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Transforming healthcare through sustainable and resilient data infrastructure

In the past two decades, global spending on health has doubled. Yet, optimal healthcare remains out of reach
The post Transforming healthcare through sustainable…



In the past two decades, global spending on health has doubled. Yet, optimal healthcare remains out of reach for most of the world as many countries continue to struggle with the burden of disease, growing complexity of healthcare, and persistence of health disparities.

The problem is not a lack of innovation. Advancements in technology and medicine have made it possible to improve nearly every aspect of care by analysing vast amounts of data, uncovering insights into each person’s disease and experiences, and using these insights to tailor care to the individual. For example, AI-enabled imaging techniques can help doctors detect diseases earlier and more accurately. Genomic profiling has made it possible to diagnose and treat patients with far greater precision. Wearables and digital health technologies are empowering patients to manage and monitor their health outside of a traditional clinical setting. At Roche, we call this personalised healthcare.

The challenge is integrating these advancements into healthcare ecosystems – meaning the relationships between all the stakeholders involved in healthcare delivery – when these ecosystems are historically built around compartmentalised, one-size-fits-all models of care.

I see daily how healthcare ecosystems around the world are working to integrate all elements of care into a seamless experience for people. Often, the initial focus is on participating in the data revolution by expanding genomic sequencing capacity, implementing electronic health records (EHRs), and so on.

However, though the growing volume of health data holds promise to reveal more insights into patient care, outcomes have not yet improved as much as expected. In addition, the data revolution has raised concerns about privacy and maintaining patient trust, with many countries tightening regulations around what data can be collected and shared.

To make personalised healthcare a reality, data must be safely and responsibly used in a way that provides real value for patients and the entire healthcare ecosystem. Healthcare systems need to build infrastructure that can integrate data. Only then will the healthcare industry gain insights that truly accelerate the improvement of care – from prevention and diagnosis to treatment and monitoring, to reimbursement and access models.

Accelerating this infrastructure revolution can be achieved by forging partnerships among healthcare stakeholders around the world to set up common systems for processing, and sharing data. That way, the insights uncovered can be used to provide more seamless patient care, while empowering patients to have a more active role in the process (e.g. deciding how their data can be used, and being able to access and contribute to it on a daily basis through tools that help them manage their health). This is one of the first steps toward delivering personalised care.

The pandemic has fuelled these efforts by demonstrating the importance of robust data infrastructure. Thanks to unprecedented data-sharing efforts between researchers, countries, and global health bodies, scientists were able to sequence the virus’ genome in a matter of days, develop and refine vaccines in record time based on a combination of clinical and real-world data, and track risk factors for the disease, the emergence of new variants, and other signals in real time to inform public health decisions. However, this rapidly-built infrastructure often fell short in terms of long-term sustainability and resiliency.

These are the challenges we are working to address as we collaborate with countries and regions to build data infrastructure that is sustainable – designed not just for emergencies like COVID-19, but for improving day-to-day care. While this will look different in every place depending on the structure and needs of the local healthcare ecosystem, we’ve identified several strategies for success.

  1. Bring as many stakeholders to the table as possible. In Australia, we joined forces with the Ministry of Health, the Australasian Lung Cancer Trials Group, Omico, and the National Health and Medical Research Council Clinical Trials Centre to provide comprehensive genomic profiling (CGP) for people with a difficult to treat form of lung cancer. The trial generated data that not only helped uncover better treatment options for these patients, but also demonstrated the value of incorporating CGP into the standard of care, especially for people with advanced or metastatic cancers. Thanks to the involvement of these stakeholders from the beginning, we’ve been able to evolve the program into the national rollout of a tool that will provide thousands of patients with access to CGP.
  2. Sometimes policy solutions are the best starting point. We recently established a consortium with the South Korean government, medical societies, and industry leaders focused on influencing expansion of more targeted therapeutic options for patients with different types of cancer across the country. The goal is to create a new framework for improving patient access to molecularly guided treatments under South Korea’s National Health Insurance, supported by real-world evidence. This framework could serve as a blueprint for the use of real-world data to support patient access decisions, creating additional opportunities for innovation and adoption of personalised healthcare.
  3. Anchor infrastructure in a common database. Singapore is already a leader in terms of data infrastructure, due to its high level of healthcare digitisation and investment in integrated care delivery. Yet, when it comes to cancer care, there is no central oncology data repository that brings together all the information generated from the EHR systems of the two largest cancer centres in the country. That’s why we are partnering with the Singapore Translational Cancer Consortium and the two major cancer centres to build a national clinico-genomic database of anonymised data from cancer patients, which all healthcare stakeholders can use to accelerate precision oncology research and develop a more personalised model of care. It will also help position the country as a hub for innovation, thus increasing the sustainability of its own health ecosystem and strengthening others throughout the region.

These are just a few examples of how partners within the healthcare ecosystem can strengthen data infrastructure, breaking down silos until we can deliver the right solution to the right person at the right time. We will continue to scale these efforts across national and institutional borders so we can build not just a data revolution, but a health revolution, where every person can benefit from personalised care.

About the author

Kelly Haenlein leads Roche’s international real-world data strategy and personalised healthcare ecosystem teams at Roche. She and her teams collaborate and co-create with external partners to enable sustainable healthcare systems that make personalised healthcare accessible to patients worldwide. Throughout her career in healthcare, Kelly has valued the impact of partnerships to change healthcare systems and shape healthcare ecosystems that enable people access to innovative care solutions.

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“We Are Headed For Another Train Wreck”: Bill Ackman Blames Janet Yellen For Restarting The Bank Run

"We Are Headed For Another Train Wreck": Bill Ackman Blames Janet Yellen For Restarting The Bank Run

Yesterday morning we joked that every…



"We Are Headed For Another Train Wreck": Bill Ackman Blames Janet Yellen For Restarting The Bank Run

Yesterday morning we joked that every time Janet Yellen opens her mouth, stocks dump.

Well, it wasn't a joke, and as we repeatedly noted today, while Jerome Powell was busting his ass to prevent a violent market reaction - in either direction - to his "most important Fed decision and presser of 2023", the Treasury Secretary, with all the grace of a senile 76-year-old elephant in a China market, uttered the phrase...


... and the rest was silence... or rather selling.

Commenting on our chart, Bloomberg's Mark Cudmore noted it was Yellen who was "to blame for the stock slump", pointing out that "the pessimistic turn in US stocks began within a minute of Janet Yellen starting to speak."

The S&P 500 rose almost 1% in the first 47 minutes after the Fed decision. Powell wasn’t the problem either: the index was 0.6% higher in the first 17 minutes after his press conference started.

Why am I picking that exact timing of 2:47pm NY time? Because that is the minute Yellen started speaking at the Senate panel hearing. The high for the S&P 500 was 2:48pm NY time and it fell more than 2.5% over the subsequent 72 minutes. Good effort.

Picking up on this, Bloomberg's Mark Cranfield writes that banking stocks globally are set to underperform for longer after Janet Yellen pushed back against giving deposit insurance without working with lawmakers. He adds that "to an aggressive trader this sounds like an invitation to keep shorting bank stocks -- at least until the tone changes into broader support and is less focused on specific bank situations." Earlier, we addressed that too:

Looking ahead, Cranfield warns that US financials are likely to be the most vulnerable as they are the epicenter of the debate. Although European or Asian banking names may outperform US peers, that won’t be much consolation for investors as most financial sector indexes may be on a downward path.

The KBW bank index has tumbled from its highs seen in early February, but still has a way to go before it reaches the pandemic-nadir in 2020. Traders smell an opening for a big trade and that will fuel more downside. Probably until Yellen blinks.

And if Bill Ackman is right, she will be doing a whole lot of blinking in days if not hours.

Ackman crying in public

While we generally make fun of Ackman's self-serving hot takes on twitter, today he was right when he accused Yellen of effectively restarting the small bank depositor run which according to JPMorgan has already seen $1.1 trillion in assets withdrawn from "vulnerable" banks. This is what Ackman tweeted:

Yesterday, @SecYellen  made reassuring comments that led the market and depositors to believe that all deposits were now implicitly guaranteed. That coupled with a leak suggesting that @USTreasury, @FDICgov and @SecYellen  were looking for a way to guarantee all deposits reassured the banking sector and depositors.

This afternoon, @SecYellen walked back yesterday’s implicit support for small banks and depositors, while making it explicit that systemwide deposit guarantees were not being considered.

We have gone from implicit support for depositors to @SecYellen explicit statement today that no guarantee is being considered with rates now being raised to 5%. 5% is a threshold that makes bank deposits that much less attractive. I would be surprised if deposit outflows don’t accelerate effective immediately.

Ackman concluded by repeating his ask: a comprehensive deposit guarantee on America's $18 trillion in assets...

A temporary systemwide deposit guarantee is needed to stop the bleeding. The longer the uncertainty continues, the more permanent the damage is to the smaller banks, and the more difficult it will be to bring their customers back.

... but as we noted previously pointing out, you know, the math...

... absent bipartisan Congressional intervention - which is very much unlikely until the bank crisis gets much, much worse - this won't happen and instead the Fed will continue putting out bank fire after bank fire - even as it keeps hiking to overcompensate for its "transitory inflation" idiocy from 2021, until the entire system burns down, something which Ackman's follow-up tweet was also right about:

Consider recent events impact on the long-term cost of equity capital for non-systemically important banks where you can wake up one day as a shareholder or bondholder and your investment instantly goes to zero. When combined with the higher cost of debt and deposits due to rising rates, consider what the impact will be on lending rates and our economy.

The longer this banking crisis is allowed to continue, the greater the damage to smaller banks and their ability to access low-cost capital.

Trust and confidence are earned over many years, but can be wiped out in a few days. I fear we are heading for another a train wreck. Hopefully, our regulators will get this right.

Narrator: no, they won't.

Tyler Durden Wed, 03/22/2023 - 21:20

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China’s Auto Industry Association Urges “Cooling” Of Price War, As Major Manufacturers Slash Prices

China’s Auto Industry Association Urges "Cooling" Of Price War, As Major Manufacturers Slash Prices

Just hours after we wrote about maniacal…



China's Auto Industry Association Urges "Cooling" Of Price War, As Major Manufacturers Slash Prices

Just hours after we wrote about maniacal price cutting in the automotive industry in China, China's auto industry association is urging automakers to "cool" the hype behind price cuts.

The statement was made in order to "ensure the stable development of the industry", Automotive News Europe reported on Tuesday. 

The China Association of Automobile Manufacturers even went so far as to put out a message on its official WeChat account, stating that "A price war is not a long-term solution". Instead "automakers should work harder on technology and branding," it said. 

The consumer disagrees...

Recall we wrote earlier this week that most major automakers were slashing prices in China. The move is coming after lifting pandemic controls failed to spur significant demand in China, the Wall Street Journal reported this week. Ford and GM will be joined by BMW and Volkswagen in offering the discounts and promotions on EVs, the report says. 

Retail auto sales plunged the first two months of the year and automakers are facing additional challenges in trying to transition their business models to prioritize EVs over conventional internal combustion engine vehicles. 

Ford is offering $6,000 off its Mustang Mach-E, putting the standard version of its EV at just $31,000. Last month, only 84 of the vehicles were sold, compared to 1,500 sales in December. There was some pulling forward of demand due to the phasing out of subsidies heading into the new year, and Ford had also cut prices by about 9% in December. 

A spokesperson for Ford called it a "stock clearance". 

Discounts at Volkswagen are ranging from around $2,200 to $7,300 a car. The cuts will affect 20 gas powered and electric models. Its electric ID series is seeing price cuts of almost $6,000. The company called the cuts "temporary promotions due to general reluctance among car buyers, the new emissions rule and discounts offered by competitors."

Even more shocking is Citroën-maker Dongfeng Motor Group, who is offering a 40% discount on its C6 gas-powered sedan, now priced at $18,000. 

Kelvin Lau, an analyst at Daiwa Capital Markets, told the Journal that automakers are also trying to get rid of 500,000 vehicles collectively stored in their inventory, most of which are older vehicles that won't meet new emissions standards.

David Zhang, a Shanghai-based independent automobile analyst, added: “Some car makers have been seeing very few sales. At this rate, the manufacturers’ production and dealership networks will collapse.”

Tyler Durden Wed, 03/22/2023 - 18:00

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COVID origins debate: what to make of new findings linking the virus to raccoon dogs

New reports suggest the pandemic’s origins may be linked to raccoon dogs sold at Wuhan’s Huanan Wholesale Seafood Market. A virologist explains.




The origin of SARS-CoV-2, the virus that causes COVID, has long been a topic of heated debate. While many believe SARS-CoV-2 spread to humans from an animal at Wuhan’s Huanan Wholesale Seafood Market, others have argued the virus was accidentally leaked from a lab at the Wuhan Institute of Virology.

Over the past week there has been intense activity surrounding the emergence of new data relevant to this question. In particular, reports emerged that the pandemic’s origins may be linked to raccoon dogs which were being sold illegally at the market.

The excitement stemmed from a re-analysis of raw data generated as part of official investigations into the role of the Huanan Wholesale Seafood Market in the outbreak.

The team of international scientists working on this re-analysis (from North America, Europe and Australia) alerted the World Health Organization and discussed the topic in an article published in The Atlantic. And the scientists themselves have now released a report on the issue, providing greater detail.

So what can we make of their findings? Will this development shift the course of the ongoing debate? Let’s take a look.

The Huanan market

In January 2020, writing about the emergence of what we now call SARS-CoV-2, I stated the importance of understanding how this pandemic began. It remains important to determine the virus’s origins because this knowledge may help us stop the next pandemic occurring.

Even very early in 2020, it was clear that the central Chinese city of Wuhan (a major metropolis and travel hub) was the epicentre of the outbreak. Within Wuhan, the Huanan seafood market stood out as it was associated with many – but not all – of the earliest cases. Indeed, the market was closed on January 1 2020, animals were culled, and the site was disinfected.

Suspicions arose given the role that animal trade and markets had played in the emergence of the closely related SARS-CoV-1 virus (which caused SARS, a widespread outbreak of viral respiratory disease) nearly two decades earlier. Evidence emerged that the Huanan seafood market also sold live mammals, including a fox-like mammal known as a raccoon dog, that we now know are susceptible to SARS-CoV-2.

Later epidemiological and genetic analyses further focused in on the market, and even specific stalls within it, as being the origin of the pandemic.

Read more: The original Sars virus disappeared – here's why coronavirus won’t do the same

The new data

As part of the official investigations into the market, swabs were collected from various parts of the market in the two months after it shut down at the start of 2020. The scientists who undertook this research, from the Chinese Center for Disease Control and Prevention, posted their analysis as a pre-print (a study yet to be peer-reviewed) in February 2022.

In this, the team concluded that the market likely played a significant role in SARS-CoV-2’s early spread, but that they couldn’t detect the virus in samples taken directly from animals. They reported that all the virus evidence found was associated with humans, and it was therefore likely the virus had been brought into the market by humans, not animals, and so perhaps the pandemic began elsewhere.

An illustration of SARS-CoV-2, the virus that causes COVID.
The origin of SARS-CoV-2 has been a topic of heated debate. Kateryna Kon/Shutterstock

However, prior to any official peer-reviewed publication, the raw data from this work was released on an open scientific database called Gisaid. And the group of scientists who re-analysed this data did actually find an association between SARS-CoV-2 and animals, in particular raccoon dogs in the market.

They found DNA from animals mixed in with SARS-CoV-2 in a number of samples from the market. Some positive samples contained no human DNA and mostly raccoon dog DNA. This mix of virus and animal material is consistent with an infected animal – not a human – shedding virus, which is what you might expect if SARS-CoV-2 originated from animals brought into the market. Unfortunately, samples from a living raccoon dog were either not taken or not reported, and the official investigation makes no mention of raccoon dogs.

Where to from here?

While this latest data is one additional piece of the puzzle that supports an origin of the pandemic linked to Wuhan’s animal trade, it is unlikely to provide irrefutable evidence. It’s important to note it’s also a pre-print.

Ideally, we would like animal samples from early December 2019, and to compare animal virus genomes with human ones. It will also be crucial to follow events backwards through the animal trade and farming systems to work out where the animals got the virus from in the first instance.

Further, we must bear in mind that the virus could have easily been given to a raccoon dog by an infected human, or that the association between raccoon dog DNA and SARS-CoV-2 may be coincidental.

Read more: We want to know where COVID came from. But it’s too soon to expect miracles

However, evidence is accumulating that official investigations have left a gap in their research – particularly around the role that animals like raccoon dogs and the wildlife trade played in the origins of the pandemic.

While it may be unlikely that we will ever get concrete evidence as to how SARS-CoV-2 entered the human population, we can still think pragmatically and seek to alter behaviour and practices to reduce the chance of a new pandemic. One immediate target would be food systems (encompassing farm to fork), and how to make farming and the wildlife trade safer for all, potentially by enhancing virus surveillance in animals.

Connor Bamford receives funding from Wellcome Trust, UKRI, SFI and BMA Foundation.

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