This is a very cool technology, but I’m a bit skeptical that this will solve the issue at hand. As you mention, significant common and adverse side effects to medications as well as patient misunderstandings of “unseen” chronic conditions (e.g high blood pressure) are big contributors to non-adherence. While this new pill coating helps with tracking when a person has taken their medication, the technology doesn’t change underlying motivations for health-seeking or drug-ingesting behaviors. As it stands now, it seems like the pill just provides additional data points for healthcare professionals to sort through. In my perspective, this technology does not provide much of a value-for-money add compared to traditional, cost-effective biochemical assays. I fear that, as you mentioned, this is a way for pharmaceutical companies to find ways to re-formulate their drugs and extend their patents, ultimately increasing drug prices.
As an aside, many common drugs actually come in extended release forms to combat the non-adherence problem. Toprol XL is an extended release version of metoprolol, a blood pressure controlling medication. The extended release version can be dosed once a day since its duration of effect is ~24hrs, versus metoprolol’s 3-7hr usual duration of effect. Further, some psychiatric medications actually have extended-release versions that last a much longer period of time. This is especially key in conditions like schizophrenia, as these injected drugs can actually help improve symptoms if other treatment options with multiple daily doses have failed in the past. One such example is Invega (paliperidone palmitate), which can be dosed once a month.
While the pharmacology and mechanism of action of drugs influences the ability to dose at these types of intervals, it is key to realize that this is a lever pharmaceuticals can pursue to help patients with the adherence problem.
As a medical student pre- and post-Epic rollout at Mass General Hospital last year, I can say with full certainty that productivity dropped significantly in the beginning, even though the interface is reasonably user-friendly. With that said, what I find most puzzling is that Epic actually tailors its software to each hospital system — for example, within a hospital network of a smaller community based hospital, larger tertiary/quarternary care hospital, and outpatient facility, professionals may use 3 different versions of Epic for their operations. This means that healthcare workers who work across settings may find themselves learning three different systems at once. That certainly creates room for error and slowing of processes.
Another limitation of Epic is also one of its strenghts. Epic is great at tagging ICD-9 & 10 codes (symptom/situtational and/or diagnosis codes) to the patient record, which can make billing much easier. However, in some instances, practitioners may feel the pressure to assign these labels to ensure that their documentation is “complete” and “billable,” despite the label being overly narrow or not comprehensive enough. Epic has certainly enjoyed its first movers’ advantage, but this is a big weakness of Epic (and other EMRs).
As a final point, the Epic rollout at Partners Healthcare last year cost $1.2B dollars, and also involved hiring 600 new employees and hundreds of consultants to work with Epic to build the system and then train thousands of doctors, nurses, physician assistants, and other workers to use it.  I think that’s one of the main reasons why they haven’t moved globally — Epic is still figuring out how to work at big institutions, and is still uniquely tailoring its platform to each individual client. While there is significant overlap between different versions, this process is extremely costly and may not actually show improved outcomes or profitable retunrs until the learning curve stabilizes. Plus, more fundamentally, other healthcare systems may not be able to sustain these types of costs as easily as institutions that Epic has actually chosen to pair with.
As a user (although inconsistent!) of the Peloton app, blogilates, and Kayla Itsines workout plans, I totally agree that boutique fitness is increasingly more digital and that the space is increasingly becoming crowded. While competition is certainly increasing, I think the core asset of each of these apps is the trainer teams themselves. As we experience in real life, trainers are not one-size-fits all, and that’s true in personal training, too. I wonder if demonstrating measured user outcomes and attributing them to one or a set of personal trainers’ programs may help some of these players differentiate themselves from the other options. Further, if that’s possible, figuring out which types of workout-followers are achieving those same results could be a rich data source to try to collect. I wonder if an emerging leader may be able to merge data and workouts, so as to achieve the fan followings that these other existing workout plans enjoy.
Great post! As someone who spent the past three years writing my notes on my tablet (albeit with a bad stylus and some timelag!), I totally agree that the younger, tech-savvy generation may help the shift from traditional pen-and-paper to digital inking. With that said, I also agree that it may be challenging for the pen-and-paper to be eliminated entirely. Although many educational institutions rent out tablets with limited app-downloading capabilities for students in specific classes (e.g. my pediatrics rotation as a 3rd year med student, some high schools), there are certainly still individuals, communities, and institutions whose technology assets are pretty limited — going to the library to use a computer is not so foreign a concept. Is there a way to show value in hardware-sharing so that we can incentivize the use of digital writing?
Additionally, I am curious about the software side. I have personally used apps like Notability and Evernote, both having different pros and cons. One shared by both is the inability to actually structure notes intuitively on the app — my notes end up being a digital version of the notes I may write on a pen or paper, and are just as unstructured as handwritten notes are, as you mentioned. I wonder if apps are realizing some of the key pain points (e.g. inability to create linkable sections, the clunky and obscure places to find where to change fonts and switch to use other graphics, and the inevitable need for linking to cloud storage). Hopefully Microsoft or Apple may figure it out to produce a more user-friendly experience!
Very interesting read! I imagine Walmart’s supply chain innovations (e.g. packing materials) could be great for other industries dependent on distribution networks to emulate. Transportation related to healthcare services are also one of the major ways in which the healthcare sector contributes to greenhouse gases. I wonder if hospitals and their related distribution networks could invest in those packing materials for healthcare products — the amount of waste from packing materials in hospitals is actually staggering! Do you know whether Walmart has promoted these packing strategies or if other players are adopting them?
Very surprising that despite potentially more beneficial conditions for banana production that there are negative economic consequences of climate change that may offset those benefits! I was specifically intrigued by the increasing predominance of weather-related diseases that may affect crops in the near term. Given that Dole is one of the largest banana producers in the world, are they pursuing ways to mitigate this burden of disease with other banana producers? As some others have pointed out, are they also pursuing research that may create banana models? Some preliminary ideas might be to create a banana strain variant that requires less water to grow or to find microbacterial solutions (like in the Indigo Agriculture case) to offset the disease burden. I wonder if those are projects Dole might consider worth investing in, or whether it is more beneficial for them to continue optimizing their footprint in the short term.
In the process of reading these blog posts, yours included, it has become clear that inertia, public perception, and regulation are consistently affecting corporations’ ability to become environmentally impactful in both positive and negative ways. More specifically to your post, this technology is incredibly cool! I wonder if there is data on how many CO2 emissions are avoided collectively by the startups and Alter NRG’s efforts? Additionally, has the Japan implementation of this technology been successful? Either way, are there takeaways from that scenario that could be useful in implementing this technology elsewhere, like in developing nations as you suggest?
It is really surprising that AWS’s drivers for pursuing sustainability are both their external regulations and their consumers’ perspectives/desire for transparency, yet AWS themselves benefit very little financially from the sustainability if they do not increase their own prices — it certainly paints a picture that the burden is moreso on them.
On the note of electricity being the largest contributor to greenhouse gas emission, I think your recommendation for AWS to increase their share of wind purchases is an excellent one. Kaiser Permanent, a hospital system in California, is pursuing a similar strategy of purchasing wind and solar energy. I wonder if investments in these energy sources are influenced by geography, and if there might be a better way to understand when and why certain energy purchases are made. This may help other corporations co-invest with each other in these energy purchases or even help them pursue such energy saving strategies themselves.
Interesting post about my favorite indulgence! (Seems like all the above comments feel similarly…) 🙂
Your post highlighted a number of things for me:
-The internal tax related to Ben and Jerry’s carbon footprint resonated with me as well. It seems based on other articles on the website (http://www.benjerry.com/values/issues-we-care-about/climate-justice/carbon-pollution-tax) that this is being modeled after a VT legislative proposal that calls for both tax cuts for individuals and organizations and for decreasing heating bills by contributing to efforts making buildings more green. (I couldn’t find more clarity on where the dollars are going?) If so, is this akin to the benefits of producing renewable energy from solar panels? Or is this a penalty for exceeding a particular carbon footprint based on an operating model? The differences in these approaches certainly would influence how peer organizations and unrelated ones might respond in improving their own operations.
-The idea of vegan/non-dairy ice cream options is an interesting one, but I am skeptical that 1) the end customer base of Ben and Jerry’s would be amenable to this shift (I promise I’m not biased…) and 2) how the supply chain involved in the production of Ben and Jerry’s products (e.g. dairy farmers) might be impacted. I would be curious to see how radically (or not) the economy might shift in order for them to pursue the non-dairy options aggressively. Additionally, I think this ties back more broadly to local sourcing, encouraging the population to consume more naturals foods, and the obesity crisis and how those components of our food cycle impact the environment as well.