This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of October
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:
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners. The topic of COVID19 remains top of mind and we review the latest guidance on the new safety data available for vaccination younger children. The data so far, from Pfizer has shown no serious side effects but the efficacy remains uncertain because there are not enough cases of the disease occurring in the control arm. This is not peer reviewed data and is still to be analyzed and reviewed by experts but there will be a lot of parents ready to breathe a sigh of relief knowing their children can join them in being protected.
Credit: George Takei https://www.instagram.com/p/CUDqlgUF4qU
We discuss the risk/reward balancing act that everyone has to apply, not just to vaccines but to life in general and something we (that’s us humans) are bad at assessing long term risk. We tend to be quite good at assessing short term risk – is that bear going to eat me for example, but when it comes to long term implications and calculation not so much. This creates plenty of opportunities for conspiracy theories as defined in this post by George Takei.
Unfortunately this content abounds online and is amplified by the speed of (social)media and the filters are missing. Risk and emotion are oftentimes intertwined and the brain makes a fast assessment of the odds, but when the amygdala (part of the brain that involved in emotions, emotional behavior and motivation) gets swamped it clouds our ability to rationally assess probability. That worked with Bears and Sabre tooth tigers but not so much in today’s world.
Assessing Risk
We tend to overestimate the odds of unlikely or rare events, while simultaneously underestimating how dangerous or risky commonplace events are – think air travel and cars. People are frightened of flying (aviophobia) but happy to step into a car after the flight and don’t feel at risk there
- Risk of dying in a car Crash about 1 in 84 (lifetime)
- Risk of dying in a Plan Crash about 1 in 11,000,000
Boosters or Another Dose?
We cover the terminology in use for another dose of the COVID19 dose and Craig makes an important point about Boosters vs a third dose. He also references this article Preventing a Pandemic’s Toll—We’ve Been Here Before that highlights the similarities between resistance to HIV treatments with drugs in the early days of newly discovered therapies for that disease (one we still don’t have a vaccine for) and the current slew of anti vaccine positions. We saw the same with seat belt mandates.
Listen in to hear our discussion on the entry of Big technology and retail into the healthcare sector. In my commentary some time back I said
Round 1 was a knockout
Now Round 2 sadly has gone the same way for Google
Healthcare is hard, very hard – even with great people finding an effective path is challenging
➡️Google Dismantling Health Division
Aaron Martin had a more nuanced interpretation – what is interesting is that CVS and Walgreens have gone from being a pharmaceutical pick up point to a nexus of healthcare delivery. Dollar general has stormed into the space hiring a Chief Medical Officer. It has significant reach in rural areas which suffer from “Pharmacy Deserts” and may give them the edge. In fact the combination of these local facilities and the likes of Andrew Suggs (Medicine Back to the Barber Shop) make for a powerful solution to delivering rural care. Expect more from the likes of Google, and Amazon too.
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
Today as I am each month I’m joined by Dr. Craig Joseph is the chief medical officer at Nordic consulting partners and this month’s episode of news you can use Craig, thanks for joining me today.
Craig Joseph
I’m glad to be here. Thank you for having me.
Nick van Terheyden
So, unfortunately, we’re still talking about COVID. Because it’s still a preeminent topic. It’s I think it’s still one of the top trending topics on Twitter has been for as long as I can remember COVID that that hashtag? What’s the latest and greatest that you’re aware of? Especially from a pediatricians perspective?
Craig Joseph
Well, first of all, I thought COVID was over. But now you’re reminding me that it’s not. So I guess, yeah, we do have to talk about it. I think there’s some exciting news vaccine wise, the very first, studies have started to come out or at least done by the manufacturers, but by Pfizer on children. And so children five to 12. In again, according to Pfizer, not yet peer reviewed, children do well tolerate the dose that they’ve given to them, which I think is half of what the adults get. We’re not sure how well the vaccine works, because too few children so far, have gotten ill from COVID, who are in the study. And so we know it’s safe. We think it’s effective. But we’re not sure yet. So certainly moving in the right direction, lots of parents are very worried about sending their kids to school. And you know, all of the all of the, you know, being around lots of other children are appropriately worried and really wanting the vaccine that safe and effective to come out so they can they can vaccinate their kids. So I think that’s, that’s big news.
Nick van Terheyden
Right. But also, parents are worried about giving their children a vaccine that, you know, is safe. I mean, we have decent data for the vaccine schedule. And it’s it’s been developed over time and continue to be refined. This is a newish vaccine. They’re trying to balance those aspects. But, you know, based on the data that we’ve seen, and you’re right, it’s it’s not peer reviewed. It’s, as somebody put it, it’s I want to see more than the PR from those companies before I really sort of pass opinion, which, you know, is the appropriate level of science. But the data that has been shared and published suggests that it is a safe vaccine, and as you rightly say, we’re not sure about the effectiveness, but based on the effectiveness in adults, it’s probably going to be effective.
Craig Joseph
Absolutely. There’s and you know, with regard to, you know, safety, yeah, these are new, new vaccine, some, they’re there. And there’s no two ways around that. And so, you know, really, you have to look at the risk of, of a new vaccine that you know, will be stuck before it’s approved, we’ll, we’ll have the numbers and we don’t have them today. It’s not approved today. So we will have those numbers in but again, you need to compare it to the risk of not vaccinating. And, you know, we’re not in a we’re not in a controlled environment. And in life, there are there are other risks. And there’s so there’s risks of taking a vaccine and there’s risks of, of not taking a vaccine, I think both have to be weighed. And so I think, unfortunately, we’re not in a position during a global pandemic, to wait a couple of decades on the science to be sure. Lots of people, though, I think, have decided that they’re going to do that. It’s not turning out well for them, statistically speaking. And so, you know, we know, a 90 to 95% of the folks dying in the hospital with COVID. Today are are unvaccinated. And so the risk for children is is smaller, we think, from from COVID. But the risk is real. And there are disease processes that are associated with COVID that cause death and in perfectly previously healthy children. So I get it and and there’s reason to be cautious. And none of these have been approved yet in the United States, for kids. But it seems like the writing’s on the wall and that that’s what we’re heading to unless we see something that’s surprising or shocking in the data. It’s really just how much data do we need to convince The federal regulatory focus and then the medical profession, that the vaccines are safe and effective. Again, safety seems to be coming out already. But efficacy is the thing that we’ll need to see.
Nick van Terheyden
You know, it’s interesting, one of the things that I continue to reflect back on and I, I’m going to give the credit to the individual that I believe first gave this to me as the analogy was seatbelt. And that would be you. And I, I think a great analogy. We wear seatbelts, but they don’t absolutely prevent you from dying in a car accident, but they really, really help. And we, you know, advocate for them. Here’s what’s interesting about that, relative to this balance and safety and, you know, getting this risk reward essentially, for parents. I saw some interesting data that said that the whole pushback on seatbelts when they were first introduced was identical.
Craig Joseph
Yes, there. Yes. I read that. And I think it was a 60 Minutes interview, I think, our piece that I saw from, from the 70s, where people are like, well, I don’t, I don’t need the government interfering in my, in my affairs, and I don’t like the seatbelt because I find it too restrictive. And it’s not safe. Because if you get into a car accident, the seat belt can jam. And then you’re trying to get out of a fiery car crash and you can’t because you’re you’re locked in because of the seatbelt challenge. And and yeah, nowadays, none of those, you know, we don’t we don’t talk about it. Because it’s it’s been proven to be helpful, under almost every circumstance, a seatbelt. And there were no airbags back then. You know, I wrote a blog piece last night, based on a an article in an editorial in the Journal of the American Medical Association, by an infectious disease Doctor Who said, Hey, this is not new, this pandemic, remember AIDS. And I was intrigued, because, like, I do remember aids, but I don’t remember. People refusing to get medication that was, you know, proven to be life saving. But it absolutely happened. It absolutely happened to so that when oral, anti retroviral meds came out, and we finally learned in the mid 90s, the magic combination of medications that could take someone who was dying of AIDS and almost miraculously bring them back to their previous state of health. Many, many people refuse to take the medications and died, unnecessarily died, because they didn’t trust the doctors that were telling them to, that the meds were safe and, and effective. And for various other reasons, as well. But, you know, going through some of the things that people said it’s the exact same thing that people are concerned about in saying about vaccinations today and about, you know, COVID I don’t think anyone with AIDS was questioning whether it really existed, but they were absolutely questioning that the medications were safe and effective and significant number of people died of AIDS because they wouldn’t take the meds. And seems, it seems, you know, the parallels are are scary to see balance and to you know, other pen other epidemics.
Nick van Terheyden
Right and and previous pandemics. In fact, going back to 1918. I read that the the book on that that was published before this most recent pandemic, and the similarities are, I guess something of a struggle, because despite knowing the history, history is set to repeat itself or is repeating itself with some of these resistance positions that don’t seem to innovate. And the thing that I find most troubling in all of this is that we have new tools that make the distant misinformation campaigns so much more effective than megaphone given to individuals that used to be on the back of a car running around the Wild West selling their latest snake oil is now far more effective and very targeted. I think that’s one of the things I recent piece on one of the big players in social media that they’ve known this and you know, have been playing to it for an extended period of time. In fact, as far as they’re concerned, that’s just table stakes for having solutions that allow people to share information. With no controls, and, you know, I’m all about freedom of information. But what happens when that information damages people which it’s doing at the moment?
Craig Joseph
Yeah, well, certainly, social media and big tech have some some answering to do with respect to their, their effects on, on, on the population in general, we don’t need to even you know, talk about health and science or lots of other areas where it’s, it’s, we’re gonna look back and say, how did we ever let this happened? How did we ever let you know, experienced professionals get on the same level as someone who just are making things up. And we’re, you know, that’s the problem, I think, with social media, and sometimes with Reagan is regular media, equating people with no experience and no true understanding of what they’re talking about, to be able to, you know, be on the same level as those that do. And so, again, another problem with society, I think his lack of believing in experts or expertise, but that’s, that’s a whole different topic. Yeah, we’re
Nick van Terheyden
not gonna be able to dive to that. But I will, in the blog post, I’ll post something from georgia tech guy that I thought absolutely captured the conspiracy theory defined as essentially a belief of the world scientific experts who miss something that they’ve spent their life researching, that you were able to uncover in three minutes of googling and got to the appropriate piece of information. I yeah, I just I struggle with where we’ve gotten to, but we
Craig Joseph
we call that doing your research. doing your research. Three minutes on Google. That’s the that’s it.
Nick van Terheyden
If only that were the case, when when we were originally doing research, it would have been a whole lot faster. But so for those of you just joining, I’m Dr. Nick incrementalist. Today, I’m talking to Dr. Craig Joseph, he’s the chief medical officer at Nordic we’re doing a news you can use we were talking about COVID-19. And the the improvement on access of vaccines to the five to 12. So some potential for opening up access to school aged children, which is, you know, obviously another pool that has been not available. not available today, but it will be a little bit more on boosters. So I think there’s lots of confusion on boosters, right? I know I’m confused.
Craig Joseph
Well, you know, there’s, I think one of the things in the in the pediatric literature that we’re really focusing on is the difference between a third dose and a booster dose. And sounds like we’re splitting hairs here, but they are they are different. So for immunocompromised folks today, assuming that they’ve gotten one of the mRNA vaccines were the recommendation is if you’re immunocompromised if you’re if your immune system is not working well that you get a third dose. And that calling it a booster, because a booster implies that that the first two doses work great. And slowly or your immunity is waning and going down over time and you need a quick boost to get your backup as opposed to a third dose. So with the idea that well if you’re immunocompromised, you actually never really acquired excellent protection, and you’re getting a third dose, which is what your what you need to get up to that to that level as opposed to a booster work, you’re at that level that you needed to be and now you’re not there anymore. Be that as it may. There are lots of questions, though about boosters for adults. And and who needs one, if anyone and when do they need it? And so as you as you allude, Pfizer, came out months ago saying that they their data showed that people do need boosters and the FDA is contemplating and the CDC is contemplating those data and trying to make a determination. One of the advisory groups that read makes recommendations to the FDA thought that there was no indication right now for a booster for most of us. They did recommended for for patients over 65 and again, for anyone with an immune an immune problem be that we call it a booster or third dose, whatever you want to call it, so we’re not sure where we’re going to go Is the FDA going to accept that recommendation? They typically but don’t always. it’ll, it’ll be interesting. I read an article today that CVS is hoping to hire something like 7500 people in one day to boost their their numbers because they’re afraid they’re going to get under water. If slash when more COVID doses are recommended, plus, there’s concern that the flu season is going to be bad this year, because virtually no one got flu last year. And so there’s going to be a big need for flu vaccination. There is right now a big need for flu vaccination as well.
Nick van Terheyden
You know, so it’s interesting, you bring up CBS, I think the other area of sort of exploration and discussion is, you know, the impact of these other companies. And one of the things that strikes me about that is that, you know, CVS is concerned about being overwhelmed, because they’re right there, they’re at the coalface where people are, and as a result, end up being on the front line for just, you know, a lot of access to health care, resources, medications, in this case of vaccinations. But we’ve seen a number of these organizations sort of dip in and dip out, I posted something about this, you know, Google, decided to dismantle its Health Division. And, you know, for me, that was round two, because we had the previous one where they created the database, you know, your health record, I forget what it was called it. I don’t think it was helpful, because that was Microsoft’s they stepped away from that they came back in, I sort of said, Well, you know, healthcare is hard. Even these folks can’t get it right, even with some incredible talent that they pulled in. Well, not not right. What are your thoughts around that?
Craig Joseph
Well, you know, first of all, just kind of talking a second about CVS and Walgreens. If five years ago, you’d have told me that people would be lining up to get, you know, flu shots and other vaccines from the corner drugstore, I would have thought you were crazy. Five years ago, I would have because why would I go and get my flu shot at the at the corner drugstore, I would go to the my doctor’s office. I mean, that’s just typically I think it was five years ago, maybe it was a little bit more. But you know, as you say, the the corner drugstore, so become a nexus of healthcare delivery, when, up until very, very recently, they were just a place you picked up prescriptions, and some over the counter, you know, ibuprofen or acetaminophen. So that transformation, it’s been amazing. You know, with respect to some of the tech companies, yeah, healthcare is hard. And I’m not sure that they couldn’t make it better. But I think they figured out that the amount of time and money that it would take to make healthcare better, at least in the United States, there wasn’t a good business case there. Our system is is pretty entrenched and takes all takes a lot to move even a little bit. When you’re used to making changes that affect the world and days to weeks to months. It’s the idea of thinking about decades. I think it’s so doesn’t doesn’t appeal. But
Nick van Terheyden
I mean, as Aaron Martin said, they haven’t really gotten out that’s just a pullback of the, you know, that division, they’ve got all these other divisions, they’re still looking, they bought Fitbit for a wearable they’ve got it, you know, medical devices.
Craig Joseph
Hey, you know, the Tim Cook, the CEO of Apple has said that his legacy of his company will be in healthcare. That’s what he has, he has predicted so far, not so much.
Nick van Terheyden
That’s not true. That’s not true. If you watch the apple event, it was full of Radiology images.
Craig Joseph
Yeah, well, okay. I’m not gonna deny that. And I do I love the company. I just don’t think that, you know, if they’ve changed healthcare is full of intent is that’s great. And they might be proven to be right. I just certainly haven’t seen it yet. You know, but there there are companies that are kind of combining technology and their location to work in different ways. So, you know, we were talking about Dollar General, I think, previously, you know, this is again, if you would have told me even a few years ago that we’d be done with $1 General as a provider of Healthcare Services, an innovative provider of Healthcare Services. I would have thought you were you were not fully there. But that seems to be where they’re going. They’ve hired a chief medical officer right there first, and they’ve pointed out a few things. But hey, we are in the rural areas where others are not. People know what they’re, you know, they they know us and trust us to some extent. They noted a term that I’ve never heard of before that many of their stores aren’t pharmacy deserts. I’ve heard of food deserts, where you can’t get food, healthy, fresh food, but they’re noting that, hey, people have trouble getting to pharmacies, where, where a lot of their stores are, and they’re exploring, you know, how they can help, can they take a put a few telehealth kiosks in the back of their store, connected either to their own doctors or to another network of doctors, and then can they facilitate prescriptions? for those folks? Again, how does that work? I don’t know maybe is that regional pharmacies? Do they overnight medications to people? I’m not sure. But it sounds like they’re exploring it. And it’s, it’s fascinating to me to kind of meet people where they are to leverage both your technology and your your physical, you know, brick and mortar stores. That seems to be the sweet spot. It’s not all technology. It’s not all location, and brick and mortar.
Nick van Terheyden
It really isn’t. And what I remember from years back when we were working on a telehealth model, and you know, one of the stats that was really surprising to me, was that more people, as a percentage of the population live within five minutes, it could have been five months, I know it was a reasonably close distance, although you had to have a car. So let’s call it 15 minutes by car, to a pharmacy of one or another. Now, there is a percentage that fall into the group that or not, and we still have to sort of address that. But that opportunity for me is extraordinarily exciting. I mean, I was impressed with the Dollar General hire, I thought the individual was, you know, wow, what a great resource to bring in. And the other thing about trust, and you know, you were talking about this, and why we’re Dollar General, but I interviewed somebody, Andrew Suggs, who is essentially a barber shop, that he is morphed into a resource for healthcare. He’s actually in the latest cohort for health innovation, how that one of the innovations, I forget which one, but I was super impressed. I mean, that for me, was, as you point out, meeting them at the space or area that people are, and part of me thinks he should partner with Dollar General and start to set up that because people come to those kinds of services, not just to have the telehealth or the pharmacy, but bring people in and create that trusting network. Because we lost a lot of the trust with the existing systems. And we’ve disconnected a lot of people who don’t have access.
Craig Joseph
I agree, it’s really meeting meaningful, it’s where they are, and not where we want them to be or where it’s convenient. For us. It’s, again, as physicians, so we’re used to people coming to us at our, at our, you know, putting the health system around us at our convenience so that, you know, we can maximize our efficiency and those days are seemingly over, as sad as it is to say, for a physician, the world is not revolving around us anymore. And, you know, the faster we get on board with that, I think the better off we are. I?
Nick van Terheyden
Yes, I’m going to push back a little bit and say, it’s not that the world revolves around the physician, I mean, I think, you know, revolves around the patient, we sort of remain a central resource. But I think the the change or the move is that it can’t be in these, you know, fancy buildings, those remain the sort of sub activity, we focus too much energy on healthcare, which is actually sick care, that’s where all that, you know, high level high intensity activity goes on. And the vast benefit one of the reasons that we’ve seen better results against this pandemic in some countries in Africa, for instance, is they have a fantastic public health, community based community facing interaction the community, and we may we need more of that in this country. And some of these companies Dollar General Walmart’s of this world I think, at least closer to that community that I think will help to start deliver that. I think it’s you know, this is all good news. From my perspective. Maybe some physicians see it as bad news, but I think this is great opportunity. Unfortunately, as usual, we have run out of time. It just remains for me to thank you, as usual, Craig for a fantastic conversation, and I look forward to the next time I’ll be there.
