kmahan's Profile

I am glad you brought up the recent approval of Abilify MyCite, as I am torn about the use of this data. Should we allow pharmaceutical companies, and perhaps PBMs and even pharmacies directly, to use this information to their advantage? And if we do allow it, is it because it is in the best interest of the patient?

Personally, I fall on the side of this information being useful for everyone in the pharmaceutical supply chain. I believe that this information is comparable to a wearable or a bluetooth/wifi enabled glucose monitor, giving a healthcare provider valuable information about a patient’s adherence to a medication. With a medication like Abilify, for example, adherence is key to treatment and therefore a device like Ability MyCite has definite value to a patient’s well-being. In addition, this information can be valuable to the pharmacy and the pharmaceutical company. Companies can predict demand, know when refills will be due, and produce pills in a “just-in-time” manner. In a similar vein, pharmacies can order pills exactly as needed (or perhaps engage with pharmaceutical companies to have them delivered as needed without ordering) and can save inventory costs and more efficiently ensure that patient’s refills are available before they even come in. Unfortunately, this would not just benefit CVS, but if they were able to access this kind of information, it could give them a temporary leg-up on opponents such as Amazon, especially if they had access to health records through Aetna. The ethics of this is still a very gray area, but I see benefits for everyone from the patient to the physician to the pharmacy and pharmaceutical company.

Chip, I think that this piece encapsulates the question of “what are we willing to sacrifice for the good of our environment?” The most interesting part of this paper is that this question is not being asked of the layperson, but of the Fortune 500 company looking to buy their new private jets. Cessna is taking a gamble here, hoping that executives and companies will see the benefits of lower fuel consumption and reduced emissions without feeling like they are sacrificing much in regards to thrust, speed, and airport restrictions.

I see the Citation Hemisphere as a huge potential for the industry of private planes, depending on price. With the G-650 pricetag currently hovering around $70 million and the Citation Hemisphere expected to launch at closer to $35 million, the Citation seems like a no-brainer.[1,2] A smaller carbon footprint is something nearly every company loves to brag about, regardless of how they achieve it, and they can even do it at a discount!

My only concern is the size of the market that this will impact. As a layperson, what can I do when traveling to reduce my carbon footprint? Will Airbus and Boeing introduce similar measures and begin to fight not just on speed or capacity, but on emissions? It looks like most of these businesses already meet Paris Accord requirements, but perhaps that means our standards aren’t set high enough.[3]

1. https://www.flyingmag.com/aircraft/jets/textron-aviation-launches-citation-hemisphere
2. http://www.businessinsider.com/photos-tour-the-65-million-gulfstream-g650-2013-7
3. https://www.nytimes.com/2016/02/16/business/energy-environment/a-hollow-agreement-on-aviation-emissions.html

Very interesting post Jon! As someone with a tangential interest in disaster medicine, the access of medications during natural (and other) disasters is a fascinating and very complicated topic.

I think that Anusha is absolutely right – in order for this to work well, highly accurate predictive measures should be in place. This idea of proactively diversifying one’s supply chain when it comes to the generic, basic necessities for disasters (saline, gauze, certain antibiotics, and perhaps even blood or synthetic blood products in the future) is highly valuable when disaster strikes. The problems arise when costs outweigh benefits, as it is incredibly difficult to convince stakeholders to invest in such diversification, especially if events are unpredictable.

One such stakeholder is the U.S. government, specifically FEMA (Federal Emergency Management Agency). FEMA is famous for being reactive, even when situations are at their worst (see Hurricane Katrina). To convince a stakeholder like FEMA to invest in diversifying a medical supply company’s supply chain prior to a natural disaster would be incredibly difficult. These agencies often operate on a shoestring budget and instead usually end up spend far too much money acting reactively rather than proactively.

Instead, Baxter could try to convince health insurance companies, as others have mentioned, to engage in a risk-sharing model. By offering to split costs based on either risk-sharing (if no disaster occurs and we lose out on our supply chain, we both lose) or profit sharing (if a disaster does occur and we save money because we diversified, we both win), insurance companies may be happy to help companies such as Baxter prepare for natural disasters.

Of course, the “scheming CFO” in me also sees the opportunity for price gouging in a time of dire need. By diversifying one’s supply chain, regardless of cost, Baxter could become the sole provider of necessary medical supplies. Prices in medicine are constantly negotiated and re-negotiated, and people are willing to spend anything to keep themselves alive. While I hope no company would take this stance during a disaster, I can’t help but worry that someone might.

Zack raises some very interesting points regarding the current subsidies for solar companies in the U.S. and other countries. While they are directly impacting manufacturing, they have a downstream effect on installation prices. While I’m sure Elon Musk would like to argue that manufacturing is the more important part of the solar panel market, I agree with you, Katie, and believe that cheap upfront installation prices drive homeowners to “go solar.” Without panels that are affordable to the average consumer, are we really making the impact on clean energy that Musk and others are clamoring for?

These import taxes seem like a stopgap measure to allow U.S. solar panel manufacturers to continue to operate while the government refuses to invest in clean energy on the same scale as other governments such as China and Germany. Instead, perhaps we should allow Chinese solar manufacturers to pressure U.S. manufacturers to develop new techniques, focus on automation, or utilize other methods to drive down solar panel costs to compete. Instead, we artificially inflate prices, drive installers out of business, and continue to subsidize other forms of energy first. If this tariff does go through, President Trump should consider subsidizing installers, otherwise we will likely see solar installations slow to a near-halt until we can start producing at scales that can compete with the current prices offered by China. However, I would hate to have to wait until 2019 to see the Gigawatt factory save the U.S. solar economy.

This idea of a “no deal” situation for the NHS under Brexit is a scary one, as you pointed out. It reminds me of similar issues we expect to see in the United States in coming years, often referred to as the “physician shortage.” The number of the elderly, and therefore the number of those with chronic diseases, is on the rise, and we have not seen similar increases in the number of physicians. More importantly, we have seen a shift away from primary care, where the majority of these patients should be seen. In order to address this issue, the United States has been considering options such as utilizing other medical professionals to the top of their license, incorporating more technology, and setting broad standards to which physicians and others must adhere.[1]

I feel as thought the solutions to a “no deal” situation will have to be similar. If we rule out options such as opening private medical schools or expanding the number of physicians in training under the current UK model, then without a healthy influx of immigrant physicians there must be other resources to tap into. One such resource is standardization, something that the UK already does well through NICE and the NHS. Technology can also aid in standardization through EMRs, and also allow physicians to see more patients than ever before through telemedicine and more efficiently with dictation and natural language processing of patient medical records. Lastly, I believe that using NPs, PAs, and even medical assistants to the very top of their ability to practice will be key, as physicians and nurses alone will not be able to handle the burden that a “no deal” solution may bring. These other providers can help immensely in the primary care setting and in the hospital setting, allowing physicians to perform those procedures or tasks that only they can do, promoting efficiency within the system.

1. https://www.ncbi.nlm.nih.gov/pubmed/24191075

While I believe that Monika has a point regarding automation of diagnosis, I do believe that there will be many short- and medium-term solutions in this area that will augment the way that physicians diagnose. While Watson is already an efficient diagnostician, there is still a long way to go to encourage patients and doctors alike to accept diagnoses from Watson and other AI.[1] Instead, I believe a step-wise approach is in order involving electronic medical records and big data mining.

As you mentioned, there are many patterns and trends in patient data that can be used to not only diagnose, but to predict possible outcomes. Imagine the EMR with built-in differential diagnosis, allowing physicians to see not just the common diseases that often come to the top of mind, but also the rarer diseases that a simple test, additional question, or physical exam maneuver may be able to rule out. Building AI into EMR, and accumulating significant EMR data, is the key to bringing Watson and others to their full potential as diagnosticians and even predictors of potential disease.

1. https://www.newyorker.com/magazine/2017/04/03/ai-versus-md