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A dish of living brain cells has learned to play the 1970s arcade game Pong.

About 800,000 cells linked to a computer gradually learned to sense the position of the game’s electronic ball and control a virtual paddle, a team reports in the journal Neuron.

The novel achievement is part of an effort to understand how the brain learns, and how to make computers more intelligent.

“We’ve made huge strides with silicon computing, but they’re still rigid and inflexible,” says Brett Kagan, an author of the study and chief scientific officer at Cortical Labs in Melbourne, Australia. “That’s something we don’t see with biology.”

For example, both computers and people can learn to make a cup of tea, Kagan says. But people are able to generalize what they’ve learned in a way a computer can’t.

“You might have never been to someone else’s house, but with a bit of rummaging and searching you can probably make a decent cup of tea as long as I’ve got the ingredients,” he says. But even a very powerful computer would struggle to carry out that task in an unfamiliar environment.

So Cortical Labs has been trying to understand how living brain cells acquire this sort of intelligence. And Kagan says the Pong experiment was a way for the company to answer a key question about how a network of brain cells learns to change its behavior:

“If we allow these cells to know the outcome of their actions, will they actually be able to change in some sort of goal-directed way,” Kagan says.

To find out, the scientists used a system they’ve developed called DishBrain.

A layer of living neurons is grown on a special silicon chip at the bottom of a thumb-size dish filled with nutrients. The chip, which is linked to a computer, can both detect electrical signals produced by the neurons, and deliver electrical signals to them.

To test the learning ability of the cells, the computer generated a game of Pong, a two-dimensional version of table tennis that gained a cult following as one of the first and most basic video games.

Pong is played on a video screen. A black rectangle defines the table, and a white cursor represents each player’s paddle, which can be moved up or down to intercept a white ball.

In the simplified version used in the experiment, there was a single paddle on the left side of the virtual table, and the ball would carom off the other sides until it evaded the paddle.

To allow the brain cells to play the game, the computer sent signals to them indicating where the bouncing ball was. At the same time, it began monitoring information coming from the cells in the form of electrical pulses.

“We took that information and we allowed it to influence this Pong game that they were playing,” Kagan says. “So they could move the paddle around.”

At first, the cells didn’t understand the signals coming from the computer, or know what signals to send the other direction. They also had no reason to play the game.

So the scientists tried to motivate the cells using electrical stimulation: a nicely organized burst of electrical activity if they got it right. When they got it wrong, the result was a chaotic stream of white noise.

“If they hit the ball, we gave them something predictable,” Kagan says. “When they missed it, they got something that was totally unpredictable.”

The strategy was based on the Free Energy Principle, which states that brain cells want to be able to predict what’s going on in their environment. So they would choose predictable stimulation over unpredictable stimulation.

The approach worked. Cells began to learn to generate patterns of electrical activity that would move the paddle in front of the ball, and gradually rallies got longer.

The brain cells never got that good at Pong. But interestingly, human brain cells seemed to achieve a slightly higher level of play than mouse brain cells, Kagan says.

And the level of play was remarkable, considering that each network contained fewer cells than the brain of a cockroach, Kagan says.

“If you could see a cockroach playing a game of Pong and it was able to hit the ball twice as often as it was missing it, you would be pretty impressed with that cockroach,” he says.

The results hint at a future in which biology helps computers become more intelligent by changing the way that they learn, Kagan says.

But that future is probably still a long way off, says Steve M. Potter, an adjunct associate professor at Georgia Tech.

“The idea of a computer that has some living components is exciting and it’s starting to become a reality,” he says. “However, the kinds of learning that these things can accomplish is quite rudimentary right now.”

Even so, Potter says the system that allowed cells to learn Pong could be a great tool for doing research.

“This is sort of a semi-living animal model that one can use to study all sorts of mechanisms in the nervous system, not just learning,” he says.

A few brave professionals have publicly shared their journeys with bipolar disorder — including psychologist Kay Redfield Jamison, physician Justin Bullock and entrepreneur Andy Dunn. Recently, while serving as California’s Acting Surgeon General, I chose to join their ranks.

To help dispel stigma and to spread hope, I shared my own long path to diagnosis and recovery in a National Alliance on Mental Illness conference keynote speech, social media messages and a personal essay in the LA Times.

Despite my early fears that having bipolar disorder would forever derail my path, I shared that I now attribute much of my professional and personal success to the lessons I took from my mental health journey.

This disclosure reached millions, and has brought me the gift of dialogue and deep kinship with hundreds of people touched by mental illness who’ve reached out to me — many of whose voices sound like mine from years past.

Many wrote that they have never seen someone in a high-profile public role with a serious mental illness speak out. Some, in the midst of the hardest parts of their own journeys, wrote that my words were “live-saving” and had helped them feel less alone, ashamed and hopeless.

I’ve been in tears at the vulnerability people have shown me and their raw, all too recognizable truths.

For instance, one parent described their teenage daughter’s struggles with bipolar disorder:

“It has been a difficult journey for us and her,” they wrote. “Thank you… for making us feel a little less alone and giving us hope that [our daughter] has a beautiful life ahead!”

My most fervent hope — and the reason I chose to “come out” — had been precisely to reach those still finding their paths to recovery. To help them know that there is a way forward. That a difficult diagnosis or a long period of struggle does not preclude living out their dreams — to hold out hope that with the right treatments, a full life is possible.

The stakes couldn’t be higher. More than one in five American adults lives with a mental health condition — and about one in twenty has a serious mental illness like bipolar disorder — with rates soaring during the pandemic. And it can take years to receive the right diagnosis and find the right treatments that return us to our full functioning and potential. While suffering, we’re at increased risk for dying 10 to 20 years earlier, including by suicide or from chronic conditions like heart disease.

Stigma and its cousin, internalized shame, end up compounding the many difficulties on the road to recovery, leaving us to believe that we are undeserving of help and alone in our struggles — and leading to discrimination in the workplace and in opportunities and access to care. Many find the experiences of stigma and discrimination to be more painful than mental illness itself. In fact, in part because of stigma, more than half of adults with mental illness are not in treatment.

Sharing our stories allows us to chip away at this stigma and spread an understanding of the commonalities in our experiences — that with treatment, positive outcomes are not only possible, but likely.

But the messages I’ve received have underscored just how much further we have to go in achieving equal access and acceptance for mental health treatment as for physical health.

One business professional of Indian origin wrote of the stigma bordering on taboo that limits access to treatment in our culture.

“Growing up in India, speaking about mental health was traumatic, and I’ve seen family members in significant pain who were never able to ask for or seek help,” she wrote [emphasis added]. “My mother, now deceased, would have [benefited] had she known she could have asked for help, been treated, and lived a fulfilling life.”

Like former me, countless others today are not free to live as their full selves free from discrimination and unfounded judgment blemishing their careers.

“I’ve been told by bosses and others that I don’t have potential because of what I struggle with, and I’ve ended up internalizing it,” wrote one woman.

I also heard from scores of health professionals, who are particularly prone to hide their diagnoses and not seek treatment for them.

Stigma is embedded directly in regulatory processes in medicine like those of state licensing boards, which can take punitive, paternalistic approaches to monitoring clinicians with mental health conditions, even when well-controlled.

A mental health professional wrote about needing to hide their bipolar diagnosis during their training. “I daily hear people look down and shame those who have this disorder in [the] field, even coworkers, people who I learn from in my clinical training,” they wrote. “I hope that one day I can fully convince myself that my success as a clinician will not be reduced to this disorder

A medical student living with bipolar disorder wrote: “I have felt silenced and often times like I don’t belong in this field. You have reminded me that I do belong here and that my diagnosis will not prevent me from being successful as a doctor.”

In the wake of these outpourings, I have never been more convinced that to dispel mental health stigma, professionals who feel comfortable need to speak our truths — to spread the understanding that mental health conditions, especially serious ones, are treatable. This is essential to help change the prevailing stereotypes and often pejorative cultural associations tied to mental illness, and to enhance access to care.

Public opinion of mental health conditions is still largely anchored in extreme images of people at their most unwell. When we make space to understand varied individual mental health journeys, including recovery, we embrace nuance and context.

When we join our disparate voices together and share our stories — of illness and wellness — we can and will dispel stigma, shame, and stereotypes, and achieve lasting change in the limiting and incomplete ways many currently view those of us with mental illness.

In my own life, I’ve come to see my mental health journey as driving my superpowers — as a doctor, leader, and loved one. As my son’s namesake, Rumi, once wrote: “The wound is the place where the light enters you.”

My journey has brought me deep self-insight and shown me my own capacity for strength and vulnerability. It’s given me strong motivation to implement the boundaries and care strategies it takes to stay well, as well as an empathic ability to support others through their most vulnerable moments.

Many readers wrote that hearing my perspectives empowered them, some for the first time, to reinterpret their mental health experiences as enabling their most unique assets.

“As someone living with [complex post-traumatic stress disorder], I… never before thought it could be my superpower,” wrote one reader.

“Now, after almost a decade, [I] can see clearly as you do that bipolar did not fundamentally change me or realign my understanding of self, but it has been one of the greatest gifts I have ever been given,” wrote another.

Out of everything, I’m most grateful that my disclosure has given me the chance to forge deep bonds across a global community and to join a movement — with a shared conviction to reclaim our narratives.

Working together, I have real hope that we will end mental health stigma and discrimination, and usher in better access to treatment within our lifetimes. So that our children can live in a world that honors and enables their fullest potential.

Dr. Devika Bhushan is an equity-focused pediatrician and public health professional who has served as California’s Acting Surgeon General. She’s an Indian-American immigrant and a parent. She’s on Twitter and Instagram as @DrDevikaB.

Multinational digital health firm Babylon said it plans to sell its independent physician association business in California to focus on digital-first contracts.

Meritage Medical Network is a group of about 1,800 doctors who provide in-person care across six counties in northern and central California. Babylon said divesting from the network will allow the firm to focus on its core business model, its digital-first, value-based care contracts.

Proceeds from the sale will be enough to fund the company through profitability, Babylon said. When Babylon released its second-quarter earnings in August, it said it was still evaluating how long it would take to reach profitability based on both cash flow and adjusted EBITDA, but the company was targeting no later than 2025.

THE LARGER TREND

In addition to the sale of Meritage Medical Network, Babylon said its previously announced reverse share split will take place during the fourth quarter this year. 

Last month, the company said it had received notice from the New York Stock Exchange that it was not in compliance with a rule that required companies to maintain an average closing share price of at least $1 over 30 consecutive days. The split aims to boost the stock price to prevent Babylon from being delisted. 

The company, which started in the UK, also said it plans to move to U.S. domestic reporting status with the Securities and Exchange Commission in 2023. The company recently dialed back contracts with NHS Trusts in its home market, while it noted its U.S. value-based care members grew by 220% year-over-year in its Q2 results. 

However, Babylon also recently hired Andrew Hine as vice president of the go-to-market team for Asia, Europe, the Middle East and Africa. Fine will manage Babylon’s contracts and partnerships and work to increase its offerings and services in those regions, the company said.

ON THE RECORD

“The sale of our IPA business and streamlining of our reporting and governance processes will result in a more focused business, simpler structure and stronger balance sheet,” Ali Parsa, Babylon’s founder and CEO, said in a statement.

American VR digital therapeutic company MyndVR and European company Oroi announced a strategic partnership to expand MyndVR’s catalog of cognitive, physical and occupational therapies using Oroi content. 

Oroi is a VR content platform aimed at improving the wellbeing and cognitive stimulation of seniors. The company currently works in Spain, France, Germany and the U.K.

With the partnership, MyndVR will offer Oroi Cognitive, which includes several exercises and games simulating daily life situations like orienting oneself within a city, shopping in a market, getting dressed and cleaning a room.

Additionally, MyndVR will utilize Oroi Fit, a VR exercise app that combines physical exercise with immersive content where users can row down a river or bike in the countryside.

“What we’re adding with Oroi is an entirely new portfolio of brain games and exercises, and physical and cognitive exercises. So they’ve created some amazing content for seniors in Europe that we have translated now into American English, etc. And that content now will be riding on the MyndVR network in the U.S.,” Chris Brickler, CEO and cofounder of MyndVR, told MobiHealthNews.

“They kind of have the same cultural mindset that we do around the love/care/compassion model of providing this content to our seniors. And so the cultural fit is just really, really great.

“Then I think the blending of some of the avant-garde content that they’ve been preparing for seniors in Europe that are really facing some of the same challenges that our seniors face here, obviously. It’s just a great way for us to expand the content that we are able to provide on the network.”

THE LARGER TREND

Senior-focused MyndVR has grown in the past several years, announcing partnerships between the company and other organizations. 

MyndVR formed a strategic partnership with HTC VIVE, a virtual reality platform for businesses and consumers. HTC VIVE’s VR accelerator, VIVE X, and MyndVR teamed up to launch MyndVR 2.0, the second version of the company’s signature VR product for senior-care communities.

In March the company announced the launch of MyndConnect, an intergenerational communication platform for older adults intended to connect family members virtually and connect friends in a metaverse via HTC’s VIVE Flow immersive glasses.

On Thursday GoodRx, best known for its drug-cost transparency tools, announced a platform for providers, allowing them to search for medication-cost information during appointments with patients.

Provider Mode, which is now launching out of beta, lets providers or other healthcare workers to search for medications at the point of care. They can input information on location, dosing and quantity, and then print out coupons or send them to patients via text or email. 

The medication page will also include a comparison tool of other drugs in the same class, home delivery options and informational articles about the medication for patients. 

“We wanted to improve this experience for the provider where they can actually give all of these cost savings opportunities and information and have that conversation at the point of care during the visit, instead of once the patient gets to the pharmacy,” Dr. Preeti Parikh, executive medical director at GoodRx, told MobiHealthNews.

With name brand drugs, GoodRx will enter into strategic partnerships where pharmaceutical companies can sponsor patient savings programs on the medication information page.

Alongside the Provider Mode launch, the company announced a collaboration with Biogen for its multiple sclerosis drug Vumerity whereby providers will be able to submit enrollment forms for the specialty therapy through the portal.

“Our hopes are that it will not be as big of an administrative burden on the provider, and then it can get the medication to the actual patient in a very timely manner, instead of three to four weeks,” Parikh said.

By the end of the year, GoodRx plans to add new features to Provider Mode, including options to create an account where providers can verify their prescriber status. The company will use previously announced partnerships with RxVantage and AssistRx to develop tools for communicating with pharma representatives and finding information about a patient’s insurance coverage and prior authorization requirements. 

THE LARGER TREND

Like a number of other digital health companies this year, GoodRx recently approved layoffs of approximately 140 employees, about 16% of its workforce. In a filing with the Securities and Exchange Commission, the company said it was focusing on its prescriptions business and its pharma-manufacturer solutions segment, as well as improving consumer engagement.

Though GoodRx reported “disappointing” financial results during its second quarter, cofounder and co-CEO Trevor Bezdek said there was an “enormous opportunity” for its provider-facing tools during an earnings call.

On paper, Medicare Advantage enables all the tools payers need to provide the plan of choice in rural communities. This potential, however, has generally not translated to real-world success for Medicare Advantage plans.

Despite consistent enrollment growth in metropolitan areas, rural markets remain relatively untapped. Data from the Centers for Medicare and Medicaid Services (CMS) show market penetration is consistently less in rural areas than non-rural. 

So, what’s keeping Medicare Advantage enrollment from surging in rural America? With most Medicare Advantage plans providing low-to-zero cost premiums, it’s not cost. It’s access to care.

A study published last year in Health Affairs indicates restrictive provider networks can be enough to drive rural seniors in access-constrained areas to switch back to original Medicare. In communities where the emergency room is often miles closer than the nearest in-network primary care provider, Medicare Advantage plans must shift their basis of competition. 

Bringing Medicare Advantage to rural communities to scale will require solving fundamental access issues first, by offering solutions that make providers consistently available. Retaining rural members and keeping them healthy will necessitate benefit plans designed to meet their needs, from transportation benefits to special coverage for chronic conditions.

With the flexibility to invest in preventive care and adopt innovative care delivery models, Medicare Advantage plans have all the assets they need to succeed in rural America. An understanding of the unique needs of rural members and designing purpose-built offerings that can drive enrollment will spell success. 

Shifting the basis of competition to access  

In order to turn access into retention and engagement, a care professional needs to be at the center. Rural communities are struggling with provider drain: Community hospitals are closing, specialists can be difficult to access, and primary care physicians are retiring at a faster clip. Rural provider scarcity has been the biggest challenge to scaling for Medicare Advantage plans. 

This gap in access is an opportunity for Medicare Advantage plans to play a more strategic and innovative role in the way rural care is delivered and how it can be accessed. 

Benefit design can be structured to bridge the gap in access and help members get the care they need when and where they need it. These benefits should be anchored in convenience and eliminate geographic and financial barriers to care.

Many older adults, for instance, want to engage with the healthcare system at home or on their way to the grocery store, and are becoming more comfortable using technology. Medicare Advantage plans that can take affordable services to rural seniors where they are will be all the more appealing for enrollment. 

Virtual care alone, however, will not be enough to bridge the access chasm, particularly as data show a decline in telehealth sessions. Until Medicare Advantage plans focus on solutions that fundamentally expand access to the care rural seniors need – real touches with clinicians they can trust who are sitting directly in front of them – adoption will continue at a lethargic pace.

Simply offering these services will not be enough to keep members who have historically lacked access to quality healthcare engaged. The “If you build it, they will come” approach will not work in rural America. Health plans need an integrated model that can transcend geographic and financial gaps in access to solve the needs that are most important to rural members. This level of service cannot be delivered through traditional fee-for-service Medicare.

Experience will drive growth and retention

Growth and retention in rural markets require not only bridging gaps in access, but doing it in a way members love, and providing a constellation of affordable services layered on top of the innovative clinical models plans enable.

Medicare Advantage plans should think beyond the reach of the traditional healthcare system and provide solutions that solve fundamental problems – offerings members may not expect from their health plan.

Social determinants of health like financial instability and food insecurity are potent underlying factors in our health and wellbeing. For many seniors – especially those in underserved rural communities – concerns over the electric bill may take priority over scheduling an annual wellness visit.  

By providing benefits such as food and transportation health plans are supporting a more robust patient experience. Clinical solutions like remote patient monitoring devices and in-home care services can be leveraged to extend the reach of providers members know and trust in their own communities. These benefits should be structured in a way that reduces financial burden for members by making services low to zero cost. 

The most effective vehicle for these solutions is within a total cost of care arrangement through which providers are accountable for managing cost and outcomes. By unshackling providers from the fee schedule, Medicare Advantage plans can create greater access to the supporting services that will help dismantle the entrenched barriers to care.

In any other market, success in scaling Medicare Advantage has required purpose-built solutions designed to meet the needs of specific populations. Rural communities are no different. Health plans can create a blueprint for success in rural America by working to better understand the needs of members who live there, delivering services that get them the care they need and ensuring the experience is accessible, convenient and affordable. 

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Dr. Aaron Friedkin is the chief business officer of Homeward, a company focused on improving access to high-quality, affordable, comprehensive care in rural communities. Previously Dr. Friedkin was the senior vice president of care delivery transformation at Blue Cross Blue Shield of Michigan. Before joining BCBSM, Dr. Friedkin supported large national employers on their healthcare strategies at Blue Cross Blue Shield of Minnesota and developed strategies for both payers and providers as a management consultant with McKinsey & Company. 

Dr. Friedkin is a board-certified radiologist, with subspecialty certification in pediatric radiology. He completed his diagnostic radiology residency at the University of Michigan and his pediatric radiology fellowship at Boston Children’s Hospital. He earned his Doctor of Medicine and Master of Science in Anatomy at Case Western Reserve University.

Analysis by Dr. Joseph Mercola
Fact Checked

• October 15, 2022Download PDF

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Analysis by Tessa Lena

• October 15, 2022Download PDF

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Thirty-seven percent of adults used telemedicine within the past 12 months, according to a report by the CDC.

The analysis outlined the percentage of adults who used telemedicine in the past 12 months by geographic and sociodemographic characteristics based on the 2021 National Health Interview Survey (NHIS).

Women were more likely to report telehealth use, with 42% reporting using telemedicine compared with 31.7% of men.

Telehealth use differed by race and Hispanic origin, with 40.6% of Non-Hispanic American Indian or Alaska Natives reporting telehealth use during the time period.

Non-Hispanic white adults were close behind, at 39.2% using telemedicine over the past 12 months, while 33.1% of Non-Hispanic Black adults utilized the service.

Of Non-Hispanic Asian adults, 33% used telemedicine, and of Hispanic adults, 32.8% remotely connected with healthcare providers.

For adults with family incomes less than 100% of the federal poverty level (FPL) and those with incomes of 100% to less than 200% of the FPL, the use of telemedicine was similar, at 33.1% and 32.1% respectively.

Use of telemedicine, however, increased to 40.7% with a family income of 400% or greater of FPL. 

The percentage of adults using telemedicine also increased with education level, with 28.7% reporting use among adults with less than a high school diploma or GED and 43.2% use by adults with a college degree or higher.

Telemedicine use was highest among individuals living in the Northeast (40%) and West (42.4%), as opposed to those in the Midwest (33.3%) and the South (34.3%).