Category Archives: healthcare information

defining success, healthcare information, Uncategorized

A Point on the Horizon Past COVID 19

The rainbow signaled the end of bad times in biblical times. May this one signal the coming of better days once again.

Two doses and time are needed.

We need to be careful and deliberate.  There seems to be a growing sense now there is a vaccine, and we are protected when we get it.  Israel has had issues with people getting infected after the first dose.  It looks like the first vaccine only gives about 50% of the protection needed.  So please don’t go out thinking yourself protected after the first dose.  That is how Israel had a large increase in COVID cases after they started rolling out the vaccines.  From my friend in Israel, they are having problems with people getting the vaccine and thinking they are good to go.  What isn’t in that article is the protection from the second shot is not instant either.  It still seems to take about 2 to 3 weeks after the second shot for full protection to kick in.  That in combination with people thinking they are protected after 1 shot has lead to their recent surge in cases.

In the face of this, we have things like Gov. Hogan demanding MD schools reopen by March 1 or else…However, there isn’t enough of the vaccine to vaccinate the teachers at the moment (even a first dose).  They are being told to try calling again starting Feb 1.  Well, if all of them got their first dose Feb1 and their second dose at the earliest time on Feb 14, they would not get the full protection in time to open March 1.  What do you think are the odds we will get the best case roll out with no days of delay?  This ignores kids as spreaders of the virus to their homes as we learn more about the more contagious variants currently spreading through the U.S. We already lack enough teachers in our schools, especially for special needs children.

We need to be careful.  The end is now in sight, but it is a spec on the horizon, a still distant destination.  At least we now have a direction to progress towards, but we have a long way to to get to heard immunity of 80%.  We need the steady increase of production and distribution of the vaccine.  As the Washington Post editorial today pointed out, Biden’s stated goal of 100 million doses administered in the first 100 days is only 1 million a day.  To reach heard immunity levels of 80%, we would not reach our goal until the summer…of 2022.  The 100 million in 100 days needs to be the start up of an expanding effort to vaccinate our society.    

However, I fear this is another case of the public not understanding the scope of the problem and the project needed to get us to our destination of herd immunity. We hear 100 million and think this is great because it represents a pace faster than we are currently moving. However, this is another case of us not internalizing large numbers.

When I wrote before about our understanding of large numbers, I said the best way I have seen to get us to understand large numbers is either in relationship to another number we kind of understand or as a percent change. So let us look at this aspirational goal in terms of a percent completion towards the goal of herd immunity.

For herd immunity, we need 80 percent of the population to get the shots. We have 330 million people in the U.S. So we need 264 million people to get a total of 528 million doses. If you get rid of that pesky “million” in the doses needed and doses given, suddenly we are left with the daunting thought of progressing 0.18% of the way towards our goal every day. To put it in an easier to digest way, we need 528 days to reach our goal.

I cringe thinking of another year and a half of this covid isolation. Granted, some people have already gotten the vaccine or had COVID 19. So we are not starting our count towards 264 at 0, but we are only a couple steps down the road to where we need to be. We also do not need to make it all the way to 264 before we start reopening. That is simply a safety target. However, we need to make the 100 million in 100 days merely the first step of our run, a step towards getting up to speed. We have a long way to go, and need to be clear our goal is more ambitious than 100 million in 100 days.

So if you have a chance to get us another step towards 264, please take it both for your own health and everyone else’s. Like wearing a mask, it is not just about you. It’s a step towards a healthier society trying to push through COVID19.

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application of logic, complex systems, healthcare information, patient centered healthcare, Uncategorized

Death of Expertise and the Birth of Alternative Facts

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O's fact: "This is a cool pig's head." A's alternative fact: "This is disgusting!" My fact: "Looks like the pig is done, and we are eating well tonight!"
O’s fact: “This is a cool pig’s head.”
A’s alternative fact: “This is disgusting!”
My fact: “Looks like the pig is done, and we are eating well tonight!”

I was recently pointed to an essay on the perception that our country faces a “Death of Expertise.”. The scary part is the article was written in 2014. As we now seem to live in a world of facts and alternate facts, I am becoming more and more aware how limited our perceptions are when it comes to our ability to discern actual reality. The lines blur, and worse the titles we use to convey a sense of expertise are often cheapened by those who benefit from “alternative facts.”

As a patient advisor to the American Board of Internal Medicine, I find this article on the Death of Expertise relevant as we begin to embrace patient centered care. We are looking at the impacts of the patient becoming a partner in their healthcare rather than a subject upon whom the art of medicine is employed to better their health. It’s interesting to me because I find myself frequently commenting to the doctors there is no way most patients know enough to really understand the impacts of a treatment on their health as a whole. We know what we experience, and we tend to assume what did not happen could/would never have happened to us. Many have little or no understanding of likelihoods, especially rare ones. Our minds are not primed to understand such information. As a result, preventative care can be a very hard sell, and it takes only a little bit of fear mongering to send us down an anti-vaccination route.

Of course, our body is a complex system (note: different from a complicated system that it also is). We are still learning the down stream implications of many of the things we do to and with our bodies. I recently gave a presentation to doctors, insurers, regulators and patients on patient generated data and how we can use it. It is “big data,” a term very few understand. Big data is simply data collected from many sources, collected for different purposes and then used as if one data set. We can use it to assert a position or confirm a position, and we are already doing both. We are just in the infancy of understanding how best to use the huge trove of information, and one of the challenges is pulling in most uninformed perspectives into something useful.

The ability to gleam and present such insights is where I predict the next generation of experts will arrive. The best of them will be able to sift out the trash to present and stay current with the overall trends. The hard part is recognizing the limits of our knowledge. The Dunning-Kruger effect is real, and ironically one mentioned at the last board meeting. When it comes to medicine, we have the added frustration coming from double complex system issues around both the complex system that is our health and the overlapping yet distinctly separate complex system that is our emotions about our health and healthcare.

Still, we are coming a long way at a fast pace. As our traditional study based medicine is either directed or confirmed by huge amounts of data, our knowledge is refined faster than ever. Heck at the last meeting, the doctors were talking about the study in Stroke showing an increase in strokes and dementia for people who drink one or more diet soda a day. It was mind breaking to them, and they were shocked by my only mild surprise. I told them I stopped drinking coke zero because my headaches were worse, and when I switched back to regular coke I looked at other patients’ info. I was far from alone across neurological conditions to note worsening symptoms on diet sodas. As a result, I was less surprised than they at a link between diet sodas and neurological issues. My knowledge was not based on a formal study, and I would never present it as fact. However, a smarter person could have made the connection and presented a decent level of proof from expanding the small amount of research I did, and they could present something I would believe as much as my doctor telling me. However, I need the doctor to tell me which of the millions of “facts” and “alternative facts” available to me are most likely to help me feel better and live the life I want to live better. Alas, I do not have the base to make such distinctions well.

That is why I need a doctor. What’s more, that is why I need the term doctor to convey a level of current expertise. It is why I endorse the idea of a body of “experts” who can set a minimum bar to be called an expert in their field. Note that is what the American Board of Internal Medicine is. It is a group of doctors (experts) who say to be accredited with them, a doctor must know X.

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