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The crisis of Black deaths, the 'invisible kingdom' of chronic illness, & how AI could help patients choose care

October 23, 2023
Reporter, Morning Rounds Writer
Good morning. Let's dive into ideas for ending the Black mortality crisis, one way to fix the U.S. health care crisis, and what might be next for health tech ventures.

healh inequity

What will it take to end the crisis of Black deaths?

Monica McLemoreSTAT

It's a monstrous metric: Over the last 20 years, there have been 1.63 million excess deaths among Black Americans compared to white Americans. "If we continue to have a maternal health crisis, if we continue to have an infant mortality crisis … then we're going to potentially see a situation or circumstance where Black people can be extinct in the future," Monica McLemore (above) of the University of Washington School of Nursing said at the STAT Summit last week. "And as long as I'm around and a whole lot of other people are, we're not going to allow that."

McLemore and other panelists pointed to structural racism and discrimination rooted in the U.S. health system. They also singled out some remedies:

STAT's Anika Nayak has more.


health

Revealing the 'invisible kingdom' of chronic illness

STATSummit_65
STAT

Over her decades-long search for answers about what was happening in her body, Meaghan O'Rourke (above), a journalist, poet, and teacher, struggled for words to describe what she felt. "The image I use in the book — and I invite everyone to imagine this for a second — is a feeling that my body was made of sand and I had to hold it all together," she told STAT's Angus Chen at the STAT Summit last week. 

In her efforts to gain a diagnosis and treatment of what she learned was POTS, hypermobile Ehlers-Danlos syndrome, autoimmune thyroiditis, and more, she saw the failures of the health care system in caring for people with chronic conditions, reflected in her book "The Invisible Kingdom." She told Angus, "alone, people may feel invisible, but really there's so many of us and if we collectively are able to raise our voices and medicine hears us, change can come." Read more.


insurance

Here's one fix for health care woes in the U.S.

MIT economist Amy Finkelstein and her Stanford colleague Liran Einav have an "actually very simple" way to fix the U.S. health care system, Finkelstein said last week at the STAT Summit: Universal basic health care coverage. "We're already paying as taxpayers for universal basic automatic coverage, we're just not getting it," Finkelstein told STAT reporter Bob Herman. "We might as well formalize and fund that commitment upfront."

Such a single-payer system wouldn't involve copays or deductibles, a recognition that financial "skin in the game" through these fees — an approach she once championed — hasn't worked and wouldn't in a future plan she believes must be basic to be sustainable. "We'd all like a private hospital room. We'd all like to get to see the doctor tomorrow," she said. "But our view is that's not part of the social contract of what is actually essential."  Read more.



closer look

Health tech VCs foresee slow growth, consolidation

arrowAdobe 

Investors backing health tech ventures tell STAT's Mohana Ravindranath they're cautiously optimistic for 2024, despite a steep drop-off in deals compared to 2021. Startups selling hospital IT, digital therapeutics, and other health-related services shouldn't abandon hope, they say — but they should expect fewer checks and possible market consolidation. It's a stark change from the industry's investment peak in 2021, when backers wrote checks to U.S. health tech startups for almost $30 billion dollars over several hundred deals, according to Rock Health data. Enthusiasm for virtual care, deep into the pandemic, fueled that hype.

But now they've had a few years to observe those startups' performance, and as investment dollars shrink, they're increasingly savvy about the types of metrics they demand. As competition for funding heats up, winners will demonstrate higher margins and potential to scale their businesses, instead of financial growth, said Andreessen Horowitz health team general partner Julie Yoo. Still, she said, it'll be "harder to distinguish the best tech-enabled services companies from software companies just by looking at their financials." Read more.


health

Hep C treatment at the time of diagnosis worked in street outreach, study says

If you are experiencing homelessness while injecting drugs, being tested or treated for hepatitis C may be hard to achieve. The No One Waits study in JAMA Network Open asked if there's a better way to bring not just diagnosis but also curative treatment to people at the same time. In the non-randomized trial from July 2020 through October 2021, street-outreach providers offered people a test and, if needed, they followed up right away with a simpler treatment plan than typically used: a two-week supply of medications when they got their test results, followed by a 12-week treatment plan.

Among the 87 out of 111 eligible people who chose to start treatment when diagnosed, 69 finished treatment and 58 appeared to be cured after 12 weeks. "The NOW model of care shortened the steps between testing and treatment initiation," the researchers conclude. 


opinion

At its best, AI could enlighten patients about their care

Well, this is discouraging: "There's far more information available today to guide you in betting a few dollars on the performance of your local sports team than in betting your life on the performance of your local hospital," Michael Millenson and Jennifer Goldsack write in a STAT First Opinion. Enter ChatGPT and Bard, its generative AI cousin from Google. Both can pinpoint individual doctors, survival rates at certain cancer centers, or hospital infection rates. But how reliable are they, coming from a tool that sometimes hallucinates?

For now, what if patients could ask their doctors about what AI has told them, as a starting point for a thoughtful discussion?  "AI is set to act as a transparency-forcing function, stripping away information control," the authors write. "It shines a spotlight on the tantalizing possibility of using AI to give patients immense new informational power precisely at a time when AI regulation and legislation have become a policy priority." Read more.


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What we're reading

  • Exclusive: UnitedHealth discontinues a controversial brand amid scrutiny of algorithmic care denials,  STAT

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  • Roche drug slashes recurrence, death risk in lung cancer that afflicts younger patients, STAT
  • The next hot obesity drug won't be approved for years. Online sellers hawk it anyway, Wall Street Journal
  • Study on Amgen's 'bispecific' immunotherapy could lead to approval in small cell lung cancer, STAT

Thanks for reading! More tomorrow,


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