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Brainstorm Health Daily: February 21, 2017

Nature was once a “separate and wild province” from human civilization, as Bill McKibben wrote in his famous 1989 call-to-arms, The End of Nature: It was “a world apart from man to which he adapted and under whose rules he was born and died.”

But, claimed McKibben, we have effectively killed off this independent sphere—that wondrous, self-sustaining, life-generating realm which existed for eons before us.

“There’s still something out there,” he said, but “in the place of the old nature rears up a new ‘nature’ of our own devising”—a construct where “each cubic yard of air, each square foot of soil is stamped indelibly with our crude imprint, our X.”

Some now call this evolved world (or new layer of the planet) the “technosphere,” a term coined by Duke University geologist Peter Haff. And it is filled to the brim with stuff. Indeed, there is so much of this human-made stuff—machinery, skyscrapers, packaging, waste, Ikea furnishings—that it’s almost impossible to fathom, let alone measure. And yet—gotta love science!—that is precisely what a team of researchers has tried to do in a recent academic paper.

Their conclusion? Our stuff weighs approximately 30 trillion metric tons. (Yes, the authors used the word “approximately.”) That works out to a mass of over 50 kilos per every square meter of earth’s surface, and one that’s an order of five magnitudes larger than that of the human beings who created it. Or so they estimate.

The diversity of stuff—the manufactured flotsam and jetsam of our daily lives—may even exceed the total diversity of biology throughout Earth’s history, the same research team asserts. This endless assembly of things and devices, moreover, interacts and evolves in its own dynamic, emergent way: “In this sense,” writes Haff (in another paper) “one might say that technology is the next biology.”

It’s a thought-provoking thought.

On the one hand, says Haff, we can no longer live without the “support structure and the services provided by technology”—the communication, transportation, energy, and other networks that developed to make human life on an increasingly crowded planet function in the first place.

On the other hand, we are positively drowning in it. Our days are consumed by consumption, our calendars an endless parade of Presidents’ Day sales, Black Fridays and Cyber Mondays. And each trip to the garage bin gets more laden than the last.

What this stuff-to-trash-to-stuff cycle does to our collective well-being is anybody’s guess. Our so-called e-waste alone has dark, if still imprecise implications for human health, say lots and lots of scientists and public institutions.

As I said, it’s too early to know what the effects of all of this will be. But as we head deeper into a realm of digital health technology, we should perhaps consider that the new whiz-bang thingamajigs we create today will surely end up atop the piles of thingamajigs we created yesterday.

Hmm. It does sound biological, after all. Call it the reproductive cycle of stuff.

More news below.

Clifton Leaf


IBM announces slew of new services at HIMSS. The ongoing Healthcare Information and Management Systems Society (HIMSS) annual conference is the biggest health IT meeting around. And that means fresh announcements from the biggest players in the game and fledgling upstarts alike. For its part, IBM Watson Health on Monday unveiled several new initiatives leveraging the power of its artificial intelligence capabilities. The new offerings will aim to integrate the expertise of companies that IBM has snapped up in recent years, including Truven Health Analytics, Phytel, and Explorys. Several of the services will focus on population health management, including a predictive system that analyzes patient health records and insurance claims to anticipate patients’ future needs (and health care providers’ costs). Watson is also teaming up with the Central New York Care Collaborative in a project that aims to slash Medicaid spending by cutting down unnecessary hospital stays and partnering with the nonprofit Atrius Health system to create a cloud-based service which can analyze how various social and physical factors can influence health. But the slew of announcements, as well as IBM CEO Ginni Rometty’s keynote speech on Monday, came on the heels of a reported setback: the University of Texas M.D. Anderson Cancer Center froze its collaboration with Watson, according to Forbes‘ Matt Herper, following a number of technical issues and potential problems with bureaucratic red tape. IBM’s partnerships with other major cancer centers like Memorial Sloan Kettering are still moving forward. UPDATE: Reporting from ArsTechnica paints quite a different picture from Forbes‘ account. “MD Anderson officials snubbed their own IT experts, mishandled about $62 million in funding, and failed to follow basic procedures for overseeing contracts and invoices, according to the audit,” writes the publication, also noting that Watson itself initially hit its goals. An IBM spokesperson said that ArsTechnica‘s story is accurate.

American Well and Samsung to team up on telehealth. In another big HIMSS announcement, telemedicine specialist American Well and Samsung have teamed up to expand telehealth services’ market reach to far more consumers. American Well, which is partnered with some of the biggest providers and payers in health care (including the Cleveland Clinic and insurance giant Anthem), is aiming to create a host of new services with Samsung and being dubbed as an end-to-end digital health “ecosystem.” Beyond that, however, the details are still pretty sparse. But there have been recent rumors that Samsung’s existing S Health wellness app could be getting tweaks to add various telemedicine capabilities. The partnership with American Well would automatically make those services available to millions of people.

Health IT software still has a long way to go, say two former CMS administrators. Two prominent government officials from two very different administrations have a message for the health IT sector: Step up your game. Andy Slavitt and Mark McClellan, who ran the Centers for Medicare and Medicaid Services (CMS) under Presidents Obama and Bush, respectively, had a frank discussion during a fireside chat at HIMSS. “I’m talking like Trump,” said Slavitt. “You’re not satisfying the customers.  I’ve talked to thousands and thousands of physicians this past year, the majority don’t like the technology they’re using. It’s an enormous opportunity.” A big part of the problem, according to the former administrators, is that health IT software is being molded around regulations rather than health systems’ and patients’ needs. (Healthcare IT News)

Amazon Alexa can now help diagnose your condition. Digital health startup HealthTap, which launched an artificial intelligence-fueled digital doctor app called Dr. AI last month, is now bringing the power of Amazon Alexa to its services. Dr. AI is a “triage” platform that lets users know the potential causes of various medical symptoms and then ranks them by severity and likelihood (it can also direct you to a doctor who knows how to treat the conditions). Now, people who own an Amazon Echo can use Alexa to call Dr. AI and present their symptoms in a conversational manner. “We’d been doing text and video before, then expanded into voice and that’s exciting in healthcare because we serve many populations that are older, disabled, or frail,” CEO Ron Gutman tells Fortune. “Records and data from those doctors make up Dr. AI’s health care data trove… Voice is cool, but more important, it’s fills a real need of people who have difficulty using their hands or whose eyesight is not that great.” (Fortune)


Sarepta sells Gilead priority review voucher for $125 million. When Sarepta Therapeutics nabbed a pioneering approval for a Duchenne muscular dystrophy (DMD) drug last year, it won more than just bragging rights and a controversial FDA approval: the firm also landed a coveted “priority review voucher,” which can either be sold off to another company or used to slash the review period for a future Sarepta treatment. On Monday, the biotech announced it had gone the sales route and hawked its review voucher to Gilead Sciences for $125 million. That cash haul is nothing to shake a stick at – but review vouchers have been cashed in at far higher prices in recent years (including United Therapeutics’ staggering $350 million sale of one to AbbVie). And that has Leerink analyst Joseph Schwartz dubious that Sarepta got the most it could out of the deal. “While this non-dilutive amount will surely add additional runway to Sarepta’s cash position, we cannot help but wonder if this transaction reflects a 1) broader decline in PRV interest among bidders, or 2) an undervalued asset sale,” he wrote in a research note.

FDA rejects Amphastar’s intranasal opioid overdose antidote. Amphastar became yet another drug price-hiking villain facing intense public scrutiny when it raised the price of naloxone, an opioid overdose antidote, by more than 100%. (Other naloxone sellers like Kaleo, Mylan, and Adapt Pharma have pursued similar strategies, inspiring the wrath of U.S. Senators who say the firms were taking advantage of America’s widespread opioid addiction epidemic and putting profits over patients.) Now it’s facing a clinical setback with an FDA rejection for an intranasal version of naloxone. The reasons for the rejection aren’t clear (these FDA notices, called Complete Response Letters, aren’t public, which is itself a controversial reality). But by no means does it represent the end of the road for Amphastar. “While we are disappointed to have not received approval at this time, we intend to continue to work with the FDA to address their concerns in the CRL and hope to bring Intranasal Naloxone to the market as soon as possible,” said CEO Jack Zhang in a statement. (Endpoints)


New York-Presbyterian’s CEO sounds out on Obamacare. One of New York’s most prominent hospital CEOs shared his thoughts on the future of health care reform in an interview with the Wall Street Journal. Steven Corwin, who heads up New York-Presbyterian’s $7 billion-in-revenue per year health system, says that a dramatic reversal of Obamacare’s insurance expansion would spell trouble for hospitals by bloating the ranks of uninsured patients. “We have to be able to provide access to care for as many Americans as we possibly can, hopefully every American,” he said. “That generally involves access to insurance. If we say access to care is just, ‘If you get sick and you go to the hospital and you go to the emergency room, you effectively have access,’ I think everyone would agree that’s a very costly way to do business. But what I mean by access is people get insurance.” He also added that dismantling the Affordable Care Act’s Medicaid expansion, as Congress has indicated it’s willing to do, would be “a real problem.” Corwin also listed the changes he’s want to see Congress tackle when it comes to American health care. “Adequate and accessible care for all, most notably through the maintenance of Medicaid expansion to keep vulnerable populations covered and with access to care. Greater investment and regulatory flexibility around the mainstreaming of new technologies like digital health. And more of an emphasis on the value of preventative health and the impact of better access to behavioral health services,” he said. Read the full interview here. (Wall Street Journal)

Trump administration to give insurers more time to set 2018 rates. The Centers for Medicare and Medicaid Services (CMS) is proposing to give insurers an extra month and a half to set their premiums for 2018 health plans sold through Obamacare’s marketplaces. The original May 3 deadline has been pushed to June 21, allowing companies to better assess what their costs might be next year as uncertainty continues to swirl around the health law’s future. The Trump administration has already proposed a number of other administrative changes to Obamacare, including loosening penalties for those who lack insurance and cutting the open enrollment period to buy coverage. (Modern Healthcare)


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Produced by Sy Mukherjee

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