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Advancing NEMT with Ride Sharing — featuring Megan Callahan of Lyft Business

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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

About Trevor Martin:

Dr. Trevor Martin, Co-founder and CEO of Mammoth Biosciences, is leading the company with the mission to democratize access to CRISPR and affordable and effective diagnostics that enable individuals to better understand their health. To make his vision a reality, Trevor partnered with CRISPR discoverer and pioneer, Jennifer Doudna, and her two recent Ph.D. researchers, Janice Chen and Lucas Harrington along with fellow Stanford Ph.D., Ashley Tehranchi. Since its founding, the team has built the world’s next generation CRISPR platform and the world’s first CRISPR-based diagnostics platform capable of detecting any biomarker or disease with DNA/RNA. To do so, Mammoth has raised $23M from lead investor Mayfield and other influential institutional and angel investors including Tim Cook, Brook Byers, Bob Nelsen, and Jeff Huber.

Trevor kicked off his career in science at Princeton, where as an undergraduate student in Molecular Biology, he began his research career in the university’s Storey Lab. In his time there, he conducted independent research in quantitative biology and was ultimately awarded the top honor for his senior thesis in molecular biology. After Princeton, Trevor went on to complete his Ph.D. in Biology at Stanford University, combining techniques from statistics and genetics and developing methods around mapping the determinants of quantitative traits in both humans and microbes. In addition to having taught multiple courses in statistics at Stanford, Trevor has penned educational guides for university courses across the globe. His work has been featured in outlets like FiveThirtyEight and The Atlantic, and he has been featured on Forbes’ 30 Under 30 list in 2018.

COVID-19 Discussion with Trevor Martin

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I have participated in several group training discussions focused on reducing racism and bias in healthcare. At some point in the training everyone is asked to turn to their neighbor and share how their childhood experiences and family’s viewpoint shaped their perspective on racism. After a few minutes of discussion participants are asked to share a little about their conversation. I know from my own experience that people are very reticent to dig deep to share their real story and want to present the best version of themselves to the group, so I haven’t found the discussion particularly insightful.  Never in those trainings has anyone said that they came from a racist family or that during childhood they wouldn’t sit next to another child who didn’t look like them. In fact, the comments most often heard are, “my family treated everyone the same” and “I don’t see color, I see people”. At first, I didn’t realize the dismissive nature of those comments or how they serve to create inequality.   The light bulb moment that changed the way I think occurred when a wise training facilitator advised that to not see color, and to treat everyone the same is not the goal, nor is it even the right thing to do. The right thing is to appreciate each other for our differences and meet each person where they are to ensure each person has what they need to thrive.   This is a start toward building equity in healthcare. When we don’t attend to important differences between us, and we don’t intentionally create structures which meet each person where they are, we perpetuate systems and policies which are built on a foundation of inequality.  Breakthroughs that bring hope can happen in the darkest of times. Our response to COVID has illuminated the pervasive inequities in healthcare in an unprecedented way, because it came on as an isolated event with enormous data analyzed in real time. This gave us pause to ask, ‘Why?’ Why are Black patients 5x more likely than other races to test positive for COVID? Why is the COVID mortality rate more than 2.5 times higher for Black people than white people? Why are low-income and minority children more than twice as likely than white children to test positive for COVID?  COVID-19 brought focused attention to differences in health outcomes between different populations of people. We must now look beyond the pandemic to the rest of healthcare to understand the harmful impact of implicit bias, racism and disparities brought on through the many social determinants of health.  Healthcare must work to eliminate “systematic differences in health outcomes which arise from the social conditions in which people are born, grow, live, work and age” (Health inequities and their causes, 2018) To eliminate inequalities in healthcare we must attend to those very things that make us different and ensure care considers those differences. Until healthcare has equity at the center, some people will be left out.  Our experience fighting COVID has demonstrated that safe, high-quality, patient-centered care is limited by inequities in how care is delivered. We are fortunate to have technologies focused on improving care delivery. But we must pay close attention to how we design, test, develop, and deploy these new technologies. Take the pulse oximeter, one of healthcare’s most used medical devices. In the few times that I have had to go to the emergency room, such as when I had an anaphylactic allergic response to a dye used during my MRI or when I tore the ACL on my right knee, one of the first steps in my care was the nurse placing the pulse oximeter on my finger to gauge the oxygenation of my blood. Healthy blood oxygenation should fall between 95-100 mm Hg. Anytime blood oxygenation falls below about 95 mm Hg is cause for concern and if it falls below about 90 mm Hg it may be time to receive life-saving oxygen at the hospital.   Pulse oximeters use infrared and red light shined through your finger to measure the oxygenation of your blood. Well oxygenated blood is bright red, while blood depleted of oxygen is dark purple-red in color. Bright red blood absorbs infrared light and allows more red light to pass through than deoxygenated blood. This information coupled with your pulse determines the oxygenation of your blood.   Simple, right? But not so fast, because to “see” your blood the light must pass through your skin. But pulse oximeters are calibrated for light skin, not darker skin, and as a result they may overestimate saturation levels by several critical points. A 2020 study from University of Michigan Hospital found that oxygenation levels were significantly overestimated by the pulse oximeter when compared with the more accurate arterial oxygen saturation in 11.7% of Black and 3.6% of white patients. This device is an important tool for use at home to help COVID patients know when they have reached a level of illness that requires them to go to the hospital. It is also used by clinicians to help assess when it is time to be placed on supplemental oxygen. What happens when the information is not accurate? What decisions are made about patient care based on that information?  This isn’t the first time this problem has been identified. In fact, there are several technologies that depend on color sensing which can contribute to racial bias, including the health monitoring device you may be wearing on your wrist. When we see everyone as “the same” and we aren’t mindful in our development and deployment of medical technologies, we risk perpetuating racism in healthcare.   It is essential that we employ diverse teams of people with different backgrounds including race, gender, age, and culture to research, design and implement new technologies and data informed solutions and proactively ensure the development of unbiased algorithms in AI and ML which appreciate each other’s differences to improve care for all. Silver linings can happen in the darkest of times. What we’ve learned from COVID has opened the door we use to hide structural inequities in healthcare. We need to not only open the door wider, but we must step through the door to fix what is devastating to our communities, our patients, and our workforce.   ReferencesHealth inequities and their causes. (2018). Retrieved from World Health Organization : https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes#:~:text=Health%20inequities%20are%20systematic%20differences%20in%20health%20outcomes,people%20are%20born%2C%20grow%2C%20live%2C%20work%20and%20age. Michael W. Sjoding, M. R. (2020). Racial Bias in Pulse Oximetry Measurement. New England Journal of Medicine, 383:2477-2478. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMc2029240 Oxygenation and Ventilation. (2021, December 16). Retrieved from NIH COVID-19 Treatment Guidelines: https://www.covid19treatmentguidelines.nih.gov/management/critical-care/oxygenation-and-ventilation/ Yash Mantri, J. V. (2021). Impact of skin tone on photoacoustic oximetry and tools to minimize bias. Biomedical Optics Express, 13(2), 875-887. Retrieved from https://opg.optica.org/boe/fulltext.cfm?uri=boe-13-2-875&amp;id=468620

Technology Must Be Intentionally Designed to Appreciate Our Differences

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Physician & Host

As I prepare for my talk on October 28th at HLTH 2019, I’m reflecting on my work as a physician, End Well founder, and palliative care activist. As a clinician, I regularly meet people dealing with serious illness or nearing the end of their life. These moments bring an urgency and focus to getting to know a patient’s goals and values in order to determine the right treatment and care. I am excited to have the opportunity to share how the lens of palliative care, combined with the latest innovations shaping our increasingly customizable world, might transform the entire healthcare experience.  The Broken System  As a hospital-based physician, I’ve witnessed the terrible toll broken systems, miscommunication, and perverse incentives can have on patients and their families. Far too many people end up alone and in pain rather than surrounded by those they love. This is particularly true for those who are at the end of their lives. I have also seen that things can be markedly different when a palliative care team (usually comprised of a nurse, social worker, chaplain, and physician) is involved. When I learned that the data shows the earlier the engagement with palliative care, the longer people tend to live with a better quality of life, I became obsessed with moving the dial on improving perceptions and access to this kind of care. Rather than defaulting to “doing everything we can,” no matter the negative impact on quality of life, palliative care helps people receive the care that’s in line with their individual goals and values. Rethinking the Status Quo When we stop to ask the question, “What matters most to you right now?” the answers can be illuminating. This got me thinking, what if we radically transformed healthcare by shifting from a top-down approach to engaging patients and their families in a completely different way? What if the entire healthcare system was geared toward asking patients one question: What are your goals and values of how you want to live your life? We could then tailor all care based on the answers to that question. To do this, we’re going to have to stop asking “What’s the matter?” and instead start asking “What matters most?” When we do this, the patient-provider relationship becomes truly collaborative. We strive to enhance the patient’s ability to engage with their own care, and as providers, we actively engage with our patients over time. In other words, to start making this shift, we need to start talking more. The Future of Care Thinking about the future of healthcare through this lens requires those of us who are linear, data-driven, and analytical thinkers to step far out of our comfort zones. We must learn and become comfortable with soft skills like communication, empathy, compassion, and cultural awareness—skills that, for the most part, neither our training nor our current system enables or incentivizes. I very much believe that the entire health care system can benefit enormously from engaging with patients in new ways across all aspects of treatment and care. What draws me to make this conclusion through the lens of end of life is that at those final moments, the stakes are so very high. I look forward to seeing all of you at this year’s HLTH and hearing how you think we can transform healthcare for good.

Let’s Start Asking “What Matters Most?” Instead of “What’s The Matter?”

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