by Dr. Makary is a professor at the Johns Hopkins School of Medicine and author of “The Price We Pay: What Broke American Health Care and How to Fix It.”

Public-health officials ruined many lives by insisting that workers with natural immunity to Covid-19 be fired if they weren’t fully vaccinated. But after two years of accruing data, the superiority of natural immunity over vaccinated immunity is clear. By firing staff with natural immunity, employers got rid of those least likely to infect others. It’s time to reinstate those employees with an apology.

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Molnupiravir, made by Merck, a big pharma firm, and a Florida-based biotech called Ridgeback Biotherapeutics, is the first oral antiviral medicine available to treat covid-19. The approval marks another milestone in the world’s fight against covid-19.

Other countries are also working quickly to approve the new medicine, which has provoked keen interest.

Last month the interim results of a trial found that patients with a risk factor for covid-19 were 50% less likely to be hospitalised or die if the oral antibiotic was taken in the first five days after symptoms.

Britain has secured 480,000 courses of molnupiravir, and sales of the drug are already brisk. America, Australia, Britain, the Philippines, Indonesia, Japan, New Zealand, Malaysia, Thailand and Vietnam are some of the countries that have secured deals, or are in the process of doing so.

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This will affect individuals who have been eligible to receive one major eye exam every 12 months, plus any minor assessments. It will also affect those of any age with certain medical conditions including glaucoma and retinal disease who receive eye exams covered under OHIP.

Those affected should be aware that these services cannot, by Ontario law, be charged to private health insurance.

Ontario regulation prohibits optometrists from billing direct to patients, to workplace health insurance, or to individual private insurance for any services provided to those eligible under OHIP. 

Residents of Ontario between the ages of 20 to 64 may continue to receive eye examinations under the terms of their workplace health insurance or individual private insurance plan.

We are very curious about how this will be handled by the authorities.

It will likely end up being similar to the way that dentist’s bill for services.

But until then, there is real uncertainty about our eye examinations and the delays in care that might occur.

Raymond Rupert patient advocate.

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RCM Health Consultancy has worked with individuals, companies and insurers to achieve dramatic discounts on hospital bills in the USA, Canada and globally.

Here is case study to demonstrate the state of US hospital billings.

When a woman gets a caesarean section at the gleaming new Van Ness location of Sutter Health’s California Pacific Medical Center, the price might be $6,241. Or $29,257. Or $38,264. It could even go as high as $60,584.

The rate the hospital charges depends on the insurance plan covering the birth. At the bottom end of the scale is a local health plan that serves largely Medicaid recipients. At the top are prices for women whose plans don’t have the San Francisco hospital in their insurers’ network.

Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs. As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost.

Source: Wall Street Journal 2021

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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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We used to hae Connaught Labs at Steeles Avenue and Dufferin St in North York. Then it disappeared. No more vaccine capacity of significance in Canada.

Then recently, I learned about Medicago and its greenhouses in Quebec City.

This business is one of the most interesting and innovative organizations that I have ever heard or read about and I have been around for a while.

Medicago uses plants as bioreactors. The plants produce virus like particles (VLP) which resemble Sars-COV-2. Spike proteins and all.

Check this out below. The virus and the virus like particle.

The virus like particles (VLPs) are injected into us humans which results in the development of antibodies to COVID 19.

Medicago has partnered with GlaxoSmithKline (GSK) to produce the final vaccine which is entering into phase 3 trials at this time.

I am a total supporter of Medicago and wish them well on the way to making 1,000,000,000 vaccines per year.  By the way, they also have a vaccine for Ebola.

High fives all around.

Raymond Rupert patient advocate and disruptor of healthcare for the common good.

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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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We have heard from our friends in Tel Aviv who have already received the vaccine.

Their process of vaccine distribution is very well orchestrated.  Our friends belong to one of 4 major HMOs ( health maintenance organizations) in Israel.

The HMOs are like OHIP. The big difference is that these 4 HMOs in Israel must compete for customers. OHIP is a monolithic monopolistic bureaucratic entity. Sometimes no one answers the phone.  Try it and you will see. Service levels are likely not even measured at OHIP.

The need to compete changes the entire service delivery experience for customers in Israel. If customers of the HMO do not get good service, then they can change to another HMO. The more customers, the more revenues and the more advances in technology and facilities that can be developed.

Competition amongst the HMOs forces them to up their game to the benefit of their customers.

Years ago, I toured the head office of Clalit, one of the HMOs. Their use of information technology (IT) at that time was light years ahead of the IT in Canada. Their managers manage service delivery and take pride in being excellent at it.

So when it came time to distribute the vaccine, the managers at Clalit pushed a few buttons and mobilized the effort. Somewhat like going to war. But this time, the enemy is a virus.

So the question for the political leaders and ministers of health in our provinces and territories is why don’t we use this model of competition to increase the service levels for Canadians. Lives depend on it.

Might be a useful thought exercise for our leaders to engage in, if their time permits.

All the best of luck with this initiative. I will be watching from the side lines.

Raymond Rupert patient advocate and part time health industry disruptor.

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