Our pre-existing condition

It was as if a couple of guys in their 70s were at the dinner table, ready to bang heads over just about anything. And of course, it was usually Uncle Don who interrupted, throwing a fork of lies into the spaghetti and meatballs, slobbering himself. His mouth was full of venom. Nowhere to turn, nowhere to hide. Said Uncle Joe, “C’mon Man!”

The debate between President Trump and former Vice President Joe Biden was that crazy dinner table. Nixon-Kennedy, geez, they were nice. Remember when it appeared that Nixon was sweating and it cost him votes. Ah, a simpler time. I asked someone if she watched the debate, and she read a bit about it as it was going on, and just went to bed. She didn’t want to interrupt her sleep. They were shouting, and I was listening on the car radio. Later I forced myself to take glimpses of it on my computer screen. Numbers kept jumping up at me despite the turmoil and vitriol, those health-related figures. We’ve got only so many days before we either oust Trump or elect Biden.

The name of this blog is Health Data Buzz and as one of my kids tells me, “Dad, too often it’s not about the numbers.” He is right.

The numbers:

One million.

One million people have died around the world from COVID-19. Tragic, terrible, awful. Sorry, that was a few days ago. It’s now at 1,010,147. according to the Johns Hopkins Data Center. There are 206,494 deaths in the U.S.

There are a mind-boggling 33,785,178 covid cases around the world. It’s been well documented how sluggish and stutter-stepped our response has been. Finally, there is a consensus: wear a mask. Wear a mask. That’s not the only final answer, but its helpful. Our president and some of his — yes, even health officials — don’t wear masks all the time.

Pre-existing conditions

Many people in this country have pre-existing health conditions. They might have cardiovascular problems, diabetes, sleep apnea, any of the long-term or chronic conditions. Medicine and pills are their steady companions as they lean on advice from their doctors. And then they worry as the medical bills arrive. To get better, they are told to reduce stress, breathe deeply — then the medical bills pile up.

Biden says about 100 million people have pre-existing health conditions — and these people could lose their health insurance should the Affordable Care Act be eliminated. Trump says that isn’t the case. The numbers appear to be in the middle, from 53.8 million to 102 million, according to NBC News. citing different studies. The thing is, if the Affordable Care Act is wiped out — and nothing put in its place – millions will lose health coverage, and now at the time of COVID-19, that’s pretty devastating. Trump says he would protect pre-existing coverage, but supports a lawsuit trying to overcome the Affordable Care Act.

COVID-19 has been devastating to Black Americans. Biden cited a figure that 1 in 1,000 African-Americans have been killed because of the coronavirus. Vox confirmed the numbers, referring to a report from the APM Research Lab.

Covid testing, for one thing, has been not equal, which is inexcusable, and that is costing too many lives. And there’s Trump. Having a real chance to condemn white supremacy. He opened his mouth. He could have done it. He didn’t.

For years, the Affordable Care Act was simply called Obamacare because it was enacted under the Obama administration.

I wonder if the name is truly and deeply one of the main reasons why Trump detests the law so much. Just a thought.


And, another nagging number, just rolling around my brain. $750.

If I was another Joe — Biden, that is — I would stamp that $750 all over the place as a campaign slogan. Don’t Trump supporters care about that $750?

Of course, $750 represents the amount of taxes that President Trump paid the year he was elected president. For most of the last two decades he’s paid zero taxes, according to The New York Times.

Yes, the Art of the Tax Avoidance.

There are other kinds of avoidances, too, even deadlier.

In Bob Woodward’s book “Rage,” the famed journalist discloses contents of 18 recorded interviews with Trump.

Trump, in his own words, said that he knew about how bad the pandemic was, but downplayed it — not revealing it until it was too late, according to Woodward’s book.

It’s an outrage. – Joe Cantlupe, Health Data Buzz

In the Lab, Discovery As the World Changes

my story at Academic Pharmacy Now


As data science changes the way drugs are discovered and developed, pharmacy schools are exploring the possible benefits for research and patient care.

At the Quantitative Biosciences Institute at the University of California San Francisco School of Pharmacy, there were hints in January that the world was changing. As the coronavirus pandemic began to emerge on the West Coast, much of academia was on vacation. Inside the QBI scientists scrambled, trying to figure out something massive and unknown: what made the coronavirus tick. Over the next few months, the lab went full bore to examine the intricacies of the coronavirus, spilling its research across three countries and enlisting more than 200 scientists.

QBI Director Dr. Nevan Krogan formed the QBI Coronavirus Research Group, eyeing multiple research projects related to COVID-19. Researchers pooled their expertise in biochemistry, virology, and structural, computational, chemical and systems biology to understand the intricacies of how the coronavirus effectively undermines human cells to replicate itself rapidly, enabling spread to others, and what could be done to thwart it. They began to explore immense possibilities in their research: rapid diagnosis using gene-editing technology to track the spread and evolution of COVID-19, and diagnosing infected patients with no or minimal symptoms.

The researchers tapped into the world of data science, which is constantly evolving and changing the way drugs are discovered and developed and how treatments are delivered to patients. Pharmacy schools are moving forward to be part of this trend, especially in research, where data and computational methods are becoming a major part of pharmaceutical and health sciences.

For Krogan, his around-the-clock work with his research team was an opportunity to embrace research unburdened by bureaucracy and focused on a team approach welcoming to students. “We had a foundation for collaboration, which doesn’t happen overnight. It was expedited in an exciting way,” Krogan said. Noting the progress that the multidisciplinary team made, he said similar academic work “would have taken a year, but it came together in a few weeks.”

As the QBI Coronavirus Research Group set out to uncover the human proteins enabling the coronavirus to spread, it looked at how human and virus proteins interact and studied the clusters they formed. In the meantime, the team identified at least 75 over-the-counter prescription and development-stage drug compounds that they said had the potential to target cellular proteins that are possibly “hijacked” by the virus to promote its spread. The Krogan team, which included 38 scientists, made maps of cells both in healthy and disease states and disseminated the information around the world for other researchers to examine.

Data Opening Doors

“It’s all data-driven, what we piece together in this pipeline, and show how fast it can move,” Krogan said. “We interface and try to find the right targets to have an integrative suite of tools for the underlying biology. It’s sharing across the board and it is done in a more fully open way across academia.“

At the University of Florida College of Pharmacy, Dr. Steven M. Smith, assistant professor, focuses on heart disease, stroke prevention and hypertension control. He also is beginning to examine the coronavirus and possible links to hypertension and its treatment. In his research, Smith aims to “improve the way we inform treatment decisions and interact in multidisciplinary teams in the future through data visualization and clinical support.”

Smith, who is in the pharmacotherapy & translational research department and was AACP’s second NAM Fellow, also runs a family medicine fellowship at Florida and is involved in training. Data flows through many areas of healthcare. It involves interactions with patients, providers and insurers and includes medical records, administrative claims, such as billing and patient pharmacy data related to medication adherence, and even patient-reported outcomes. Fundamental issues in his work include data collection and curation, standardization, privacy and interpretation. Emerging technologies, like artificial intelligence and advanced data visualization, have to account for these issues, he said.

“If you ask 10 different people what data science is you’ll get 20 different answers,” said Smith, noting a longstanding debate over the issue. “People who call themselves data scientists don’t necessarily agree on what that means. I think pharmacy schools are recognizing that it’s important to start integrating this into the profession. Some have had this focus for a while, but others are just beginning to appreciate the importance of bringing data science into pharmacy.”

At the University of Florida, data science and related concepts are not a major focus of the professional Pharm.D. program but are taught in graduate Ph.D. and master’s programs. The graduate programs require students to get coursework in fundamentals of inferential statistics, data analysis and interpretation, all related to but not explicitly framed as data science, Smith said. The university is advancing a large-scale initiative focused on what officials say is making the school a leader in artificial intelligence research and training, including the use of supercomputer technology.

Smith is also interested in using big data sources for developing prediction models, especially related to hypertension studies. The results of blood pressure measurement may differ in so many ways, depending on where the clinicians are: in a doctor’s office, a home or a hospital. Making sense of these data can be challenging. Smith works closely with the Patient-Centered Outcome Research Institute’s PCORNet that aggregates real-world patient data, linking electronic health records, health plan data and patient-reported outcomes within a standardized common data model. PCORnet serves as a repository for data on nearly 70 million Americans receiving care across the U.S. and provides infrastructure for large-scale pragmatic clinical trials, he said. “We have started to push the boundary of the scale, speed and kinds of data that can be collected and use that to try to rapidly answer questions that weren’t previously possible, such as whether certain treatments are better or worse for patient groups that are often excluded from phase 3 clinical trials.”

Building on Existing Capability

Dr. Allen Flynn, assistant professor in the Department of Learning Health Sciences, and a research analyst and technology lead at the University of Michigan Medical School, discusses data science as “essentially the automation of algorithmic data modeling.” And that, he said, is steeped in statistics. At a place like the University of Michigan, “data science is getting a lot of attention and support campuswide these days.”

Pharmacy schools can build on their data science capability, beginning with statistical training, by adding a course in data science and machine learning, Flynn said. “One of the challenges, which is also the case in statistics courses these days, is that data science is pursued with sophisticated software tools that students also need to learn,” he pointed out. As in many areas of healthcare, data can be scattered in different uses, complicated and difficult to scrutinize. “In healthcare, because data are highly fragmented and often productized and commercialized, it can be difficult to find sufficient data to get significant value from data science studies.”

Still, substantial strides are being made, especially with large image data sets, big electronic health record data “and with enormous quantities of streaming data from physiologic monitors,” he said. Michigan Medicine is working to implement models from data science to help predict “sepsis, readmission, [electronic records] utilization and the downward trajectory of clinical worsening.”

I think pharmacy schools are recognizing that it’s important to start integrating this into the profession. Some have had this focus for a while, but others are just beginning to appreciate the importance of bringing data science into pharmacy.DR. STEVEN M. SMITH

Flynn has a long relationship with technology. After he graduated in 1993 with a Pharm.D. from the University of Michigan, Flynn studied computer science. “I am personally interested in using data science to help predict ADEs (adverse drug events) and medication issues. But finding sufficient, high-quality data about ADEs is a real challenge,” he admitted. As data science evolves, so does Flynn with the courses he teaches. He is working to change course content to incorporate data science. “I teach introduction to health informatics and I am sharing with my students what I’m seeing as data science evolves,” he noted. “My course is a survey course and I do not teach data science per se.”

While different schools work various ways through the tributaries of data science, one area is emerging that everyone seems to agree on: it is opening the door for teams to collaborate easily and produce academic studies. Whether it’s data modeling or biostatistics or data security, “I am watching what NIH is doing through the National Center for Advancing Translational Sciences (NCATS) CTSA program, as well as efforts from PCORI, the Patient-Centered Outcomes Research Institute, and OHDSI, a stakeholder collaborative that supports application of large-scale analytics to health data, what some large insurers are doing, and what ‘big tech’ is doing in these areas,” Flynn said.

Team Approaches

As Krogan worked in California with other researchers—remotely—around the world to study coronavirus, the studies bridged what had been longtime gaps. For instance, specialists in cancer and infectious diseases may not have interacted as much, but the effort to understand COVID-19 brought teams together to brainstorm ideas and share experimental information. That’s the stated vision behind the launch of the QBI by Krogan and UCSF School of Pharmacy Dean Dr. B. Joseph Guglielmo. The idea was straightforward: strengthen interdisciplinary research. QBI includes more than 100 research labs as affiliates and has earned more than $70 million in federal research funding from the National Institutes of Health for projects ranging from psychiatry to cancer.

As they explored COVID-19, the level of collaboration that resulted was eye-popping, said Krogan. The UCSF team collaborated with research groups at Mount Sinai Hospital in New York and Institut Pasteur in France and tested drug candidates that were FDA-approved or in development against live coronavirus. Krogan said the academic teams were also collaborating with pharmaceutical companies during the coronavirus studies. In a separate effort at a team approach before the outbreak, the University of California San Francisco and UC Berkeley announced a collaboration with Janssen Research and Development—part of Johnson and Johnson—for a new data science fellowship program that will “explore innovative data-driven approaches to improve human health and train the next generation of leaders in the healthcare data sciences.”

The teamwork offers great rewards in instructing students, illustrating the possibility of shared accomplishments, Krogan said. “Students look at their professors in the labs and if they work with those who are not open to collaboration and worry obsessively about who gets an asterisk on a paper, that trickles down to the student,” he said. “Students can look at what we are doing, at what can happen in collaboration, and how exciting that is. The system has to change not to just reward an individual. Let’s start rewarding groups of people, and this helps young people participating in these groups. The problem with academia is that it’s so siloed, so competitive.” The multidisciplinary team approach exhibited in the coronavirus research “is freeing, a great feeling,” he added. “We are demonstrating how fast we could move if we want it to move.”

The challenge, he acknowledged, “is keeping infrastructure in place for the next thing” beyond coronavirus. “The system can change, and attack not just COVID-19, but breast cancer and other diseases the same way. We can get exciting results.” P

Marking 9-11 Amid a Pandemic

With a complicated present, we are at the vortex of history and the future, figuring out lessons of the past and the present, and the need to recharge our imaginations toward a better, healthier country in years to come, with public health very much a key centerpiece for our direction.

The COVID-19 pandemic is our current harsh lesson. We have more than 6.3 million cases of COVID-19 in the U.S, that have resulted in nearly 200,000 deaths, testimony in part to a failure of our own thinking in evaluating the scope of the disease, trying to get over an initial slow-start response, and the nagging untruths continuing to haunt us from the top.

Bob Woodward’s new book, Rage, was the latest President Trump not-so-funny sideshow. In a Feb. 7 taped call with Woodward, Trump told what he knew about the emerging coronavirus. Much much more than he told the American people.  “You just breathe the air and that’s how it’s passed,” Trump said. “This is deadly stuff.”

Really. Americans were thinking, ok, this will be a flu, just go away, as Trump hinted many times. Left in the dark, many Americans died. Trump said he wanted to play it down. Play it down? At what point do we not tell Americans what we need to know, to survive? Do we not tell them about an impending attack from an enemy?

As we combat this virus, and the headlines rage, we will pause and mark the solemn anniversary on Sept. 11, 2011 when terrorists hatched a plot to bomb the World Trade Center, the Pentagon and a passenger airliner, resulting in more than 2,000 deaths.

The repercussions of the attacks still devastate us, and called into question our thinking of protecting our nation from outside extremists and how naïve we were that the airliner hijackings were of a distant world causing trouble  that couldn’t happen to us.

There are similarities between the COVID-19 pandemic and the 9-11 attacks, notably the immense contributions of those in public health, risking their lives every day.

Public health workers, emergency crews, first responders, physicians and nurses were front and center after the Sept. 11 attacks, working tirelessly amid the chaos of that brutal day, often at the cost of their lives after environmental exposures resulted in adverse effects on their health.

During this pandemic, public health workers are again at the forefront of responding to the relentless outbreaks, working tirelessly, jeopardizing their health and safety, risking their lives.

Since the terrorist attacks, we have taken strides to ensure more safeguards to protect the country from such threats, and some of the ways we have done so – the wealth of security checks at airports, public buildings, for example – are now second nature in our lives.

With that same mindset, we can protect ourselves against COVID-19 until a vaccine is available. We need to improve contact tracing and testing, continue to follow the known techniques to protect ourselves, like wearing a mask or practice physical distancing, and not being around large crowds.

As a country and government, however, we were  misguided in our thinking when we first confronted the COVID-19 virus. We were misguided in our thinking about how safe we were before the terror attacks.

We can change that.  – Joe Cantlupe, Health Data Buzz

Photo by Lars Mulder from Pexels

Covid-19 and the Workers’ Comp Question


From my article at Leader’s Edge Magazine

Some states have passed legislation or imposed regulations that would establish a presumption of workers compensation coverage for COVID-19 claims.

By mid-June, more than 2,800 federal employees filed workers compensation claims for contracting COVID-19 on the job, a number expected to double in a month.

Brokers may best be able to help on the risk management side at this point.

States Enact COVID-19 Workers Comp Legislation

More states are passing legislation and imposing regulations to mandate the presumption of workers compensation coverage for COVID-19, which experts say is unprecedented. Brokers and insurers say the overall situation is in a state of flux, but many predict there will be legal battles ahead.

Even the lowest of estimates of COVID-19 workers compensation claims could result in twice as many awards than in the previous year, according to the National Council on Compensation Insurance (NCCI), which analyzes workers compensation systems. For example, the Department of Labor reported in July that more than 2,800 federal workers had filed workers compensation claims for contraction of COVID-19 on the job as of mid-June, and DOL expected that number to double in a month. Families of 48 federal workers filed death claims with the agency’s Division of Federal Employees’ Compensation.

“The workers compensation system faces significant uncertainty in the years ahead because of the COVID-19 pandemic and resulting economic fallout,” according to Donna Glenn, chief actuary at NCCI, in a recent analysis. “Covid-19 is a shock to the industry, impacting almost every aspect of workers compensation,” the report says.

At a minimum, according to NCCI, “there is a reasonable likelihood for COVID-19 to result in significant [workers compensation] claims costs during the accident year 2020.”

NCCI has listed a wide range of possible workers compensation financial outcomes from the COVID-19 pandemic. For instance, claims payouts for the estimated 86.3 million workers covered by workers comp in the United States could range from $2.7 billion to $81.5 billion. An NCCI report also referred to a wide range of possible compensability rates of 20% to 60%.The presumption laws are creating lots of confusion and have preferred classes of workers,” Wilhelm says. “As the country opens up, it will raise the question of whether new COVID-19 cases arose out of employment risk.


With more people working from home, the overall number of workers compensation claims could fall. But Christine Williams, managing director for the Worker’s Compensation Center of Excellence at Marsh, says there might be “greater [COVID] claims frequency for some industries,” generating higher overall costs and even additional cost burdens of processing such claims. The industries most affected would be those that have continued operating throughout the pandemic.

A Labor Day Tribute to Those Who Work in Public Health. (Ok, Where’s the Funding?)

Day after day, the country’s public health workers – whether working a microscope in a lab or running a health clinic –  focus on encouraging healthy behaviors and wellness. The pandemic has put a greater burden on many of them who really have been engulfed in crisis mode since last winter, working long hours and often with few resources.

They are the local health department leaders, fielding calls, coordinating responses and administering tests for COVID-19,   They are the epidemiologists who map out the virus path and work diligently to put a lid on its spread in a community. They are contact workers who are checking out people worried if they have COVID-19 or other diseases, and get them help if they do. They are restaurant inspectors who make sure eateries open when they should, or shouldn’t. They are the nutritionists, educators and social workers trying to help school districts put together plans for the fall. They are the policy makers and scientific researchers planning for what’s ahead, and occupational  health and safety experts keeping watch on today’s workplace, as physicians and nurses checking our day-to-day pulse.

Public health workers’ efforts, always crucial, are now being magnified with COVID-19, and they are laboring tirelessly and often at high personal risk. As they have been on the front lines of this pandemic from day one, they continue to work in the face of shortages of lifesaving protective gear, gowns or gloves.

Indeed, hundreds of doctors and nurses, hospital administrators, paramedics and custodians  and other public health workers have died as a result of COVID-19, often because they were simply doing their jobs. Many who perished who were people of color or immigrants.

The public health workforce, beset by continual shortages. There may be a shortfall of 250,000 workers by 2020, academic papers show. Congress should pour much more federal funding, especially for state and local health departments, who are working feverishly not only to fight COVID-19 but every emergency we face.

In the U.S. per capita spending on public health is less than 3 percent of all health care expenditures, and that percentage is probably going to drop.

Everyone always calls Labor Day the unofficial end of summer. The pandemic continues, and proper precautions must be taken to prevent the spread and thwart the coronavirus by wearing a mask, be physically distant, continually wash our hands, and be careful about large gatherings.

These are the simple tools that everyone can take to thwart the pandemic.

In the meantime, public health workers are the front-and-center heroes, helping us overcome this crisis a day at a time. – Joe Cantlupe, Health Data Buzz

Photo by Karolina Grabowska from Pexels