This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of Aug 2023
News You Can Use with your Hosts Dr Craig Joseph and Dr Nick van Terheyden
The show that gives you a quick insight into the latest news, twists, turns and debacles going on in healthcare withmy friend and co-host Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners and myself, where every diagnosis comes with a side of humor. We hope you stay curious, stay engaged, and keep seeking the truth in healthcare in a world that thrives on information.
Buckle up as we dive into the ER of excitement, the ICU of irrationality, and the waiting room of wacky wisdom in this months show that features a review of:
- Blue Shield of California discontinuing CVS Health pharmacy services and opting for Mark Cuban’s cost plus drug company and Amazon for prescription services
- We take a look at the rise, but mostly fall of Babylon Health – another Theranos, perhaps not but some questionable activities
- We seek clarity in the title of Doctor and who should be allowed to use it – what are the merits of the latest lawsuit that demands another group be allowed to be called “doctor”
- A look at a couple of recent Epic research publications one on the significant advancements in cystic fibrosis treatment and the “Medicare Effect” on screening study which indicates improved screening rates for breast cancer (50% more likely) and colorectal cancer (twice as likely), which gets us to Statistics
- And the BMJ Randomized Control Study of parachute use and its effectiveness in preventing major trauma when jumping from an aircraft (at 30 days follow no differences were detected), but as you’ll hear this highlights the importance of critical analysis and not taking data at face value
We hope you enjoy our take on the latest news and developments in healthcare and want to help you keep untangling the web of information, dodging the sensational pitfalls, and emerging victorious, albeit a little dizzy, on the other side. In the end, the stories we uncover, and the discussions we ignite, all shape the narrative of our shared future. We want to hear from you especially if you have topics covered or questions you’d like answered. You can reach out directly via the contact form on my website, or send a message on LinkedIn to Craig or me.
Until next week keep solving healthcare’s mysteries before they become your emergencies
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
Welcome to the month of August. I’m Dr. Nick.
Craig Joseph
And I’m Dr. Craig.
Nick van Terheyden
This week we’ll be dissecting the latest healthcare news, unraveling the twists and turns and making sense of the debacle.
Craig Joseph
Just remember, life’s a lot like a breaking story unpredictable, often absurd, and occasionally leaves you wondering if it’s all just a cosmic prank.
Nick van Terheyden
This week, we’re looking at the Blue Cross Blue Shield dropping of CVS Health, and indeed looking at Babylon and their decline from a position of power. I do want to note that no zebras were harmed in the recording of this episode.
Craig Joseph
Further, we’ll talk about who deserves to have the title of doctor and a healthcare facility. We’ll look at two excellent pieces of research from Epic research about cystic fibrosis and improvements in terms of chronic care with Medicare. And we’ll be reviewing not incredibly recent article from the British Medical Journal, talking about parachute use to prevent death and major trauma when jumping from an aircraft a randomized controlled trial.
Nick van Terheyden
First off this week, we have the Blue Shield of California ditching CVS health. What are they doing? Well, then removing CVS Health pharmacy services, and instead going with the cost plus company, Craig, what are your thoughts?
Craig Joseph
Well, first of all, I’m glad to hear that they’re not trying to close down every CVS pharmacy, because that seems a bit that seems a bit strong. So they’re, they’re simply saying that as an insurer, they are not going to be leveraging CVS health, or CVS, pharmacies for a lot of the services that they’re that their insurance patients, clients, whatever we want to call them are going to be receiving. And instead, instead of using CVS and some of their subsidiaries, there’ll be using Mark Cuban cost, plus Mark Cuban cost plus drug company to actually manufacture and then Amazon to actually deliver the the prescriptions. Obviously, this is not going to be for every prescription, and I’m not sure what they’re going to be doing with respect to things that you need, right? If you go to the doctor’s office, and you have a bad pneumonia, and they want to give you an antibiotic, you, you are not going to go online and order a medication that’s going to take four or five days to get to you. So we’re talking about chronic medications, like for your cholesterol medicine or for your high blood pressure medicine. But it is it’s, you know, it’s pretty convenient. And I know that I use Mark Cuban’s cost plus drug right now for one of my prescriptions and seems pretty convenient. It looks like they’re trying to cut out one layer of middlemen.
Nick van Terheyden
Only one layer? What do you bet? You’re kidding, right?
Craig Joseph
Well, I mean,
Nick van Terheyden
you’re bleeding exceptionally kind, I think there’s a few more layers in that PBM layer.
Craig Joseph
You’re correct. And every layer, you know, takes a cut. And so kind of going, and I think that’s what when cost plus started, that was the idea that, hey, you know, we, Mark Cuban and company are going to manufacture these medications. And they’re all you know, they’re not brand names, or they’re, they’re all generic meds. And it’s not rocket science to create them. And so that’s what they’ve done. And then, and then what they’ve done outside of CVS to say, Hey, if you want to get your prescription meds from us, if we make them, we don’t make them all, that’s for sure. But if we make them, we’re just going to charge you a small percentage above whatever we think our costs are. So we’re not trying to not trying to get rich, trying to get rich slowly, not trying to get rich quickly, maybe. And you know, a service fee and postage and that kind of, it’s very reasonable. So it’s interesting to see one of the first you know, big players like Blue Cross of California, jumping into this this game.
Nick van Terheyden
I can’t cut out the visual in my mind of you know, the dominoes in. I think it was the big bang theory where Sheldon had built the whole room fallen, he hit one and, you know, just cascaded it feels a little bit like that. Because here we have a large player, they’re saying, you know enough of this. I think what’s interesting, and you and I both use it. I’m a big fan. There’s no secret about this. Love that whole system. I’ve found it. I’ve talked about some of the discrepancies, you know, in terms of pricing. Couple of things. First of all, they don’t take insurance. There is no insurance involved in this. They’re just taking a straightforward cash price, that cost plus thing, is it that’s it? Exactly. I think my recollection is it’s a 15% markup on the base trial base price of these generic drugs that have been made for years. And it was 110 drugs when they first launched, I think they’ve expanded significantly. I wonder if they’ll be taking insurance or even if there’s a need for it in, you know, some of these I mean, I know some of the medications that have been around for a long time, we’re talking pennies for daily doses and so forth. You’re right, it’s not quick, but wow, you know, we’re finally seeing I think a break in this layer that I’ve got to be honest, there’s you know, a lot of frustration with people in terms of costs that seem opaque. You know, Crystal would seem opaque by comparison to what’s going on behind the scenes here. It’s just it’s oh my god and god bless him for doing it. I got to say I’m just I’m super excited. I want to see where else they go with it.
Craig Joseph
Yeah, it is, it’s quite interesting when you, if you’re lucky enough to have insurance that has a copay, and you go to the, you know, your local drugstore. And for me, I would get a prescription and it would, it would say, for this cholesterol medicine that I’m on, you paid $25 or whatever my my monthly copay was, your insurance saved you 179. Right. So like, Okay, well, that’s, uh, they’re telling me that if I were to come in there with cash, it would be that much really be $200 or so for that for that one month, and then I can go to, to, you know, that cost plus drugs, and I can get it for 799. And that’s with no insurance 799. And then I have to pay like a $5 fee or whatever. It’s, um, it’s, it’s reasonable. Again, the only thing that I think my local pharmacy has some use fast, but it just shows you like, wow, they’re charging $200 For something that a business is charging $8 for. And that seems to be a significant markup, even my copay is much more expensive than, than just buying it, buying it online. So it’ll be very interesting to see how they get together. I think, also, it’s fun to talk about the culture of the organization, Mark Cuban was very clear when he started the company, we’re not talking to anyone, we’re not making deals with anyone like this is just how much it is, if you want to pay it, pay it, if you can get a better deal somewhere else, you should go there, you know. So I’m assuming that he’s he’s got a similar stance with now Blue, Blue Cross of California,
Nick van Terheyden
but no, unreasonable, let’s be clear, and you know, I think it’s a little bit unfair, because obviously my association because I’m not a basketball, sporty kind of person. But you know, it’s Shark Tank. That’s where I know him from and, you know, he’s, he’s, you know, no, here’s the deal, if this is the way it works, and that just seems like, you know, this is reasonable behavior. I think they’re being very transparent in their sort of interactions. Although my sense is that he’s not involved actually was a physician, I want to say a radiologist that actually came to him with the idea and emailed him. So those of you thinking up great ideas, there is opportunities like this, and, you know, here it is launching, so we’re good.
Craig Joseph
Yeah, yeah. It’s crazy. You know, I am interested in that. But I’m also interested in your, your take on this company that’s having trouble. It’s called Theranos. Oh, wait, it’s not called Theranos. It’s called. It’s called Babylon health. I’m sorry. I’m sorry. I got those confused. Dr. Nick.
Nick van Terheyden
Let’s do the time warp again, shall we? We can talk about Theranos that that’s definitely, actually that’s all gone quiet since some folks went to jail over that. But
Craig Joseph
you know, jailing companies, leadership does often quell that the chatter around the companies.
Nick van Terheyden
It certainly quells their ability to tell us it. Because I think all the calls that come out of there have a pre recorded, hey, this call is coming from because it used to be all sorts of problems. But I only know that from the movies, and it’s probably fiction, but who knows?
Craig Joseph
Well, just to recap, let me throw this over to you. So Theranos was a company that said that they could do lab testing on tiny, tiny amounts of blood. And as it turned out, they made everything up. Oftentimes, when they were testing, sending out erroneous lab results, and ultimately, ultimately, due to an article in the Wall Street Journal, or a series of articles, their leadership has gone to jail. And now Babylon health, they don’t do I don’t think they do. Labs. What do they do?
Nick van Terheyden
Yeah, so Babylon health interesting company that is now in the doldrums. They use one of these old SPAC mechanisms that, you know, if you understand it, you understand it, but essentially, it’s like a reverse IPO where they try and extract out cash early, but it really has to be something that’s doing well, what was their solution? Well, in good news, in this sense, it was an AI solution that said, Hey, we can take an interaction, we’ll create a chatbot or a whole process where you can ask questions and you can get a diagnosis and they were on a tear. In fact, they signed deals in the United Kingdom with the NHS. However, through the course of history, what we saw was some shenanigans going on behind the scenes, and in fact, it was launched and offered as an alternative in some respects to going and talking to you or physician or clinician for a diagnosis. So, hey, I’ve got a sore throat, what should I do? And, you know, there was this whole process and actually one GP in the UK, who had behind a handle, stood up and said, Look, I’m I’m not comfortable with this. And here’s why, and showed a series of chats that essentially demonstrated that this thing was not safe, it failed to pick up serious clinical conditions. They might have been outliers, but that’s the point of healthcare. That’s one of the reasons that we go to physicians, because they are hunting for zebras. We’ll talk about that some other time, I’m sure. But you find the rare conditions, you have to exclude them. And it was failing to do that. He was doxxed. He was at they went after him in a big way. He finally you know, we know who he is and everything. Well, you know, I have the sense that he’s ultimately, maybe well, he was definitely proved right, because he was right at the time, this was all going on, they continue to expand, they took this SPAC notion, and then just failed to meet their debt obligations. And in fact, they are now in receivership chapter 11. I’m not sure which of the chapters it is because I can’t follow any of the financial codes. And they’re now going to disappear in as a company, because they’re not really delivering the value that they offered, which was oh, we’re going to take all the load off the NHS problems of people having minor conditions and then a consultation.
Craig Joseph
Well, I mean, it sounds like a good idea.
Nick van Terheyden
I would say yes.
Craig Joseph
Yeah. You know, there, there are lots of things. And I think, as a, as a primary care doctor, that there are so a big percentage of what I, I used to do, it doesn’t really require advanced training, as you said, and the key though, and I want to let me emphasize this, first of all, that when you talked about hunting, zebras, really we’re not we don’t have guns, we’re not going to the Sahara. Your your your
Nick van Terheyden
your job. We have cameras No, no.
Craig Joseph
Yeah, no. So we like zebras, I think like we declare you and I are we like the animal we like all the animals.
Nick van Terheyden
We like all the I don’t know, I’m not into mosquitoes, I’m just saying,
Craig Joseph
Well, I would call that more of an insect. But let’s not, let’s not get into the details now. But a Zebra is a that uncommon thing. And I think that’s really what you need, right? That’s what you’re paying your human physicians and clinicians for, is to say, Wow, this seems like this is out of the realm of normal, normal, you probably don’t need me for the standard stuff, but for the stuff that’s outside the realm of normal and discovering when those are popping up. That’s where the, that’s where you’re you earn your money. And so, yeah, it’s no good if you’re, if you’re right, 99% of the time and wrong 1% of the time, and and that 1% turns out very, very poorly, because you need to be approaching 100%. And I think they were stat a lot more. Yeah. Well, we’ll get to STATS more in a second. But I do think that they, you know, it’s a good idea. It’s it’s gone wrong, and and now it’s gone wrong in a big way. Sounds like,
Nick van Terheyden
right. So another piece of trending news, certainly received a lot of attention. When I posted something about this was the lawsuit by some nurses in California, I believe it was who said we must be called Doctor, we are entitled to it because they were getting, I think it’s a PhD of some variation. Forgive me for not getting it exactly right. And an ethicist posted a video blog along with, you know, details that said, here are the reasons why not. And boy did that create a firestorm? This has been going on for a while. I’m just going to say but what do you think?
Craig Joseph
Well, it’s certainly a touchy, a touchy subject. So I think that most
Nick van Terheyden
like the blue Touch Paper and step back. Well, that’s what I just did.
Craig Joseph
I know I like that. I like how you did that. Hey, Craig, what do you think about this controversial issue that some people feel very strongly about? I’ll just listen and nod my head. No, you know, here’s the thing. So in the state of California, the reason that the some of those nurses with advanced degrees were able to did sue is because there’s a law in the state of California that regulates your ability to call yourself a doctor in certain settings. So what we’re really talking about is in the hospital or a clinical setting, who can call themselves doctor. And I think most of us know what a doctor is right? Like what you’re expecting, you’re expecting someone with a medical degree, either in the United States, that’s an MD or a do. And, and you’re not expecting a pharmacist. And you’re, you’re also not expecting a nurse with an advanced doctoral degree. And you may not be expecting an occupational therapist, who now has, or physical therapist who now has a degree called Doctor of Physical Therapy, my daughter is in a program now that will end up with she will end up with a doctor of occupational therapy right. Now, does that mean that she should call herself doctor and in the hospital? I would argue no, she’s already told me that once she graduates, I will have to refer to her as Dr. Joseph. But that’s, that’s neither shocking. That’s neither here nor there. So that’s really what it comes down to is, are we confusing patients, the American Medical Association, the ethicist you reference in the state of California, think that we are and and I have to say, I think that we are as well. And so at a conference at a scientific conference, completely different story, right, if you want to refer to yourself,
Nick van Terheyden
any other settings as well, I think that’s that’s the, you know, let’s be fair about this. And, you know, I am married to a nurse, midwife health visitor. And I have repeatedly talked about the value and just the enormous benefit that I received from fantastic nurses. You know, there is no, you know, understanding here that says this is, you know, these are not contributors to the team, aspect of medicine, but it’s confusion, it’s clarity. And I think, you know, we’re entirely respectful of it. But also, you know, other folks need to understand exactly what it is that they’re buying. So, let’s move on to Epic research. I think you have, you’ve spent a lot of time around this. And, you know, we saw a couple of articles that I think just, you know, fantastic information coming out cystic fibrosis patients, a huge personal area for me, because I used to take kids with CF on a trip of a lifetime, the, you know, Give Kids the World type approach from the UK, we would take them and, you know, they were all pretty much terminal in their early 20s, sometimes earlier than that. And we have seen an astounding improvement that was shown by the CF research, right?
Craig Joseph
Yeah. And let’s just go back just a second. For those who are not familiar, Epic is the name of a company that makes him one of the big players in the electronic health record industry. They pool on identified, de identified is the proper term, I think, data from I’m trying to want to be a doctor Nick, okay, sorry. All right, I’m trying to move on, you don’t need to call out, you know, you make me feel badly when you call out my mistakes. And luckily, for our listeners, we don’t edit that stuff out. That’s all we
Nick van Terheyden
do there for you. No editing, no charge. Making this episode, we
Craig Joseph
don’t charge extra for the non existent editing for the de identified patient data for hundreds of 1000s of hospitals in the United States, and I think somewhere else too. So they’ve got these rich data sources, and they were able to publish, you know, the, the median age of death of patients with cystic fibrosis, starting around 2008. And then their most recent information is from last year, and showed that the average age of death was 26. Not a long time ago. 2000. Right. And now, it’s 66. That’s crazy. Right? That’s, that’s crazy. And lots of reasons for that. And but, you know, we always talk about bad things and how things are not going the way we want them to. Here’s something that was we’re sciences really helped us.
Nick van Terheyden
So there was another one, right? Medicare, and they’re their screening activities. What was what was that?
Craig Joseph
Yeah, so epics research team looked at patients who had Medicare, which is people get that in the United States, when they turn 65 or under a few circumstances if they have some chronic illnesses up But most people get it when they turn 65. And they looked at what or they looked at people who were supposed to be getting screening. So things like cancer, you know, breast cancer, colorectal cancel cancer. And what they found is that, you know, patients were 50% more likely to get breast cancer screening, and twice as likely to get colorectal screening if they were on Medicare, actually. So I think that’s like, set off. That’s 100% improvement for colo or double is.
Nick van Terheyden
Two stats here. Are you getting confused? Because I have, I have just the study for you to make sure that you really understand what’s going on here. Great.
Craig Joseph
All right. I, I’m always open to learning.
Nick van Terheyden
I, you know, I know we’re normally about current news. But this was a 2018 BMJ paper that said parachute used to prevent death and major trauma when jumping from an aircraft to the randomized control study. And it didn’t show any difference.
Craig Joseph
So people were randomized. So a randomized control study, is when you take a person you say, you flip a coin, and you say, either you’re gonna get the regular stuff, or you’re gonna get, you’re gonna get this new, this new idea that we have. So the regular stuff was, you’re gonna we’re
Nick van Terheyden
gonna be at the plane door saying, hey, take your here’s your bag, it may or may not contain a parachute. Yes, that’s exactly right.
Craig Joseph
And that’s the key, right? Randomized, it’s usually double blinded, meaning that when I put that parachute, even, I don’t know how I don’t know if there’s really a parachute in there, or just an empty bag. And you don’t know until you jump out of the plane. And what this this is actually quite interesting from 2018. What this study showed was, there was no difference right
Nick van Terheyden
now, and a difference in death or trauma, as a result of,
Craig Joseph
of juggling what you call an aeroplane,
Nick van Terheyden
I was just delighted to see this paper. And I’m just excited that folks are taking the time to carry out these. But this
Craig Joseph
was not in a this was not in a real journal. Was it doctrine? This was the BMJ which what is that? I’ve never heard of the British Medical Journal. So it’s British? Well, let’s just start off there.
Nick van Terheyden
And just to be clear, that’s in Lansdowne Square in London, used to live very close to that I had friends, they had a nice park on the outside.
Craig Joseph
So So British medical journals are real, real scientific. Journal. And so how did this happen? Because one would think, Dr. Nick, one would think that if you jumped out of what you call an aeroplane, or what I call an aeroplane, when we think if you jumped out and didn’t have a parachute, that your risk of injury and death would be, I don’t know, higher than someone who did have a parachute. How did this happen? Was there were there any details that we well,
Nick van Terheyden
so and you bring up the exact point in all of this. And, you know, that’s, that’s really the issue here. And you know, we’re making light of it. But I think it’s really important to understand and I, I’m making fun of, you know, your inability to work out the stats, but let’s be honest, unless you need even this. And even if you are, I think it can be challenging to work out, especially when you get into percentages, percentages are used to sort of confuse and conflate issues very frequently. And you cannot take data or information at face value. In this particular instance, they had 192 people that were originally screened, it was a bunch of them that were excluded, they got 23, in that were randomized into the intervention and control group, the control had no parachute, the intervention group had a parachute. And they completed their jumps all of them, and then had a follow up, no contact for 30 days and then had a 30 day follow up just to make sure that there was and there was no difference between the two. And of course, the critical piece of information.
Craig Joseph
That is they feel something’s missing, what’s missing.
Nick van Terheyden
Now, here it is, they were jumping out of an aeroplane, it was actually a biplane, and it was parked on the ground. They even introduced a picture of somebody jumping out, arms in the air. And of course, you know, nobody was getting injured in this, but we make light of this, but it is an important point. And I think essential for folks to understand this that you cannot take everything at face value, it is important to get to the second or third level of information, and also to be you know, using the appropriate trust for all of this. So hopefully you get a sense of that will continue to do this. But unfortunately we find ourselves At the end of another episode of Exploring healthcare Miss Healthcare’s mysteries before they become your emergencies until next time I’m Dr Nick I’m Dr Craig
