Recently, I spent an hour on a zoom call hosted by Zurich Children’s Hospital. What they have accomplished is world class.  

The Zurich Children’s Hospital has great clarity and focus plus the committed and competent leadership to implement the mission which is to find a cure for pediatric brain tumours. 

They have created a global network of the top researchers in pediatric brain tumours.

The network is a working community of highly collaborative researchers. They share. They inform. They work separately and together. This community is working with the mission of finding a cure for pediatric brain tumours. They are not concerned about fame or fortune. 

The researchers were present on the zoom call lead by the key researchers at Zurich Children’s Hospital. Drs Javad Nazarian from the DIPG/MG Center Zurich and Sabine Mueller from UCSF/ the Pacific Pediatric Neuro-Oncology Consortium were the clear leaders of the entire community. PNOC brings 225 clinicians and researchers together to push for breakthrough.  Without effective leadership this could not be accomplished. 

The other key participants were the executive directors of family foundations with an interest in pediatric brain tumours. Most had had a personal experience in having lost a child to this lethal disease. 

Zurich Children’s Hospital had created a distributed centre of excellence of the top research centres in pediatric brain tumours and the funding sources able to fund the community and the research machine which has over 30 different approaches to curing pediatric brain tumours. 

Some of these approaches include using novel agents that disrupt mitochondria in the cancer cells and sono-sensitization which uses a drug to sensitize the cancer cell to high intensity focused ultrasound. 

The other dimension of Zurich Children’s Hospital is their clinical outreach. Pediatric brain tumours are rare. To gain the critical mass of patients, the ZCH has a global clinical outreach service which provides clinical assessments and virtual expert opinions for children with brain tumours irrespective of where they live.  This allow the ZCH to have the cumulative experience with patients necessary to deeply understand the disease and to have enough patients for the many clinical trials that are organized at and by ZCH. 

So the combination of the top researchers in pediatric brain tumours, the biggest database of patients with pediatric brain tumours and a vast inventory of clinical trials with novel agents and technologies plus the committed funding sources presents the highest probability of finding a cure for pediatric brain tumours. Well done Zurich Children’s Hospital.

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In the scramble for COVID-19 vaccines, the UK emerged in November as the first country to offer a shot outside of clinical trials — and one woman bears the credit.

Kate Bingham put her role as a life-sciences venture capitalist on hold last July when she was approached by Prime Minister Boris Johnson to head up the UK’s Vaccine Taskforce.

A year into the pandemic — despite limited buying power — the UK has secured deals for 407 million doses of COVID-19 vaccine from several companies, according to the government.

As of February 1, 13.7% of the country’s population has had at least a first dose of the two-part Pfizer vaccine, according to The Times of London — outstripping progress in the US and European Union.

As a direct appointee of Johnson, she was given wide discretion to speed up the process and lay steep bets on vaccine candidates. Her six-month, unpaid appointment ended in December.

In that time, she also faced questions about potential conflicts of interest and her handling of government information marked as confidential.

At the outset, the VTF was given three objectives: To get the UK access to the most promising vaccines, shore up global vaccine distribution, and develop the country’s long-term vaccine strategy.

Almost nothing about that list of tasks looked promising. As COVID-19 spread across Britain, the country was embroiled in Brexit negotiations, the economy was tanking, the National Health Service was getting overwhelmed, and the government was reeling from multiple accusations of incompetence in its pandemic response.

So Bingham got to work.

• Kate Bingham, a biotech VC in the UK, was very successful in working with pharma to supply vaccine to the UK.
• Kate simplified the decision-making process of getting vaccines. “I just asked for everything to be streamlined,” she told The Times in December.
• “I didn’t know much about government but when you have 58 people cc’d you are not going to be able to make decisions quickly. We had one shot at getting it right and no time.”
• VTF (vaccine task force) rejected the chance to join the EU’s vaccine-buying bloc. According to a VTF end-of-year report, the partnership would have barred the UK from making outside negotiations.
• Bingham’s existing VC contacts in the pharmaceutical industry helped get the UK’s negotiators at the table, despite the country’s waning influence and small budget, The Times reported.
• Kate placed numerous high-risk bets by ordering early from several promising vaccine candidates at once. In total, the VTF bought doses from seven different candidates, across four different types of development processes. Some of those processes had never been approved.
• Doing this early meant that the NHS could buy up the refrigerators needed for some of the vaccines’ storage, and prepare for distribution, the VTF report said. 
• Kate created the 360,000-strong “National Citizen Registry” to get people on board with the country’s clinical trials as quickly as possible, the report said. 
• Kate made it easy for manufacturers to sell without onerous liabilities if things went wrong 

But while the UK may have secured access to a hefty vaccine supply, many of the risks remain. According to the VTF report, the group used “creative deal structures and approaches.”

When asked to explain what that meant, a spokesperson for the Department for Business, Energy and Industrial Strategy (BEIS) — which oversees the VTF — told Insider the deals were commercially sensitive and would not give further detail.

According to The Times, the UK gave vaccine manufacturers enormous legal leeway should any of the vaccines go wrong.

As part of the VTF, Bingham was tasked with keeping the UK on board with the COVAX initiative — the UN-led project to ensure equitable vaccine distribution around the world.

The UK government contributed $751 million to this, and also shared expertise, according to the report.

But the World Health Organization has warned that COVAX is on the brink of failure, in part because richer countries — like the UK, Canada, and the US — have bought up huge amounts of the current vaccine supply.

The BEIS spokesperson denied that the UK’s success in ordering vaccines ran counter to COVAX’s mission.

There was a public outcry when Dido Harding, another MP’s wife, led the country’s largely failed Test and Trace system with no relevant experience. Meanwhile, companies with personal ties to government were also scooping up personal protective equipment contracts.

But as a life-sciences investor, Bingham had much more relevant knowledge and extremely useful high-level contacts in the pharmaceutical industry.

Source: The Business Insider, The Times.

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He has a section that looks at confidence and incompetence.

There is a principal called the Dunning-Kruger effect in which a person who is incompetent is overly confident.

These persons are so incompetent that they do not recognize their own incompetence.

And they tend to surround themselves with underlings who praise them without being critical in any way.

And according to the Dunning-Kruger effect, these incompetent persons are overly confident.

The perfect job for them is politics.

Because as a politician they must appeal to the voters and seek and achieve approval that is mostly based on being overly confident.

And to really nail the approval, they might distort the truth somewhat to sell themselves to voters.

It is interesting to think of political leaders who have proven to be incompetent when stress tested by crises such as COVID 19 or economic failure of their economy.

Thanks Adam Grant for explaining the Dunning- Kruger effect to us.

Raymond Rupert patient advocate and part time health system disruptor.

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That is a certainty and all you have to do is look at the stats to see that it is a reality for many families.

It is time to start putting a plan in place for these mental health crises. Or the vague reference by a family member to ending it all might, in fact, happen.

In planning for a mental health crisis, it is important to realize that the family doctor is not likely going to provide the solution. And the healthcare system won’t likely provide a solution. A patient might be admitted to hospital for a crisis but that is just the beginning and not a solution. Solutions have to be crafted one patient at a time with a team with deep expertise in this field.

A family needs a mental health advisor to take the role of mental health coach. The mental health coach’s job is to build deep and trusting relationships with the family members. He/she has to understand how to use langugage to build trust.  And how to engage the family members either individually or as a group.

The mental health coach should have training in the assesment of mental health conditions. RCM Health Consultancy team members can take this role and RCM is able to provide an audit of the mental health status of the family members. Or at least an audit for those where there is some concern.

The family member will get feedback on their metrics and understand that if the family member wants help that the mental health advisor/coach can help to guide them on a treatment pathway. Crafting the treatment pathway requires a multi-disciplinary team with various skillsets.

This is a complex role. If there are 4 generations in the family, and an individual can have any of 30 conditions and if there are at least 40 different options for that person, then there are 4800 different scenarios to possibly consider.

This is a complex decision that a family needs to consider and hopefully with a team of professionals supporting their decision. That is what we do at RCM Health Consultancy.

A  family can call RCM Health Consultancy Inc. to learn more about how RCM can assist the family to prevent mental health crises.  We are always pleased to assist.

Raymond Rupert CEO  RCM Health Consultancy Inc.

647 350 5500 ext 118 /   info@rcmhealthconsultancy.com

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She tested negative for COVID in early January. Her 5 family members all tested positive.

She did develop symptoms of COVID with productive cough, loss of sense of smell and taste, muscle aches, myalgia, gut pains and intermittent headaches.

This was classic for COVID and post COVID syndrome even though her COVID test was negative.

She reached out to her GP who had been her GP for 20 years. His office announced that they don’t see or treat COVID patients.Betsy said that he is much more interested in the botox part of his practice.

Betsy was feeling worse and somewhat short of breath. She went to the ER. The ER doctor measured her oxygen saturation. It was 84% which is low. It should be over 95%.  He admitted her to the hospital. When she got upstairs, another doctor saw her. Her oxygen sat was 95% so the doctor discharged her with no meds. No followup. Nothing.

Betsy’s company has a corporate account with an executive checkup company. This is a concierge care service. When she called, the nurse would only text with her. They never spoke. The nurse said that she could not do anything. She had no access to the ER records and she must go back to her GP.

So that is the state of the customer experience in some primary care settings.

I feel sorry for these patients who are not getting the support, advice and care that they want and need.

That is why we offer a service to meet these types of needs on an expedited basis.

It is described at www.quest-executive.com

Raymond Rupert  CEO  RCM Health Consultancy Inc.

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The sum of an person’s observable characteristics is their phenotype. A key difference between phenotype and genotype is that, whilst genotype is inherited from one’s parents, the phenotype is not. Whilst a phenotype is influenced the genotype, genotype does not equal phenotype

Any digital phenotyping systems used to track a person’s mental health status will be inaccurate. There is no such thing as a 100 per cent accurate medical test, and it’s important to consider the potential misuse of any mental health data.

But to dismiss digital phenotyping because of these limitations is to miss its potential utility. At the very least, a person’s smartphone information could help to inform their clinician’s decision-making and the mental health care that they provide.

Even if a test can’t be used to home in on an exact diagnosis, it could narrow down the range of possibilities and ultimately help inform human judgment and treatment-path selection in a field that needs better diagnostic tools.

Traditional mental health care relies on a person self-reporting their symptoms, which can be unreliable. Furthermore, once a therapy session is over, there’s no established way to monitor a patient’s thoughts, feelings or behaviour in their real life.

Thus, being able to assess mental health objectively and continuously by analysing a person’s daily digital footprint offers a transformative alternative to traditional methods. Digital phenotyping will be an important tool for use in mental health care.

To learn more call RCM Health Consultancy  647 350 5500 or email us at info@rcmhealthconsultancy.com

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The young adult had overdosed on opioids but survived. He was stunned that he lived because he had learned a lot about how to suicide successfully but he had failed.

So there he was not really believing that he was alive.  But 5 days in a locked unit in a psychiatric facility dining on macaroni and cheese and listening to the other patients screaming at the nurses had brought him back to a reality that he did not really like.

So he was able to talk his way out of the locked facility.

Now at home, he could resume his secret activities on the dark web of buying and importing opioids. Unless someone started to monitor what he was doing. No one seemed interested in that. Might be a breach of privacy.

It did not matter that importing narcotics with the intent to distribute was a Federal crime. Didn’t matter. He was invicible, maybe.

So our ultimate job as patient advocates was to help him.

Unfortunately, our plan to introduce an integrated team of experts to provide advice did not fly with his parents.

In fact, there was a dust up with the parents and our team of advocates.

The only way for us to help this young adult was to transfer him to the care of another provider.

This is known as a bridging strategy.  So we offered to allow for a peaceful and seamless transition to the next provider.

And the bridging strategy was used to ultimately help this young adult who otherwise would have been left without a treatment plan or continued to break the law and eventually end up in prison or in the trunk of a car.

Remember, to use or recommend a bridging strategy if you run into a similar type of situation and ultimately want to help the patient.

Raymond Rupert patient advocate.

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Raymond Rupert patient advocate, former family doctor, founder of RCM Health Consultancy.

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Uber complex implies high levels of uncertainty. Somewhat like a wicked problem. Not a complex problem.

The objective in using an expert panel is to go deeper in the analysis of the problem.

Hosting a diverse panel generates more options and more viewpoints.

We strive for diversity on the panel. Different disciplines. Different angles. Different styles.

With complexity, we don’t want to address the problem with a single lens.

We want to generate many diverse viewpoints. Then we want to seek consensus. Hard to get there but worth the effort.

Sometimes, we will do this blinded. The experts won’t know what each other thinks.

Sometimes, we will do this as an open discussion. Hard to reach consensus, if the opinions are ever shared.

For our current case involving the mental health and substance use disorder of a young adult with a history of self harm, we are going to start with a closed process. Like a delphi technique.

Then invite all the experts to an open discussion with each one knowing the opinion of the others first.

We hope that this process of using an expert panel delivers the best possible option for our client.

Experts should not be concerned that AI will replace them. Not yet.

Raymond Rupert patient advocate , former family doctor, founder of RCM Health Consultancy.

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