Month before
This months episode of “News you can Use” on HealthcareNOWRadio features news from the month of February 2022
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
This month with COVID19 fading and many restrictions lifting we focus on the latest innovations and concepts in healthcare that are bringing real solutions to the healthcare world. We discuss Fabric Health that is bringing healthcare to meet people where they are – in this case the Laundromat. As they point out – 32 million Americans show up every week to the laundromat and they are standing up health services to meet these people. I covered a similar concept of Live Chair set up by Andrew Suggs in the early part of the pandemic (Medicine Back to the Barber Shop) that offers healthcare centered on the community barber shop
There are additional steps to adding services but some of that may be arriving with technology, but in the meantime just reaching people and providing high quality reliable and accurate healthcare in their community will bring about real change. This is especially important as we face the wave of people who have delayed care or screening or wellness visits. The expectation is this wave of people will sweep over the health system adding to an already strained system with additional requirements or diseases that have been untreated or undetected for months. In medicine – the earlier we identify a problem the better the chances of successful outcomes
Listen in to hear our discussion on vaccine development and the long history of science and innovation that has brought us to this point with faster access to treatments that can be customized and where you “Digital Twins” fits in
You can read more about the series here and the concept of keeping up with innovating 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 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 month, I’m delighted to be joined by Craig Joseph, he is the Chief Medical Officer at Nordic consulting partners. Great. Thanks for joining me today.
Craig Joseph
I look forward to our conversation.
Nick van Terheyden
So we’re going to break with a long standing tradition, we’re not going to open with COVID. In fact, we might not even mention that word except for the mentioning the idea just for now. It’s done.
Craig Joseph
Great that was gonna start has now stopped,
Nick van Terheyden
unfortunately. So as we do, traditionally, we sort of look at what’s going on and the latest news and I have to say you posted something about fabric health. And I was intrigued. I certainly had some thoughts. But tell us what that is. And what was interesting to you about that.
Craig Joseph
Yeah, I read an article about fabric health. And I think my tweet was something like I love it. I love everything about it. I love the name, I love the idea. They are a group of healthcare providers that decided that they want to meet people where they’re at. And they are putting air quotes around this providing health care at laundromats they’re they’re going in to kind of pop up healthcare. So just sitting there and engaging with folks who are coming in. So I don’t think that they’re doing you can schedule an appointment at a laundromat yet to get your headache checked out. But they’re there to pay. We’re, you know, here in a you’ve got some time generally, if you’re going to a laundromat, right, you You’re, you’re you’ve got some free time. And maybe you want to have a conversation about something that you’ve heard, so a way of kind of cutting through some disinformation that’s been out there. And I think that they also can actually provide some care, they have the ability to provide certain I think vaccines and other kinds of treatments that are are pretty generic, but this just the concept of meeting people where they’re at, in a you know, no white coats and not a stodgy office. And I think that’s just a it’s an interesting idea. I don’t it’s certainly not certainly not a moneymaker. But boy, we can save our save the country money, because the more folks that you can get to get good solid medical information from medical professionals, you can prevent illness by preventing illness you prevent work, you know, folks from missing work unnecessarily. So you’re actually helping in so many different ways by just doing these little little small interventions, I thought.
Nick van Terheyden
So I got to say I was entirely disappointed having read the hell headline, I was thinking my merino wool jumper or actually you don’t call them jumpers. I forget what the word is here. But
Craig Joseph
yeah, I always speak American. So that’s a problem for me.
Nick van Terheyden
I was looking for something that would wider sweater. That’s the word Yeah. You know, the emergency care for my merino wool sweater that was suffering from a disaster. But joking aside, I think, you know, your point is exactly right. You have to meet people where they are we talk a lot, or at least I do about friction and the friction is, if you keep calling me, and I don’t answer the phone, we’re not going to communicate. And if any of you have children out there, you’ve probably either had the experience of calling and getting the voicemail that says Send me a text message or don’t bother leaving me a voicemail. And it’s the same principle. It’s the essential nature of communicating with people where they are. And, you know, I think the laundromat is a good place. I you know, I’m curious about other people in their experiences. I fortunately don’t have to use one currently, but in the times that I did, I would always leave because my clothes were never worth very much so I didn’t worry about it. So I didn’t use I tried to be more productive with that time. But you know, sometimes it wasn’t in a great place, but I think it gives you some opportunity and you know, setting up of resource. The other place that I saw this I thought was truly brilliant. was Andrew Suggs and I interviewed him on this show. He has live chat A similar principle, but in his case, it was the barber shop, which, you know, ultimately was the home of the surgeon, that was where surgeons originally practiced their or developed some of their skills before we had the, you know, true medical profession. And, you know, it is the nexus of a, some communities in this case, you know, this group tends to trust, it was equipped with technology. So Andrew and live chair started to equip these places with technology that allowed people to check in, it had capabilities to deliver information support that, I mean, for me, I, why would we not be doing this? We, you know, why should I have to go to a hospital, perhaps that’s a sort of post pandemic influence that’s delivering a different view that says, we don’t have to do things the way it’s always been done, you don’t have to go and see the doctor, the doctor could come and see you. Although to be clear, that’s what we used to do in England, we had home visits, that was an integral part of the general practice, I think it still occurs, but much less, unfortunately. But it was an essential part because you got much more information about the individual, because you could see what their home living circumstance was.
Craig Joseph
Yeah, I think it’s, you know, we have to reset our expectations. My expectation is I go to the doctor’s office, and everything I need is right there. So I’m going to have access to the doctor, I’m gonna have, if I need a test, I’m expecting that they’ll be able to draw that lab for me, I need a vaccine, I expect that they’re going to be able to give it to me, you know, a referral to a specialist. And and to some extent, that makes sense to another extent, I think we’re all now kind of living in this technology world whereby we don’t need everything all the time, all at once from one source, right. And so now it might be reasonable that you go to a doctor or a doctor comes to you and says, Well, you need a shingles vaccine, and you need a flu, flu shot. And when you say, well, after you can give those things to me, nope, you can go to a CVS or Walgreens or local health department and get that, and it may not be as convenient. But it might be also actually more convenient. Because if you’re if you’re going to be seeing a doctor or a healthcare professional at a laundromat, or at a barber shop, there’s no way you’re going to be able to get all the everything that you need. But half the battle is knowing what you need. And I think that’s what you have the ability to do when you’re when you’re actually in the community, seeing people who, again, I expect that most people who walked into the barber shop or walked into the laundromat were not anticipating interacting with a health care professional. But most likely they had folks had some questions. And unless they just seen their doctor, this would be a great opportunity for them to get some of that information and get pointed in the right direction. And who knows, maybe I’m wrong. And we can offer some quick, easy lab tests and the like,
Nick van Terheyden
I’m uncertain that we’re going to be able to do that we’re going to see more of that we’ve seen it sort of rolled out to the remote patient monitoring the home medical capabilities, you know, you described it as a sort of, you know, drop in solution, the capacity. But you’re right, you don’t have to see anything. One of the things that I’m willing to bet is already taking place pre fabric health and live chair was, I’m willing to bet the people were getting health care information in those instances prior to the arrival of these organizations. Because that’s where we go, we chat. And you know, we trust those resources and maybe not getting the best information. So if we can improve that information chain, I think that’s great. And as I think about, you know what that means for the future. One of the things that we’ve seen post pandemic is this incredible increase in delayed care, I want to say at least for the first six months, it could even be a year, there was a huge reduction in the amount of care that was being delivered, people weren’t going out. They delay things either because they had to or because that was just what was felt to be the right thing to do. And the consequence of that is that we’re seeing, or we’ve had less screening, and as we know, in medicine, the earlier you catch something, the more likelihood that we’ve got of actually having a successful outcome. Huge problem around that. And I think we’ve got to turn that ship because everybody sort of why I’m not doing it anymore. It used to be a habit. Now it’s no longer a habit. We’ve got to turn Turn that around, maybe this is bother turning it around.
Craig Joseph
Yeah, I Well, I agree. And again, you know, you need to know that you need that that test. And and then you can get it safely. You know, we’re talking about mammograms and colonoscopies and routine childhood vaccines which had fallen way behind the starting to catch up. But these are things that we will be this the the outcomes and will be, you know, felt for for years and years, especially with some of the cancer diagnoses that were, we inevitably are going to be making more of at a later stage which are more difficult to treat. And, you know, trying to get back on that, on that a on that. treadmill, you know, this is what I do every year, I get a flu shot in the fall. And I know that every 10 years, I need to get my colonoscopy you know, these are the these are the things that we need to kind of get our mindset to get back on that on that treadmill to healthy journal. But also we in the medical industry need to be available, right. And so up until very recently, hospitals were canceling what they consider to be non emergency surgery. And sometimes that’s cancer surgery is not emergency. Right? And, and certainly having beds available for folks who are having a same day procedures, which sometimes people need to stay overnight, all of those procedures, and tests and studies have been had been canceled or delayed and, and so Absolutely, it’s going to be essential to kind of to get back on track. And it’s hard to get folks on that they’ve they’ve been they’ve been off of it, which we all understand why and how and how we fix it. And and these are some of the you know, fabric health going to laundromats and barber shops, I think it was part of the way that we can we can get folks to consider their preventative care. Because it is it’s so important. I’m a as as you know, I’m a pediatrician, and much of what I do clinically is trying to get kids to not get sick to try to prevent this from happening in the first place. And vaccines are an important part. But certainly checking their development and making sure that things are moving along as they shouldn’t be and what we find problems acting immediately. All of that’s been kind of pushed off and so COVID is either I said, even if the even if we never see the virus that causes COVID ever again, which I suspect is not the case. The effects of it, the effects of the pandemic will be with us for for years or decades to come. Unfortunately.
Nick van Terheyden
For those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Craig Joseph, he is the Chief Medical Officer at Nordic consulting partners. We’re in our news you can use monthly edition, just talking about the delayed care. And, you know, as you rightly pointed out, Craig, the importance of vaccinations and you know, interestingly, the book I’m reading right now, you bet your life by Paul Offit sort of talks about the history of polio. And that, for the most part predates me, I mean, I saw the tail end of some of the instances of it before we really purged it. But it’s really quite interesting to see how terrifying that disease was to the community and what it did in terms of an impact in terms of the fear. There was definitely missteps in terms of the rollout of the vaccine in case in one specific instance, where the batch of the vaccine actually caused polio, and then not just caused it in the people that received it, but also transmitted it, you know, terrible things. The important point here is that we’ve learned through the course of that history to improve. So every time that we make a misstep, and this has been true in, you know, the recent times, we don’t understand everything, it’s a constant learning process, and we have to refine our understanding. And I think, you know, your point about prevention is, is an imperative here, because polio as a disease was entirely debilitating, you know, really making a mess of many people’s lives and we’ve purged that, thanks to the wonders of science and the wonders of vaccines that, you know, are truly safe at this point. As you think about the future, well, we’re seeing more of this what people term precision medicine or accuracy and, you know, one of the things that I’ve seen is this concept of digital twins. So I look at Craig Joseph, well, I don’t look at him because I, it doesn’t deliver me any information. We’re not sufficient for a digital twin. But I have to I can analyze, Craig, Joseph with all the tools that are available, I can take some genomic information, for instance, type some blood, I can obviously, access elements of your vitals, pull all that together. And the concepts that I’m starting to see that I suspect will start to permeate out is that we’re all going to have digital twins. And they’re not there for testing so much as looking at what the impact of treatments so we can model. So instead of giving you a treatment, I would model what treatments might work in your case. And the more data we input to this, the more customized that treatment will be to Craig versus to the group of patients with a similar set so we can start to narrow it down. For me, that’s terribly exciting, because now I think we’ll start to see more of this precision or individualized care, that is no longer grouping. As you know, diabetes is one of my favorite examples that, you know, we talk about type one and type two, based on the data, we can see that there are at least three types, and there’s probably more. Same with cancer care, we know that, you know, we sort of tend to describe it based on the organ of origin. So you have lung cancer, but actually, when you dive into that somebody with lung cancer can have many variations of a cancer that’s more at a cellular level. And as we start to understand that, I think we’ll get to this customized therapy blog that I’m reading of an individual that was essentially told that he had very short period of time to live, but they discovered a therapy that works in his particular case. And there are increasing numbers of stories around that. So I think this precision medicine concept is going to expand, I’m hoping rapidly, because that’s what I would want I know.
Craig Joseph
Yeah, well, I, you know, certainly cancer cares is how I think most of us think about personalized medicine, or at least IV fluids, that’s where it all started. And, you know, looking at the, at the, at the cellular level of the of the cause of the cancer and, and individually, you can make very differing recommendations. So to patients who are very similar in terms of what their diagnosis is, like lung cancer might have very different outcomes based on particular malformations, and the DNA of the of the tumors that are causing their problems, and kind of leads us into vaccines as well. Right. So creating a vaccine for you for your particular exact problem for diabetes, or cancer, or for other times. It’s, it’s, it’s amazing. And we’re hoping again, I know you said not to say the word COVID. But the you know, the RNA, these these mRNA vaccines, it’s a word were and are being investigated not only for infections, but also for for cancer. And that the idea that you can get a vaccine and the same way that a vaccine creates an immune response to a virus, or a bacterium, it could induce a an immune response to tumor or to a type of cancer cell. And so instead of giving you chemotherapy, which is Yeah, I think we all know, many kinds of chemotherapy really are just poison, that we’re trying to direct ad a specific kind of cell that has side effects on on other cells. Boy, if we can be more precise, and indirect, either that medication or the vaccine to help direct your own body to to attack these foreign cells. It’s, it’s amazing. And I I do hope that something that’s positive, maybe that came out of a pandemic is the the acknowledgement that this technology works, right. This is how we were able to come to get a vaccine so quickly. And so effectively, and hopefully, it’s a launching platform, so that all kinds of new and exciting things that we’ve been dreaming about can actually start to, to come to fruition.
Nick van Terheyden
You know, it’s interesting, you bring up that point. I mean, we’ve seen the steady progression, and I’m trying to think of the most recent one I can’t think of the most recent example but you know, historically the Epstein Barr virus that causes Burkitt lymphoma, hepatitis B, hepatitis C, HIV and you know, some of the cancers that were caused, and, you know, now herpes and human papilloma virus that’s showing, you know, a direct link. I, as, as we sort of look forward, the importance of the speed of, you know, research to understand. So we identify a virus that causes it, now we need a vaccine, because that’s now preventative of that disease. Because if you can then roll out the vaccine, obviously, with acceptance and approvals. One of the things we’ve certainly seen in this pandemic is this accelerated approval process. And, you know, I, I certainly feel confident, confident enough, I’ve had my shots in the army, you know, watch the data. I can’t say I was as knowledgeable as I feel like I am now in terms of vaccine vaccine developments. But we were talking years, I think four or five years was potentially the fastest we’ve seen a vaccine, you know, go from start to finish. We did that in under a year. Do you think we’ll see more of that?
Craig Joseph
I do. I do. I think it’s the genies out of the bottle. And, and we now know that we can. There are times where we don’t need to do such large studies, right, that we can draw conclusions from smaller numbers and putting in other experience and other information into that mix. I want to bring us back to what you were talking about with Dr. offerts. Book and, and polio. And you had mentioned there were some missteps at the beginning. And so no one well, I don’t I haven’t met very many, actually, I’ve never met anyone who’s opposed to the polio vaccine, especially to someone. For some of our elderly who have lived through polio, most of us have never actually seen polio. I’m most young folks have no clue what it even is. It wasn’t all rosy. And it did and had some fits and starts and people, there were people that were clearly injured, as we tried to get the science right, and the science develops, and it doesn’t, you don’t snap your fingers. And it’s, and it’s done. Again, that’s been one of the major problems with this pandemic, is our inability to, to properly and optimally communicate how science works, to the masses, to the non scientists, which is like, hey, we think we got the answer. And we find out that we were wrong. And usually, that’s to no one’s hard. No one was trying to do that on purpose. It’s just, that’s how science work. And so I do think that we’ve made these tremendous strides in reassuring the public reassuring physicians like you and me, just like you I was, the second I was able to get my vaccines I did. And did I understand everything? No. Did I understand more than have the average vote probably just because of my training and my ability to meet some of the literature but you know, I do, I do think that we can, we can relax. And we’ll we’ll have to relax some of our some of our very strict rules, but it can still have the same outcomes, even without the the very strict rules that were in place. So I don’t think anyone is talking about saying, Well, you know, we’re okay with a bunch of people die if this doesn’t work out. Right. That is, that is not what anyone’s saying. I think what we’re, what we’re trying to say is, hey, we’re, we think we can, we can have the same very, very low level of side effects and ill effects but not need to have as much time or enroll as many people are spend as much money so we can get some of these life saving and limb saving therapies out into the public and being used. And if that’s the case, and that continues to be the case, then that is a win for everyone. For the people who are the scientists who are researching the manufacturers who are creating the clinicians who are administering everyone, everyone wins if we can if we can do all of this life saving and kind of magic faster.
Nick van Terheyden
And I think the interesting thing that I got from Jonas Salk and his regrets, aside from obviously the devastation of the sense of, you know, any harm done, but, you know, it’s interesting, one of his big regrets was all the people that were in the control arm of experiments that suffered polio that he felt entirely guilty about, but you know, it was an appropriate course of action for the discovery, the proof, you know, these randomized controlled studies that are essential, but I think you’re Right, we’re finding better ways. If I have one piece of, you know, advice at the end of all this for folks entering the profession is really get to understand statistics because I think you’re gonna need them essentially into the future. Unfortunately, as usual, we’ve run out of time. So it just remains for me to thank you as usual, for joining me. Thanks for joining me on the show, Craig.
Craig Joseph
Always pleasure. I look forward to our talk next month.
