Archive for March, 2012

Four Ways Personalized Medicine will Change Doctor-Patient Relationship

March 27, 2012 12 comments

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Personalized Medicine Gains Traction

Since completion of the Human Genome Project  in 2003, the promise of personalized medicine (PM) caused many to consider its effect on bio-science, pharma and healthcare delivery.  Physicians contemplate a future in which patients enter their office equipped with symptoms and a list of the genetic variants they posses and questions about what they mean.

The problem hasn’t materialized because  the cost of discovering and developing drugs customized to the needs of a sub-genetic group have been prohibitive. Today however,  IT frameworks like Hadoop deploy massively powerful, inexpensive processing power. Now the huge genomic database becomes a more accessible resource to develop medications that are effective for targeted patient populations.

These new drugs offer improved cost-effectiveness over blockbuster drugs  for conditions like high cholesterol or hypertension.  Physicians will spend less time and money in trial and error to find which drugs work for which patients.

Disruption in Healthcare

In my last post, I raised the question, “Will Personalized Medicine have a disruptive influence on medical practice?” Those familiar with Christensen’s theory of disruptive innovation understand that market leaders focus resources on product development for advanced users who don’t care about cost. Often products contain features and benefits that don’t matter to most users. This leaves room for competitors to develop new technologies and business models to meet the needs of average consumers and “disrupt” the market leader’s business from the bottom up.

Healthcare is not like other businesses. The role of payers and policymakers as well as the interests of public health intervene and create barriers to natural market forces.  These factors slow the rate of disruption. Yet there will be fundamental change in the way physicians and patients interact as PM gains traction.

Four ways PM will disrupt healthcare delivery

#1 Predictive, not reactive:

  • Rather than waiting to treat symptoms of a disease that occur, physicians can predict which diseases a patient is susceptible to.
  • The physician develops a personalized health plan to prevent or detect these diseases early.
  • Patients will become a true partner in the delivery of healthcare, monitoring their progress and reporting results to their caregivers.
  • Home testing may replace testing in the doctor’s office.
  • Fewer office visits, less face time with the PCP is less expensive, but is it better medicine?

#2 More information on more treatment options:

  • Physicians  prepare to answer patients’ questions about new genetic tests and the treatments for their sub-group.
  • Continuous access to up to date, peer-reviewed medical information will increase dramatically.
  • As more options for care become available, will the patient’s trust in the sources of clinical information and outcomes begin to erode?

#3 New ethical and moral obligations: 

  • What is the physician’s role with patients on the moral and ethical questions surrounding access to genetic tests?
  • If one family member wants genetic testing and another doesn’t and a serious disease potential becomes known, what is the physician’s obligation to inform?

#4 Physician’s role in decision to test:

  • Should patients have their own testing done without supervision of a physician?
  • Should tests be offered for genetic disorders for which no treatment is available?
  • Who pays for development of testing and treatment for small sub-groups of patients?

What do you think? Will PM disrupt or enhance healthcare delivery?

Personalized Medicine in 3 – 5 Years?

March 23, 2012 30 comments

Healthcare Delivery Symposium

The optimism was overflowing at the Aspinwall Symposium at WPI yesterday.  The healthcare transformation is on with distributed care, quality payment models, analytics and big data on display.

Most interesting were the panel presentations and discussions. Recently I wrote about the need to accelerate building our health information infrastructure nationwide. This enables a faster transition to digitized health records, I argued.  The news for me at this conference is that an interoperable  infrastructure in the traditional “plumbing” sense may become less important.

Distributed Care Models

David Dimon at EMC spoke about the growth of distributed care models which rely on an “exostructure”. Virtual data centers enable caregivers to connect with patients in a variety of settings outside the doctor’s office or hospital.  Monitoring patients vital signs at home is certainly less expensive than at the hospital and may change some treatment protocols around length of stay.

Dale Wiggins, CTO of Phillips Patient Care and Clinical Informatics shared an example of how one distributed care model works. Phillips eICU is a virtual Intensive Care Unit. Its aim is to end the need for multiple, highly trained and highly paid Intensivists – the physicians who specialize in the care of ICU patients.

The center of the eICU is a cockpit where an Intensivist works, monitoring patients’ vital signs and video real-time over distance.  This model extends the ability to dramatically improve outcomes, particularly among patients in more rural settings. The eICU is now deployed at UMass Memorial Hospital system.

The next logical step is to extend the ICU to the home, reducing readmission during the critical 30 day period after release from the hospital.

Analytics, Predictive Informatics and Big Data.

Robert Friedlander IBM Master Inventor spoke about the promise of breakthroughs in distributed data processing create massive computing power. Google’s open source MapReduce framework and its successor Hadoop have given researchers in biotech and pharma an unprecedented ability to query very large data sets quickly and with great flexibility.

Prior to Hadoop, a large data set like the human genome was impossible to analyze and query in-depth. Relational databases are  efficient with tabular data. Medical research requires analysis of very large  “heterogeneous” data sets which don’t fit into tables.

Medical breakthroughs can happen by applying predictive analytics which involve many complex queries of these massive data sets.  All this happens easily and relatively inexpensively through distributed massively parallel processing powered by Hadoop and MapReduce frameworks.

Bob predicted that these technologies may radically change the way healthcare is delivered and in the foreseeable future. “The promise of truly personalized medicine may become a reality in the next three to five years.”

Can the healthcare system handle that kind of disruption? Let me know your thoughts.

photo credit:

Three Reasons for a Hospital to Advertise

March 20, 2012 7 comments
Is Hospital Advertising Effective?

Why do hospitals advertise? As someone who spent a career making and watching advertising, it seems like a waste of money.

Take a look at hospital ads on YouTube. If you edited the name of the hospital from the commercial, it would be impossible to tell the difference between them. All deliver top-notch healthcare, with world-class doctors and an attentive staff of happy people.

This should be no surprise; all hospitals share the same mission.Their physicians train to the same standards. There is little tangible differentiation at level of the institution in the hospital world.  If there was, you would be hearing about it on the evening news and soon they would close their doors.

Yes, there are teaching hospitals and community hospitals and regional hospitals, but they compete with others of the same ilk on the same dimensions.

When to Advertise

In my view, there are only three legitimate reasons for hospitals to advertise:

  • Change of ownership.  The hospital is obligated to tell the communities it serves of any change in ownership. With it may come enhancements to facilities which improve the patient experience or a renewed commitment to serve the community. Corporate ads like this are often full of  platitudes. During my agency career we used to say corporate advertising is where the rubber meets the sky. Try to stick with the facts.
  • Marketing a center of excellence.  These ads work because there is a tangible, differentiated benefit to the patient. Centers of excellence usually are excellent.  And the halo they create enhances the overall image of the hospital.
  • Improve the patient mix.  Hospitals in blighted neighborhoods are often burdened with high costs of treating the uninsured, and shrinking subsidies for paying for that care. Often, these hospitals deliver superior outcomes treating chronic disease states because of the problems of their populations. Targeted, program specific spending in adjacent neighborhoods can revitalize a hospital’s profitability.

My advice to hospitals considering an ad campaign outside those purposes…scrap it and put your money to work engaging with the communities you serve. It’s more work, but it actually demonstrates the “commitment” that is too often spoken of in those commercials.

The Act of Becoming: Branding on Social Media

March 15, 2012 7 comments
Social Influencers

Malcolm Gladwell wrote The Tipping Factor. He showed that trends are not spread by the many, but by a few influential connectors.  Marketers identify and leverage these connectors or social influencers to build their brands in the social marketplace.  As  brands engage with these key customers and taste makers, what are they hearing? The social marketplace is no place for brands who don’t have a firm grasp of their identity. Social media marketing is an exacting science and but it can also be a rude awakening.

The Exacting Science Part

Like the ripples of water from a rock thrown in a pond, marketers identify each degree of separation and influence. There are  power influencers, idea starters, amplifiers, etc.

Marketing agencies and research firms have developed innumerable measurement and analysis tools. From buzz analysis to tweet and blog level,  Klout to PeerIndex we know who to court and woo. We seek favor for the brand with a blog or podcast mention. We know the demography and social media profile of  second level influencers, the “brand ambassadors” and on to the next. Let the word of mouth begin.

The beauty of social media marketing is that you can learn which programs, messages and offers work and which don’t.  ROI is a snap.  For new brands and small marketing budgets, it’s the only way to go. For many big brands, it’s an effective way to keep their customer base. Ford Motor Company is revitalizing their brand with an improved product line and great social marketing.

The Rude Awakening Part

The world of social media has no tolerance for executive, top down brands.  Traditional brand messaging does not resonate in this world. Today’s consumers are on information overload. They want to make brand decisions on their own terms, filtered through their network.

Consumers use social media to create a cultural context that has meaning for them, a “collective I”, as Alex Wipperfurth describes it.  The brand must become something with meaning and authenticity to take part in that world. Who are you and what do you stand for?  It’s surprising, but many companies don’t really know.

Luxury brands that rely on cache have not done well in the democratic arena of social. Campaigns with even a hint of controversy can go viral negative in days. The California Milk Board’s “PMS” campaign polled positive, but stirred a firestorm of negative social media backlash. Relevance and resonance displace reach as the prescription for success in social media marketplace.

To quote Mr. Wipperfurth again, “It’s no longer about positioning…it’s about taking a position.”

Please let me know your thoughts by clicking on the “Leave a Comment” link at the top of the post.

Why is Health Information Exchange so Hard?

March 13, 2012 1 comment

US Healthcare Information Technology is still paper based

Fatal Communications Breakdown

Josie King died at Johns Hopkins Hospital in 2001 – age eighteen months. She did not die from her condition but from dehydration coupled with non-indicated use of narcotics. She died from poor communication and coordination of care at one of the best hospitals in the world.

Every year, almost 100,000 people die from medical errors in the US. The Joint Commission‘s Annual Report on Quality and Safety 2007 found that inadequate communication between healthcare providers, or between providers and the patient/family was the root cause of over half the serious adverse events in accredited hospitals. The instantaneous movement and sharing of information is part of daily life in the US. The lack of the same capability in our healthcare system is appalling.

Interoperability: the Biggest Challenge

The US has a private medical system. Healthcare delivery happens locally and regionally. IT implementation grew organically in that model and today is a crazy quilt of antiquated incompatible systems. The US is building a healthcare IT infrastructure to connect these systems together. IT Infrastructure is the central nervous system, a conduit for medical information to flow from anywhere to anywhere. Interoperability is an enormous problem in a fast-changing world of wired and wireless devices.  Standards committees work on two-year timetables while our innovation economy pours new devices into the marketplace at a dizzying rate.

Glacial Progress

The priority for HIT gained traction in 2004-2005, but since then progress has slowed to a crawl.

  • 2004 – H.R. 4880 The Josie King Act introduced to spur growth of national HIT infrastructure – bill died in committee.
  • 2004 – HHS Secretary Tommy Thompson launched the “Decade of Health Information Technology“.
  • 2005, IBM announced it was investing $250 million in R&D to design a national IT infrastructure.

It took until 2009 to enact meaningful legislation.The HITECH act invested nearly $30 billion in health IT to improve the quality, safety and efficiency of health care. Most of this money went to the CMS for incentives to healthcare providers to accelerate implementation of electronic health records (EHR). Widespread adoption of EHR’s  in the healthcare system is a key enabler to achieve cost and quality reforms.

Three years after passage of  HITECH, less than 20% of the healthcare is delivered electronically in the US. According to Charles P. Friedman, CSO for the Office of the National Coordinator for Health IT, adoption of EHR’s will become more or less “national” in 2019 when penetration will hit 80%. Can we wait that long?

The pace of change will remain glacial unless health IT is given the national importance it deserves. The effort to create a robust interoperable health information backbone deserves the same urgency that built the interstate highway system or US space program. Instead the popular political dialog focuses on the health insurance mandate.

We lack the threat of Russian ICBM’s orbiting the earth to motivate us in this goal, yet our need is urgent. Efficient healthcare information exchange will not only improve patient safety, it will improve outcomes and cost-effective care. Without it, access to care may one day depend on one’s ability to pay for it.

Please let me know your thoughts by clicking on the “Leave a Comment” link at the top of the post.


“Jumpstart Startups” Act Passes in the House

March 9, 2012 3 comments
Sarbanes-Oxley Stifles Innovation, Job Growth

After the Enron, WorldCom and Tyco scandals Congress passed Sarbanes-Oxley Act in 2002. The “SOX” act intended to protect shareholders from shady corporate disclosures and overstated earnings reports.

What SOX actually did was paralyze innovation and job growth. It imposed a heavy capital burden on growth companies seeking to go public.  Pre-SOX, the average time to IPO was 5 years, post-SOX it is 12 years. For companies that did go public, many defected to a foreign exchange.

For large companies, Sarbanes-Oxley preoccupied C-suites and boards of directors with accounting rules and SEC compliance. As Dr. Chandra Mishra wrote in the Orlando Sun Sentinel, “Sarbanes-Oxley has created a trillion-dollar industry, consisting of lawyers, accountants, compliance officers and programmers, pushing for more bureaucratic procedures and criminal penalties for company management and entrepreneurs, creating fear and confusion, and discouraging risk-taking and corporate growth.”

For small and medium-sized companies seeking to go public, complying with SOX rules adds roughly $4.2 million to their capital requirements.

Even representative Michael Oxley, one of the original sponsors of the bill, said “Frankly, I would have written it differently…Everyone felt like Rome was burning.”

Legislation Passes the House, Senate Yet to Vote

Last year bills in the house and senate addressed this issue and failed. Yesterday H.R. 3606, sponsored by Rep. Stephen Fincher,  passed overwhelmingly in the House of  Representatives.. This bill will cut the costs of going public for small and medium-sized companies buy phasing in SOX requirements over five years.  It also ends SEC rules prohibiting crowdsourcing and advertising to raise capital.

As congressman Fincher said, “Small companies are our nation’s best job creators, but have been the hardest hit by burdensome regulations. On average, 92% of a company’s job growth occurs after an IPO.  It is imperative we reduce regulations to help these small companies create private jobs for Americans.”

The Senate has not yet voted on its corresponding bill, but passage this legislative session looks good according to Senator Charles Schumer.

Graphic credit: Forbes Magazine

Uncertain Future for Growth in Life Sciences

March 6, 2012 2 comments
Clusters Create Competitive Advantage

 Michael Porter, in his essay Clusters and Competition describes a virtuous geographic relationship among government, finance, education and industry which combine to create competitive advantage. Think high performance autos in southern Germany, high fashion shoes in Italy, tulips in Holland. Think life sciences in Massachusetts.

Life sciences are the engine behind Massachusetts’ growth economy. But they might face an uncertain future due to:

  • Reduced appetite for venture funding of life science
  • Fewer IPO‘s, more acquisition activity
  • Shortage of trained “middle workers”
  • The high cost of healthcare
Prospects for the New England Life Sciences Cluster

State Economic Development czar Greg BialeckiPeter Abair from MassBio and David Pierson from Foley Hoag met on a panel at NEHEN to discuss the long-term health of life sciences in Massachusetts. I’ve summarized their views below.  Much of the data presented lies in a PWC MoneyTree Report on data supplied by Thompson Reuters.

By all accounts, growth in the life sciences sector saved Massachusetts’ economy from tanking in the great recession. Venture funding fell; it bottomed out in 2009. But NIH funding remains high, higher than any other state except California.  And on a per capita basis, NIH funding in Massachusetts is off the charts. Momentum in the sector is strong, yet there are clouds on the horizon.

Venture Funding Down for Biotech

By 2011 venture capital rebounded, but not for biotech companies. High tech is booming behind new business models fueled by cloud computing, social media and smart phones. These start-ups get the lion’s share of deals.

There are fewer venture funds today and fewer investors in those funds. There is a focus on capital efficiency, faster exits. Biotech is not an efficient investment. New products are slow to market and the failure rate is high.

Another disturbing trend in biotech start-ups is that fewer successful ones ever reach an IPO.  They get gobbled up by larger firms. M&A exits far outpace IPO’s in this space, and the trend has increased. More big pharma companies take an ownership stake after Phase I or II. Often, an acquisition means relocating the company and its jobs out-of-state.

Should we be concerned about the loss of local investment on the long-term health of the biotech cluster? Porter argues, “The ultimate test of the health of a cluster is its rate of innovation.”

There is no shortage of innovation in the state. Incubators and accelerators are full and growing. But the high cost of doing business in Massachusetts and the lack of a vibrant, skilled middle work force makes it hard to scale a company here.

So far, the high cost of discovery has paid off because of the healthcare system’s willingness to pay a high price for new products. As the ACA, payers and employers conspire to lower the cost of care, there will be less room in the budget for high-priced innovation unless it creates a better outcome and a lower cost per care dollar spent.

Government, Education Key to Health of Sector

How to improve the prospects for a healthy biotech sector and a healthy state economy? Porter’s cluster theory points to the role of government as potentially making the biggest difference. Investment will follow the path of least resistance and greatest return. Our university system is world-class and likely to stay that way. But the lack of affordable housing and a qualified workforce is an addressable problem.

Local zoning ordinances often get in the way of increasing access to affordable housing. Put innovative legislation like Massachusetts’ Comprehensive Permit Law and incentives like Connecticut’s Incentive Housing Zones on the front burner to create a more comprehensive approach for solving this problem.

Much of the emphasis of our education system is toward earning a 4 year college degree. But educators should pay more attention to encouraging  high school graduates who might not otherwise continue their education to earn an associate degree or attend a technical school in one of the STEM areas. These are the skills which are in short supply and a primary reason biotech companies outsource jobs.

There is no guarantee that our vibrant biotech sector will persist.  We need only remember the legacy of our once bustling high-tech sector as a reminder.

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