Transformational Healthcare: Reversing the Effects of a Broken System and Ill Health

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Healthcare used to be a rather simple transaction between a physician and his patient. However, with knowledge and technological advancements and the commoditization of healthcare, third parties soon realized the extraordinary amount of profit that could be made by interrupting this relationship, and shoe-horned between physicians and their patients to develop a better business model. 

These same technological advancements rapidly improved medical care and helped extend the lives of many while somewhat necessitating 3rd party intervention as no individual physician could afford these devices such as CT and MRI scanners to care for their patients though larger medical groups could. This quickly morphed into increasing governmental regulations in most every aspect that protected third party interests but limited physicians’ and patients’ abilities to autonomously interact, opprobrious insurance and Medicare contracts, hospital ownership of physicians and their practices, the expansion of non-physician providers who extended care for much less expense though at a lower quality metric, a primary focus on pharmaceutical interventions with eventual direct-to-consumer advertising, and on and on. Of course, there were benefits to each of these, but in the long run, except for direct stakeholders those benefits were significantly impacted by the negative effects caused by their implementation. That impact took the form of decreasing access to healthcare for many, decreased quality in certain areas of healthcare delivery, and significantly increased costs to the consumer to the point of being prohibitive to a large percentage.

With the above in mind, the United States still had worse outcomes and spent more on health care compared to other high-income countries (i.e., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.).

Though tens of trillions of dollars have been spent on healthcare over the past few decades, and despite incredible scientific discovery and innovation, access to physicians has decreased, costs of delivery have exponentially increased (due primarily to an explosion of administrators and related costs), and quality has continued to decline in some areas while it has improved in others. Though healthcare expenditures eat up close to 20% of our annual GDP, and though healthcare is always a forefront issue in political campaigns and Congressional activities, we continue to falter in each of these three core areas – Access, Cost, and Quality, as we continue to fall further and further behind the OECD countries we refer to as comparators.

What has happened is that the message of Medicine – the message of hope and healing, has been replaced by the business of healthcare except for a cursory hat-tip to quality and patient satisfaction primarily meant to increase reimbursements. With the promulgation of chronic disease management brought on by an upside-down USDA food pyramid, we’ve also seen the advancement of forced governmental mandates, increasingly complex reimbursements, expansion of non-physician providers delivering autonomous and unsupervised care, we’ve also noted an explosion of distrust, complexity, inefficiency, and hostility resulting in a nearing implosion of US healthcare. This is being quickened by fed-up consumers, low morale among providers, unsustainable costs, and an ever increasingly overbearing regulatory environment. Despite this, healthcare stocks continue to climb and pay huge dividends.

Of course, as broken as it is, there is yet great hope and opportunity for those who understand the business side while also pivoting in their perspective of what healthcare should be. In fact, even now, our healthcare system does work and despite the obstacles above, we are still able to receive some of the best medical care in the world in the management of disease.

Though most every OECD country has lower costs and better outcomes with healthcare that is almost entirely governmentally subsidized for all citizens, access is still an issue with many long delays at the point of care. As we consider healthcare delivery in these other nations, we see variations on pretty much free and subsidized healthcare for all for even noncitizens. The United States made a move towards this model in 2010 with the Affordable Care Act (ACA) by essentially laying the burden of subsidizing payment for the less fortunate on those who better off through up to tripling monthly premiums while doubling annual deductibles and heavily subsidizing hospitals to incentivize engagement. Though improving access for some, the ACA decreased it for others. 

There is a new movement that is rapidly expanding as many break free of the current sluggish and overwhelmed system and re-establish the long lost direct physician-patient relationship unencumbered by third parties. However, this necessitates 3 things.

First, the approach to healthcare delivery must change. We must shift to a model that incorporates a physician-led, patient-driven collaborative relationship that utilizes truly exciting innovations proven to significantly alter the health of all who engage. With the proactive use of rapidly expanding artificial intelligence and machine learning, nanobots, biosensors, 3D printing, stem cells and exosomes, biomes, peptides, proteomics, and unique methods of early diagnosis and therapeutics, this genetically driven precision and personalized medical approach that addresses every aspect of a person’s health will radically transform individual and national healthcare for the foreseeable future. We are shifting away from a model of chronic disease management to one that encourages prevention and disease reversal through education, behavioral change, personal responsibility, and revolutionary scientific advancements.

Second, patients must take personal responsibility and must realize that the majority of their healthcare lies in their own hand. In fact, over 70% of one’s health is determined by the personal every day decisions we make in terms of what we eat, how we sleep, and what activities we take part in. So much so that our daily habits can significantly alter genetic expression and cellular function. Patients must also break free of the mentality that their health is the responsibility of the government and realize that they will necessarily incur some personal expense for improving and maintaining their health if they want the best cutting-edged care available that enables them to increase the time they live disease-free. However, we understand that this may not be for everyone as many are either unable or are truly satisfied with what amounts to an inefficient and relatively ineffective multi-layered highly matrixed governmentally run system focused on the long-term management of chronic disease.

Third, physicians must innovate and shift their thinking from a pharmaceutically based chronic disease management style to a truly innovative scientifically-backed method focused on health. We must improve access, shift costs, and improve quality of care as we see an increase in longevity through reversing chronic disease and ageing with an improvement in health span as well as an optimization of human performance in every area from brain function to cardiorespiratory endurance to musculoskeletal strength and flexibility.

The leading causes of death in America as we age are cancer, heart disease, stroke, and dementia. Not only are these all preventable, but they are also reversible. What’s coming is incredibly exciting, but it’s not just coming, it’s already here and widely available for those willing and motivated to engage.

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US Health Care and Health Tech Innovation

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On March 28, 2019 District of Columbia’s Judge John Bates made a decision to dismiss the US Labor Department’s association health plan (AHP) rule. The AHP rule allows small businesses the affordability to pool together and provide health plans for employees in a competitive landscape. Judge Bates, however, saw the rule as an initiative to avoid Obamacare regulations. Once again, competition and choice in healthcare has been denied US small businesses, the backbone of national employment. The question now begs: if we cannot come to a workable decision on providing transparent health insurance options to the American people, how will we move forward on improving healthcare? The cost of US healthcare is predicted to reach 20% of GDP by 2025. We need to do better.

According to the Centers for Medicare & Medicaid Services, healthcare expenditures have skyrocketed from $28 billion to $2.6 trillion over the past 50 years. US taxpayers are bearing the brunt of this increase, with no foreseeable solution coming forth to mitigate the burden. The remedy here is not to block competitiveness in health insurance services, but to increase health technology in our nation’s hospitals, health centers and clinics. We need to become proactive: that is to say, not throw valuable insurance money after reactive, outdated medical facilities and treatments, but invest in the latest preventative, diagnostic and reporting technologies to foster transparency and innovation. As stated in HP’s Megatrends, we need to “shift from standardized, reactive and centralized care to personalized, preventative, decentralized…care for all US citizens” through health technology.

First, let us clarify what health technology entails. Health technology refers to all advancements in procedures which improve both the quality and cost of providing healthcare to individuals and communities. The National Information Center on Health Services Research and Healthcare Technology (NICHSR) lists the following highlights that create a health technology demand:

  • Increasing prevalence of chronic diseases
  • Advances in science and engineering
  • Aging populations (baby boomers)
  • Increasing prevalence of chronic diseases
  • Third-party payment, especially fee-for-service payment
  • Financial incentives of technology companies, clinicians, hospitals, and others
  • Off-label use of drugs, biologics, and devices
  • Strong, growing economies

The United States fits all of the above requirements, and then some. The Trump administration has been on the frontline to advance health tech, starting with electronic health records (EHR). The Centers for Medicare and Medicaid Services (CMS) announced the MyHealthEData initiative in 2018. This program is supported by the White House Office of American Innovation, as well as the National Institutes of Health and Veterans Affairs, among others. MyHealthEData shall give electronic access of all health records to patients and allow patients to choose providers based on cost and accuracy transparency. Patients will be able to share their data with whichever provider they choose. This is a revolutionary concept in healthcare! According to Jared Kusher, President Trump’s advisor, the Administration is working diligently to solve the interoperability of health data within the nation’s healthcare institutions. Prior administrations have spent over $36 billion with no clear results in fully digitizing or maintaining the accuracy of health records. Lamar Alexander, R-Tenn and Chairman of the Health, Education, Labor and Pensions Committee supports the Administration’s interagency HER plan, stating an impact on over 125 million US patients. We are comforted to see such federal initiatives be redirected to solve transparency and cost issues within healthcare.

The US healthcare industry is geared to be most impacted by Industry 4.0. As delineated by HP’s Megatrends, digital technologies such as 3D printing and emerging technologies such as augmented reality haptic holography, microfluids and autonomous robotic caretakers are now a reality, and benefits both provider and patient alike when mainstream.

  • 3D printing has been introduced to many large private US hospitals, and is making strides in lowering the cost of customized diagnostic devises and patient implants. 3D printing can actually mass produce the hospital buildings as well as customized instruments, tools and medication needed for patients.
  • Haptic Hologram technology is no longer science fiction. This new augmented reality software converts 2D medical imaging such as MRI scans into virtual reality images. Why is this important? This technology allows the surgeon to do a holographic pre-run of surgery on the actual patient without dissection! So, when the actual procedure begins, the diagnosis, time and accuracy of surgery will be dramatically increased.
  • Microfluidics is described as “an entire lab on a tiny microchip.” The tiny microchips give a full diagnosis the patient using a minute sample of patient fluid. The process is not invasive, has a lower test cost and are perfect for point-of-care (POC) tests for urban and rural populations.
  • Artificial intelligence in geriatric health care sector is on the upward trend. AI makes hospices “smart” to actually providing individualized robot caretakers that can immediately detect health changes in the elderly patient.

These technologies are already in use and are being further developed by companies such as HP and IBM, with support from large private healthcare institutions via innovation labs. While many may initially believe these technologies to be expensive to implement, we recall that prior administrations have spent billions of dollars on health care ‘reform’ with little change in our healthcare crisis.

From a policy standpoint we applaud the White House Office of American Innovation and the Health and Human Services department for currently moving forward with the Administration’s interagency plan to improve electronic health records interoperability, and suggest working with such agencies as the National Information Center on Health Services Research and Healthcare Technology (NICHSR) on emerging technology assessments innovation labs to make US healthcare technology the most innovative and accessible to US citizens. The US healthcare insurance reform is currently in legal bottleneck to the detriment of the American people. It’s time to refocus time and financial energy on augmenting our actual healthcare institutions to provide the most beneficial, accurate and transparent healthcare through health tech innovation.

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Make Cannabis Great Again

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The cultivation of Cannabis can be traced back at least 12,000 years, which places the plant among humanity’s oldest cultivated crops. Ancient empires such as China, Egypt, Syria, and India employed every component of the plant: the root for medicine, the stem for textiles, the flowers for medicine and intoxication, and the seeds for food and oils. Older civilizations used Cannabis as a remedy for headaches, edema, inflammation, rheumatism, gout. It was even used to relieve sorrow and bad humor. Cannabis was the great plant, as it was considered a gift from God, a plant that can be used ubiquitously, in virtually every part of human life. However, as society evolved, Cannabis restrictions were introduced.

HISTORY OF CANNABIS LEGISLATION

In the past century, there have been no less than 16 pieces of legislation that criminalized Cannabis in the United States. These pieces of legislation have dictated the U.S. policy towards Marijuana and Cannabis use without regard for modern innovation, medicinal uses or public support; none were based on scientific studies or sound logic – they were the result of special interests and sloppy voting practices by politicians. While states have made tremendous progress in legalization, this historically irrational legislation of Cannabis survives on a federal level in 2018 and is the single biggest obstacle the Cannabis industry is facing today.

Cannabis prohibition began in many states in 1906, and by the 1930s Cannabis was fully regulated as an illegal drug in every state. The Marihuana Tax Act of 1937 was the first federal regulation of the plant. In 1969, the Supreme Court ruled the Marihuana Tax Act to be unconstitutional, violating the Fifth Amendment regarding self-incrimination. In response to the Supreme Court’s ruling, the Nixon administration supported Congress and passed the Controlled Substances Act (CSA) in 1970, which stated the Cannabis has a high potential for abuse, and no medical use. CSA prohibited the use of Cannabis for any purpose (recreational and medical), and classified the plant under Schedule I, together with heroin and LSD.  President Nixon formed the Shafer Commission in 1972 to study the use of Cannabis and provide policy recommendations. The Shafer Commission reported in its findings that Cannabis did not cause any considerable dangers to society, and recommended decriminalization of the plant. President Nixon publicly rejected the findings and fully ignored the recommendations.

Since then, multiple efforts to reschedule cannabis under the CSA have failed. On the state level, governments have continued to push for policies that conflict with federal law, beginning with California’s Proposition 215 in 1996. By 2018, 30 states plus Washington D.C. have legalized medical cannabis, and 8 states have legalized recreational use.

HEALTHCARE IMPLICATIONS

Research shows that Cannabis is not a gateway drug, but on the contrary, it is an addiction exit drug. Cannabis has been proven to help opioid, heroin, and even alcohol addicts avoid the nasty withdrawals associated with opioid addiction. Millions are suffering from addiction to opiates (Heroin, Codeine, Morphine) and synthetic opioid medications (Oxycodone, Fentanyl, Hydrocodone etc.). Abusers of opioid drugs had a 16-percent lower likelihood of relapsing when they had the assistance of marijuana for their recovery. Furthermore, states that allow its citizens to use Cannabis to treat specific medical conditions showed a 6% lower rate of opioid prescription. With widespread over-prescription of opiates, this could provide a solution to cut down on users.

Cannabis not only helps opioid addicts with their recovery process, but it can help patients avoid opioids altogether. Cannabis has been proven to relieve patients’ pain, drastically reducing the need for use of opioid, and fatal opioid overdoses. Medical marijuana patients report fewer unpleasant side effects with marijuana than with many traditional and stronger drug treatments.  Medical marijuana patients argue they are able to function more fully in daily activities and work; unlike with many prescription opiates for symptom relief. Other than significantly reducing with use, addiction and withdrawal, medical marijuana is used in treating a myriad of medical conditions, including cancer, seizures, HIV, Parkinson’s, etc. Wide-spread legalization will only accelerate these cures and studies. Cannabis’ full impact on the healthcare industry is still to be determined, but it is well within tens of billions of dollars, and provides a much safer, healthy and less painful alternative to opioids.

BUSINESS IMPLICATIONS

Money does not like uncertainty. With the current uncertainty in U.S. federal law regarding Cannabis, there is a lot of money that is shy to enter and help develop the U.S. Cannabis industry. Still, legal sales of Cannabis reached $6.9 billion in 2016 and are projected to rise all the way to $50 billion by 2026. Legalizing Cannabis nationwide would create at least $132 billion in tax revenue and more than a million jobs in the U.S. within the next decade.

Despite 30 states having legalized Cannabis in some capacity, including 8 states that legalized it for recreational uses, it seems that AG Jeff Sessions is offering no chance of legalization at a federal level.

Even though many States have legalized cannabis, the Federal regulations stops the entrepreneurs from operating at fully capacity. National prohibitions against interstate cannabis commerce and federal banking and drug laws are the biggest obstacle for this industry. Cannabis entrepreneurs have very limited access to funds, loans, even bank accounts, business and personal.

Some of the entrepreneurs we spoke with expressed their frustration with the current legislation. First, they cannot find banks that allow them to open business accounts for their companies. This makes it extremely difficult to conduct any kind of business; they cannot properly receive investments, process payroll, pay suppliers, use credit cards, etc. There are many cases where banks agreed to open an account for a Cannabis business, only to cancel those accounts weeks later and kick those businesses out. In some cases, not only did they cancel the business’ account, but they canceled the business’s founder’s personal accounts with the same bank, even though they have been banking with that institution for many years.

Entrepreneurs in the Cannabis industry have no tools to be transparent about their business, cannot write off any business expenses, and cannot even file their taxes properly. How do you file federal taxes for a Cannabis business when Cannabis is illegal?

Even non-Cannabis, ancillary companies are suffering under this law, simply for being attributed with possible Cannabis applications. It is time to stop being

SOLUTIONS

  1. Declassify Cannabis from Schedule I to Schedule II. Decades of legal red tape, illegality and raids due to Schedule I classification have prevented the U.S. Cannabis industry from fully maturing and providing life changing cures, painless treatments, and healing solutions. Propaganda and misinformation must be eradicated so that safe innovation can be brought to an industry that has already garnered widespread public support to provide safe and efficient healthcare solutions, as well as lucrative business and tax opportunities for the U.S.
  2. Provide ways to educate: the federal government should make a concerted effort to educate consumers of the differences in the chemical makeup of the plants especially regarding non-addictive compounds like CBD. Much of the fear is spread by propaganda. Medical marijuana compounds and methods that are used strictly in the reduction of pain and do not react with mental/job performance are very prevalent in the space.
  3. Eliminate any federal red tape that would prevent the Cannabis industry from growing. The U.S. Cannabis industry is at least 50 years behind in scientific and medical studies of Cannabis, which can provide impactful cures for our citizens. Also, too many patients desperately need it as soon as possible, but Cannabis currently has very little penetration of the healthcare system. Slowing medical Cannabis adoption accomplishes little other than to hurt patients.

CONCLUSION

During his 8-year tenure, President Obama expressed his support for the Cannabis industry, but he proved to be a closet supporter. He did not legalize Cannabis on a federal level; he simply instructed U.S. attorneys not to enforce the federal Cannabis law. As soon as Jeff Sessions was appointed as Attorney General, AG Sessions instructed those same attorneys to enforce the law, leaving many Cannabis companies vulnerable to raids and delegitimization. Entrepreneurs in the space should be able to develop and innovate without fear of retribution or be directed to close their businesses. The current ambiguity in this industry is hindering the modernization that could occur.

Declassifying Cannabis from Schedule I to Schedule II, is the single lowest hanging fruit for the Trump Administration to curb opioid addiction and treatment (which is a national health emergency), drastically improve the healthcare of U.S. citizens and reduce their healthcare cost burden, add more than 1 million jobs to the economy and add $132+ billion in federal tax revenue within one decade. This one piece of legislation can make one of the biggest contributions to Making America Great Again, on multiple levels. President Trump has already instituted a task force to determine what the Cannabis policy should be in the U.S. and I am optimistic that new developments will be made towards legalization.

SOURCES:

Where marijuana is legal, opioid prescriptions fall, studies find

Medical Pot Is Our Best Hope to Fight the Opioid Epidemic

Medical Marijuana Market Analysis By Application

History of Marijuana as Medicine – 2900 BC to Present

Marijuana Legalization and Regulation

Study: Legal marijuana could generate more than $132 billion in federal tax revenue and 1 million jobs

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