The recent signed agreement between One Medical and Amazon regarding the upcoming $3.9 billion acquisition of the primary healthcare firm by the multinational technology company has sparked many concerns, including health privacy and marketing.
“One Medical is a membership-based primary care practice with nearly 200 locations across the country that also offers virtual services. The company had roughly 767,000 member patients as of May,” according to a report by NPR.
“There is a great opportunity to make the healthcare experience more accessible, affordable and even enjoyable, and joining Amazon is a tremendous next step in innovating and expanding access to high-quality, high-value healthcare,” stated One Medical CEO Amir Dan Rubin in the healthcare firm’s website.
However, the deal has to be taken more seriously than face value because of the massive implications to the future of primary care, healthcare delivery, and health equity.
As stated by NPR, One Medical is a membership-based primary care company that charges a membership fee of $199/year, with office locations in mostly affluent areas where consumers live, work, and shop. This concierge-type of primary care service, however, is targeting healthy working individuals rather than low-income and sick patients.
It is a given that Amazon is a data-driven company. Thus, major concerns revolve around access to confidential patient information which could be obtained through a simple waiver or release—a process that not all consumers are privy to.
Data would be used to enhance profits and the only way to achieve that is by limiting choices for patients to lower costs. Thinking about this scenario, Michael Hiltzik of the L.A. Times as well as Katherine A. Gergen-Barnett and Russell S. Phillips of Stat News warn that we should all be afraid. “Very afraid.”
There are two aspects that should be of particular concern. First, the potential prioritization of drug treatments based on Amazon’s drug costs; and second, referral networks (a key part of primary care follow through) which can dictate preferred patterns of expert opinions (including Zoom consultations, as an example).
Fortunately, if approved by regulators, Amazon’s acquisition of One Medical will only have limited impact in overall healthcare delivery in the short term. However, this additional foray into the healthcare system by Amazon will enable the development of new computer algorithms for different healthcare models and reimbursements.
Healthcare is a very complex area—far different from algorithms that select or suggest new items based on your prior purchases. Where these new healthcare algorithms could lead is difficult to fathom.
Can computers and machine learning provide answers to patients?
In his New York Times article, Steve Lohr wrote about David Ferrucci, who led his team in building IBM’s renowned Watson computer.
The IBM researcher was elated when his machine beat the best-ever human contestants of “Jeopardy!” in 2011. However, Ferrucci was also cognizant of Watson’s limitations—it had “no semblance of understanding, no human-style common sense, no path of reasoning to explain why it reached a decision,” wrote Lohr.
Eleven years later, Watson’s deficiencies are still echoed by more powerful artificial intelligence (AI) systems. Now Chief Executive of Elemental Cognition, Dr. Ferrucci has set an “ultimate goal”—that “AI becomes a trusted ‘thought partner,’ a skilled collaborator at work and at home.” Elemental Cognition “combines the latest developments in machine learning with a page from the AI’s past, software modeled after human reasoning,” Lohr explained in his article.
Progress is slow. Computers can still be occasionally erroneous and tell you that a pencil is heavier than a toaster. Elemental Cognition’s plan is to use a hybrid approach—to take the results of deep analyses and then attempt to apply human reasoning to the output.
The model they are using is an around-the-world airline trip in which changes from the human standpoint can be good (such as more stops or shorter layovers) or bad (such as higher costs). With the way things are going, I would say that this model still needs a lot of work!
Patient decision-making is clearly way in the future, although raw data analyses can be provided to real humans to speed up the search for correct answers to simpler problems.
On Wednesday, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the use of updated Moderna and Pfizer-BioNTech Bivalent COVID-19 vaccines as booster doses.
The FDA authorized “bivalent formulations of the vaccines for use as a single booster dose at least two months following primary or booster vaccination. The bivalent vaccines, which we will also refer to as ‘updated boosters,’ contain two messenger RNA (mRNA) components of SARS-CoV-2 virus, one of the original strains of SARS-CoV-2 and the other one in common between the BA.4 and BA.5 lineages of the omicron variant of SARS-CoV-2,” according to the FDA’s press release.
For proper guidance, the Pfizer BioNTech COVID-19 Vaccine, Bivalent, has been authorized for use as a single booster dose in individuals ages 12 and older while the Moderna COVID-19 Vaccine, Bivalent has been authorized for use as a single booster dose in individuals ages 18 and older.
“This is the first time updated COVID-19 vaccines have received emergency use authorization (EUA) in the United States,” states a CNN report.
However, the updated Moderna and Pfizer-BioNTech booster shots can only be administered after an official recommendation is received from the U.S. Centers for Disease Control and Prevention (CDC). The CDC’s vaccine advisory group is scheduled to vote today (September 1) “on whether to support recommending the boosters for use,” CNN further noted.
Additionally, CDC Director Rochelle P. Walensky will need to sign off on the recommendation. Once an official recommendation is made, these updated boosters may then be administered to the elderly (who may have received a booster a few months ago) and to younger individuals who have been ineligible for an additional booster shot during the most recent wave of cases, added CNN.
UPDATE: On Thursday evening, CNN reported that CDC Director Rochelle P. Walensky has signed off on the CDC's recommendation to administer the updated Moderna and Pfizer-BioNTech Bivalent boosters this fall. Earlier in the day, the CDC's Advisory Committee on Immunization Practices voted 13 to 1 in favor of said updated mRNA boosters.
This means that the updated boosters could be available as early as Friday (September 2) as stated by pharmaceutical manufacturers who have started shipping the new doses following the FDA's emergency use authorization on Wednesday, CNN further reported.
An article from the Australian Academy of Science discusses the possibilities of “escaping the slow and steady progression of aging.”
Studies of a particular type of jellyfish that is “biologically immortal” called Turritoposis dohrnii revealed that this creature can turn back time by going back to an earlier stage of their life cycle. Pretty amazing, really! It is like a butterfly going back to the caterpillar stage then evolving into a new butterfly. When triggered by environmental stress, this “immortal jellyfish” can go back into the larva stage (called the planula) and go through the whole life cycle and become a new fully formed adult jellyfish.
Other animals have different tricks for longevity. Lobsters are capable of endlessly repairing their DNA due to a constant and unceasing supply of an enzyme called telomerase which protects the caps of the telomeres at the tips of DNA strands.
Some trees live the longest. Quaking Aspens can live for tens of thousands of years while Bristlecone Pines can live up to over 5,000 years.
For humans, the answers and options are slowly coming in. I do not think that we are capable of doing the jellyfish trick, but considerable research is being done to explore telomerase as a means to extend the life of DNA with more information to come.
How healthcare will evolve is still unclear at the moment. Costs are a key aspect of gaining access to need diagnostics and treatment options. It seems that the involved tech companies will not alleviate this problem and may make an already complex marketplace less equitable and even more difficult to navigate.
Fortunately, day-to-day new advances help bring better outcomes for myeloma patients. The updated COVID-19 boosters will definitely provide better protection. The study of the immortal jellyfish and other long-living animals and plants may produce some surprising answers that may help all of us.
Professor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels, Dr. Brian G.M. Durie is the Chairman of the Board and Chief Scientific Officer of the IMF. Dr. Durie is also the Chairman of the International Myeloma Working Group (IMWG)—a consortium of more than 250 myeloma experts from around the world—and leads the IMF’s Black Swan Research Initiative® (BSRI).
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