelerate healing and recovery and build immunity to prevent post discharge readmission when we see the next wave of disease:

    1. Hospital and non-hospital care facilities, like ERs, urgent care centers, pharmacies, and , yes, pot shops and liquor stores that have been designated essential industries.
    2. Rural health facilities.
    3. Higher ed,graduate schools, health professional graduate schools and residency training programs.
    4. Biopharma , medtech and medical supply chains and innovation.
    5. The clinical trial value chain.
    6. Biomedical and clinical innovation and entrepreneurship clusters.
    7. Nursing homes and long term care facilities.
    8. Federally run care facilities like the VA, the Indian Health Service and the Public Health Service.
    9. Ambulatory surgery and office based surgery centers.
    10. Post graduate health related programs in business schools, schools of public health and health administration programs.

    It is likely that the demand for services will dry up for a while and it won't be business as usual after the Coronapocalypse. High school students will reconsider college. Patients will reconsider going to brick and mortar facilities. Medical schools will have to reinvent themselves. Retiring doctors will rewire doing remote, online work and many younger docs will rethink long clinical careers. And, the entire system might finally figure out now to stop wasting close to a trillion dollars in sick care spending every year.

    The economy is in the ICU, not just thousands of patients. Long-term morbidity, in the forms of cognitive, physical and psychological impairments, has significant consequences for survivors of critical illness and for their caregivers. ICU patients may develop PTSD anchored to their critical illness experience, with ICU-related PTSD incidence rates of 10%. Using ICU diaries during a critical illness may minimize the occurrence of future ICU-related PTSD. The same could happen to those on the front lines of the pandemic when they come back home.

    Like the virus itself, the highest mortality rates in the biomedical industrial and educational complex will be in those with compromised immune systems that can't fight the forces of change to their models and revenue streams. Those that survive, unfortunately, will not develop antibodies to the next wave of illness, that most likely will happen, it they do not fortify their defenses as they recover. The challenge is that, except in a national emergency, corporate immune systems are very effective at snuffing our innovation, not the pervasive systemic and operational effects of the new corona virus.

    Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@ArlenMD and Facebook.

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    We Need to Build Post COVID Sick Care System Immunity

    Arlen Meyers, MD, MBA
  • 2
    object(stdClass)#13810 (59) {
      ["id"]=>
      string(4) "5772"
      ["title"]=>
      string(46) "Coronavirus - of Risk and Ruin, Ideas and Hope"
      ["alias"]=>
      string(43) "coronavirus-of-risk-and-ruin-ideas-and-hope"
      ["introtext"]=>
      string(226) "

    I am just back from being tested for COVID19- very efficiently and professionally, I might add- at Griffin Hospital in Derby, CT.

    " ["fulltext"]=> string(13841) "

    I can’t commend my Griffin colleagues enough for how beautifully they organized. Below are images of the test facility, and the print guidance I received. That said, I won’t have my test results for 3 to 5 days, which is far too long- not just for me, but for the system that needs those data to understand and best address the pattern of the epidemic.

    In the interim, I very much suspect I have coronavirus- today I feel moderately sick- and frankly, hope I do. If I am this sick with something else while still vulnerable to getting coronavirus, too- then I am in real trouble!

    If I do have COVID19, it is for the very reasons I have been writing about since before the pandemic reached our shores: lack of advance preparation, lack of risk stratification, and lack of policies predicated on risk differentials. What I mean is this: my most likely exposure is from my adult children sent back to the family home when (A) universities closed down, and (B) businesses closed down and laid people off. I am not saying these things didn’t need to happen- but they needed to happen with some careful consideration of risk tiers.

    COVID 19 US

    One of my daughters was working in a now closed restaurant in New York City, now declared the American epicenter of the contagion. She is a very healthy young woman (in fact, ran the 2019 NYC Marathon)- and thus is in a group that appears to be at very, very low risk of severe coronavirus infection. I, however, am a 57-year-old man. I’m not in a high-risk group, but the global data certainly suggest my risk of severe infection to be much higher than my daughter’s.

    Fortunately, in my case, my prior health was excellent- that’s my job, after all- health promotion. I practice what I preach. But I am very concerned about my contemporaries around the country- the many hundreds of thousands of late 40-something, 50-something, or early 60-something parents who are not in perfect health, and some far from it, now huddling at home with adult children sent home, infectious status unknown, from the large populations of universities, and in many cases, big cities. I am all the more concerned about those households with yet another generation under that roof, namely the grandparents of those young adults.

    COVID19 US
    COVID19 US

    We were badly prepared for this pandemic, despite public health experts -me among them- shouting about it for years, begging for preparation- going ignored. If anything, those of us advocating for public health have suffered a blistering assault by the anti-vaccine crowd. I have written about this innumerable times over the years, and of course- no one paid much attention.  

    Hence, my worry at the start of this that an approach not focused on risk tiers would spread our very limited resources far too thin to protect anyone reliably. Elderly people, with no clear guidance, were gathering in NYC's Central Park with younger people as of yesterday. They are likely getting exposed to an infection they- the older people- really cannot afford to get. It looks thus far like most of the healthy, young people passing it to them probably can “afford” to get it, because it is overwhelmingly likely to be mild in them- although we need more data to know for sure. Which reminds me: my test result will take too long!

    I have been suggesting from the start that- given how ominously ill-prepared we have let ourselves be- that we must think through targeting the resources we do have to those who most need protection. Evidence from other countries with much better data than we have so far shows that to be: the elderly, and those with chronic disease like heart disease and/or diabetes, and those with significant immunocompromise. 

    What we can do now is gather and assess data from the US experience, and determine if a pivot to a more risk-based concentration of protections can be carried out. The goal is better protection, not less, for those most in need.  To me, the prospect looks promising.

    As for the economy- it simply can't be unbundled from public health; this is what the vitally important “social determinants of health” is all about. It is a major reason, even the major reason, why some people are healthy and others are not. As my colleagues focusing their entire careers on this matter have said: your zip code may say much more about your prospects for health than your genetic code.

    Many people in this country are financially marginal, living pay check to pay check. They are now subject to true destitution, desperation, ruin, food insecurity, hunger, and the fallout from that: addiction, domestic violence, suicide. Colleagues and I looking at all that don't know if the deaths from coronavirus will be less, or more, than the deaths resulting from societal collapse. Does anyone want to argue that deaths and misery resulting indirectly from this pandemic are less important than those resulting directly from it? 

    Every argument I’ve made is predicated on this simple idea: there is more than one way to lose or ruin a life, devastate a family- and any of them is bad. Preventing any of them is good. Our goal as a society should be to use the best data we can amass, to inform the best policies we can devise, to minimize total harm. Our job is to save the most people, and families, possible from every variant on the theme of calamitous ruin and loss. Some of this can be done with federal financial support; but much of it cannot. 

    I am getting emails from vulnerable people with chronic conditions who really don't know what to do now that their young adult children are back home. Can anyone leave the house? How do they handle grocery shopping? We need hotlines to deal with such matters, and we need them now, before all of those most vulnerable to severe infection wind up needing a hospital bed.

    Our only immediate option is the best population-wide containment and interdiction we can manage. So to be perfectly clear, we must all now abide by all the rules to the very best of our ability: social distancing, shelter in place as advised. There can be no rush from these policies and practices until there is a fully developed, reliably better next phase ready for implementation.

    Accordingly, while social distancing and attempting to interrupt viral transmission, we can gather and analyze data regarding variation in risk. Coronavirus risk differentials, and policies predicated on them, could offer the promise of much better, more dedicated protections of those most in need; less risk of overwhelming the medical systems around the country as a result; a path to more proximal crisis resolution via herd immunity; and more than one way to save a life. 

    I also think it would be enormously reassuring to people like my 80-year-old mother, who is somewhat afraid of getting coronavirus and dying, but even more afraid of dying of some other cause over an indefinite period of time in isolation before ever again being able to hug her grandchildren- to know that there is a plan in place. Or, at least, planning for a plan.

    I think authorities could align and announce now a commitment to both immediate interdiction efforts that are on-going, and data analysis. That data analysis will inform a major public update "on or by SOME DATE" a week, or two, or three away. It would give people a lot of hope to know there are policies in the works, and a proximal timeline for hearing about them, that address prospects for restoring any semblance of life as we knew it before the pandemic disfigured it all. Actual dates should not be arbitrary, and should be based on progress. But I think there should be announcements now about announcements to come, and work on a phased sequence of policies- including some clear thinking about what will suffice as the "all clear," first for some, and ultimately, for all.

    We need to be thinking about more than one way to save lives, because there is more than one way to ruin and lose them. Any of them is bad, preventing any is good. Our objective must always be to use data to inform policy aimed at total harm minimization.

    Disagreeing with one another’s ideas is something reasonable people do. Running ideas through a gauntlet of disagreement is, in my view, the best way to ensure that only worthy ideas survive. But we live in a post-truth era our president has effectively institutionalized where every idea is dumbed down, and messed up- before ever getting cautious consideration.

    Disagreeing with mangled distortions of one another’s ideas is where all ideas- good and bad- go to die.

    It’s not too late for us to think carefully through policy options informed by the best data we can gather, and all we know and learn about the various risks in play. It’s not too late to acknowledge that we want barricades on every route that leads to health and lives lost, health and lives destroyed. It’s not too late for common cause, common ground, common effort, common good, and shared hope. We can practice social distancing- and still, all, be in this together.

     

     

    Dr. David L. Katz  is a board-certified specialist in Preventive Medicine/Public Health, a practicing clinician for nearly 30 years, a clinical research scientist focused on disease prevention, and co-author of multiple editions of a leading textbook on epidemiology.

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    Coronavirus - of Risk and Ruin, Ideas and Hope

    David Katz
  • 3
    object(stdClass)#13813 (59) {
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      string(36) "Advice to Unmatched Medical Students"
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      string(291) "

    The 2019 main residency match was larger than any that preceded it, according to the National Resident Match Program (NRMP). 

    " ["fulltext"]=> string(9486) "

    The total record-high 38,376 applicants submitted program choices for 35,185 positions.

    According to data on the 2019 Match compiled by the National Resident Matching Program (NRMP), 47% of seniors from U.S. allopathic medical schools got the top choice on their rank-order list—the lowest figure on record—while 72.5% wound up in their top three on Match Day.

    The number of available first-year (PGY-1) positions rose to 32,194, an increase of 1,962 (6.5%) over the prior year. That increase in opportunity reflects the growth in the number of osteopathic programs joining the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education (GME) programs.

    The number of U.S. allopathic medical school seniors saw a modest rise of about 100 from the prior year. The 93.9% match rates for such applicants holds with recent trends. Because of the shift in GME, the number of U.S. osteopathic medical school students and graduates who submitted program choices also hit a record high of 6,001, an increase of about 1,400 over last year. Among that group, a record 84.6% matched to PGY-1 positions, up from 81.7% in 2018.

    But even that high match rate in 2018 left 1,171 individuals seeking an alternate way to advance their careers. Now everyone is encouraged to use soap. However, some will need to use SOPE-The Supplemental Offer and Acceptance program, while others will pursue non-clinical career opportunities

    Here is some advice on what to do if you do not match and are interested in reapplying next year.

    The status of more than 4,200 foreign doctors who were chosen to do medical residencies in American teaching hospitals — hospitals that will desperately need their help to cope with Covid-19 — is in doubt because the State Department has temporarily stopped issuing the visas most of them would need to enter the country, according to a group that sponsors international medical graduates.

    he status of more than 4,200 foreign doctors who were chosen to do medical residencies in American teaching hospitals — hospitals that will desperately need their help to cope with Covid-19 — is in doubt because the State Department has temporarily stopped issuing the visas most of them would need to enter the country, according to a group that sponsors international medical graduates.

    Here is some advice to medical student entrepreneurs who don't match and are thinking of a non-clinical career opportunity:

    1. Do an internship with a startup this summer after you graduate. Here are some examples from medical student entrepreneurs. Take advantage of technology, online job searching, interviewing and remote working in the Corona economy.

    2. Network as much as you can and find a mentor. A good way to do this is to join The Society of Physician Entrepreneurs and attend virtual (and face to face when they resume) local chapter meetings, connect to other members and get involved with other organizations in your local biomedical and clinical clusters, like biopharma, medtech and digital health organizations and accelerators.

    3. Be sure to use social media aggressively to find like minded students around the world and create a ready for prime time profile.

    4. Take advantage of free MOOCs being offered in bio-entrepreneurship, medical innovation and digital health. Attain the entrepreneurial knowledge, skills, attitudes and competencies you will need to succeed.

    5. Identify others in your class who are interested in biomedical and health innovation and entrepreneurship and start a special interest group or student club and invite members of your local cluster or ecosystem to speak at lunch and learn sessions.

    6. Focus on getting education, access to resources, networks and mentors and experiential learning. Find out whether your school offers bio-entrepreneurship workshops, courses or degree programs and rethink getting an MBA. You should also look into iCorps training.

    7. Take the requisite tests to get your medical license.

    8. Just as there are some states where it is "better to be a doctor", there are locations that have stronger innovation ecosystems with more opportunities. The list will be different depending on whether you are interested in biopharma, medtech, digital health or care delivery innovation and entrepreneurship.

    9. If possible, reapply to the match and complete a residency and several years of practice to understand the problems beguiling sick care and possible opportunities to fix them. It's called physician entrepreneur for reason.

    10. At this stage of the game, stay fixed on being a problem seeker, not a problem solver. Start by developing your entrepreneurial mindset and practicing entrepreneurial habits. Here are 10 crucial steps to becoming a "pre-entrepreneur".

    11. Start to learn about the business of medicine particularly innovation, marketing, the use of health information technologies and business models. There are big opportunities in health IT and data science so consider additional training that does not require enrolling in another expensive, lengthy degree program.

    12. If you are not internally motivated to do this for some time, then quit now and save yourself a lot of heartburn.

    13. Renegotiate your student loans and debt obligations.

    14. Take care of yourself.

    15. Out yourself and seek help.

    16. Identify were you can add value as the pandemic changes opportunities, the economy and business models.

    If you fail to match, it is not the end of the world. There are many non-clinical career opportunities where you can still help patients without spending your career seeing them face to face, or , these days, online. It's your choice whether to use soap, SOAP, SOPE or SOPE. Just because you didn't match, it does not mean you have to wash your hands of medicine. Good luck in the match.

    Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@SoPEOfficial and Facebook.

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    Advice to Unmatched Medical Students

    Arlen Meyers, MD, MBA
  • 4
    object(stdClass)#13818 (59) {
      ["id"]=>
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      ["title"]=>
      string(65) "Coronavirus: It's Time for Physician Entrepreneurs to Take Action"
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      string(64) "coronavirus-it-s-time-for-physician-entrepreneurs-to-take-action"
      ["introtext"]=>
      string(121) "

    These are scary times. But, if you are a physician entrepreneur, don't fall prey to fear and to playing defense.

    " ["fulltext"]=> string(9114) "

    Now is the time to flex your medical and entrepreneurial muscles to not only contribute to managing the pandemic, but setting the stage for the recovery. Take COVID action, not small doses of covert action.

    We are now in the post-Corona economy and things have changed and will continue to evolve in fundamental ways . Generally those changes will be about:

    1. Rules and regulations
    2. Ecosystems
    3. Business models
    4. How we innovate
    5. Crisis leadership
    6. Corporate culture and employee relations
    7. The nature of work
    8. Corporate salary and benefits
    9. Personal attitudes about life and work-life balance
    10. Rethinking the pros and cons of living in an interconnected world

    You know what you are supposed to do personally- social distancing (particularly if you are young and not in the vulnerable population), hand washing, stay away from people if you are sick, use the telephone or virtual care platforms to see if you need to be tested.

    Here's a to do list of what you can do as, not just as a physician, but as a physician entrepreneur as well:

    1. Continue to work on your business using apps and virtual work platforms

    2. Volunteer to staff shifts on virtual urgent care platforms even if your medical license has expired

    3. Reach out and touch (not exactly) someone who might be suffering from additional social isolation

    4. Use your moral compass to follow your true north rather than taking advantage of people who are frightened and susceptible to misinformation and scams.

    5. Look for business opportunities . Join one of the amazing Open Source Ventilator Projects to contribute your passion, creativity, time and expertise to help develop low-cost ventilators to fight the Coronavirus (COVID-19). Here are some ways of getting involved and some inspiration and some cheaper ventilator options:

    6. Lobby and vote to change archaic laws and regulations that have crippled our ability to respond to national or global public health crises. For a start, we need a national medical and telemedicine licensing or reciprocity agreement and refunding of public health agencies.

    7. Create products and services that truly add value and transform sickcare into health care.

    8. Follow the shifting investor money and take advantage of state sponsored advance technology investment tax credits. Health tech innovators are developing capabilities, products, and services that will likely be critical to the future of health. And as health tech investors and innovators continue to develop differentiated products and solutions for this market, they should consider where the industry is headed in the future.

    9. Take advantage of dropping prices and increasing availability of talent, technology and money and other resources to start and grow your business.

    10. Pay attention to cash flow and manage your operating reserve. Cut unnecessary expenses and control payables and present and future receivables. Did you save for a rainy day? If not, learn your lesson and start when you can to deal with the next catastrophe.

    11. You may need to pull the plug on your idea. Add it to your failure resume without shame.If so, do so boldly and learn from the experience for next time.

    12. Build your virtual side gig profile and portfolio. Learn to thrive in the medapocalypse.

    13. Participate in crowd sourcing solutions.

    14. If you are looking for a job, perfect your video-interviewing skills.

    15. If you are a medical student entrepreneur, your match day on March 20 or graduation celebrations will be put on hold, cancelled or be virtual.

    16. Reset all of your value proposition and business model assumptions.

    As long as you are stuck at home, take a minute after reading this and list what the world will look like after the pandemic ends and think about how you can pursue the resulting seven sources of opportunity. The depression and WWII defined my parent's generation. The great recession molded the millennial mindset. Generation Z might be the Corona generation, and I don't mean the beer.

    Then, go wash your hands for 20 seconds (that's singing happy birthday to yourself twice), or use the countdown timer on your phone. Here's how to clean it after you are done.

    Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@SoPEOfficial and Facebook.

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    Coronavirus: It's Time for Physician Entrepreneurs to Take Action

    Arlen Meyers, MD, MBA
  • 5
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      string(61) "Which Home DNA Test Kit Company Proves the Strongest Science?"
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    At-home, or as they should be called direct-to-consumer, DNA testing kits are growing more popular by the day.

    " ["fulltext"]=> string(5645) "

    They are a rather new gig, and yet already over 26 million people have bought and used them. However, there are many concerns as to what exactly such kits can determine. Many manufacturers claim that their tests are able to diagnose diseases and provide accurate health advice. But before you trust those promises, you should consider the following.

    Direct-to-Consumer DNA Test Kits: Types

    First of all, you need to understand that DNA testing is an extremely complex process. The human genome contains a humongous amount of information. However, tests are limited in their capacity. Professional-grade tests used in advanced medical labs have a bigger scope of things they can actually glean from your DNA. But home testing kits are very basic.

    Therefore, the most important thing to understand is that not a single one of these kits is perfect or even highly accurate. Also, you should know that out of all the products on this market, only one has FDA authorization to detect ten highly-specific genetic conditions.

    That said, these tests still can provide valuable information. But as these tests differ quite dramatically, you should start by a thorough comparison of the options. And to understand the differences between kits, you need to know about the types of genetic testing they are able to do.

    Autosomal Testing

    This is the most common type of at-home DNA testing kit. It tests your autosomal chromosomes. 22 out of 23 chromosomes that humans have are autosomal chromosomes. Therefore, scientists can glean a lot of information from this part of your DNA.

    Y-Chromosome Testing

    The 23rd chromosome that every human has is the sex chromosome. Every female has two XX chromosomes in this category and males have XY. The Y-chromosome always comes from the father. Therefore, it can be sued to study this part of your ancestry.

    But note that men and women both have X chromosomes. Therefore, the majority of tests classify and study them as autosomal chromosomes.

    Mitochondrial Testing (mtDNA)

    The father’s line can be explored through your Y-chromosomes. But to learn more about your ancestry from the mother’s line, researchers study mitochondrial DNA. This type of DNA is located in the organelles that are responsible for creating energy that fuels your body. The organelles are called mitochondria and they are passed on directly through the ovum or egg. Therefore, they carry genetic information from your mother.

    Which Type of At-Home DNA Testing Kits Is More Scientifically Accurate?

    Despite the fact that at-home DNA testing kits study different parts of your genome, their accuracy is about equal. This is because of how this type of testing works, in principle.

    In order to run this kind of test, companies use SNPs (single nucleotide polymorphisms). They are the tiny parts of the DNA that contain small mutations. These mutated particles are what makes us different, because the three billion of individual nucleotide base pairs contained in our DNA are, pretty much, the same. So, the testing doesn’t really “decode” your entire DNA. Instead it focuses on finding genes with specific known SNPs, which are associated with certain conditions.

    The majority of DNA companies use SNP chips from the same manufacturer (Illumina) to look for specific sequences of SNPs in the genes. The higher the number of SNPs in a chip, the higher is the chance of a true positive identification of specific genes.

    What Can an At-Home DNA Testing Kit Tell About You?

    All things considered, the part that’s truly important for people who use these tests to know is what they are capable of diagnosing. The truth of the matter is that there is very little truly helpful information to glean from them. Some specific tests can determine specific genetic disorders, for example, cystic fibrosis.

    However, the majority of these tests offer health and lifestyle advice based on some data they, supposedly, learn from your genes. That kind of “advice” is sketchy at best. It’s impossible to say what kind of cheese you should be eating from the information in your DNA. The whole concept of diet planning based on genes is very new and has no solid science backing at present.

    There are also reports of multiple mistakes in the results from home DNA testing kits. Therefore, you should never take those as some absolute truth. Start by checking the level of validity of genetic tests in the CDC Public Health Genomics Knowledge Base. There you will learn which conditions can be determined by this type of testing at all. From there on, treat any information in the test results with skepticism.

    If you are truly worried about your health, consult a health professional. They will prescribe specialized genetic testing if it’s needed. But if you are simply looking for some fun and lifestyle tips, enjoy these tests. However, double-check any dietary recommendations if they fall outside the scope of general healthy nutrition guidelines.

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    Which Home DNA Test Kit Company Proves the Strongest Science?

    Anas Bouargane

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