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Interesting article, thank you for writing!
As a former lender on Lending Club I found the discussion of the company’s recent troubles fascinating. I originally got into Lending Club to find higher interest rates for my money than those I could get from CDs or other stable investments at a bank. I made an account, logged in, and immediately sent small loans ($5 each) to more than a hundred different borrowers (diversification is magic, amirite). I had chosen a balance of borrowers with different risk profile, all paying different interest rates. All was going well for a year or two, while I was earning roughly 7% on my money, and had no defaults. Then, in 2014 I had my first borrower default (he still owed me like $4.50!!!) and then another and another. In all, though historical rates of default were cited to be below 1% on Lending Club, about 6% of my portfolio ending up defaulting. When it was all said and done, after 3 years I had earned an effective interest rate of about 0.5%–roughly in line with what I probably could have gotten from a savings account. Oh well, I guess there really is no free lunch.

As La Pistola said above, I agree that Lending Club will likely struggle to remain afloat during an economic downturn. Investors will likely look for products that have a long track record of low risks, and will pull their money out of Lending Club, causing dramatic decreases in fees coming into the company. Coupled with their ongoing regulatory and legal troubles, it seems like the future of Lending Club may not be secure. I think disintermediating banks is a good idea, but perhaps the next player will create a more sustainable business model.

On November 20, 2016, Mike commented on When Epic Digitization is Not So Epic :

Fascinating article, thank you for writing MRP!
As a user of both Epic and other EMR systems, I think this article is spot on. While clinicians are constantly told that Epic will enable us to better collect and analyze patient information, the user-interface is typically clunky and finding information about previous appointments or hospitalizations (especially if they are out of network) is incredibly tedious if at all possible. We are also told that Epic greatly simplifies the billing and administrative functions of a patient’s visit, something that seems to driving the expansion of Epic more than any of its clinical systems.

While I lack any insight into the strategic decisions behind the adoption of Epic, I do know that BIDMC, the only Harvard teaching hospital not a part of Partners Healthcare, recently chose to go in another direction. Partners spent more than $1 billion to adopt Epic at all of its sites. Rather than foot a similar bill for a lackluster program, BIDMC partnered with Athenahealth to create and implement an alternative EMR. BIDMC has a proprietary EMR (webOMR) that it produced in-house over the years. While webOMR has only a fraction of the functionality of Epic, it was designed with the clinician in mind, and is simple to use. In the deal, Athenahealth will further develop the capabilities of webOMR, which it can then market to other healthcare systems. This system is expected to be significantly cheaper than Epic and will be able to communicate with other IT systems. Hopefully this partnership and others like it will incentivize Epic to improve its produce with all stakeholders in mind–patients, clinicians, insurers, administrators, etc.

On November 20, 2016, Mike commented on e-Estonia: How Estonia is digitalizing an entire country :

Wow, I want to live in Estonia! Their digital programs seem to provide very efficient governmental services, something of an oxymoron in the United States. I was most fascinated by their electronic health record system that provides medical information for each citizen no matter where they receive care in the country. I think such a system can create dramatic efficiencies in healthcare and could lead to better care for all. I wonder though, to what extent this program is possible because the government of Estonia directly pays for the care of all citizens. It seems relatively straightforward to create this system when a single party is in control of providing access to healthcare. However, I think it would be harder to create such a system in the US, where so many public and private organizations coordinate, provide, and pay for care. What’s more, many of these parties would likely be disincentivized to help create a universal health information system–for instance, an insurance company with a high proportion of healthy (and cheap) patients might invite significant competition from other insurers if their patient’s health information was readily accessible to all. Nonetheless, I believe that Estonia’s EHR system is definitely the way of the future. It is interesting to note that other large countries, like France, have experimented with IT systems to aggregate healthcare information for their citizens. Their “Carte Vitale” system currently provides health insurance information for all patients in the country, but small pieces of actual medical information are being added to the database–things like vital signs and prescription information. It will be interesting to see how their system develops over time. The French (and Estonian) experiences could inform a feasible path forward for the US.

On November 18, 2016, Mike commented on A Hospital’s $1.2 billion Digital Transformation :

What a fascinating read!
EHRs certainly are ushering in a new area for healthcare providers across the country. While the promise of EHRs are clear–providing all important medical information about a patient in a single, accessible place–I am concerned about 2 things: the cost of such systems and patient privacy. I understand that a lot of institutions are currently using Epic as their EHR. However, seeing that Partners spent over $1 billion to implement it at their site, I wonder how much further Epic can proliferate before other, lower-cost competitors (like the partnership between BIDMC and Athena Health) start to steal their market share. With that being said, does the promise of EHRs break down if different institutions are using different systems? A multitude of proprietary systems may not easily communicate with one another, keeping patient information as fractured as it is today. Secondly, I wonder if EHRs should be used as a database in which to analyze patient information in aggregate. Something feels “icky” to me about hospitals selling patient information (even if it is de-identified) to pharma companies or other research institutions. I wonder who should be seen as “owning” the medical information in EHRs–the hospitals or the patients? I personally think using the information for anything other than individual medical care brings up some troubling legal and ethical issues. It will be interesting to see how EHRs can deliver on their benefits while minimizing the potential complications in the future.

On November 18, 2016, Mike commented on How Technology is Changing the Treatment of Type-1 Diabetes :

What a great read, and thank you so much for sharing your experiences!
As you mentioned in your article, I truly believe that the power of medical technology is in allowing patients to better monitor, understand, and control the conditions with which they live. I am impressed with the focus DexCom and the JDRF have put on making continuous glucose monitoring more available and reliable. I am curious though, about the degree to which patients and doctors are willing to trust new technology. For instance, I understand that patients with T1DM must still have their blood sugar levels intermittently checked by finger pricks in order to ensure that their continuous glucose monitors are functioning properly. Do you think that the data will one day be reliable enough to do away with this “double checking?” If so, what is the level of scrutiny that regulatory agencies need to put on these measurements, especially given that they will be used in a closed-loop control system to control insulin infusion rates. It would be a disaster if faulty glucose readings led to severe complications of hypo- or hyper-glycemia.

Really interesting article! I am surprised that, despite an unquestionably perilous exposure to the continued effects of climate change, Vail Resorts seems to be doing surprisingly little to stabilize its position (diversifying to other types of resorts, focusing on reducing emissions, etc). I think another interesting factor to consider is the degree to which Vail Resorts’ mountains have to make their own snow. Given that tha Tahoo region has been seeing much lower snowfall totals over the past years, it is reasonable to assume that their need for artificially produced snow has skyrocketed. This artificial snow, shot out from “snow guns” to cover ski trails is, in and of itself, a large source of carbon emissions. Thus, with less snow, mountains need to produce more of their own, and thereby increases its carbon emissions–creating quite a troubling cycle. Vail should invest in newer snow gun technologies that help reduce emissions, like the one discussed in the following WIRED article (https://www.wired.com/2015/02/how-to-make-fake-snow/).
Thank you so much for the fascinating read!

On November 6, 2016, Mike commented on Monsanto will help lead the battle against climate change :

Very thought provoking article. I find it interesting that Monsanto, a company that many people consider synonymous with GMOs, continues to prioritize its R&D work to focus on how crops can serve to increase the use of their other products (i.e. Round-Up Herbicide) rather than how they can provide substantial benefits to farmers and consumers. I fear that Monsanto’s clumsy roll-out of GMOs and tone-deaf R&D will imperil the continued deployment of GMOs. I believe that GMOs can offer major benefits to human-kind (by introducing improved nutrients into the food supply–like Golden Rice–and by improving yields in order to feed our planet’s growing population). I hope that, going forward, Monsanto considers these long-term benefits more than the short-term synergies offered by “Round-Up resistant” crops.
Thank you so much for the interesting read!

On November 6, 2016, Mike commented on Malaria: A Hot Mess in a Hot World :

Great article!

It is interesting to consider that GSK and other pharma companies may indirectly benefit from a changing climate given that an expanding region of vector-borne illnesses puts many more people (especially in higher income nations) at risk for disease. Medications for similar, so-called tropical diseases, are rarely studied or commercialized, given the lack of profits that can be realized from the generally poor populations that suffer from these illnesses. I am very impressed that GSK has decided to focus on combating a disease that disproportionately affects people in poorer nations, and that they have eschewed marginal profits in order to maximize the number of patients that can access their drug. I hope that other pharma and biotech companies follow their lead.

In terms of their sustainability practices, it is nice to see that they are taking their responsibilities so seriously. I am surprised to see that 46% of GSK’s carbon emissions come from “patients using their products.” I wonder what these activities are that are leading to such a high level of emissions. It can’t all be from inhaler use, right?

Thank you so much for the interesting read!

Fantastic article! Though I used to work for a biotechnology company that was focused on sustainability initiatives, I had never really considered the impact of the supply chain. In today’s globalized world it is a significant challenge to get medications from a factory certified to produce drugs that are safe for human use–so called GMP (good manufacturing practices) facilities, often located in developed nations–to patients who need them on the front lines of pandemics. I wonder if there are different schemes that Novartis should consider. For instance, instead of shipping boxes of vaccines filled in vials, would it be more economical from an emissions perspective to ship larger loads of unformulated bulk material to regional GMP filling facilities? Is there any consideration of finding improved formulation recipes to reduce the need for refrigeration during transport? Could Novartis, and other similar pharma companies somehow be incentivized to establish GMP production facilities in emerging markets, thus reducing the need for costly shipments of finished goods?
Thank you so much for the interesting read!

Very interesting article! I know very little about the airline industry, but this article was very well-written and easy to understand. I do have a few questions though. 1) With CORSIA regulations setting a baseline of emissions at 2019-2021 levels, are there any drivers, other than cost-savings, incentivizing carriers to reduce emissions today? Is there concern that carriers will game the system, artificially elevating emissions in between 2019 and 2021? 2) Continuous-descent arrivals seem to make a lot of sense, so why aren’t they currently employed? What are the advantages of a staircase-pattern descent that might be lost if all carriers switch to a continuous scheme? 3) Given that Alaska Airlines already has a much more efficient fleet than their major rivals, what else can they as an organization do to drive airline manufacturers to produce more energy efficient planes?
Thanks so much for the interesting read!