💌 🏥 ‘Exceptionally weak’

"Roe was egregiously wrong from the start. Its reasoning was exceptionally weak..." ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌

PARTNERED WITH   Good morning! This is week 2 of the Hospitalogy x Healthcare Huddle crossover send. As a reminder, this Sunday edition is written 99% by Jared Dashevsky, and I've added a section below about what to expect for Hospitalogy in the week ahead. Let us know what you think as this will continue to be an iterative process. Work with us here! You can subscribe to Healthcare Huddle by itself to get the industry news, insights, and analysis you need every Sunday by clicking here. Huddle up for: The strike down of Roe v Wade. Biogen gives up on their Alzheimer’s drug. Did Cerebral run an Adderall mill? Was this email forwarded to you? Subscribe Here SPONSORED BY SYNAPSE MEDICINE As a med student (me, Jared), my job is to bring good vibes to the team and do thorough medication reconciliations on patients. The former is easy to do, the latter is hard, time-consuming and inefficient. Med students know this and doctors know this.  Synapse Medicine’s platform is streamlining the medication reconciliation process. They’re a physician-first platform, providing physicians with a unique solution to prescribe quickly and safely, especially for complex prescriptions.  Synapse Medicine is hosting a webinar, diving into how their medication reconciliation platform improves patient safety and fosters coordinated care. We can all benefit from a more streamline med rec process. Join Synapse Medicine on May 17th @ 11 AM ET.  For every attendee Synapse Medicine will donate $10 to Carbonfund.org. Register for Webinar POLICY "Roe was egregiously wrong" Leaked documents from the Supreme Court reaffirmed what many expected but wished would never happen: a strike down of the Roe v Wade decision. Roe was egregiously wrong from the start. Its reasoning was exceptionally weak, and the decision has had damaging consequences. And far from bringing about a national settlement of the abortion issue, Roe and Casey have enflamed debate and deepened division. — Justice Samuel Alito Recall that Roe v Wade established a constitutional right to abortion before fetal viability (around 23 weeks) and prevented states from banning abortion. Catch Up Last November, the Supreme Court justices heard arguments over a Mississippi law that bans abortion after 15 weeks of pregnancy with exceptions for medical emergencies or several fetal abnormalities incompatible with life. Jackson’s Women Health Organization—Mississippi’s only abortion clinic—filed a lawsuit to block the law, arguing it was unconstitutional. The lawsuit quickly moved through the courts, landing on the Supreme Court’s desk. Based on the arguments in November, it seemed most Supreme Court justices would vote to uphold the Mississippi law, thereby striking down the Roe v Wade decision. My Thoughts I will die saying this: abortion is health care. To deny access to safe and common abortion procedures before viability is unjust and neglects patient autonomy—a pillar of medical ethics. An abortion procedure is care that is simple, extremely safe and way more common than you think. For example, around one in five pregnancies in the U.S. end in induced abortion. While you may expect abortion rates to decrease once the Supreme Court releases its final draft, they won’t decrease. People will continue to get abortions—it’s just a matter of safety. This is problematic from a health and equality standpoint. Abortion restriction laws are inherently pro-inequality. Take Texas’s heartbeat ban: pregnant people needing an abortion face a 20-fold increase in driving distance to reach the nearest abortion clinic. That’s assuming everyone has access to the transportation (and funds) needed to travel such distances and can afford to take off from work. Companies like Apple, Salesforce and Amazon are being proactive, offering to cover expenses for abortion procedures if the employee has to travel out of state. But, it’s unlikely these employees fall under the “low income” group, missing the populations who’ll suffer the most from restrictive abortion bans. My Predictions Nearly half the country will immediately ban abortion once the ruling is final. I have two predictions: Telemedicine abortion will likely become even more popular since it’s so accessible. Patients will travel across state lines, pick up mifepristone and misoprostol, drive back to their homes and carry out the medical abortion in the comfort of their homes. More progressive states will create “safe havens” for patients receiving abortion procedures and doctors providing them. Look at Connecticut. They’ve already done it. The states that ban abortion will have higher maternal mortality rates than those that protect abortion by law.  HOSPITALOGY THIS WEEK Hospitalogy's Week Ahead Be on the lookout for the Hospitalogy sends this week (Tuesday morning & Thursday mid-day)! Tuesday I'll be following up on staffing firm's earnings reports to see if they match up with hospitals' contract labor narrative that I covered in last Thursday's send. I'll also be diving into the other biggest healthcare stories from the week. Then, assuming there's no insane, crazy story that drops this week, on Thursday I'll be taking a dive into the care platform landscape, starting with Privia, ApolloMed, agilon, and P3 Health Partners. It's a space I want to learn more about too, so let's dive in together to understand the economics of their platforms. See ya Tues & Thurs, Hospitalogy fam.  PHARMA Biogen Throws in the Towel Biogen’s CEO Michel Vounatsos is stepping down after a five-year run. Biogen needs a turnaround. The company’s “revolutionary” Alzheimer’s drug, Aduhelm, was a massive flop, putting a dent in the company’s financials. The Deets The FDA approved Aduhelm in June 2021. While there was a lot of hype around Aduhelm being the first Alzheimer’s drug approved in 18 years, the clinical trial data was shaky. Several FDA advisory committee members ended up resigning, and hospitals across the U.S. said they wouldn’t carry the drug because of its iffy efficacy. Biogen originally priced the drug at $56,000 for one year of treatment but slashed the price in half to $28,000/year after continuous complaints from hospitals (and much of the medical society) that the drug’s high cost was not worth its benefits. To hammer the nail in the coffin, CMS announced it would restrict Aduhelm coverage to patients only in clinical trials, citing insufficient evidence that its use is reasonable and necessary. Biogen’s plan to shake things up in the company, including cutting the Aduhelm commercial team, is expected to save the company around $1B. My Thoughts The medical society, patients and families have long awaited a groundbreaking Alzheimer’s drug. Aduhelm's turnout is a letdown. Unfortunately, Alzheimer’s is only becoming more prevalent in society: the number of people living with the disease is expected to triple from 5.8M to 14M by 2060. Read: an Alzheimer’s drug is desperately needed. My Predictions Biogen will gear up to acquire another biotech firm. They recently sold their equity stake in a joint venture with Samsung Biologics and bought into Roche’s cancer drug mosunetuzumab. Their acquisition capacity was/is expected to increase to $10B. If they don’t make M&A moves, then the next option is to expand their focus outside of the nervous system. This, however, would be a major shift given the company’s mission is centered on neuroscience. DIGITAL HEALTH Cerebral: Digital Health's Icarus Mental health startup Cerebral is under a federal investigation for excessive prescribing of controlled ADHD medication. While their story sounds eerily similar to Purdue Pharma’s, I do think Cerebral had/has the potential to do good for patients. Catch Up Cerebral is a digital mental health startup founded right before the pandemic. The company provides a subscription-based, virtual service for patients to access therapy, counseling and medications for depression, anxiety and ADHD. In response to the pandemic, the DEA quickly adopted policies to allow DEA-registered clinicians to prescribe controlled substances virtually throughout the public health emergency. The Deets Cerebral was in the right place at the right time and saw business boom during the pandemic. They’re now valued at over $4.8B. Given the DEA’s relaxed prescribing rules, Cerebral was able to hire DEA-registered clinicians to evaluate patients for ADHD and prescribe them medication like Adderall. And boy did they (and other similar companies) prescribe: Total Adderall prescriptions jumped 10% to 41.4M from 2020 to 2021. I can’t imagine, though, the true incidence of ADHD diagnoses jumped like that, too. Something’s up. Anyway, Cerebral employees started speaking out, saying the company’s prescribing practices were unethical. The company also aggressively marketed how easy it was to get ADHD treatment (my Instagram was filled with Cerebral marketing). ADHD diagnoses were being made within short, 30-minute appointment slots, and over 50% of patients who subscribed to the company’s service with concerns they had ADHD left with an ADHD diagnosis. That’s a pretty high hit rate, in my opinion. Pharmacies like CVS, Walmart and Truepill started catching on to Cerebral’s prescribing practices and recently cut off Adderall prescriptions being sent from the company. My Thoughts Cerebral has worked to destigmatize mental health conditions like ADHD. Adults who had gone their whole life struggling with attention or hyperactivity but feared seeking help for it could easily get tested for the condition and receive appropriate therapy. This is especially true for women who’ve historically been underdiagnosed. Therefore, I’m sure Cerebral has made a remarkable difference in people’s lives regarding productivity. But now, the company is being scrutinized for essentially being an “Adderall Mill.” Like opioids, Adderall is a class 2 substance because of its high risk of misuse and addiction. Also, like opioid drug makers, Cerebral aggressively marketed its ADHD service. We don’t have any data yet regarding the increased misuse of Adderall. Still, if it mirrors what happened with OxyContin, I’m sure we’ll see something soon regarding its (negative) impact on health. My Predictions I predict the ADHD stigma will return as companies like Cerebral fade out their diagnoses and prescriptions for ADHD. As for Cerebral as a whole, I agree with Blake here: Cerebral will likely increase their focus on depression and anxiety, which they say has been the money maker for them, not so much ADHD. So maybe that will be their secret sauce—an increase in focus on depression and anxiety? Lastly, I imagine the demand for psychiatrists will skyrocket, especially if the DEA doesn’t extend its relaxed prescribing rules post-public health emergency. A trained psychiatrist will do a better job of making an ADHD diagnosis in a clinical setting, especially after sufficient history taking and testing (as opposed to Cerebral’s in-and-out 30-minute visit). OUTSIDE THE HUDDLE Curebase, a platform for decentralizing clinical trials, raised another $40 million. They have the potential to drastically improve the way we do clinical trials by both increasing and diversifying study populations. Telemedicine abortion providers are expecting a huge increase in demand in places where surgical abortions are banned. While our policies are going back in time, these new means of access are a (small) consolation. Medicare Advantage plans are on path to overtake Original Medicare. What does this mean for beneficiaries and for the future of the Medicare program? The Commonwealth Fund released a new, easy-to-read primer on MA. A recent study published in Health Affairs found that the largest increase in telemedicine usage was in disadvantaged neighborhoods. As medical technology has advanced, the long-standing socioeconomic and racial disparities have persisted, so this is an extremely promising finding. A bill to protect healthcare providers from violence is being led by Senator Baldwin D-Wis. Attacks on healthcare providers have become ubiquitous, especially in the ER, and protection on a federal level would be very welcomed. HUDDLE HITS 📺 What I’m Watching: Jon Oliver released another damn-good video on environmental racism, and how both government and industry are failing people of color, and pandas. 🎵 Album of the Week: New album from Bad Bunny, Un Verano Sin Ti 🥂 Healthcare Huddle Happy Hour: Want to mingle with other Huddlers? Come to happy hour on May 19th in NYC. 💙 Mission-Driven Startups: Here’s a thread of some reproductive and women’s health startups that are hiring!! HEALTHCARE JOBS Here are some jobs that I’m curating for the healthcare industry. Use this link to submit your role to be featured if you’re looking to hire. Senior Growth Manager of Health Services, Hinge Health Hinge is looking for someone who has Health Plan relationship management experience as a management consultant, vendor or other partner to lead their growth efforts. If you’re interested in health care and making a difference in people’s lives, and passionate about the intersection of technology and healthcare, then this is for you. Regional Medical Director, Teladoc:  Teladoc is looking for someone who will support the Senior Medical Director with implementing and directing policies and procedures, ensuring exceptional medical quality and service is delivered to patients. Represents focused leadership in the creation of an employed model supporting provider needs, process innovation and provider mentoring.  Senior Manager, Compensation and Analytics, Virta Health:  This role is an opportunity to lead the design and refinement of foundational compensation and people analytics practices, policies and processes in partnership with Virta’s leadership for an organization that is focused on impactful work such as variable compensation standardization. View More → THE WEEK AHEAD Sunday (today): Happy Mother’s Day! Monday: MD+ is hosting a virtual fireside chat with Dr. Aaron Chamberlain, director of the Healthcare Innovation curriculum for medical students at WashU. Topic to be discussed: how medical students can prepare for a medical landscape that is evolving technologically at an accelerating pace. Tuesday: MD+ is hosting another fireside chat with two residents, Dr. Aakash Saraiya  and Dr. Julia Pian, who are pursuing careers outside of clinical medicine. Check it out to learn how to balance a hybrid career in medicine. Wednesday: Join Hurdle Health’s annual Black mental health round table in D.C. where they’ll discuss the Black experience of vicarious racism. Thursday: Do you have a pitch on how to improve care in the ED? Submit your pitch to Pitch ‘EM at StEMI X 2022. Friday: Sorry to remind you, it’s Friday the 13th. Thanks for the read! Let me know what you thought by replying back to this email.  Keeping it simple,  — Jared & Blake     Loving this newsletter? Get in front of 11,000 doctors, nurses, PAs and healthcare decision-makers by clicking below: Partner With Us       Share    Tweet    Share    Forward  Written by Jared Dashevsky and Blake Madden. Workweek Media Inc.  2952 Higgins Street Austin, TX 78722 Want to ruin my day? Click below to unsubscribe: Preferences  |  Unsubscribe