Category Archives: Articles

Is Someone Stealing Your Health Data?

Facebook and others are turning your personal health information into a hot business commodity

From my article in the August 2018 issue of Men’s Journal

When the news broke that Facebook had allowed third-party apps to harvest troves of data from its users to influence U.S. elections, people (rightfully) freaked out. Now here’s something else to worry about: Facebook and others are turning your personal health MensJournalHealthDatainformation into a hot business commodity. Facebook and others have reportedly been looking into selling user information to hospitals and medical institutions eager to identify patients and build digital profiles that might include diagnoses, tests, prescriptions, and even sex-drive data.

This health data can be found in your posts, app downloads, fitness trackers, and phone activity, where it can be gathered and sold. And what Facebook has attempted to do is only a snippet of the kinds of health privacy violations hanging over the online world….Read more

What If Elon Musk Succeeds?

Everyone is fixating on whether Tesla can succeed—and ignoring how that success could drive us closer to a future of jobless automation

From my cover story in the August 17, 2018, issue of Newsweek

NwswkMuskCover180817Elon Musk has been making a habit of shocking. Tuesday afternoon he tweeted that he was ready to take publicly held Tesla private, and trading had to be halted as everyone from investors to the SEC tried to figure out if the Tweet was a weed joke (given the 420 reference), a potentially illegal effort to manipulate stock price, or a genuine financial disclosure of unheard-of magnitude and form.

That was just the latest Musk surprise. During a conference call with Wall Street investment analysts in May he refused to answer basic questions about Tesla’s faltering financial prospects. “Boring, bonehead questions are not cool,” he said. A few months before, he treated his 22 million Twitter followers to harassing rants against reporters who published critical pieces about Tesla.

But if you’re focusing on Musk’s bad manners, you’re missing the point. His plan to transform the car industry is picking up speed. Along the way, it could put tens of millions of people out of work, dismantling what has been a foundation of the nation’s social and economic life for a century. And it’s happening in the service of plying the wealthy with cooler cars. Read more

Should You Let Your Kid Play Football?

The truth about concussions is more nuanced than most of what we’ve heard 

From my article in June 2018 in Men’s Journal

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What the public has heard about research into chronic traumatic encephalopathy—the degenerative brain disease that seems to be caused by repeated blows to the head—suggests that suffering concussions as a kid is likely to cause depression, memory problems, and violent behavior years later. But what if this new conventional wisdom doesn’t get it quite right? Christopher Giza has been calling for a bit of calm and context. A pediatric neurologist who heads UCLA’s BrainSport program, Giza is one of the world’s leading experts on concussions in contact-heavy sports. Before you pull your youngsters from football—or sign them up for it—Giza has some advice. Read more

Health Care’s ‘Upstream’ Conundrum

When it comes to the long-term health of the country, findings now show the big problem might not be health care at all—it might be everything else. Can researchers get politicians to pay attention?

From my article in January 2018 in Politico

At the heart of America’s vaunted health care system is a frustrating puzzle. The United States pays three times as much per citizen as the average of other wealthy nations—far more than even the second-highest spender, Switzerland, adding up to $3 trillion a year. Yet for all that enormous expenditure, we come in dead last among those nations in lifespan. And as the bills climb, our life expectancy is actually shrinking.

What’s going so wrong? If our national health care were a corporation, that return on investment would get its CEO immediately fired. Plenty of experts are ready to point fingers at various causes: our lack of universal health care, industrialized food system, PoliticoUpstreamsuburban lifestyles, and profit-driven tangle of insurers and drug companies and hospitals. Surely those play a role. And yet other countries face each of these, and other challenges as well, and still manage to spend less and enjoy better health overall.

Looming over the American conversation about public health is a growing suspicion that there’s a bigger reason for our uniquely poor showing, one that has been staring us in the face for years. It’s an explanation rooted in one simple statistic: While we pay more for health care than any other country in the world, when it comes to spending on social services—education, subsidized housing, food assistance and more—we rank in the bottom 10 among developed countries.

It’s easy to think of “health” as just another category of social-service spending. But a great deal of modern research suggests that it might be more accurate to think of it as the payoff of all the other services put together. Elizabeth Bradley, president of Vassar College and a former Yale researcher widely seen as the world’s foremost expert in the relationship between social services and health, has documented how the ratio of a country’s social-service spending to health care spending is highly correlated with health outcomes around the world. “The right question for our political agenda is, ‘What’s going to give us the most bang for the buck in health outcomes?'” says Bradley. “What our work has shown is that the answer is spending on social services.” Read more

The missing Alzheimer’s pill

America faces explosive growth in chronic disease, but our drug system is set up to fail in fighting it. What needs to happen?

From my article in December 2017 in Politico

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If there’s a dream of what a new drug is supposed to do, it might look something like Kalydeco. In 2012, the new light-blue pill from Vertex Pharmaceuticals rocked the world of cystic fibrosis, a fatal disease that affects 30,000 people in the United State. It’s best known for its attack on the lungs, slowly suffocating its victims while attacking other organs—but when patients got the drug in its experimental phase, some started reporting such enormous improvement in their breathing and energy they were able to take up running, even marathoning.

Kalydeco is emblematic of the promise of new approaches in drug development. Built on a new understanding of how a particular defect in a gene can disrupt the workings of the body, the drug zeroes in on critical proteins inside cells to keep them functioning. “The drug was so good it broke the blind,” says Bernard Munos, a senior fellow at FasterCures, a think tank based at the Milken Institute—meaning the positive trial results were so clear that patients and doctors could easily tell who was receiving the drug and who got a placebo.

At the same time, Kalydeco serves as a cautionary tale. “The results for the patients it helps are absolutely spectacular, but those patients are only a sliver of the population with the disease,” says Munos. If you haven’t heard of Kalydeco—and you probably haven’t—that’s because this drug, which costs the U.S. health care system nearly half a billion dollars per year, currently helps fewer than 2,000 American patients.

The drug-development system that produced Kalydeco is one of proudest achievements of American medicine, and one of our biggest investments as a society. When American leaders talk about “innovation” in health care, they’re largely talking about the development of new pharmaceuticals. But as America looks squarely at the biggest health challenges of the future, there’s reason to worry that the system we’ve built may not be adequate to what’s in front of us. When it comes to the two diseases likely to become our biggest killers— Alzheimer’s and diabetes—death rates are relentlessly ticking up, with few solutions on the horizon. Read more

A Reality Check for IBM’s AI Ambitions

IBM may have overhyped its Watson machine-learning system, but the company still could have the best access to the kind of data needed to make medicine much smarter.

From my article in the July/August 2017 issue of MIT Technology Review

Paul Tang was with his wife in the hospital just after her knee replacement surgery, a procedure performed on about 700,000 people in the U.S. every year. The surgeon came by, and Tang, who is himself a primary-care physician, asked when he expected her to be Watsonback at her normal routines, given his experience with patients like her. The surgeon kept giving vague non-answers. “Finally it hit me,” says Tang. “He didn’t know.” Tang would soon learn that most physicians don’t know how their patients do in the ordinary measures of life back at home and at work—the measures that most matter to patients.

Tang still sees patients as a physician, but he’s also chief health transformation officer for IBM’s Watson Health (see “50 Smartest Companies 2017.”) That’s the business group developing health-care applications for Watson, the machine-learning system that IBM is essentially betting its future on. Watson could deliver information that physicians are not getting now, says Tang. It could tell a doctor, for instance, how long it took for patients similar to Tang’s wife to be walking without pain, or climbing stairs. It could even help analyze images and tissue samples and determine the best treatments for any given patient.

But lately, much of the press for Watson has been bad. A heavily promoted collaboration with the M.D. Anderson Cancer Center in Houston fell apart this year. As IBM’s revenue has swooned and its stock price has seesawed, analysts have been questioning when Watson will actually deliver much value. “Watson is a joke,” Chamath Palihapitiya, an influential tech investor who founded the VC firm Social Capital, said on CNBC in May.

But if Watson has not, as of yet, accomplished a great deal, one big reason is that it needs certain types of data to be “trained.” And in many cases such data is in very short supply or difficult to access. That’s not a problem unique to Watson. It’s a catch-22 facing the entire field of machine learning for health care. Read more

How Your Suburb Can Make You Thinner

Inside the new movement to engineer healthier lives for Americans by rethinking the places they live

From my article in May 2017 in Politico

To appreciate the classic American town, go to Europe. The narrow streets of most European cities and towns meander past a parade of tightly packed homes, cafes, shops, markets and parks, all teeming with people on foot. Today, we think of this buzzing pedestrian existence as the kind of quaint thing you plan a vacation to experience. It used to be daily life for Americans too, says James Sallis, a public-health and behavioral medicine researcher at the University of California, San Diego—right up until the early middle of the 20th century, when we started rebuilding the American community around PoliticoSuburbthe automobile. “People liked riding in cars, and so we got the suburbs,” he says. “Now everybody has privacy, quiet and space.”

What they also got, Sallis adds, was fat and unhealthy. Suburban Americans came to build their lives around sitting—sitting on the sofa, sitting at an office desk and, most of all, sitting in the car. The car became essential, increasingly so as work shifted from the local factory to offices in the city; as the local butcher, baker and grocer were replaced by more distant supermarkets; as malls three towns over pulled business from local shops. Kids went from meeting up with friends at nearby playgrounds or soda shops to being shepherded in a car from school to math tutoring to tae kwon do to soccer practice. Lost along the way were the daily walking and biking that used to get people from place to place in their self-contained communities.

This loss might not be worth mourning as more than the march of progress, if it weren’t for the bonus it had quietly been delivering. We now have decades of ever-growing, nearly incontrovertible evidence that moving our bodies on a regular basis is a very healthy thing to do, and the loss of this habit in America has taken a horrific toll. Eight hours or more a day of sitting nearly doubles the risk of Type 2 diabetes and sharply increases risks for heart disease, cancer and earlier death, according to research from the University of Utah and the University of Colorado. The average American sits more than nine hours a day.

If people can’t be cajoled to walk for its own sake, is there another way to get them moving? In recent years, planners and policymakers have begun to pull back and consider another solution: If suburbs are the problem, maybe suburbs can be re-imagined as the solution. People drive because their neighborhoods encourage it—and sometimes even leave them with no choice. What, then, if their neighborhoods were built to foster walking? With the right layout and development, the notion goes, our suburban towns and sprawling new cities might become havens of human-powered rather than petroleum-fired motion. Along the way, health should soar. Read more