2021: A year of transformation

Show Notes

While 2021 has been a rollercoaster year, Daniel was able to cover plenty of exciting and innovative topics. He sat down with experts in public health data (discovering the data supply chain), precision oncology care, functional medicine, cutting edge red blood cell research, a venture capitalist, a former CEO and more. Health care and health care innovation is going to continue to accelerate in 2022 as the industry evolves from “intermittent, reactive sick care to a future that's continuous, proactive, anytime, anywhere, bringing us better outcomes at lower costs and bringing better health equity all around the planet.”

What is Healthy Conversations?

Healthy Conversations brings together leaders and innovators in health care to talk about the biggest issues facing patients and providers today. Every month, we explore new topics to help uncover the clinical insights and emerging technologies transforming health care in real time.

Dr. George:
We need to think about the information supply chain. What do we need to do to collect data? What do we need to do to aggregate it, share it, analyze it and present it and communicate it effectively so that we can provide the evidence that would allow us discriminate amongst different policies, different clinical decisions, or just different personal decisions.

Speaker 2:
Welcome to Healthy Conversations. I'm Dr. Daniel Kraft. We use these open discussions with physicians and healthcare experts as a way to explore how our industry is transforming in real time.
Today I want to take a look back at 2021 and give you a sneak peek into what we're working towards in the year ahead. My conversation with Dr. Kim Blackwell is one that really stuck with me. Kim talked about the current and future state of precision cancer care.

Dr. Blackwell:
Although we offer what we call panel testing of tumors, which is a very highly selected group of over 600 genes, we also offer something known as whole exome sequencing, which is basically sequencing every gene in the tumor. It generates a lot of data, and now we have 15,000 RNA endpoints, we have the DNA. We have the DNA from the normal tissue as well, and that's kind of important because we realize now that a lot of cancers that we didn't think were genetically linked as their cause are now genetically linked.

Speaker 2:
Is it an opportunity to now look at response to therapy and really predict how someone's going to do, particularly as things mutate and change through the course of therapy?

Dr. Blackwell:
I would envision five years from now what we call methylation changes on circulating DNA, which doesn't require which genes you're looking for, but basically just look for pattern changes will be the standard of care that will predate any 1970 CT scans to let patients know that maybe their therapy is not necessarily going to work long term for them in what we call the metastatic or incurable setting.
Or that they've done all of the treatment they thought they needed to do, but they're still at risk of their cancer coming back. Once you find those patients, how do we get the patient on the trial that is just enough to get the drug approved for widespread use? So we have a program now available to over a thousand oncologist where if you identify a patient, we've already worked out all the contracts, and the IRB and we open up these trials in less than 14 days.
When I joined Tempus a year and a half ago, I was like, yeah, right. I mean, I seriously was the biggest cynic and then I saw it happen.

Speaker 2:
Treating an illness with precision requires a deep understanding of what's going on in the body. Dr. Patrick Hines and his team are studying and in many ways redefining what we know to be a healthy red blood cell.

Dr. Hines:
We've really been committed to how can we leverage biomarkers to understand when red blood cells are starting to function abnormally and intervene at that point.

Speaker 2:
Give us a little bit of a visual picture of the technology developed, maybe how you invented it and what does it do to actually measure what happens in terms of the physiology of the red cell.

Dr. Hines:
A normal healthy red blood cell should not do much at all besides delivering oxygen and removing carbon dioxide from working tissues and cells in the body. It should flow easily, get back to the lungs, pick up more oxygen and do the whole thing all over again.
Well, one of the properties of red blood cells that are sick are that the membranes become abnormal. One of those things that it can do is become sticky. It can actually stick to components of the blood vessel wall, and that can contribute to the slowing of the transit of red blood cells from the body back to the lungs.
In addition to that, it can completely block the flow of blood, and so we specifically have designed tests that are able to measure at what level does a patient become in danger of having one of these problems develop based on the stickiness properties of their red blood cells. We are able to measure the likelihood that a red blood cell will be stable and survive, but we measure this in intact red blood cells.
When I'm in the ICU and I have a patient that has a problem with red blood cell stability because they're on dialysis, or because they're on a bypass circuit, or a heart lung bypass or ECMO, we don't know that there's red blood cell problems until those red blood cells have been destroyed.
Well, with this test, we can measure the stability of the intact red blood cell non-invasively at a point where they can actually intervene.

Speaker 2:
A lot of innovation is naturally driven by data. I had a conversation with Dr. Dylan George. At the time he was working for Ginkgo Bioworks. Today he's the director of operations for the CDC'S New Center for Epidemic Forecasting and Outbreak Analysis.
His comments about the information supply chain have echoed throughout the past year for me and only seem more relevant in the shadow of our material supply chain challenges.

Dr. George:
We need to think about the information supply chain. What do we need to do to collect data? What do we need to do to aggregate it, share it, analyze it and present it and communicate it effectively so that we can provide the evidence that would allow us discriminate amongst different policies, different clinical decisions, or just different personal decisions.

Speaker 2:
How do we create... You've got a lot of experience with data, but the dashboard piece, because no clinician wants to get just more data. They want to understand how does that change where they're driving with their patients.

Dr. George:
I love that you asked this question though too because as a clinician you think this way because it's just like what is the clinical decision? What is the differential that I need to go through and what is the action that I need to do for the person in front of me?
That to me is the information supply chain and how we actually drive, but it has to be rooted in the decisions to action. Everything else is just nice to have. But once we drive towards those decisions, then we know we've got something real. It's like we've talked a lot about with people to donate blood, to help people in need. We need to start talking to people about donating data to help people in need in responding to clinical situations, but also public health situations.
We need to start shifting our mindset that data is the new oil, but it's also the new way of protecting our kids, our families and our communities in an effective way. We need to do it safely. We need to do it in a privacy preserving way, but that's what we need to start moving towards, a world where we're sharing data to keep everyone safe.

Speaker 2:
There have also been a number of times when what a guest said just turned on a light bulb for me. For instance, this nugget from Dr. Joanne Armstrong.

Dr. Armstrong:
So one of the examples that I'm working on now with a team of creative people at CVS Health is to look at this issue of a disease in pregnancy that's called preeclampsia. So preeclampsia is this kind of weird form of hypertension. It only happens in pregnant women, and the only treatment for it is delivery. It's a major cause of preterm birth, and low birth weight and a significant driver of maternal death in the country.
What's neat about this is the preventive step for preeclampsia is low dose aspirin, 81 milligrams of aspirin. It costs three or $4 for an entire treatment course. It is safe, it is readily available. So what we are doing is putting that educational focus on the patient. We can identify women who have risk for preeclampsia and send them both educational probation about risk factors and symptoms, but also give them the bottle of aspirin. So there's one simple gap that you close. It's here it is, it's in your hands.
Then one of the areas that we're iterating on as it relates to preeclampsia is looking at it through the lens of disparities because preeclampsia is also more common in Black women, and Black women tend to have more severe disease. There's even data that shows it's not explainable, but Black children have worse outcomes when cared for by white physicians.
But as you get to this issue of unconscious bias, our own assumptions about patients, assumptions about pain, there's literature that says that the physicians assume Black patients can handle more pain. So what happens in a delivery environment? You say, "You're eight centimeters dilated, you don't need an epidural because I think you can handle it." I've seen that before. That's how it plays out.
Certainly training is needed, but we also need to give patients tools so that they can recognize that, get some allies and sort of fight through it.

Speaker 2:
As we turn a look at what's coming in 2022 and beyond, I recall my conversation on our podcast with Dr. Robert Pearl, a former CEO of Kaiser Permanente, who's now an author and podcast for himself. I'm fascinated by Dr. Pearl's focus on changing health care by changing the culture in which it operates.

Dr. Pearl:
The current system as well as the current culture need to evolve to the 21st century, and particularly challenges we're going to face in the post coronavirus era.

Speaker 2:
Yeah, in your new book about health care, it's actually called Uncaring. The tagline is How the Culture of Medicine Often Kills Physicians and Patients.

Dr. Pearl:
The overriding culture of medicine continues to value what it was that made doctors so special in the last century. We valued our intuition. So 30% of what doctors do has been shown by the Mayo Clinic to add...
We don't value things like telemedicine that are very convenient for patients. We don't value things like prevention that could avoid a huge amount of disease. We value the interventions, the multimillion dollar robots and proton beam accelerators shown to do nothing. The fact that we only control hypertension 55% of the time, and what we know is that large medical groups are able to do it 90%, and the difference is 40% lower rates of stroke, heart disease, kidney failure.
I think what drives the change that I believe that we need is going to be the shift from fee for service to some variant of a single payment given to a group of doctors and hospitals. If you're being paid a certain amount of money to take care of a population and you're at risk, you start to value prevention. I've often asked myself, why is it that health care's the only industry in which technology raises costs, not lowering them? Because the technology that we love are the things that are expensive, and the ones that we don't pay a whole lot of attention to are the ones that improve the convenience of the patient.
What do we call that space at the front of the doctor's office? It's a waiting room. Why do we call it a waiting room not a reception area? An educational arena? No. Our expectation is patients will come and wait on us. That's not a consumer mentality. I think the real interesting question to me is going to be how doctors evolve into being able to make the transition.
Daniel, I think back to December of 2019. This is two months before the coronavirus comes ashore and what do we see? The federal government announces that they've just done a big study and for the next decade, cost of health care are going to go up five to 6% every year. Health care is 3.7 trillion. By the time you do a compound interest in five to 6%, it's 6.2 trillion. Two and a half trillion more dollars in health care.
When I read that study, I waited. I waited for the organizations, the specialty societies to stand up and say this is ridiculous. Imagine what we could do with two and a half trillion dollars for education, for infrastructure, for prevention, for social determinants of health. I could think of so many great uses and this didn't even pay attention to it.
No, it's a broken system that we've got to change and to do that, we've got to evolve our culture and the two have got to move together. When that happens, I believe that we can make American health care once again the best in the world.

Speaker 2:
We've learned a lot from our guests on Healthy Conversations about new approaches to diagnostics, therapies, cancer care and how we might think about collaborating and innovating in the years ahead. I think if we've learned anything from the pandemic, it's that we all need to collaborate in new ways to accelerate our knowledge, whether it's at the bedside or the website.
What's possible in 2022 would've seemed like magic in 2012 or certainly 2002. Health care and health care innovation is going to continue to accelerate in 2022. Sputnik was a spark for the space age, and Covid has really been a catalyst for a new health age. It's a real time for innovation to reset and reimagine health care from intermittent reactive sick care to a future that's continuous, proactive, anytime, anywhere, bringing us better outcomes at lower costs, and bringing better health equity all around the planet.
I think our opportunity now is to use the pandemic and many of the new mindsets and shifts and technologies that have emerged to really change our game to up-level all of us. See you next time on Healthy Conversations.