A Shocking Failure That’s All Too Ordinary

A patient comes to the ER by ambulance on a late Friday night with a 102 fever, complaining of bad digestive problems: She hasn’t been able to keep anything down…or in…for 24 hours. She’s admitted. Blood’s drawn. Fever wanes overnight. She looks better. Walking around. She’s discharged and sent home at 7:30 in the morning.

Two days later, on Monday night at 9:00 p.m., the blood cultures from the patient finally come back. In one of the two culture bottles, there’s a surprise: Gram negative rods (GNR) of bacteria—a class that includes E. coli, Salmonella, Shigella, Klebsiella, Pseudomonas, among others, and that has within its lineup a murderer’s row of multidrug-resistant strains. The other culture is clean.

There’s a good chance the positive reading has come from cross-contamination in the lab. GNR are as common in hospitals these days as red Jell-O. But if the infection is real, it could be very grave—particularly in elderly patients. The woman in this case is 86 years old. And she’s diabetic, with evidence of kidney disease to boot. So the patient is told to come in to the ER right away. Scared, she rushes to the hospital, leaving her cellphone at home.

When she arrives, she’s put on a gurney in the ER, covered by a sheet, where she waits for five hours. Then, at 2:30 a.m., the new, initial blood work comes back: No sign of bacteria. It could take another 48 hours for whatever pathogen might be living quietly in the cultures to grow, but for now the patient’s blood looks clean.

Okay—now here’s your test, O wide-eyed med student: What do you do?

If you said, “Discharge the patient at 2:30 in the morning and send her home alone in the wintry night in a cab,” well then I’ve got a job for you: Welcome to today’s modern hospital system.

In full disclosure, that 86-year-old woman is my mother-in-law, and this happened last night—or, rather, early this morning. I’m tempted to reveal the name of the hospital, but honestly it doesn’t matter. Because this scenario showcases a slew of problems that are endemic to our modern healthcare system—from the utter lack of bacterial control in clinical settings and the associated infections that result…to a process that shuttles vulnerable patients in and out of emergency rooms for piecemeal diagnosis and treatment…to overcrowded, overburdened hospitals that still mindlessly cling to patient-management processes that haven’t worked for decades.

All of this is ripe for disruption. All of this is BEGGING for disruption. And perhaps—just perhaps—as Congress figures out its “replace” for Obamacare, we’ll get a chance to see some fresh ideas put to the test.

In the meantime, you innovators out there—and, hopefully, that will include some of the med school graduating class of ’17—now is your chance to figure out a better way.

Sy has the day’s news below.

DIGITAL HEALTH

Trump HHS pick draws insider trading scrutiny over medical device company stock. Georgia Congressman Tom Price, President-elect Donald Trump's choice to lead the Department of Health and Human Services (HHS), is under the spotlight as CNN reported Monday night that he had purchased stock in the medical device firm Zimmer Biomet right before introducing legislation that may have benefited the company financially. Price introduced a bill to delay implementation of the Comprehensive Joint Replacement (CJR) regulations within a week of buying $1,000 to $15,000 worth of company stock; the firm then donated to his re-election campaign. Zimmer Biomet spokespeople say they were unaware of Price's stock purchase and that the company supports CJR implementation. Senate Minority Leader Chuck Schumer of New York said that it was imperative that the Congressional Ethics Office must "conduct an immediate and thorough investigation into these potential violations of the STOCK Act before Rep. Price’s nomination moves forward." Price is slated to testify before the Senate tomorrow. (CBS News)

Can big data curb medical errors? Phoenix Children’s Chief Medical Information Officer Dr. Vinay Vaidya and his team were able to pull off a remarkable feat by harnessing the power of big data and electronic records: completely eliminating dosing errors for treatments given to pediatric patients. The health care provider's Pediatric Dose Range Checking System made the achievement possible. This system alerts a doctor or nurse at the point when they're ordering a prescription whether or not they should consult with a pharmacist or change the ordered dosage. The hospital says there hasn't been a single overdose at the prescribing stage of care since the checking system was implemented in 2011. (Healthcare IT News)

Health IT funding reaches $5 billion in 2016. A new report from market intelligence firm Mercom Capital finds that there was $5 billion in VC funding for health IT in 2016 - a significant rise from the $4.6 billion raised in 2015. Deal volumes swelled last year, too, with 622 deals in 2016 compared with 574 in the preceding year. The sector that's seen the most serious gains? You guessed it: mobile health applications, which drew an all-time record $1.3 billion. But while the surge in VC money is a positive sign for the industry, Mercom CEO Raj Prabhu notes that, "[d]igital health public companies on the other hand continue to struggle." (MobiHealthNews)

INDICATIONS

Biogen pays big money to settle Tecfidera patent spat. As I've noted before, 2017 promises to be a year of high-profile patent battles (Merck-Gilead, Sanofi/Regeneron-Amgen, the various CRISPR innovators). Well, at least one biotech giant is putting up a boatload of upfront cash to try and settle an important IP spat: Biogen announced Tuesday that it will pay Forward Pharma $1.25 billion in order to "clarify and strengthen" its intellectual property rights surrounding the blockbuster multiple sclerosis med Tecfidera. Forward could actually wind up netting even more from Biogen if it succeeds in U.S. and European courts, where patent victories would open up a royalty stream of at least 10% from Tecfidera sales. (FiercePharma)

Potential Trump FDA pick purges his Twitter criticism of the agency. President-elect Donald Trump is reportedly considering Peter Thiel associate Balaji Srinivasan for FDA commissioner. But the bitcoin entrepreneur has made some pretty controversial statements on Twitter about the agency he may end up running, including advocating for a "Yelp for Drugs" that would ostensibly be more efficient than the FDA. Srinivasan has played up this extreme free market idea on multiple occasions, arguing that online reviews for treatments with star ratings from doctors would make therapies available to patients much faster. But since news of his potential nomination broke, Srinivasan has deleted the statements from his account, replacing them with a simple message: "Don't argue on Twitter. Build the future." (Endpoints)

THE BIG PICTURE

Why Trump's drug price bidding plan would revive "death panel" politics. File this one under the "hot take" category: I have a piece up arguing that Trump's Medicare bidding/negotiation proposal for controlling drug prices would revive one of the nastiest (and most mendacious) political storylines of the Obamacare era: the specter of care rationing and "death panels." While that slur was used as an attack on Affordable Care Act provisions like the Independent Payment Advisory Board (IPAB), which were meant to keep Medicare spending in check, it's not hard to imagine a similar line of criticism against giving government bureaucrats the power to unilaterally reject covering certain treatments because their manufacturers made insufficient bids. Drug makers have been furious with European pricing watch dogs like the U.K.'s NICE, which has rejected NHS coverage for numerous cancer and rare disease therapies for not being cost-effective. You can have relatively unfettered access or cost controls; having both is a much more complicated matter. (Fortune)

Former HHS chief Sebelius warns against a hasty Obamacare repeal. Kathleen Sebelius, who oversaw the implementation of the Affordable Care Act in its nascent years as HHS Secretary, has some commentary up on Fortune today warning that a ham-fisted and hasty repeal of the health law would create massive market disruptions. "We should all be alarmed by their rush to repeal: It will hurt patients throughout the country, disrupt the entire health insurance industry, and inflict huge damage to state budgets and the entire U.S. economy," writes Sebelius, noting that before Obamacare's passage, insurers could discriminate against sick customers and yet "the individual market had double-digit annual cost increases and was losing customers every year in the decade before the ACA was passed." (Fortune)

Nevada woman dies from superbug resistant to all U.S. antibiotics. Some truly sobering news from the weekend: an elderly woman in Nevada died last year from a superbug that proved resistant to every single antibiotic available in the U.S. That means the bacteria was able to withstand 26 different treatments. The woman, who had spent considerable time in India and contracted the pathogen there, was infected with carbapenem-resistant enterobacteriaceae (CRE) after breaking her leg. Other than the need for more new antibiotics, the Centers for Disease Control stated in a report that hospitals need to do more to learn whether or not patients had recently traveled abroad or been hospitalized in another country. (STAT News)

REQUIRED READING

Tricks for Getting a Better Night's Sleep, by Uncubed

Scrapping Obamacare Without a Backup Plan Hurts Us All, by Ezekiel Emanuel 

Beards Are Growing Into Big, Bushy Business, by Jeff John Roberts

We Just Got a Much Clearer Picture of Marijuana's Health Effects, by Sy Mukherjee