Tech Tonics

For 20 years, advocates of telemedicine have been trying to break through to common usage. For all of modern human history, those with mental health challenges have held back from seeking treatment due to the stigma associated with doing so. And then, a Chinese bat opened the flood gates. Today we are seeing record usage of telemedicine, especially for mental health needs of all types.

Regular Tech Tonics listeners know our usual approach is in-depth personal interviews with individuals. Today, in light of current events, we decided to take a topical detour into how the coronavirus pandemic has driven vast advances in the use of telemedicine and has brought out into the open the importance of access to mental health treatment. The combination of these things into what we know now as tele-behavioral health, is our topic today. We invited three tele-behavioral health experts serving different populations to join the show and share with us what they are seeing in the new world order; those people are:

Notably, all three of these organizations are experiencing skyrocketing use of their tele-behavioral health products and have seen some surprising customers enter their system. Interestingly, the pandemic has driven a stunning rise in telemedicine, but also a much greater openness to discussing and acting on the need for mental health care. Un-hampered by lack of reimbursement or physician/provider reluctance, these companies’ digital approaches are gaining in popularity in a way that may be persistent post-crisis. And not only are patients enjoying their experiences; they consistently report that access challenges have been markedly reduced as compared to the pre-pandemic era. Imagine that.

Never has the need for mental health care been more acute. The Kaiser Family Foundation notes that “More than four in ten adults overall (45%) feel that worry and stress related to coronavirus has had a negative impact on their mental health, up from 32% in early March.” If one needed more proof of the mental health crisis we are facing, prescriptions per week for antidepressants, anti-anxiety and anti-insomnia drugs increased by 21% between February 16 and March 15, peaking the week of March 15 when the virus was deemed a pandemic. The largest increase was in anti-anxiety medications, according to the report, which rose by 34.1% over that month, in contrast to double digit drops in the use of some of these medications over the previous five years, according to this Fierce Healthcare article.

We are grateful to our guests for their willingness to do the show and even more so for their commitment tackling the issues that are plaguing so many people today. Whether you are an adult, a child, a teen; whether you are someone with serious mental health issues or more common ones; whether you are alone, with your family, or in any other situation, know that there is help out there for you – you can access mental health services 24-hours a day by telemedicine by accessing these three companies and many others.

We are grateful to Manatt Health for sponsoring today’s episode of Tech Tonics—Manatt Health is a multi-disciplinary professional services firm that integrates a full-service law firm with a broad-based strategic business and policy consulting practice to help our clients grow and prosper.  Manatt Health supports the full range of stakeholders in transforming America’s healthcare system.

Show Notes:

Kaiser Family Foundation report on coronavirus impact on mental health

Press Release about Free Access to Mental Health Coaching during the Pandemic

https://abcnews.go.com/US/living-ocd-pandemic/story?id=70237405

Lisa’s article on the dramatic rise in digital health as a result of the pandemic.

David’s interview in Timmerman Report with his brother, Jonathan, a psychiatrist in L.A. who was an early adopter of telemedicine. Jonathan discusses his first-hand experiences adjusting to this technology.

A brilliant and creative cardiac surgeon who went on to become the brilliant and creative CEO of the Cleveland Clinic for 14 years, Dr. Toby Cosgrove surprised many when he was invited back to his alma mater, Williams College, to give a convocation address. As his topic he picked: failure.  In our latest episode of Tech Tonics, we learn more about Toby’s unusual journey, and why, in reflecting on his exceptional career, he chose to focus on such an improbable theme.

Toby grew up in Watertown, N.Y., in a family that emphasized both academics and sports (all of them, it seems); he attended college at Williams, and told us his experience was “terrible.”  He struggled to keep up with the large amounts of reading required, and only later learned that he had dyslexia, a circumscribed defect in “phonological processing,” often seen in the context of exceptional intellect and other talents – the so-called “Sea of Strengths” model. Toby’s described this experience as “terribly dispiriting,” adding “I thought I was dumb.”

Toby persevered, attended medical school at University of Virginia (“the only acceptance out of 13 schools I applied to”), discovered he enjoyed it, and gravitated towards surgery in general, and cardiac surgery in particular.  He completed two years of surgical training then served a year at a military hospital in Vietnam during the war, ultimately receiving  a Bronze Star for his contributions.  He then continued his training in cardiac surgery at Massachusetts General Hospital, where he was helpfully told he was the least talented individual in his residency group and advised not to pursue cardiac surgery – a recommendation he fortunately ignored.

In short order, Toby emerged as an incredibly talented, soon legendary, cardiac surgeon, known for his creative solutions to patients with valvular disease.  Toby says he embraced the mechanical ingenuity cardiac surgery required.

Toby’s rapid ascent through the ranks of medicine culminated with his appointment as CEO of the Cleveland Clinic, where he focused on two areas that were in a sense at the opposite ends of the spectrum: careful measurement and transparent metrics, on the one hand, and a deep commitment to essential intangibles, like empathy, on the other.

After fourteen years, Toby stepped down as CEO; today, among other responsibilities, he serves as an advisor to Google Cloud, and discusses with us his perspective on the role of digital and data in healthcare.

We’re grateful our sponsor, Manatt Health—a multi-disciplinary professional services firm that includes a full service law firm and a broad-based strategic business and policy consulting practice to help clients grow and prosper.  Manatt Health supports the full range of stakeholders in transforming America’s healthcare system.

Show notes:

Famous Cleveland Clinic “Empathy” video, an initiative launched by Toby.

A childhood fraught with illness, loss and uncertainty drove Torrie Fields to an adulthood focused on making these experiences better for others.  Torrie sincerely believes that we are all here for a reason and that her reason to is help people have more dignified, less painful experiences at the end of their lives.

Having learned early in life that you could take nothing for granted and that you really need to show up when things are going in the right direction.  Torrie has parlayed these guiding principles into an accelerated and notable career, culminating in the founding of Votive Health, which she views as a company in the business of making better memories – by that she means, “There is an intimate tie between how you die and how people remember you.” Votive Health is also a company focused on using data and people to help manage the care of patients with serious illnesses.  The company, which is now launching, also works firsthand at the intersection of illness, insurance and employment, which is clearly a critical confluence at this currently challenging time of COVID-19.  Notably, David and I recorded this show well before we knew what was coming on the plague front.  This  show seems particularly relevant now.

Torrie’s early career you focused on emergency preparedness and epidemiology with a special focus on systems design.  This skill set served her well through her time at McKinsey and then later, when she somewhat randomly applied for an actuarial program at Cambia Health Solutions, the parent of Regence Blue Cross Blue Shield and several other companies.  The wonderfully kind and very community-minded CEO of Cambia, Mark Ganz, encouraged employees to seek a special project that was meaningful to them – ultimately this led Torrie to found and ultimately lead Cambia’s palliative care program.  She later joined Blue Shield California to start a similar program. She later joined Blue Shield California to start a similar program.

Torrie discusses the challenges at the intersection of palliative care, end of life vs. the traditional medical and insurance systems, where there are no standard definitions of palliative care, few appropriate payment models, bad program packaging and low prioritization.  Given the current COVID-19 environment, perhaps we will see some changes in that.

We loved having Torrie on the show, as despite what can be a dark topic, she is a perennial ray of sunshine.

We are grateful to Manatt Health for sponsoring today’s episode of Tech Tonics—Manatt Health is a multi-disciplinary professional services firm that integrates a full-service law firm with a broad-based strategic business and policy consulting practice to help our clients grow and prosper.  Manatt Health supports the full range of stakeholders in transforming America’s healthcare system.

Show Notes: 

Dr. Laurie Zephyrin was disappointed to learn that a less-than-rock-star voice was going to stand in the way of her career as a singer, but fortunately she locked onto her healthcare destiny in her teens.  A formative moment in high school set Laurie Zephyrin in the direction of public health and she has never looked back. This path has taken her through the White House, the Veterans’ Administration, into tiny villages in Africa and back to New York City.  Through it all, Laurie is  always seeking to drive towards a high-performing healthcare system, and especially one that effectively meet the needs of underserved populations.

Laurie went to medical school and became an OB/Gyn, heavily influenced by Dr. Jack Geiger at CCNY, who was a leader in bringing the concept of community-based care and the importance of human rights and social determinants of health to the fore.

She spent time after as a White House fellow, assigned to the Veterans Administration to assist with the medical impact of Hurricane Katrina, among other things.  After a stint in community practice, Laurie returned to the VA as the first National Director of the Reproductive Health Program, where she had to undertake a major system redesign to transition a program designed to serve male soldiers to one that served all genders well. In 2016-2017, she became Acting Assistant Deputy Under Secretary for Health for Community Care, and later Acting Deputy Under Secretary for Health for Community Care, managing a $13B budget in a system that was getting a lot of publicity, not always the good kind.

Along the way Laurie became a Robert Wood Johnson Clinical Scholar and then Aspen Institute Health Innovation Fellow (where she met Lisa).  She also earned an M.B.A. and M.P.H. from Johns Hopkins University to augment her M.D. degree from the New York University School of Medicine.

Laurie recently left government to broaden her impact on public health through her leadership role at the Commonwealth Fund, one of the first private foundations started by a woman in 1918. It’s a perfect match in many ways, given The Commonwealth Fund’s mission to promote a high-performing health care system and Laurie’s commitment to improving health for all, but especially women.

Tech Tonics is sponsored by Manatt Health, a multi-disciplinary professional services firm that includes a full service law firm and a broad-based strategic business and policy consulting practice to help clients grow and prosper.  Manatt Health supports the full range of stakeholders in transforming America’s healthcare system.

Taking on challenges is nothing new for Dr. Lynda Chin. It started with learning English well enough in a couple of years to graduate valedictorian of her high school, evolved to a distinguished career as a physician-scientist and then full professor at Harvard & the Dana Farber Cancer Institute, and ultimately led to her current role as founder and CEO of Apricity, seeking to bring digital technology to improve the care of oncology patients.

Lynda Chin’s family emigrated to the United States from China when she was in high school.  Through determination, and with the help of television (she cites “Starsky and Hutch” as her primary vocabulary inspiration), she taught herself English, graduated at the top of her class, and went to college at Brown University, where she created her own major – neuroscience – and conducted research involving echolocation in bats.

Over time, she became interested in molecular biology, attended medical school at Albert Einstein College of Medicine, and continued her training in internal medicine and dermatology, while developing a research program on mouse models of cancer, which she was then recruited to Harvard to pursue.

An unanticipated setback at the lab – a mouse hepatitis virus infection in the mouse facility wiped out her engineered mouse colony, putting much of her research program on hold– led her to focus on the emerging technology of transcriptome profiling at scale.  She adapted it to engineered  mouse tumors for cross-species comparison, and more broadly, to an expertise in translational oncology, which she pursued at both the Broad Institute and the Dana Farber Cancer Institute as part of The Cancer Genome Atlas (TCGA) project.  She was particularly proud of the work in building the genomic data analytic pipeline (Firehose) to enable not only access to but use of TCGA data by the broader community.  She rapidly rose through the ranks to the level of full professor, and was elected to the National Academy of Medicine for her research contribution.

Lynda ultimately decided she was ready for the next challenge: she joined MD Anderson Cancer Center with the idea of creating a forward-looking translation-centered department to develop technology and analytic infrastructure to enable Genomic Medicine.  She was also interested in the promise of AI, and helped set up a collaboration with IBM Watson to explore its application in cancer.  This project surfaced important hurdles for effective and responsible application of AI in the healthcare context.

Lynda is now applying these lessons as CEO of Apricity, a digital medicine company seeking to leverage data and AI to close the gap between promising clinical trial outcomes and the often more disappointing results in real-world care.  She is also championing the importance of pragmatic implementation of AI and other technologies in medicine, a focus of an upcoming conference she is leading in Boston (David is also on the organizing committee).

Tech Tonics is sponsored by Manatt Health, a multi-disciplinary professional services firm that includes a full service law firm and a broad-based strategic business and policy consulting practice to help clients grow and prosper.  Manatt Health supports the full range of stakeholders in transforming America’s healthcare system.

Show notes:

David’s recent Wall Street Journal review of Facebook: The Inside Story, by Steven Levy here.

“AI and Big Data In Cancer: From Innovation To Impact” Conference, March 29-31 in Boston, more here.

Seth Feuerstein’s grandfather was a physician and his parents were both attorneys, so naturally his parents thought he would become…a comedian!  While that didn’t come to be, he did end up as both a doctor and a lawyer who practiced neither discipline full time.  Instead, Seth combined his skill sets to serially create new behavioral health companies that make a real difference.

Always deeply influenced by following his grandfather, an old fashioned family doctor  who went to patients’ homes on the lower east side of New York.  Seth reports remembering how important understanding the family dynamic was and how understanding each person’s personal circumstances was essential to treating them effectively.  He went to college at Cornell and followed that by enrolling in a joint medical school/law school program at NYU that was essentially a program of his own creation. In fact, being the pioneering co-creator of this joint degree program was not his first entrepreneurial experience – Seth had a custom t-shirt business and a baseball card business in his early years; the innovation gene ran deep.

As an aspiring MD psychiatrist and a JD, Seth spent his early career working at the nexus of these fields  – in forensics working for the medical examiner.  When he got his your first full time medical job, as an internal medicine doctor in New Haven, he quickly figured out that he was not meant to be a full time doctor.  He also realized he had a penchant for business that he leveraged into a Yale fellowship in new venture creation, working with the technology transfer office.  He then joined the venture world and had a lucky first win with Histometrics, his first board and formal business experience.

He was soon appointed CEO of Carigent a nano-particle delivery company, but that did not go as planned, in part due to the financial crisis and in part due to his own health crisis.  As a doctor and a lawyer, Seth was misdiagnosed, mistreated, dealt with major healthcare system hassles, and did not have training he needed to engage with his kids about his diagnosis. He realized that there was great opportunity, as well, in engaging around the behavioral health needs of those undergoing care for serious and terminal conditions.  But despite the death sentence that he had been given, Seth was eventually relieved to find that he would recover.  He and his wife, Sharon, started a non-profit, Little Wonder, a non-profit organization dedicated to enriching the lives of patients suffering from cancer by providing them tickets to local concerts, family entertainment, live theater, and sporting events.

But soon Seth was back to scratching the for-profit entrepreneurial itch, starting Cobalt Therapeutics in 2009, a digital Cognitive Behavioral Therapy (CBT) company that was before its time.  Cobalt was acquired by Magellan Health fours later, and Seth became the company’s chief innovation officer.  He remained there until he decided it was time, again, to start something new.

Seth’s latest venture is Oui Therapeutics, a digital therapeutics company focused on treating suicidality.  That company, Oui Therapeutics, is early stage but eager to address this horrific public health challenge. According to Seth, digital therapeutics will thrive as a sector because software can bring patients and clinicians together and refocus the relationship on the right things better handled between patient and computer.  Essentially he sees software as a way to optimize the patient-clinician relationship, enabling the clinician to work at the top of their license and giving the patient the ability to engage in treatment on more flexible terms.

We are grateful to Manatt Health for sponsoring TechTonics—Manatt Health is a multi-disciplinary professional services firm that integrates a full service law firm with a broad-based strategic business and policy consulting practice to help our clients grow and prosper.  Manatt Health supports the full range of stakeholders in transforming America’s healthcare system.

You can donate to Little Wonder.org