Oct 7, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. Perhaps I am revealing my age, but I can't understand why anyone thinks that gluing their lip anywhere, let alone to the skin underneath their nose, is a good idea.

Today's word count is 941 words, or ~3.5 minutes.

1 big thing: Medtech's quick-fix addiction

Illustration: Eniola Odetunde/Axios

Some technologists look at the pileup of crises weighing down American health care — overworked doctors, overpriced treatments, wacky health record systems — and see an opportunity to overhaul the industry, which could save lives and make them money, Axios' Kaveh Waddell and Bob Herman report.

Yes, but: There's frequently a chasm between can-do engineers itching to rethink health care and the deliberate doctors and nurses leery of tech that can make their lives more complicated, or worse, harm their patients.

Where it stands: Last year, investors handed more than $8 billion to health tech startups. But the other end of the pipe is mostly dry — relatively few products have integrated deeply into the labyrinthine medical system.

  • Those that do often focus on sideshows like wellness, instead of core issues like caring for the chronically ill.
  • "People are doing things because they can," rather than to address a need, says Ethan Weiss, a cardiologist at UC San Francisco who advises startups.
  • Even thoughtful, relevant solutions run into a money mess — persuading a critical mass of hospitals or insurance plans to shell out for every shiny new tech isn't easy.

High-profile flameouts show what happens when medicine and technology are totally out of sync.

  • IBM's Watson AI system was meant to upend cancer care at MD Anderson. It failed, at times offering "unsafe and incorrect" recommendations, and the partnership was put on ice.
  • An AI startup spun out of Memorial Sloan Kettering Cancer Center is dogged with accusations that it quietly profited off patient data.
  • Theranos and uBiome are their own unique disasters.

At the root of some failures is the way developers approach health care. Some take it on like any other technical puzzle, when it can be orders of magnitude more complex.

Go deeper.

2. Doctors struggle with genetic testing ethics

DNA sequencing is producing vast amounts of data, but researchers and doctors often don't know what it means or what can be done about the information it reveals, the Wall Street Journal reports.

Why it matters: Providers and scientists are grappling with how much information to give patients who have had their genes scanned.

  • Some argue that it's not providers' place to decide to withhold patient information.
  • On the other hand, such information can cause anxiety when it's not "medically actionable," or it can lead patients to get unnecessary or harmful care.

The big picture: Many clinics and studies give patients only a few dozen results that reveal genetic causes for conditions that are treatable.

  • The Mayo Clinic, for example, will look for gene variants that cause heart disease or breast cancer and give those results to patients. But it won't look at variants for early-onset Alzheimer's or Lou Gehrig's diseases.

What we're watching: More providers and research projects are performing broad genetic scans, often for studies or drug development. The question of what to do with the data is only going to become more prominent.

3. Drug companies lure Mexican plasma donors

Mexicans are regularly crossing the border on temporary visas to sell their blood plasma to pharmaceutical companies, ProPublica reports with ARD German TV.

  • Donors can take home up to $400 a month if they donate twice a week, and then earn extra cash through incentives like recruiting friends or family. For some, it's their only income.

Between the lines: The U.S. has less stringent guidelines than other countries around blood plasma donations, allowing them to be done at a higher frequently.

  • Donating too often can hurt the donor's immune system, and the long-term consequences are unknown.
  • The U.S. is the largest global supplier of blood plasma, and 43 of the 805 U.S. donation centers are located along the southern border. Employees at some of the centers estimated that between 60% and 90% of their donors are Mexican citizens.

The legality of crossing the border for this reason — or of collecting plasma from the people who do — is unclear.

  • While U.S. immigration law doesn't allow temporary visas to be used for employment, the plasma companies say that their payments are "compensation," not wages.
4. Trump's immigrant health care crackdown

President Trump last week. Photo: Paul Hennessy/SOPA Images/LightRocket via Getty Images

The Trump administration on Friday issued a proclamation requiring visa applicants to prove they can obtain health insurance within 30 days of entering the U.S. or cover their own health care expenses, Axios' Orion Rummler writes.

The big picture: A recent increase in the number of people without health insurance has coincided with the Trump administration discouraging immigrants from applying for and using government health care programs like Medicaid.

Details: The plan, scheduled to go into effect on Nov. 3, stipulates that if migrants "possess the financial resources to pay for reasonably foreseeable medical costs," they would be exempt from needing documented health insurance.

The impact: The proclamation is a "classic catch-22" for low-income immigrants, Larry Levitt of the Kaiser Family Foundation told Politico.

  • "They will need health insurance to be in the country legally [and] the only way they may be able to afford coverage is with ACA subsidies," Levitt said. "But, if they buy insurance with ACA subsidies, it won't count as insurance under the proclamation."

Background: In August, the Department of Homeland Security published a rule to penalize immigrants who use or are likely to use public benefit programs such as food stamps, housing assistance or Medicaid.

  • Top 2020 Democrats like Bernie Sanders, Joe Biden, Kamala Harris and Pete Buttigieg support providing health care for undocumented immigrants in the U.S.

Go deeper: Fear over Trump's immigration crackdown may be linked to rise in uninsured

5. While you were weekending...
  • Cyberattacks "are pummeling doctors, dentists and community hospitals around the country, causing some to turn away patients and others to close their doors permanently," WSJ reports.
  • The Trump administration would delay any changes if the ACA is struck down in court, and may also try to keep the case from reaching the Supreme Court before the 2020 election, the Washington Post reports.
  • The FDA approved an HIV prevention drug on Friday, but only for men and transgender women — because its maker, Gilead Sciences, only tested it in those groups, NYT writes.
  • Purdue Pharma shifted as much as $13 billion in profits to the Sackler family, according to some states — a much higher amount than was previously understood, Reuters reports.
  • Undark Magazine dives into why there's still no Lyme disease vaccine for humans.
Caitlin Owens