The Economics of Artificial Intelligence: Health Care Challenges
El llibre que cal llegir:
1. Artificial Intelligence, the Evolution of the Health Care Value Chain, and the Future of the Physician
2. The Potential Impact of Artificial Intelligence on Health Care Spending 49
3. Health Data Platforms 87
4. The Regulation of Medical AI: Policy Approaches, Data, and Innovation Incentives
Genomic medicines: the coming waves?
Miro Nature i m'explica l'estat actual de la medicina genòmica, en els seus tres apartats teràpia genètica, oligonucleotids regulatoris i edició genòmica. I diu:
The approval of the pioneering gene therapy alipogene tiparvovec (Glybera) a decade ago fuelled expectations of a subsequent wave of other virally delivered gene therapies. However, these expectations have not yet been realized, and with ~30 setbacks for genomic medicine candidates in the past 3 years (Supplementary Table 1), of which more than 50% were due to safety concerns, the valuation of public genomic medicine companies has fallen significantly.
I aquest és el panorama:
There are ~1,100 active clinical trials of genomic medicines (Fig. 1a). However, only ~20 genomic medicine products have been approved so far (Supplementary Table 2). Together, these treatments currently target <0.1% of the global population with genetic disorders.
Among the three main genomic medicine platforms we analysed, the pipeline for gene therapies is the largest (532 programmes), but regulatory oligonucleotides are the basis for the greatest number of marketed products (11 products marketed for 13 indications) (Fig. 1a, Supplementary Table 2). With regard to disease focus, 53% of programmes overall are for rare diseases; laterstage programmes are also more focused on rare diseases, including more than 80% of marketed products (Fig. 1b). With regard to delivery platforms, the dominant disclosed technologies are adeno-associated virus (AAV) vectors for gene therapies (72% of programmes) and genome editing (30% of programmes), and N-acetylgalactosamine (GalNAc) conjugation for siRNA (Fig. 1c).
I us preguntareu, perquè tant d'èmfasi en els oligonucleotids? Doncs perquè són patentables més fàcilment. I aquí comença una història difícil d'assumir. Determinades indicacions i malalties poden ser objecte de menyspreu investigador en teràpies avançades fruit de que la impossibilitat de patentar-ho. Ens ho hem de fer mirar, quan més aviat millor.
I això és el que hi ha aprovat per ara, mireu la darrera columna, hi trobareu els preus...
the current price of genomic medicines ranges from US$6,500 to $750,000 annually forregulatory oligonucleotides, and $850,000 (for Luxturna) to $3,500,000 (for Hemgenix)for gene therapy with a theoretical one-time dose (Supplementary Table 2). To make genetherapy affordable to patients with rare disorders, and sufficiently competitively pricedfor non-rare diseases to support substantial market penetration, novel reimbursementstrategies are probably needed.
Esdevé fonamental fer una reflexió sobre el moment actual i el que tenim al davant. És massa rellevant com per deixar-ho per un altra dia. Convé copsar quin és l'impacte que tindrà a la salut poblacional i als sistemes de salut.
On the Wireless Microwave Sensing of Bacterial Membrane Potential in Microfluidic-Actuated Platforms
You may remember my posts on Theranos, the company that wanted to solve in vitro diagnostics (IVD) with a drop of blood. The underlying technology was microfluidics, however at that stage was inmature, and finally Theranos was a massive fraud and Elizabeth Holmes is right now on trial.
Now you can read an interesting article in Sensors journal that tries to combine microfluidics and wireless technologies for detecting bacteria. Microfluidics is defined as the manipulation of a fluid in micrometer-sized structures or channels. In such microchannels, the behavior of a liquid is significantly different than at the macroscale. Surface effects and viscosity start to dominate and flows such as laminar flows are more predictable.
If this procedure finally works in practice, it would represent a quantum leap on In Vitro Diagnostics. Time will tell us if this is so.
THE COVID-19 CRISIS. Social Perspectives
In Chapter 13
13 Post-pandemic Routes in the Context of Latin Countries: The Impact of COVID-19 in Italy and Spain by Anna Sendra, Jordi Farré, Alessandro Lovari and Linda Lombi
In terms of health and risk communication, the COVID crisis has emphasised the lack of specific training in crisis and emergency communication of many public sector organisations, including health institutions. This first social media pandemic has been a major challenge for health communicators; individuals often failed in effectively communicating data and numbers to counteract the infodemic and thus reduce the impact of false narratives. With the increasing diversification of social media platforms, ‘individuals’ health […] will be shaped by a multitude of social forces, each of which can mediate different kinds of health contagion processes’ (Zhang and Centola, 2019). Mitigating the spread of fake news seems to involve coordinated efforts between authorities, mass media and digital companies, but it also appears crucial to invest in education and digital literacy for developing a critical awareness of the use of digital technologies that could be useful for facing future health crises. In other words, the strengthening of comprehensive population-centred responses lies on finding answers concerning how the mechanisms of public concern will operate to engage in coherent protection rules or in what ways the forms of interaction will change
Outline of the book:
PART I: INTRODUCTION
1 COVID Society: Introduction to the Book
Deborah Lupton and Karen Willis
2. Contextualising COVID-19: Sociocultural Perspectives on Contagion
Deborah Lupton
PART II: SPACE, THE BODY AND MOBILITIES
3. Moving Target, Moving Parts: The Multiple Mobilities of the COVID-19 Pandemic
Nicola Burns, Luca Follis, Karolina Follis and Janine Morley
4. Physical Activity and Bodily Boundaries in Times of Pandemic
Holly Thorpe, Julie Brice and Marianne Clark
5. City Flows During Pandemics: Zooming in on Windows
Oimpia Mosteanu
6. The Politics of Touch-Based Help for Visually Impaired Persons During the COVID-19 Pandemic: An Autoethnographic Account
Hidi Lourens
PART III: INTIMACIES, SOCIALITIES AND CONNECTIONS
7. #DatingWhileDistancing: Dating Apps as Digital Health Technologies During the COVID-19 Pandemic
David Myles, Stefanie Duguay and Christopher Dietzel
8. ‘Unhome’ Sweet Home: The Construction of New Normalities in Italy During COVID-19
Veronica Moretti and Antonio Maturo
9. Queer and Crip Temporalities During COVID-19: Sexual Practices, Risk and Responsibility
Ryan Thorneycroft and Lucy Nicholas
10. Isol-AID, Art and Wellbeing: Posthuman Community Amid COVID-19
Marissa Willcox, Anna Hickey-Moody and Anne M. Harris
PART IV: HEALTHCARE PRACTICES AND SYSTEMS
11. Strange Times in Ireland: Death and the Meaning of Loss Under COVID-19
Jo Murphy-Lawless
12. Between an Ethics of Care and Scientific Uncertainty: Dilemmas of General Practitioners in Marseille
Romain Lutaud, Jeremy K. Ward, Gaëtan Gentile and Pierre Verger
13 Post-pandemic Routes in the Context of Latin Countries: The Impact of COVID-19 in Italy and Spain
Anna Sendra, Jordi Farré, Alessandro Lovari and Linda Lombi
14. Risky Work: Providing Healthcare in the Age of COVID-19
Karen Willis and Natasha Smallwood
PART V: MARGINALISATION AND DISCRIMINATION
15. The Plight of the Parent-Citizen? Examples of Resisting (Self-)Responsibilisation and Stigmatisation by Dutch Muslim Parents and Organisations During the COVID-19 Crisis
Alex Schenkels, Sakina Loukili and Paul Mutsaers
16. Anti-Asian Racism, Xenophobia and Asian American Health During COVID-19
Aggie J. Yellow Horse
17. Ageism and Risk During the Coronavirus Pandemic
Peta S. Cook, Cassie Curryer, Susan Banks, Barbara Barbosa Neves, Maho Omori, Annetta H. Mallon and Jack Lam
HBR's 10 Must Reads on Platforms and Ecosystems
This collection of articles includes "Pipelines, Platforms, and the New Rules of Strategy," by Marshall W. Van Alstyne, Geoffrey G. Parker, and Sangeet Paul Choudary; "Strategies for Two-Sided Markets," Thomas R. Eisenmann, Geoffrey Parker, and Marshall W. Van Alstyne; "Finding the Platform in Your Product," by Andrei Hagiu and Elizabeth Altman; "What's Your Google Strategy?," by Andrei Hagiu and David B. Yoffie; "In the Ecosystem Economy, What's Your Strategy? ," by Michael G. Jacobides; "Right Tech, Wrong Time," by Ron Adner and Rahul Kapoor; "Managing Our Hub Economy," by Marco Iansiti and Karim R. Lakhani; "Why Some Platforms Thrive and Others Don't," by Feng Zhu and Marco Iansiti; "Spontaneous Deregulation," by Benjamin Edelman and Damien Geradin; "Alibaba and the Future of Business," by Ming Zeng; and "Fixing Discrimination in Online Marketplaces," by Ray Fisman and Michael Luca.
Funding of Pharmaceutical Innovation During and After the COVID-19 Pandemic
Extensive public investments also are being made in therapeutics. The 2 most prominent monoclonal antibodies (by Regeneron and Lilly) have come to market with substantial governmental support for product commercialization. Both products derive from therapeutic research platforms established with governmental support before the COVID-19 pandemic, but product commercialization and manufacturing received major additional investments in 2020. Separately, the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics program has committed $1.5 billion to supporting development of diagnostic tests related to COVID-19. The specifics of the federal contracts largely remain confidential.
Why do they remain confidential?
The lesson of the COVID-19 experience is that, when innovation in the life sciences is imperative, the traditional reliance on pharmaceutical industry prices and profits is jettisoned in favor of governmental grants and procurement. Sustained public funding for product development and commercialization will permit the sustained financing of innovation, a renewed attention to major public health needs, and the global position of the US pharmaceutical industry.
If there is public funding, why there aren't public patents?
Competition in Digital Markets
Imagine you own a company, and you see millions of potential customers for a new product. But there is a problem: all these customers live on the other side of a river and the only way to reach them leads over a privately owned bridge. The owner of that sole bridge either prevents you from passing altogether or charges excessive fees. Long story short, if that is the case, this product line and, potentially, your entire business are doomed.
Digital platforms can behave in that manner because they do not face serious competition. The platforms’ monopoly power mainly stems from network effects—that means the participation of additional users almost exponentially increases the utility of the network and creates enormous market entry barriers for potential competitors. The characteristics of data and algorithms further foreclose the markets.
Google, Amazon, Facebook, Apple, and others behave just like the railroads did 100 years ago. Instead of physical infrastructure, like bridges and tunnels, the digital platforms leverage network effects that shield them from effective competition.
To define the suitable remedies and to open the digital economy for competition, we can learn from the past. In the early twentieth century, the railroads controlled critical infrastructure and excluded competitors from crucial markets. The railroad monopolies rested on enormous investments in physical infrastructure that could not be replicated.
After all these years, a clear message, while the regulator is still on vacation.
Machine Learning Takes Laboratory Automation to the Next Level
Good article on ML applications for microbiology lab.
There are two commercially available Food and Drug Administration (FDA)-approved microbiology laboratory automation platforms in the United States, namely, WASPLab (Copan Diagnostics Inc.) and Kiestra (Becton Dickinson) (6). Each system is highly customizable and consists of front-end processing, “smart” incubation according to laboratory protocol, and plate imaging. The processing unit performs medium selection, application of patient information and barcodes for tracking, medium inoculation, and plate streaking. Automation of these processes cuts down on and improves the consistency of repetitive tasks previously performed by technologists.
Image analysis software is not currently FDA approved, so the algorithm it deploys qualifies as a high-complexity laboratory-developed test when used to make definitive calls about microorganism presence/absence or culture significance. In this context, the end user need not understand the internal workings any more than they understand the inner workings of most computers. Additionally, as with most laboratory software, manufacturer assistance is provided in training the algorithm. Labs may, therefore, validate performance according to familiar sensitivity and specificity (for significant growth), precision and accuracy (for quantification), and procedural variation (coefficients of variation, Kappa statistics). As with any test, revalidation must be performed if components of the test change. The number of samples needed to train the algorithm (hundreds to thousands) will be algorithm dependent but easily available due to their common nature, facilitating both initial and revalidation using new plate images. Validation of machine learning image analysis for laboratory automation may, overall, be comparable to that performed for whole-slide imaging as used in histopathology, where the object of validation is a process as much as a machine (12) and where modest interobserver agreement may set a similarly modest benchmark for machine learning performance.
Eivissa autèntica, Joaquim Gomis
The global business world will eventually divide into two camps—those who adopt their own version of Bezonomics, and those who don’t. Alphabet, Facebook, Netflix, Alibaba, JD.com, and Tencent have built huge, powerful businesses based on their ability to collect and analyze data, and keep applying those learnings to make their businesses smarter and their offerings to customers more attractive. In their pursuit of AI-driven technologies such as voice and facial recognition, the Internet of Things, and robotics, they’re creating automated business models that will crush traditional businesses that fail to adapt to this new world. And the emergence of 5G technology, which will replace our current digital networks, will only widen the gap. Experts predict that this next generation of Internet connectivity will be as much as a hundred times faster than today’s web.A must read. In my opinion, what really brings Bezonomics to healthcare is the largest expression of commercialism. In other words, healthcare built around excedent appropriation, not around the patient. If this is so (and Atul Gawande departure is a signal) then we all have to stand up against this model and create value and platforms based on professionalism.
The impact that Bezonomics is having on society is just as profound. Some of the big tech companies are sowing discord with fake news, interfering with elections, and violating personal privacy. As Apple CEO Tim Cook put it: “If you’ve built a chaos factory, you can’t dodge responsibility for the chaos.” The global wealth gap has become so out of kilter that politicians in America and Europe have singled out Amazon and other big tech companies for blame. These wealth-creation machines have become so efficient at creating riches for their top employees and shareholders that they’re likely to engender more public outrage and become easy targets for regulators—perhaps in some cases even be broken up.
(1) Evidence on handwashing shows that education and information are not enough. Placing hand sanitisers and colourful signage in central locations (e.g. directly beyond doors, canteen entrances, the middle of entrance halls and lift lobbies) increases use substantially. All organisations and public buildings could adopt this cheap and effective practice.
(2) By contrast, we lack direct evidence on reducing face touching. Articulating new norms of acceptable behaviour (as for sneezing and coughing) and keeping tissues within arm’s reach could help.
(3) Isolation is likely to cause some distress and mental health problems, requiring additional services. Preparedness, through activating social networks, making concrete isolation plans, and becoming familiar with the process, helps. These supports are
important, as some people may try to avoid necessary isolation.
(4) Public-spirited behaviour is most likely when there is clear and frequent communication, strong group identity, and social disapproval for those who don’t comply. This has implications for language, leadership and day-to-day social interaction.
(5) Authorities often overestimate the risk of panic, but undesirable behaviours to watch out for are panic buying of key supplies. Communicating the social unacceptability of both could be part of a collective strategy.
(6) Evidence links crisis communication to behaviour change. As well as speed, honesty and credibility, effective communication involves empathy and promoting useful individual actions and decisions. Using multiple platforms and tailoring message to
subgroups are beneficial too.
(7) Risk perceptions are easily biased. Highlighting single cases or using emotive language will increase bias. Risk is probably best communicated through numbers, with ranges to describe uncertainty, emphasizing that numbers in the middle are more likely. Stating a maximum, e.g. “up to X thousand”, will bias public perception.
Digital economics explores how standard economic models change as certain costs fall substantially and perhaps approach zero. We emphasize how this shift in costs can be divided into five types:Its impact in healthcare is starting right now. Platforms that allow communication between physicians and patients leverage such digital environments. However, all these platforms have admitted that personal contact can't be avoided. Right now, digital represents a small part. Everything will not be digital, at least in healthcare.
(i) Lower search costs
(ii) Lower replication costs
(iii) Lower transportation costs
(iv) Lower tracking costs
(v) Lower verification costs
THE DEFINITION
1. A new economic order that claims human experience as free raw material for hidden commercial practices of extraction, prediction, and sales;
2. A parasitic economic logic in which the production of goods and services is subordinated to a new global architecture of behavioral modification;
3. A rogue mutation of capitalism marked by concentrations of wealth, knowledge, and power unprecedented in human history;
4. The foundational framework of a surveillance economy;
5. As significant a threat to human nature in the twenty-first century as industrial capitalism was to the natural world in the nineteenth and twentieth;
6. The origin of a new instrumentarian power that asserts dominance over society and presents startling challenges to market democracy;
7. A movement that aims to impose a new collective order based on total certainty;
8. An expropriation of critical human rights that is best understood as a coup from above: an overthrow of the people’s sovereignty.Last month in my post on the book: Modern monopolies I wanted to highlight the current trend towards monopolies using platforms as a business model. Now you may add a complementary perspective with the book: The age of surveillance capitalism. While the former emphasizes the business perspective, the later focus on behavioral prediction surplus and how it is generated. It provides a social perspective of the current "surveillance capitalism". In my opinion there is a lot of current economy that already confirms this view, it is not a future expectation.
Our lives are rendered as behavioral data in the first place; ignorance is a condition of this ubiquitous rendition; decision rights vanish before one even knows that there is a decision to make; there is no exit, no voice, and no loyalty, only helplessness, resignation and psychic numbing; encryption is the only positive action left to discuss.
Surveillance capitalists take command of the essential questions that define knowledge, authority, and power in our time: Who knows? Who decides? Who decides who decides?As you may imagine, this is a book that once you started it's impossible to stop reading. Highly recommended if you want to understand current hot topics and social trends.
The secret to tech companies’ success lies not in the tech, but in it’s business model. A platform, by definition, creates value by facilitating an exchange between two or more interdependent groups. So, rather than making things, they simply connect people. The book helps you understand what made these companies so successful, how to tell a good platform from the bad, and how you could build one tooAnd by definition, platforms are the new modern monopolies different from the ones we have known.
Although monopolies get a bad rap, they’re not always a bad thing. In the short term, modern monopolies are often a boon to consumers. They bring valuable new inventions to market, and, in the case of platforms, they build new communities and markets that would not exist otherwise. The downside comes much later, as the monopolist ages and starts to crowd out potential new competitors without delivering new value.Today Amazon is the most valuable company in the world. That's it. Let's wait for the downside. It may be too late to react. Regulators should read today Jean Tirole and apply his recommendations.
So where should you be looking to next? Well, there are a few industries where the three factors are starting to converge
The first industry is health care, which we’ve touched on at several points in this book. Here you have platforms connecting doctors and patients in new ways, like Doctor on Demand, Teladoc, and ZocDoc. However, these platforms are just going after the low-hanging fruit. There’s still a tremendous amount of waste and inefficiency in the healthcare sector, especially in the United States. And wherever there’s waste and inefficiency, there’s a platform opportunity. For instance, although they’re relatively popular with casual consumers, wearable health devices are just starting to make their way into formal health care. These devices offer tremendous potential for improving patient wellness. But in order for them to be useful, a platform will need to build a unified network of doctors and patients. Despite the recent entrance of Silicon Valley heavyweights Apple and Google, this market is still wide open.
