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On November 18, 2016, ss commented on A New Era of Telemedicine :

Shreya, thanks for this post! Telemedicine has huge opportunities to bridge gaps in access to care, especially in rural/inaccessible locations as well as for elderly patients and patients who have limited mobility. Moreover, this can significantly reduce costs and timelines for diagnoses and treatments, not just for the patients but for the entire healthcare system. You talked about the challenges of wrong diagnoses — this makes me think that there is a deeper challenge of fully engaging the physicians and making them feel as responsible for a patient on a screen as they feel for a patient in their office. Further, outside of the doctor-patient bubble, I imagine that it will be even more of an uphill task to engage hospital administration and insurance companies. Telemedicine will need to be implemented at a large scale in way that can be profitable to hospitals so administration is not concerned about the doctor’s time being used for less profitable patients. Further, the bureaucracy of payors will be a big challenge — how will they quantifiably measure the needs, benefits and adherence, and how can they be convinced to cover this under current plans?

On November 18, 2016, ss commented on Uber’s Bet on Self-Driving Car :

Peter, thanks for starting this discussion on self-driving cars. While I completely agree with all the benefits you have highlighted, I think self-driving cars pose a deep ethical/moral question that I struggle with. Even if we assume that the cars work perfectly and have no element of human error, these cars are still driving on streets that have humans — passengers in the car, other drivers in cars, pedestrians on the street. Let’s say there is one irresponsible pedestrian crossing the street at the wrong time — if there is a person behind the wheel they will make a human judgement on which way to swing the car. Do they go straight and risk killing this pedestrian? Do they swerve left and bang into the car in the other lane? Or do they swerve right into a wall and risk their own life/life of the other passengers in their car? How will the algorithm be created to prioritize human life? While the pedestrian is at fault and the driver in the other lane is not, if the car hits the pedestrian he/she will most likely die but the other driver will probably be protected with the air bags. Should the algorithm penalize the pedestrian being unsafe or the driver being safe? As we adopt technology we must be keenly aware of its implications. I am personally not sold on self-driving cars just yet as there are too many unanswered questions.

Jacqueline, it’s really interesting to read about a real application of IBM’s Watson after learning about it in class today — thanks for the post! I think that leveraging digital health to monitor Parkinson’s is a great idea, primarily because I imagine that motor functions can be monitored remotely via technology. I wonder if this translates to other CNS disease areas, where endpoints may be more subjective (e.g. mood, anxiety etc) and will need human intervention.
Another concern I have is that even though large biopharma companies like Pfizer as well as smaller start-ups like Denali will rapidly adopt such technologies, regulators like the FDA will go through a long, winding path to evaluate these before they will accept such clinical trial results. I imagine there will be push back not just from regulators but from competitors who haven’t adopted these technologies yet, as clinical trial data comparisons may be apples to oranges now. Companies like Pfizer should to work closely with regulators and keep them in the loop, so regulators are a part of the development process of new ideas and are more likely to expedite approvals. Lastly, regulators in each geography will approach this differently, so global companies have a mammoth task to drive this adoption of technology across the value chain.

Rashi, this is such an encouraging post on healthcare access in India! Given that access to technology (and even electricity) is relatively limited in rural India, how does Apollo plan to ensure patients don’t get disconnected from this systems? I see a huge opportunity for them to work with local governments in improving infrastructure in villages that will ensure smooth delivery of healthcare to the last mile. Further, since education levels are dramatically low, I wonder how much of a barrier it is for Apollo to educate patients.
Additionally, are there any checks and balances in place on privacy data of patients? Do you think that the government should play a bigger role here? A big risk that I see here is Apollo forward-integrating into becoming a private insurance player for rural populations and using their medical data against them to drive up insurance premiums.

Thanks for such an interesting post! As someone who’s been through years of grunt work in a biochemistry laboratory, this is very appealing at first glace. However, it makes me think about how this will interfere in the training and development of scientists in the long-term. While the argument that scientists can avoid grunt work and focus on solving real problems is compelling, I strongly believe that going through years of repetitive trial-and-error at the bench is an integral part of the (current) path to becoming a good scientist. Do you think this disconnect between developing experiments and conducting them will hinder a scientist’s ability to think creatively about experiments? While I do see a huge benefit in industry for CROs, I do wonder whether this will have a positive or negative impact in higher education programs and research facilities that are a training ground today for scientists of tomorrow.

Farha, thanks for a super interesting post! As a native to this region whose primary carbohydrate is rice, this (literally) hits close to home. I like your suggestions for BRRI, especially your suggestion on financial adaptation, as I believe the biggest barrier to implementing this program will be the financial constraints of the farmers. I would push this further and suggest that BRRI give the farmers an incentive (monetary or otherwise) to test out the new varieties of rice. One way of encouraging farmers could be to guarantee a minimum purchase ( BRRI can do this either directly or facilitate it through rice buyers).

Rice farming has direct adverse impact on global warming. Flooded rice fields emit methane, that is second in importance only to carbon dioxide as a greenhouse gas.[1] Additionally, slash and burn agricultural practices are still rampant in Bangladesh, which reduces forest cover, contributing to global warming as well as increasing malaria risk for the farmers.[2] BRRI can also work to develop hybrids that would emit lower methane. Further, the government has a key role here as well — tighter regulations around deforestation should be put in place immediately as deforestation isn’t just a long-term climate change contributor, but for a low-lying country like Bangladesh it can have a (relatively) short-term impact in further degrading soil and exacerbating effects of floods.


On November 7, 2016, ss commented on Clear Skies Ahead for Boeing? :

Super interesting post — thank you! As someone who travels a lot, a (tiny) part of me feels guilty for my increasingly large carbon footprint, so it’s encouraging to read about Boeing taking active steps to decelerate their adverse impact on climate change. I think Boeing needs to invest in disruptive innovation for long-term solutions, perhaps something like Solar Impulse 2 — the plane that flew around the world with solar panels (

While Boeing and Airbus ofcourse have a big responsibility as aircraft manufacturers, I think the (arguably bigger) responsibility is with Airline operators like United, Emirates, Lufthansa etc. that are customers for Boeing. These companies directly control the negative impacts on the environment, and will directly benefit from a stronger bottom line if they can improve fuel efficiency. One way they can do this is by reducing the load each airplane carries, by restricting the bags that people are allowed to carry. While many airlines are already charging for bags, they should look into proactively offering discounts to people who travel without bags — this can improve fuel efficiency and turnaround times.

Thanks for the post! As an avid tea drinker, it’s interesting for me to see the similarities in the two industries and the problems they face, yet they approach to solving these problems in silos. Do you think there is benefit from public-private partnerships between companies like Starbucks and governments/ agriculture boards to address these issues at a systemic level?

While a lot of these solutions are very promising, they seem pretty long-term. What short-term interventions are they using? I can think of a few:
1. Planting trees for shade/to reduce temperature
2. Planting soil-binding grass to prevent soil erosion
3. Microbiomes (like Indigo Agriculture)

To encourage farmers to adopt new practices that may require investments, Starbucks can put in place long-term contracts that guarantee these farmers an income.

On November 7, 2016, ss commented on Fresh Del Monte: A Victim of its Own Success :

Thank you for such an interesting post! I totally agree with your title — Del Monte is definitely a victim of its own success, and I think that at a higher level, this issue applies to all global agri-product companies.

I also agree that Del Monte’s efforts today are very incremental, and I would push that further by saying they are so marginal that they barely scratch the surface. Given the scale that Del Monte operates at, I think it largely influences the eating habits of Americans by flooding the American produce market with products imported from South America, Africa and Philippines. With this power, comes a great responsibility that I believe they ignore: not only do they have an immensely large carbon footprint with global transportation, they also have unsustainable farming practices and questionable treatment of the workers on the farms in emerging markets. Further, they are still using chemical fertilizers, which as you pointed out, contribute to global warming. I think there should be a strong push to move to long-term sustainable practices that include using organic/natural fertilizers and sourcing produce locally. While this implies a change in the business model and will negatively impact their top line in the short-term, it is critical for long-term sustainability for Del Monte and the communities they operate in. Given this is such a fundamental change, I don’t believe it is feasible without any external pressure (governments, NGOs etc)

Jacqueline, thanks for a thought-provoking post. Given the complexity of pharma supply chains, I wonder what financial incentives Novartis would have to establish a complex supply chain, and what the financial impacts would be the make end-to-end operational changes. Moreover, can they, in practice, navigate the regulatory environment across different countries to actually implement this?

I think the suggestion to develop temperature-stable formulations is brilliant, and can have huge impacts on costs for the pharma company as well as their carbon footprint, since biotech drugs and vaccines today have to be transported by air to ensure they remain stable.

Mike, while I really like your suggestion of manufacturing in bulk and filling in vials at the country of use, do you know if they can do that with sterile products like vaccines that, in my understanding, have to be in final packaging in the sterile facility that they are manufactured in?

To mitigate some of the financial impacts of making such changes, Novartis could consider long-term contracts with governments with minimum offtake agreements for vaccines in emerging markets. This would ensure them a minimum volume, since vaccines in developing countries will be a high volume, low margin game.