This month’s episode of “News you can Use” on HealthcareNOWRadio features news from the month of September
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
We catch up on the latest news on COVID19 and the new vaccine booster set to be authorized and available at scale to everyone in America. Hoping that the uptake will be higher than it has been for the boosters available and while we may have some annual requirements for vaccination there is some hope on the horizon with broad spectrum Coronavirus vaccines and better targeting with nasally administered vaccines
We discuss the recent news from Amazon who purchased One Medical and the concurrent closing down of Amazon Care and we discuss the increasing research focus on Psychedelics with the latest use case to treat alcoholism.
Listen in to hear our discussion on the continuing drop in life expectancy in the US and some of the troubling components and contributors to this and the progress made in combatting the rise in vaping especially in the younger generation but unfortunately not being fully enforced.
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter by tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today, as I am each and every month, I’m joined by my colleague Craig Joseph. He’s the chief medical officer at Nordic consulting partners. And we’re covering news you can use for the month of August 2022. Craig, thanks for joining me.
Craig Joseph
It’s my pleasure as always.
Nick van Terheyden
So we should kick off talking about COVID-19. We’ve reached a another inflection point, this one, a change to the vaccination choices. We’ve got boosters but now we’ve got some am new vaccine, Novavax, but also the vaccines for the additional Omicron. What are you? What’s your take?
Craig Joseph
Well, you know, I think it’s exciting. We were going back and forth here in the US about a a fourth booster. Certainly, that’s been available to people who have significant medical problems, and anyone over 50, at least in the US could get a fourth booster. But now we’re looking at and that was the same booster, those same vaccine that we’ve been given, since since they they came out. Now we’re looking at with the Omicron specific vaccines, they have both the vaccine to help protect against the original strain, but also some of the newer strains that are or have become the, the virus that’s, that’s attacking all of us nowadays. So I think it’ll be it’ll be good, you know, this is all new. And I think it took about two months based on using that mRNA functionality, which is again, very, very quick. But you know, they’re just making slight changes, because the virus just make slight changes. And so you don’t, it doesn’t take that much to get to get some some new vaccine. So I think it’ll it sounds like it’s going to be available to everyone in the United States starting this fall. It’s I think most scientists are predicting that this will be probably annual events that we’ll be getting, like we get a flu shot every year, we’ll be getting a COVID shot every year. And ideally, if possible, those would both being the same syringe. So when you go for your flu shot, you’re really going for your flu slash COVID. vaccine. Who knows that’s, that’s it’s something fun to talk about. Boy, yeah, things change very quickly here in COVID. Plant.
Nick van Terheyden
Yeah, it’s funny. I can’t say that. There are many people that say fun to talk about when they’re talking about having vaccinations and jabs. But okay, there’s the pediatrician talking because it was his primary activity
Craig Joseph
we love. Come on. Dr. Nick. Yeah, we’d love vaccines. You know why we love vaccine because we don’t like treating kids with for diseases that are preventable. That’s why yes, much in the same way. I think this is something that people are still struggling with is that COVID vaccine was not intended, was never developed to prevent you from getting COVID. You know, if it does that, that’s terrific. But really, it was, it was to prevent you from dying of COVID. It was to minimize your risk of ending up in the hospital with COVID. And if you much like the flu shot, you know, the flu shot was never intended to tell people I want you to get the flu shot and never get the flu. No, we never, we never said that. What what we what I hope people were saying I know certainly what I said, when I was giving these vaccines to children and adolescents was, if you get the flu, you will, statistically speaking have a much better time of it, you will not be Asik for as long. And if you have asthma or other respiratory type problems, you will are much less likely to end up in the hospital. And that’s the goal. And so again, kind of resetting those expectations. But as this COVID As the the virus mutates and changes a little, we do have to keep up with that just like the flu shot.
Nick van Terheyden
Yeah, I think it’s interesting. And you know, you highlighted the point the two months. But let’s be clear. It wasn’t just two months for the development, it was two months to develop and scale it to deliver large numbers of doses as you rightly said, it will be available. Let’s hope the uptake is better than we’ve seen with the boosters, I believe running at about 30% which, you know, is a little bit sad, given it’s such a protective opportunity for those people that should be taking it particularly in the older age groups. A couple of points to note that I think are important, you know, the the guidance is clear that even if you’ve had booster booster, which you know, double boosted you was still eligible to get the covalent vaccine. So that doesn’t preclude you from I think the other thing that was interesting about the previous vaccines, you know, it wasn’t that we were misled. I think we were spoiled a little by the fact that they were so good, so much better than certainly the flu vaccine, the, you know, these astounding levels of protection. 95%, which, you know, some people translated, as you rightly said, into, yeah, you’re not going to get it. And importantly, that carried through multiple variants that we saw right up until Omicron. I think Omicron has been the one that’s really taken a dive in terms of the effectiveness of these previous vaccines, which is why this is urgent. I will counter the the position of the sort of annual I think that may be true, but I think there’s a couple of reasons why it might not I think the Coronavirus is more susceptible. From a targeting standpoint, the general Coronavirus is not just SARS, cov. Two, but generally, they are more susceptible to a broad spectrum, vaccine if we could find one and develop one. So there might be some potential to actually get persistent immunity to all coronaviruses. And interesting at not a lot than or not as much research as I think we would like to see for the nasal version of this, which is where there is some tremendous opportunity to apply better protection, because when you get the jab, you don’t get as much protection in the nasal cavities. Yet, that’s where we really need it, or at least as we understand it. So there’s some opportunity that you maybe don’t have to have the jab, but have to inhale. Anybody that’s had anything like that will know, it’s a pretty miserable taste at the end of the day, because it ends up in your mouth, or at least that’s been my experience. But I think good news, and it will be available soon. And I’ll certainly be accessing it for my own purposes. And for our family as well. So I think that’s great news. Moving on. We we’ve seen more movements with Amazon. So Amazon, purchased one medical, but then they said they’re getting rid of Amazon care and care medical. What is going on?
Craig Joseph
Well, if you don’t, please don’t ask me, I was gonna ask you. So Amazon just announced this week that Amazon care would be closed down by the end of the year, and other people will be out of work looking looking for a new job. You know, primary care is hard. There was an article in one of the newspapers, very recently about some concerns that some of the Amazon care employees had regarding the technology, ironically, regarding the technology, that, that they were using their electronic health record, there was some folks that were not happy with, with it, and, and, you know, some of the other, you know, basically some of the concerns from inside. And again, I don’t know how accurate these are, could be a small percentage of people but, you know, concerns that the company was more interested in, in profits and kind of growing their practice, then then taking care of patients. Now, everyone can say that every Hospital and Healthcare System is is in business No, no margin, no mission. But it is. It is different healthcare is very different. And, and Amazon won’t be the first tech company to admit after spending a lot of time and money that healthcare in the United States is, is very complicated and not as easily as disrupted, disrupted as other industries are. And this might be one example of that. Amazon still says that they are in health care for the long run. And this was a trial. And they are they’ve learned a lot and they’re evolving. And they’re going to continue to look at health care as a as a major part of what we’re going to be doing now. And in the future.
Nick van Terheyden
Yes. And obviously, part of their incremental improvements that they continue to derive failure is is nothing but learning opportunities. I’ve certainly heard in other places, and I think very much for them. I, you know, I’ll just emphasize the point here, and we’ve seen at least I’ve seen it repeatedly, folks jumping into health care who say, Oh, my goodness, this has to be easy to fix, only to discover that actually, when you get on the inside, it’s an awful lot harder, in part because it’s very highly regulated. I mean, just as an example. I don’t know that everybody knows this. I certainly didn’t as a physician, but You can’t just build a hospital, you have to get authorization to do that. And, you know, most people, if I want to build a business to sell X, I just build a business and I start selling, I mean, I do need a license. But you know, there’s not, there’s so many regulatory oversights, and then there’s an awful lot of complexity that’s tied to all this matrix version of the care the convoluted nature. So it is difficult. I’m with you, I don’t think that they’re stepping out. But it is kind of strange, you know, concurrent with the purchase, at the same time that they move to sort of get rid of this, I would have thought that they might absorb it and you know, maybe take some of the learning and incorporate it, I just, you know, that part of it is sort of somewhat strange to me, I’m not really sure why they did it the way they did, but maybe they got as much of it as they could and moved on. So. But we’ll watch and see onto lighter things. I think I was particularly blown away. Excited to see the article that talked about psychedelics to treat alcoholism. Why am I excited about this? Well, I’ve certainly been of the view that I think we’ve missed opportunities, understanding psilocybin, which is one of the primary psychedelics magic mushrooms, but you know, there are others. And because of the very strong response to the early days of, you know, the drug, 60s, you know, we turned against everything and said, you know, this is terrible. But in fact, what we’ve seen, and I’ve certainly seen with a number of papers, there was an outstanding one came out of New York that talked about psychedelics and psilocybin used to treat severe depression, and people in terminal illness who struggle with that. And with one session guided, importantly, in a setting that was appropriate, and so forth, they managed to reverse all of the depression and permanently so they didn’t have to stay on these psychedelics. In this particular case, we’re now seeing a little bit more research. So I think things are opening up, there’s, you know, more potential I’ve seen, certainly for PTSD, in this case for alcoholism, which does raise a little bit of a question, are we switching one drug for another, but equally, if you can go from something that gives you relief from the addiction to alcohol, which is extraordinarily harming I don’t know where it falls in the category of damage to people. But if we could change it, and it’s a non permanent thing, so you don’t have to continually treat but even if you did, if it was under a controlled circumstance, I think it would be great. If I was struggling with that condition, I’d certainly be very excited about and I’m excited about the scientific progress.
Craig Joseph
Well, it’s, you know, it’s great to kind of think outside the box. Right. But I would say that few folks, at least doesn’t seem obvious to me that that would be an experiment to try. Well, you’re addicted to one drug. Let’s let’s try another one, but it works. Right. And, or at least preliminary kind of studies, show some some effectiveness. And, and it’s worthwhile to kind of continue to talk about, you know, the way science works, is very clear and obvious when you look back 30 or 40 years later, but as as it’s kind of moving forward, it’s it’s very confusing. And we’ve seen some of that in the last two or three years. And I think scientists and physicians have known us for a long time, and the rest of us are figuring it out. So hey, if it works, let’s keep let’s keep looking at it, making sure that it’s, it’s not exchanging one problem for another.
Nick van Terheyden
Right, and I, you know, all respect to the folks that are trying to do this on a scientific basis. You know, I know there’s a number of individuals, certainly organizations that try and push the boundaries, and I don’t want to call them out as inappropriate. I don’t think they are, they’re just struggling with the regulatory surrounding so they’re sort of skirting around this, but there’s a number of organizations that have taken this on and, you know, have actually constructed trials created, you know, review boards, gone through i Arby’s and delivered against this all confronting the regulatory pressures that say, you can’t do anything. I mean, that was historically where we were but you know, we’ve seen it with marijuana. And I think there’s been some progress although I do think that seems to be a downside, which we’re learning a little bit about marijuana particularly with You know, early onset use, which you know, is perhaps happening, certainly based on my walking around any city that has open access to marijuana. I now understand the term skunk, which I never really understood. And
Craig Joseph
I, I’ve gotten your comments. I don’t know, you said when you’re walking around some cities that, you know, that have legalized marijuana, I think you could also walk around some cities where it’s, it’s not, and still still figure out that it’s widely available?
Nick van Terheyden
Yes, I that’s probably true. I’m just making an assumption just based on the fact that there has been some relief to the legality of that particular substance so. So on the inner city, one of the other things that showed up in my news feed that I have to say I was just supremely disturbed by was this drop in life expectancy, biggest drop we’ve seen since World War Two and not the first time this is actually a trend, and the trend got worse, I think, what are your thoughts? As an American?
Craig Joseph
Yeah, well,
Nick van Terheyden
to get America, and actually being an American, but not sounding like one and wanting to take the high ground here, somehow,
Craig Joseph
I’ll try and use just put on a British accent. But I’m not good at that. Yeah, thank you so much. Life expectancy in the US has dropped by 1.8 years from 2019 to 2020. And, to me, like, that’s not what the most disturbing number is the most disturbing that I’m reading an article here. It said that Hawaii, currently has a life expectancy of 80.7 years, almost 81 years? Well, Mississippi is at 71.9 years. So nine year differential between two states and the same in the same country. That’s kind of astounding. And so certainly, we still see huge variations in life expectancy in the United States based on where you live, and other factors that should in no way be determinative of of your life of how long you’re going to live, on average. And so, you know, certainly disappointing. Obviously, a big chunk of this is most likely due to to COVID. But well, I shouldn’t say a big chunk, a chunk of this is due to COVID. And I think I read somewhere, maybe a third of this is due to COVID. And, and the rest is, is kind of up in the air and or multi. Definitely multifactorial. So yeah, you know, we spend more than almost everyone if not everyone, and this is the return on investment, that gap. And so it’s, it’s, it’s, it’s, it’s, it’s not good. It’s not, it’s not good.
Nick van Terheyden
And to be clear, just because I have a British accent I live in the US and what we’ve certainly learned about any of these trends and impacts, you know, the same with obesity and heart disease, you can come from a healthy environment. So you could come from a blue zone. But if you come from Blue Zone and start living in a non Blue Zone, you inherit the non Blue Zone. Negative impact, so, you know, negatively impacts me even if some other countries have improved. And, you know, to your point, I think it’s it’s a better return on investment, not least of all, because they pay much less money for all of this health care. So already, they’re getting better value, but they’re actually getting better results. A couple of things stood out to me that I think I would I don’t fully understand or certainly can’t explain, but we’ve been looking at this life expectancy drop for a while, but between 2019 and 2020, it hit Black and Hispanic people the hardest, but 2020 to 2021 effective white people the most. Which, you know, I, as I try and think through the reasoning or the elements of that, I’m not sure how to explain that. But I think we should really be spending a lot of time trying to work out what’s contributing to this so that we can turn it around at least that’s what I want. I mean, I asked people if they want to live forever, and it’s funny not not everybody does, but I think that’s because they think they’re gonna decline in health. But if you could live healthily, maybe not forever based on some of the Hollywood movies I’ve watched, but um, I think you know, for the most part I Hey, I quite enjoy life, if it’s in a good quality of life, and we can get to that point, I certainly buy into that concept. So perhaps we can move towards that. So relative to that, you know, one of the things that contributed and we, I think we did a good job, I’m, it’s now past time, I have a sense that maybe we exported smoking to other countries. But you know, we’ve decreased the amount of smoking in this country, and therefore reduced it, although I did see something that really took me by surprise, 15% of lung cancers in our population have never smoked, which I thought was very surprising. So there’s obviously something else going on there. But let’s assume that we’ve dropped the relative smoking, we saw vaping, I’ve been a vociferous opponent to some of the marketing that took place. I took a lot of beating online at one point when I posted something complaining about the sweet flavors and bubble gum and so forth. And the FDA actually took this on, but apparently, they’re not really enforcing it, that seems to be a recurring problem with these regulations. We saw this perhaps with interoperability now we’re seeing it with vaping.
Craig Joseph
Yeah, well, you know, the marketing ad when it came online, but maybe four or five years ago with jewel and others, was that hey, these, this is better than smoking. And so if you’re currently smoking, then stop smoking cigarettes and and start using start vaping. And it’s not great for you. But it’s, it’s, it’s, it’s better than smoking. And that may be true, but for your point, lots of kids and lots of folks who never smoked and didn’t use this as a tool to stop smoking, actually just use it as a tool to, to, to increase law, all kinds of risks of of one disease and such FDA in the US is it has moments of brilliance and also moments of opportunity for improvement. Oh, so you see how I did that? I’m learning.
Nick van Terheyden
Oh, that was really awkward. I could definitely take take a leaf out of that book. As I get older, I
Craig Joseph
learned things. And that’s what I learned. So you know, I think jewel. So here, FDA has done some good things. And so jewel is not it’s a shadow of what it was. And I don’t I don’t think it’s quite bankrupt yet. But it’s, it’s well on its way. And so that’s good. So I don’t think they’re able to sell most of their products in the US now. And that’s good. The bad news is there’s just lots of others that have taken over. And, and we will, anything that we can do to kind of, you know, make sure that people use these tools where they make sense tools, some calling vaping the tool, but most of it is just you know, recreational, of lung cancer, ways of getting lung cancer might take a little bit longer than smoking, but sure enough, it’s going in that in that direction. So yeah, I I, you know, baby steps and we’re moving to the dirt, you know, certainly 50 years ago was much easier to get cigarettes, you could advertise on TV and magazine or in on the radio and other places. You can’t, you can’t now, but boy, we have done a good job in the US of decreasing it. And but it’s it’s not going away. And as long as it’s illegal. Once it’s legal, it’s never gonna go away.
Nick van Terheyden
And even when it’s illegal, I think it’s still not going away. I mean, you’re exactly right. I mean, it’s it’s very easy to be I think the term here is armchair armchair quarterback quarterback, that’s the one, you know, analyzing after the fact and, you know, huge respect for these people, they do an exceptionally difficult job that, you know, encompasses regulation and things that I don’t even begin to understand when would be challenged with and, you know, have they they actually took this on and I thoroughly applaud this. To be clear, I’m not anti vaping as a treatment or off ramp to smoking, it is absolutely better than that. And what was a positive move for many folks, but the idea that we sucked in many of our youth was just to me entirely wrong and needed to be stopped. Unfortunately, as we do each and every week, I’ve run out of time, always a pleasure to do hang out with you and catch up Craig thanks for joining me today
Craig Joseph
it was a pleasure I look forward to the next time
