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Three Things I Learned This Year About the Healthcare Revolution

Good morning. This is the last Brainstorm Health Daily before we break for the holidays. We’ll start up again in the new year.

But before we go, I thought I’d share three bits of wisdom that seem pertinent to the ongoing revolution in healthcare. The first two come from books I’d read this year: one by a gifted young science writer, the second by an oncologist-turned-Pulitzer-Prize-winning-author. The final offering comes not from a book but rather from a conversation I had with a young physician, Raj Panjabi, at the Fortune + Time Global Forum in Rome earlier this month. Panjabi, whom I wrote about here, is an American-trained physician who returned to his native Liberia to help build a rural healthcare system serving the poorest of the poor. That system—essentially, a brigade of local villagers trained as community health workers—helped stop the epidemic of Ebola that raged through West Africa in 2014 and, for a time, threatened the entire world.

Here, some eye-opening passages and what I took away from them:

1. “The microbiome is a not a constant entity. It is a teeming collection of thousands of species, all constantly competing with one another, negotiating with their host, evolving, changing. It wavers and pulses over a 24-hour cycle, so that some species are more common in the day while others rise at night. Your genome is almost certainly the same as it was last year, but your microbiome has shifted since your last meal or sunrise.”—Ed Yong, I Contain Multitudes: The Microbes Within Us and a Grander View of Life

My takeaway : Yong’s writing offers a lyrical reminder of something we ought to keep in our heads as we design next-generation diagnostics and treatments—Biology is dynamic; the human body is an ever-changing, interactive, and renewing system, one in which everything from gene expression to protein signaling is in a constant state of flux. So as much as we have strived for accurate “real-time” diagnostics, we must develop tests that provide context, too. Taking a Polaroid of the body offers us a picture of the most fleeting of moments. We need the equivalent of digital video—a narrative with history.

2. “It is nonsense to speak about ‘nature’ or ‘nurture’ in absolutes or abstracts. Whether nature—i.e., the gene—or nurture—i.e., the environment—dominates in the development of a feature or function depends, acutely, on the individual feature and the context. The SRY gene determines sexual anatomy and physiology in a strikingly autonomous manner; it is all nature. Gender identity, sexual preference, and the choice of sexual roles are determined by the intersections of genes and environments—i.e., nature plus nurture.”—Siddhartha Mukherjee, The Gene: An Intimate History

My takeaway : As we think about improving our healthcare interventions, we have to break free from the false notion that discrete “biological mechanisms” (a mutation in X gene, for example) “cause” disease. While that is occasionally true, in the overwhelming share of cases, disease causation is far more complex—involving a large number of factors that interact with and influence one another over months, years, and often decades. We are used to quick technological fixes—click thumbs down and a Pandora song is summarily dismissed. For the next generation of health interventions to be effective, we must move beyond that one-button mentality.

3. “The hotspots of inequality correlate very closely with the hotspots of disease. That’s true in Ebola: A two-year boy died in a rainforest community hours away from the nearest clinic. It’s true of recent elections. Diabetes and obesity rates correlated more with the outcome of the U.S. election than even typical political indicators did in rural America—Raj Panjabi, at Fortune + Time Global Forum, Dec. 2.

My takeaway : Amid the flurry of excitement over new technologies and ventures, we have to keep our eyes on the mission. Today, more than a billion people on the planet have essentially no access to healthcare because they live in rural or remote areas, too far from the nearest clinic. While great progress has been made in global health—child mortality overall has been cut by half since 1990—large portions of the earth’s population have been left behind. Our modern healthcare revolution has to keep them foremost in mind.

Says Panjabi, recounting a scene that is still played out today across much of sub-Saharan Africa: “When a two-year old gets sick in the village, a mom has to take him to a riverbed, get in a canoe, paddle to the other side, and then walk for two days just to get a diagnosis. How do you solve that?”

That, fellow Brainstormers, is our question. Have a healthy and peaceful holiday. We’ll see you on Jan. 3.

Clifton Leaf
@CliftonLeaf
clifton.leaf@fortune.com

DIGITAL HEALTH

IBM expands collaboration with Cleveland Clinic. IBM announced on Thursday that it will be ramping up its partnership with the Cleveland Clinic in order to help the vaunted hospital deliver more efficient care and implement a value-based medical care model. The five-year agreement will allow Cleveland Clinic to harness Watson's computing powers to analyze data and simplify administrative tasks. “This initiative with IBM is mutually beneficial and will significantly advance our IT capabilities, which are increasingly important to provide the best care to patients as healthcare becomes more and more technology dependent,”said Dr. Toby Cosgrove, CEO and President of Cleveland Clinic, in a statement. “With the explosion of data in healthcare, the technology solutions we will develop and implement together could transform our ability to deliver quality, evidence-based care and better respond to the needs of our patients, caregivers and partners.”

INDICATIONS

The Actelion buyout scuffle keeps getting more dramatic. Just when it seemed like Sanofi was on the verge of nailing a deal for pulmonary arterial hypertension (PAH) specialist Actelion, it appears that Johnson & Johnson is back in the mix. J&J originally walked away from the negotiating table after reportedly being told that its initial bid for Europe's largest biotech was too low, leaving room for Sanofi to swoop in with an offer that also would have paid a premium if certain experimental Actelion therapies were to win approval. But reports emerged Thursday that Actelion has now entered into "exclusive" negotiations with J&J.

Alexion gets another batch of bad news in a dreary 2016. Alexion hasn't exactly had a sterling 2016. The firm's CEO and CFO unexpectedly (and abruptly) resigned earlier this month as the company conducts an internal probe into allegations of improper marketing tactic surrounding its star product, the rare disease drug Soliris. That same probe has forced Alexion to delay releasing its latest earnings report. And now the firm is dealing with a clinical trial failure for that treatment, which Alexion was hoping could nab an additional indication for treating a major complication related to organ transplant recipients. (Endpoints)

THE BIG PICTURE

Cleveland Clinic chief Toby Cosgrove may be joining the Trump administration. President-elect Donald Trump is reportedly favoring Dr. Toby Cosgrove, CEO and president of the much-lauded Cleveland Clinic, to head up Department of Veterans Affairs (VA). Cosgrove is one of the most widely respected health care executives in American and also has experience as an Air Force surgeon during the Vietnam War. But as VA Secretary, he would have to deal with a bureaucracy that has drawn sharp bipartisan criticism for allowing claims to go unanswered for months and endangering the health and safety of veterans due to administrative mismanagement. "I think he'd be viewed very favorably," Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, told Politico in an interview. "He is definitely the most qualified of the people they have put out there." (Politico)

6.4 million people signed up for Obamacare during this enrollment period. Call it "buyer's anxiety"—6.4 million Americans have signed up for individual insurance coverage through Healthcare.gov during the latest enrollment season, the government announced Thursday. That's an increase of about 400,000 compared to one year ago, and the Obama administration expects that, all told, one million more people will have signed up for 2017 insurance coverage than did so for 2016. But the big question is: What happens next year? Donald Trump and GOP Congressional leaders have made clear that they want to do away with the law, raising thorny questions about what will happen to the approximately 20 million people covered under Obamacare. (Fortune)

That's all for us this year. We hope you'll spread the word about Brainstorm Health Daily, and we'll see you in your inbox on January 3rd!

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