Sunday, July 10, 2016

Theranos and Other Too Good To Be True Stories
“Too good to be true” is an idiom referring to something that is so excellent, so unbelievable, so good, that it is unbelievable and defies reality.
This idiom rings true for health care. The public thirsts, hungers, and pines for medical breakthroughs that will cure disease, prolong life,  relief pain,  reduce costs, provide unheard of conveniences,  usher in high tech miracles,  and make health care a right accessible  and affordable to all.
Rocks of Reality
Too often, however,  these breakthroughs, these whimsical dreams,  crash upon the rocks of reality.
Consider this week’s headlines.
·         “Theranos CEO Suspended from Blood Testing Business.”   WSJ, July 9-10. Federal regulators revoked the license of and banned founder and CEO. Elizabeth Holmes, from the blood-testing business for 2 years.    Holmes, in 2003, a Stanford dropout, founded Theranos at age 19, and grew its valuation to more than $9 billion as a Silicon Valley startup.   Holmes built Theranos around her phobia of needle puncture pain,   her belief in an unproven  technology that could perform hundreds of tests on a single drop of blood without  venipuncture,   her conviction that consumers  should be able to order and interpret their own blood tests,  and her idea that the new technology could end the $50 billion medical laboratory industry.

·         “Surprise Medical Bills Stir Tension.”  WSJ, July 9-10.   Among insurers,  there has been a movement to narrow networks of low-cost hospitals and physicians to preserve profits.    Unfortunately,  these networks could  not  and cannot provide all the care consumers need, and consumers have turned, often inadvertently, to “out-of-network “ providers  who charge 80% to 90% more than  in-network providers.   Outraged patients began receiving large bills they did not expect. The Obama administration responded be setting “usual, customary, and reasonable” out-of-network’rates, which offended some,  like the American College of Physicians, who sued the administration, claiming it had no right to set rates as low as it pleased.

·         “House Committee Investigates Illegal Administrative Spending on ObamaCare,”  “Suing Their Way Out of ObamaCare,”  “Is the Obama Administration Diverting Bills to Insurance Companies.”   Galen Institute, July 8. This series of headlines are from articles by the Galen Institute, in its ObamaCare Roundup series.  The Galen Institute is  a conservative think tank.  It  accuses the Obama administration of execute overreach  and illegal practices to make the health law work.   Whatever one thinks of these claims,   it requires no stretch of imagination to maintain the primary goal of ObamaCare -   to expand the reach of the federal government to cover  all of the uninsured  through a combination of managed care and federal regulations and mandates  while lowering overall costs to the entire population and cutting Medicare entitlements is  unbelievable.      Never in the history of the federal government  has it cut costs while expanding benefits.

·         “Medicine’s Next Step,”    Boston Globe, July 8. This is a headline of an article by the President himself.      In the article he maintains  a combination of cooperation, collaboration,  and convergent  interests among practicing physicians,  research scientists,  and organizations providing data on millions of patients will go a long way towards solving the genetic mysteries contributing to  all forms of cancer and diabetes. 

Says the President, “By bringing together doctors and data like never before, precision medicine aims to deliver the right treatments in the right dosage at the right time — every time. It helps target the causes of a condition rather than just the symptoms. This is one of the greatest opportunities we’ve ever seen. Precision medicine gives us the chance to marry what’s unique about America — our spirit of innovation, our courage to take risks, our collaborative instincts – with what’s unique about Americans – every individual’s distinctive genetic makeup, lifestyles, and health needs. In doing so, we can keep ourselves, our families, and our nation healthier for generations to come.”

It is a noble, even a sublime idea, combining precision medicine, personalized care,  and patient-centered care,  under a far-reaching,  inclusive, and comprehensive umbrella  with federal guidance.  

So too are ideas like those expressed by  Dr. Donald Berwick,  former CMS administrator,  who wrote in his book, Escape Fire: Lessons for the Future of Health Care, “The health care encounter as a face-to-face visit is a dinosaur…I think it rarely means reliance on face-to-face meeting between patients, doctors, and nurses…Tackled well, this new framework will gradually reveal more than half of such encounters – maybe as many as 80 percent of them, are neither  wanted by patients or deeply believed by professionals.”  It sounds too good to be true, and I do not believe patients and doctors believe it..

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