Tag Archives: Health

Culture Clash: A Lesson from the Theranos Case

KNOWLEDGE@WHARTON – There’s much more at stake than a potential 20-year prison term for Theranos founder Elizabeth Holmes, whose federal fraud trial opened last week. Her case has come to symbolize the perpetual conflict between big tech and health care.

“It’s a culture clash, to be sure,” Wharton health care management professor Lawton R. Burns said in an interview with Wharton Business Daily on SiriusXM.

The startup culture in Silicon Valley and beyond moves at warp speed, he said. When investors are enthusiastic about a promising new venture, the hype builds and the dollars roll in. Theranos reached a valuation of $9 billion on a bogus claim that it developed a revolutionary lab test capable of screening for a range of conditions on a single drop of blood. It was exactly the sort of cost-efficient solution that big tech is known for, so it’s little wonder that investors fell for the pitch from the charismatic Holmes, who fashioned herself after Apple visionary Steve Jobs.

But there’s almost always friction when big tech turns its eye toward health care as “virgin turf to apply all of this new, cool stuff to,” said Burns, who is co-author of the book Big Med: Megaproviders and the High Cost of Health Care in America. “The question is whether or not all this stuff is going to work and transform health care or, conversely, at the extreme, just crash and burn.” more>

Why Managers Fear a Remote-Work Future

Like it or not, the way we work has already evolved.
By Ed Zitron – In 2019, Steven Spielberg called for a ban on Oscar eligibility for streaming films, claiming that “movie theaters need to be around forever” and that audiences had to be given “the motion picture theatrical experience” for a movie to be a movie. Spielberg’s fury was about not only the threat that streaming posed to the in-person viewing experience but the ways in which the streaming giant Netflix reported theatrical grosses and budgets, despite these not being the ways in which one evaluates whether a movie is good or not. Netflix held firm, saying that it stood for “everyone, everywhere [enjoying] releases at the same time,” and for “giving filmmakers more ways to share art.” Ultimately, Spielberg balked, and last month his company even signed a deal with Netflix, likely because he now sees the writing on the wall: Modern audiences enjoy watching movies at home.

In key ways, this fight resembles the current remote-work debate in industries such as technology and finance. Since the onset of the coronavirus pandemic, this has often been cast as a battle between the old guard and its assumed necessities and a new guard that has found a better way to get things done. But the narrative is not that tidy. Netflix’s co-founder and CEO, Reed Hastings, one of the great “disruptors” of our age, deemed remote work “a pure negative” last fall. The 60-year-old Hastings is at the forefront of an existential crisis in the world of work, demanding that people return to the office despite not having an office himself. His criticism of remote work is that “not being able to get together in person” is bad. more>

Should vaccinated people worry about long Covid?

Here’s what we know about long Covid — with some hope for the future.
By German Lopez – Over the past few months, experts and officials have tried to prepare the world for a future in which Covid-19 is here to stay. They predict the vaccines will by and large defang the virus. There will still be a few cases of serious illness and death, but the coronavirus will be reduced to the level of a seasonal flu — a disease we’d be much better off without, but mild enough we won’t shut down society to fight it.

But this optimistic vision has always left open a big question: What about long Covid?

Covid-19 is most known for causing acute illness, from a cough and fever to hospitalization and death. But in some cases it seems to cause longer-term complications, including breathing difficulties, fatigue, and brain fog, though the effects vary from person to person. While Covid-19 typically resolves in the span of weeks, long Covid can last at least months after an infection.

“Without treatment, we’ve seen individuals who got sick in February or March of 2020 and are still sick and still extremely debilitated,” David Putrino, who’s treated long Covid patients at the Mount Sinai Health System in New York, told me.

These long-term complications aren’t unique to the coronavirus; other viruses, including seasonal flu, cause long-term symptoms too, sometimes similar ones. But as more people have been infected by the coronavirus, and more have subsequently developed long Covid, the long-term problems have received more attention. more>

Vaccine Greed: Capitalism Without Competition Isn’t Capitalism, It’s Exploitation

Among the pandemic’s many lessons, however, is that greed can easily work against the common good
By Jag Bhalla – DID GREED JUST save the day? That’s what British Prime Minister Boris Johnson claimed recently. “The reason we have the vaccine success,” he said in a private call to Conservative members of Parliament, “is because of capitalism, because of greed.

Despite later backpedaling, Johnson’s remark reflects a widely influential but wildly incoherent view of innovation: that greed — the unfettered pursuit of profit above all else — is a necessary driver of technological progress. Call it the need-greed theory.

Among the pandemic’s many lessons, however, is that greed can easily work against the common good. We rightly celebrate the near-miraculous development of effective vaccines, which have been widely deployed in rich nations. But the global picture reveals not even a semblance of justice: As of May, low-income nations received just 0.3 percent of the global vaccine supply. At this rate it would take 57 years for them to achieve full vaccination.

This disparity has been dubbed “vaccine apartheid,” and it’s exacerbated by greed. A year after the launch of the World Health Organization’s Covid-19 Technology Access Pool — a program aimed at encouraging the collaborative exchange of intellectual property, knowledge, and data — “not a single company has donated its technical knowhow,” wrote politicians from India, Kenya, and Bolivia in a June essay for The Guardian. As of that month, the U.N.-backed COVAX initiative, a vaccine sharing scheme established to provide developing countries equitable access, had delivered only about 90 million out of a promised 2 billion doses. Currently, pharmaceutical companies, lobbyists, and conservative lawmakers continue to oppose proposals for patent waivers that would allow local drug makers to manufacture the vaccines without legal jeopardy. They claim the waivers would slow down existing production, “foster the proliferation of counterfeit vaccines,” and, as North Carolina Republican Sen. Richard Burr said, “undermine the very innovation we are relying on to bring this pandemic to an end.” more>

Updates from Chicago Booth

A new approach to ensuring drugs are safe
Researchers propose a new empirical method for monitoring and evaluating the safety of drugs already on the market
By Sarah Kuta – In May 2007, the US Food and Drug Administration issued a strict warning for rosiglitazone after studies linked the approved diabetes drug to an increased risk of heart problems. Use of the drug plummeted 78 percent in 15 months; annual sales dropped from $3 billion to $183 million.

In 2013, following additional studies of the drug’s safety, the FDA reversed course and removed restrictions on rosiglitazone. But it was too late to undo the damage caused by their initial warning—sales never recovered, and patients had to resort to taking potentially less suitable medications.

The FDA could have prevented this six-year roller-coaster ride if it had taken a more robust, data-driven approach to its postmarket drug surveillance process, suggests research by Southern Methodist University’s Vishal Ahuja, Texas Tech’s Carlos Alvarez, and Chicago Booth’s John R. Birge and Chad Syverson.

Using rosiglitazone as a retrospective case study, the researchers propose a new empirical method for monitoring and evaluating the safety of drugs already on the market. Their approach uses large, relevant, and reliable longitudinal databases and established econometrics methods to assess the relationships between approved drugs and potentially related adverse health events.

This evaluation method could help prevent incorrect drug recalls and warnings that cause financial consequences for drugmakers, confusion among doctors, and potential harm to patients’ health, the researchers argue. more>

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Idea sharing for a new sense of purpose

By Francisco Jaime Quesado – Diogo Vasconcelos, the Portuguese politician who focused his work on innovation and on the fundamental role of ICT and next-generation broadband and who died a decade ago, was a very innovative entrepreneur and social innovator. He believed that society must have the ambition to push for a better future that would be based on the concept of excellence.

Vasconcelos’ message focused on the idea of rethinking and renewing the concept of an open society in which it would transform into a strategic idea that different civilizations, religions and ideas into direct contact with one another.

This agenda of sharing ideas is the point of departure and the point of arrival of a new way for citizens and institutions to create a new contract of trust, as sharing ideas creates a new sense of purpose.

Society will face a new reality post-pandemic, and public policy figures will have to decide on the most suitable strategy for the development of a new agenda for growth. At a time of uncertainty and uncontrolled global financial crisis as a result of the COVID-19 outbreak, an agenda of idea-sharing must focus its attention on launching an agenda of collective intelligence that is centered on effective value creation and citizenship engagement. more>

Only a fully digital Europe can keep up with China and the US

By Ludovic Lassauce – While Europe’s vaccination campaigns are only just getting into full swing, the global race towards post-Covid economic recovery is already underway – and as usual, the European Union is lagging behind. While the European Commission estimates the Eurozone will need another year to return to pre-pandemic growth levels, a surging US economy has reclaimed its former mantle as the engine of global economic activity, while China’s record 18.3% growth rate in the first quarter shows Beijing is well on its way to making up for 2020’s losses.

With his characteristic bluntness, France’s economy minister Bruno Le Maire laid out the stakes of the moment when he asked his EU counterparts this month whether they “want to play in the first league” or otherwise “lag behind China and the US.” While trillions of dollars in stimulus spending have already buoyed the US economy, Europe is still months away from disbursing the €750 billion in recovery funds it promised last year. Commission officials like Paolo Gentiloni and European finance ministers like Le Maire are thus rightly concerned that a simple ‘return to normal’ won’t be enough to keep Europe competitive in the post-pandemic global economy.

Digital silver linings

And yet, as EU leaders prepare to debate the terms of the post-COVID recovery with their new US counterpart at this month’s G7 summit, they can take heart in the progress Europe has made towards a fully digital economy in the midst of a public health catastrophe. Faced with an urgent necessity, European economies made years’ worth of progress in digitalization in mere months. Some of Europe’s least digitalized countries, such as Greece, were able to move the majority of their services online practically overnight, using the pandemic to overcome inertia in the span of just a few weeks.

By insisting EU members allocate a minimum of 20% of their shares of the EU recovery package to digital investment, Brussels has sent a clear message to European governments that their chronic failure to implement future-minded reforms and invest in the latest generation of digital technologies, exemplified by 5G, is no longer tenable. Even if China and the US enjoy an advantage in pure growth, the EU’s “green and digital” approach to the recovery can still shape the global conversation – but only if the EU’s national governments get serious about implementing the digital pledges they have signed up for. more>

Updates from McKinsey

Streaming and royalties in mining: Let the music play on
Renewed growth sentiment among miners’ management teams, combined with the rise of streaming-and-royalty financing over the past ten years, suggests that this particular type of alternative financing could be set for significant expansion over the next decade.
By Scott Crooks, Siddharth Periwal, Oliver Ramsbottom, Elijah Saragosa, and Jessica Vardy – Following the commodity downturn in 2014, many miners were forced to focus on cost-out initiatives, deleveraging balance sheets and returning cash to shareholders who had become disillusioned with the industry’s track record. Growth projects were inevitably over budget (and often behind schedule), and M&A deals were often completed at lofty premiums—but, in hindsight, they often were executed at the top of the market, resulting in value destruction. In the post-boom environment, many mining companies found it challenging to raise capital from either the public-debt or public-equity markets. As a result, many industry commentators predicted the emergence of private debt and private equity. While the growth in private debt and equity has been below expectations, one form of alternative financing that has blossomed has been streaming-and-royalty financing. Expansion in this form of alternative financing, coupled with increasing focus on growth by management teams, leads us to believe that streaming-and-royalty financing is poised for strong growth over the next decade.

Metal streaming-and-royalty contracts are transactions under which mining companies sell future production or revenues in return for an up-front cash payment. There are some distinct differences between the two types. Streaming deals are normally focused on specific commodities produced by a particular project, such as precious-metal by-products from a base-metals project. In return for this up-front cash payment (the “deposit balance”), the streaming partner secures a share of future production at an agreed-upon discounted price, which may be fixed or alternatively a floating percentage of the prevailing spot price. Thus, miners receive payment on delivery for streamed physical volumes. In contrast, royalty deals are normally commodity agnostic and based on overall project revenues; the royalty company never actually “sees” the commodities that the mine produces, but rather just receives a share of the revenue generated (the royalty). In effect, streaming deals are settled by the physical transfer of metal while royalty deals are settled with cash.

Royalty ownership in the mining industry is generally agreed to have originated with Franco-Nevada in the mid-1980s. The mining company’s first royalty investment in 1986 involved spending half the corporate treasury to acquire 4 percent of the revenues from a mine in Nevada owned by Western State Minerals. Following this initial transaction, Franco-Nevada went on to purchase royalties in various other commodities, further developing the mining sector’s royalty business model. The arrival of the precious-metals streaming business model is often attributed to Wheaton River: while seeking to raise funds in 2004 to expand its core business of gold mining, the company conceived the idea of streaming silver by-product from the San Dimas gold mine in Mexico to a new subsidiary company, Silver Wheaton. In the world’s first streaming agreement, Silver Wheaton purchased yet-to-be-produced silver from Wheaton River’s operations in Mexico in return for an up-front payment and additional payments on delivery of the silver. New players have emerged in the past decade in the streaming-and-royalty sector, including Triple Flag in 2016, Nomad Royalty in 2019, and Deterra Royalties in 2020. However, the industry remains very consolidated, with the top three players—Wheaton Precious Metals, Franco-Nevada Corporation, and Royal Gold—representing approximately 80 percent of the total value of streaming-and-royalty contracts as defined by volume of gold equivalent ounces (GEOs). more>

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Updates from Chicago Booth

Take a family approach to genetic testing
By Brian Wallheimer – Knowing whether you’re a genetic carrier for a disease can be invaluable. A patient who learns she’s at heightened risk for breast cancer, for example, may opt for more frequent mammograms or have a preventative mastectomy, potentially adding many happy and healthy years to her life.

The US Preventive Services Task Force currently advises that individuals who have a family history of a disease should consider genetic testing. But taking a family approach to testing, applying one patient’s results to understand the risks to other family members, could generate comparable health benefits at less cost, suggests research by Chicago Booth’s Dan Adelman and Kanix Wang.

In theory, everyone could be tested for a wide array of potential diseases. But that’s a cost-prohibitive proposition, so what’s the optimal testing system? The researchers studied the issue by simulating the testing of 5 million people for the BRCA1 and BRCA2 genes, which are associated with an increased risk of developing breast cancer. The algorithm Adelman and Wang developed can determine who needs to be tested and can rule out the possibility that some family members are at risk on the basis of others’ results.

At $750 per test, an optimal family-testing policy involving these genes alone would add nearly 300,000 quality-adjusted life years to at-risk people over their lifetimes, 3,000 more QALYs than would be added by testing all people who meet the USPSTF’s guidelines, for $500 million less. A QALY is a measure used by economists to tally the quality and quantity of a life, and one QALY equates to a year of perfect health. more>

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A simultaneously expanding and shrinking world

Branko Milanovic warns that the post-pandemic world could see further polarization in a now global labor market.
By Branko Milanovic – A week ago I received an email inviting me to a meeting of economic historians of the Balkans. The association was created several years ago and while I had been interested in joining I never managed to get to any of its meetings. One had to be physically present in Belgrade on such and such a date.

But now, suddenly, with the lockdown, the meeting was held online—and even I, thousands of miles away in Washington DC, could participate. It was held at a convenient time for me and I quite happily logged in. People from different parts of the globe joined. We would likely never all have met in the pre-coronavirus world.

Before the meeting started, I chatted with other attendees and we traded information about how things were at our physical locations. They asked me about life in Washington. I told them what I could see from my home (not much) and on my short daily walks along Connecticut Avenue.

But, they persisted, are the stores open, are people in the streets, are there still demonstrations? I had to confess I had no idea. I lived through last summer’s disturbances, the election-linked demonstrations, the January 6th riots, the inauguration—all of which happened within two miles of my home—but I saw none of it.

It dawned on me as we spoke that, during the pandemic, my world had weirdly changed. On the one hand, it has expanded enormously. I have given talks, interviews and college (even high-school) lectures and participated in panels—not only in Europe and the United States, where I might have done so anyway, but also in China, South Korea, Japan, Malaysia, Russia, Turkey, Argentina, Colombia and Brazil. more>