Health Care

A Cool Startup Story, Revisited

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In 2005, I posted about a company called Theranos, as part of the “cool startup story” series at  Photon Courier.  The company was founded by Elizabeth Holmes, who left Stanford at age 19 in order to pursue her idea for a quantum improvement in blood testing.  The original focus was on the detection of adverse drug reactions and the analysis of drug effectiveness on a more-individualized basis.

My, how this little company has grown up.  Theranos now has 500 employees and a valuation of about $9 billion.  They can currently perform 200 of the most commonly-ordered blood diagnostic tests, and can do it without a syringe–only a few drops of blood are necessary, and these are obtained from a finger prick using “a patented method that minimizes even the minor discomfort involved with that procedure.” (The Fortune writer tried it, and said “to me, it felt more like a tap than a puncture.”)  Theranos now has a deal with Walgreens, initially making its service available in stores in California and Arizona and with plans to roll the service out to all 8200 Walgreens stores nationwide.

Holmes:

There are a billion tests done every year in the United States, but too many of them are done in the emergency room. If you were able to do some of those tests before a person gets checked into the ER, you’d start to see problems earlier; you’d have time to intervene before a patient needed to go to the hospital. If you remove the biggest barriers to these tests, you’ll see them used in smarter ways.

and

Phlebotomy is such a huge inhibitor to people getting tested. Some studies say that a substantive percentage of patients who get a lab requisition don’t follow through, because they’re scared of needles or they’re afraid of worrying, waiting to hear that something is wrong. We wanted to make this service convenient, to bring it to places close to people’s homes, and to offer rapid results.

From a 2005 Daily Duck post about Theranos:

…in how many nations of the world could A TEENAGE GIRL get a serious audience, and then MILLIONS OF DOLLARS in VC funding, to develop her idea ?!?

There are many unpleasant consequences to American society being perpetually adolescent, a bit shallow and thrill-seeking, with an attention deficit and a naive optimism born of ignorance about the odds, but this type of thing is one of the UPSIDES of being that way.

In America, if you can do, the odds are pretty good that you’ll be allowed to do, regardless of your shortcomings and quirks. We’re flexible and goal-driven, not so much wedded to process.

How many ebola cases before a travel ban is justified?

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The usual formulation for discussing air travel bans is how many ebola cases making it to the US before President Obama is forced to stop air travel to and from west Africa. But there’s another variant of the question, how many ebola cases in the US before others will stop air or sea travel to and from the this country?

I do not think it likely that we will reach such numbers in this outbreak but it’s an interesting change from the usual breathless journalistic speculation of the US imposing a ban. If we don’t keep our house in order, others will isolate us to keep themselves safe.

10/22
Update: Since this post was written the arrival of travelers from the ebola hot zone have been restricted five airports where screening has been put in place and just now the CDC has announced that all arrivals will be under 21 day observation from entry in a sort of loose post entry disease defense regime. If they travel, they need to notify the CDC and they need to call in daily temperature readings and report any ebola-like symptoms. This might work, and considerably reduces the possibility that we will be under travel ban because we let ebola come in and get out of control.

Don’t Panic: A Continuing Series

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[Readers needing background may refer to the first member of this series, Don’t Panic: Against the Spirit of the Age, posted last month. This post, unlike that one, was hastily written due to time constraints involving, perhaps ironically, international travel to a Third World country.]

Constructive foreword: suggested case studies in disruption are the Chicago blizzard of 1/13-14/1979 (~3 million commuters immobilized) and the Milwaukee Cryptosporidiosis outbreak of 3/23-4/8/1993 (~400k residents sickened simultaneously).

Thesis: I argue that, at least with Ebola, inept and overwrought responses pose far greater risks to American society than the disease itself. With regard to managing the risks associated with Ebola in the US, it is vital that we identify easily disrupted institutions and design our processes intelligently to avoid creating bottlenecks, mostly by resisting the urge to overreact; likely candidates include …

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Ebola and the “Open Borders Derangement Syndrome”

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Sometimes looking at politics, the only explanation that makes sense is a personal identity based mental illness affecting the politicians involved.

So, we see this reported —

Texas Health Presbyterian nurse Briana Aguirre criticizes hospital over Ebola response
Nurse speaks out on TODAY Show

Ashley Fantz, Holly Yan and Catherine E. Shoichet CNN
9:54 AM, Oct 16, 2014

“The federal government is weighing putting those who treated Duncan on a list that would prohibit them from being able to fly, an official familiar with the situation told CNN.

In June 2007, federal agencies developed a public health Do Not Board list, which allowed domestic and international public health officials to request that people with communicable diseases who meet specific criteria and pose a serious threat to the public be restricted from taking commercial flights departing from or arriving in the United States. The CDC and the U.S. Department of Homeland Security manage the Do Not Board list. “

So follow me here.

American citizens who have been in the vicinity of an Ebola patient, particularly healthcare workers, would be considered “a serious threat to the public” even though;

1. They have simply been around people with Ebola but,
2. They are not exhibiting signs of the disease.

These individuals (who demonstrate no symptoms of Ebola) may soon be placed on a “Do Not Board List” by the Center for Disease Control and Department of Homeland Security.

Meanwhile, non-citizens, people from West Africa who are now:

1. Surrounded by an “out of control” Ebola virus outbreak,
2. Who are living in countries saturated with Ebola due to its rampant community spread,
3. Who are not now showing symptoms of the disease yet,
4. Are free to travel to America, plus wherever they like to in America without restrictions after they get here.

A sane Federal government would have put all passengers from Ebola Pandemic affected West African nations on a “Do Not Board List” long past. Yet they are not sane, and it gets worse.

Not only is this “American Citizens With Ebola Only “Do Not Board List” a dumb policy that destroys the credibility of the Federal Government in time of crisis when it is needed most. It is law suit bait on equal protection grounds in Federal court. Yet both Obama and Congressional Democrats, plus a few Republicans, support limiting AMERICAN CITIZENS rights to travel, but not that of WEST AFRICANS.

What we are seeing here is the outstanding symptom of a mental illness called OPEN BORDERS DERANGMENT SYNDROME. A mental illness shared by 99.5% of Democrats and the Republican leadership in the US Senate.

A political identity based mental illness now set to kill lots of Americans by Ebola for the sake of cheap immigrant labor now and future Democratic votes later (like 2016 via voter fraud enabled by Democratic Party opposition to Voter ID laws).

3rd Ebola Case in Dallas, Texas

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There is a 3rd case of Ebola in Dallas among the 70 health care workers (HCW) that treated Thomas Eric Duncan at Texas Health Presbyterian Hospital, AKA “Presby” as it is known here in Dallas This makes it 1 on 35 of the HCW exposed to Ebola getting it using the inadequate “any hospital in American can care for an Ebola patient” Center for Disease Control (CDC ) protective personal equipment (PPE) standards, which were not well implemented at “Presby” in any case, see article In statement, nurses at Presbyterian Dallas describe confused response to Ebola case

Short form, it was SNAFU from the word go at Presby and it is likely that Presby is currently facing huge legal liabilities because the CDC ignored the experience of Doctors Without Borders and the health care systems in West Africa which showed that Ebola must be treated by Ebola specialists in separate healthcare facilities.

The Ebola epidemic isn’t a matter of “Medical infrastructure” or “local cultural practices” — the two phrases being liberal terms of art for racism against West Africans in the Obama Administration public health community — it is a matter of treating a biohazard level four pathogen like a biohazard level four pathogen. Bio-hazard four pathogens require a separate medical system to deal with them, prolonged detention for medical screening, travel controls to support those medical detentions and further involuntary quarantine for a positive diagnosis, in other words, a positively controlled, 100% medical screening and detention, border immigration policy a ‘la Ellis Island.

Only a magical thinking “Open Borders” ideological cultist would do any different in ignoring the experience of the one medical organization that has treated the majority of Ebola cases in human history. Which the head of the CDC Dr Frieden now appears to be, in keeping with Obama Administration Central American minor immigration/Public Health Policies (See also the “Unattended Child Border Crisis” and the outbreak of Central American EVD68 in American public schools).

The Obama Administration is risking further epidemics of Ebola because it has done so already with EVD68, in order to increase the number of future Democratic Party voters.

I predict based upon the above, we will see we are going to see Frieden’s firing and/or the cut off of commercial air travel from West Africa to the USA as President Obama’s “Rumsfeld Replacement Moment,” after Republican’s take over the Senate in November 2014. Just in the way that the 2006 Congressional election results moved President George W. Bush to change Iraq War policy with the public disposal and replacement of Secretary of Defense Rumsfeld.

The proximate reason for this is that the “R0” of the Ebola virus in Dallas is 2.0, even with CDC recommended PPE. “RO” — pronounced “ARRH Awwght” in public health speak — means the rate of infection for each newly infected person getting even more people sick. An “RO of 2.0,” causes the doubling of Ebola cases every three weeks (24 Sept to 15 Oct is exactly 3-weeks). That “RO” in Dallas will be higher, and the doubling time will be shorter, as more HCW who attended Thomas Eric Duncan come down with Ebol…thus keeping Ebola and policy for dealing with it as “front page news” or “attracting a lot of eyeballs” right through the 2014 Congressional election.

Sad, but true, the Obama Administration is not as concerned with controlling the Ebola outbreak in Dallas as much as it is concerned with “Controlling the Narrative” about the Ebola epidemic.

Obscuring the reality of the Ebola in Dallas means far more to them in terms of retaining political power, this close to the November Congressional election, as the policy/people/political contradictions of Obama’s Ebola policies are being shown to the low information voters Democrats count on far better than anything Saul David Alinsky ever thought of. As the news of the CDC scrambling to contract 132 airline passengers in Ebola Case #3’s Cleveland to Dallas flight yesterday makes abundently clear.