Latest / CareTalk: Healthcare. Unfiltered. / Using AI to Improve Drug Testing Accuracy

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Using AI to Improve Drug Testing Accuracy · CareTalk: Healthcare. Unfiltered.

• 0:00
  Dr.
• 0:00
  Jonathan Bakhtari is board certified in three specialties, run two healthcare companies, and is quite an avid podcaster as well.
• 0:10
  What can he tell us about the use of AI in drug testing?
• 0:14
  What can he tell us about his origin story in E7 Health and how AI is gonna change drug testing?
• 0:20
  Perhaps we'll even get into his more controversial work, which is fascinating on the impact of Do Not Resuscitate Orders.
• 0:29
  Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
• 0:41
  I'm John Driscoll, Senior Advisor at Walgreens.
• 0:44
  Join the fast -paced Care Talk community on LinkedIn where you can dig deep into healthcare business and policy topics, access our Care Talk content, and interact with the hosts.
• 0:56
  and please be sure to leave us a rating on Apple, Spotify, or wherever.
• 1:01
  We'd love your feedback and attention.
• 1:03
  Dr.
• 1:04
  Bhaktari, CEO of eNational Testing and E7 Health and many podcasts.
• 1:10
  Welcome to Care Talk.
• 1:12
  Oh, thanks, John.
• 1:13
  Thanks for having me.
• 1:14
  What an honor.
• 1:16
  Jonathan, tell us a little bit about your origin story, like how you got into...
• 1:20
  healthcare and then as an entrepreneur and then maybe we'll get into the interesting companies that you're leading right now.
• 1:29
  Yeah, thank you.
• 1:30
  Well, it's actually initially very straightforward.
• 1:32
  I was a straight arrow, was pre -med and got a degree in biology and psychology.
• 1:39
  I graduated college and went straight to medical school.
• 1:42
  I went to Ohio State University for medical school and then went to Northwestern University for my internship and residency, and then UCLA for my fellowship in pulmonary and critical care.
• 1:55
  And then, you know, I joined a group, became a senior partner with clinical faculty and a couple of medical schools.
• 2:03
  Usually that's when doctors stop, they take that throughout.
• 2:07
  Like what was the pivot to technology, companies and healthcare?
• 2:14
  Most people think it was like an epiphany where you wake up one day or you're burnt out or something happens like, you know, and nothing is further from the truth.
• 2:23
  It was really an evolution because then I started to getting involved in administrative medicine first.
• 2:30
  Someone asked me to be on a committee.
• 2:32
  Next thing I know, I was nominated to be chief of medicine at one of the hospitals.
• 2:39
  Then I was medical director of the intensive care unit.
• 2:42
  And it seemed like every time I said yes to something that opened up another door.
• 2:47
  Subsequently, I was asked to be medical director for Anthem Blue Cross Blue Shield for the state of Nevada.
• 2:54
  Then after that, I was medical director of the Culinary Health Fund, which is a big health fund here in Nevada.
• 3:01
  Massive.
• 3:02
  So I was their medical director for four years.
• 3:05
  So simultaneously, I was also teaching and doing clinical work as part of my group.
• 3:10
  And that sort of gave me a perspective because now I was medical director for insurance companies I was seeing patients myself and then I was medical director for UHS, which is a big company as you know And I was medical director for their Valley Health System like six hospitals here I was I did utilization management medical directorships and other stuff and again It was like one door opening another as soon as I would do something somebody would ask me but how did you then?
• 3:39
  But there's plenty of people who were rinse, wash, repeat in their health care careers, either on the managed care side or the care side.
• 3:49
  You did both.
• 3:50
  Where did the entrepreneurship come in?
• 3:54
  Back in 2009, one of the physicians that I was a clinical faculty in one of the med schools, and I was giving lectures to the medical students, and he was coordinating that.
• 4:05
  And he came up to me and said, listen, I have a very vaccine company a travel medicine company that you know is is Starting out and you have a lot of experience in administration.
• 4:16
  Would you consider helping me?
• 4:18
  Because he was going through, you know some struggles of growing pains So we were friends and I offered to help him and next thing I knew we went in as partners and to try to really make it grow because back then I think our our thinking was there was no company that was focused on adult vaccinations.
• 4:37
  And as you know, the CDC reports at least 50 ,000 vaccine preventable deaths in the United States, many in adults.
• 4:44
  Just slow down a second.
• 4:46
  I don't think people understand that when you were getting into the vaccine business, A, it was a difficult business because reimbursement was somewhat uncertain.
• 4:55
  And B, there are that many deaths related to the lack of commonly available vaccines.
• 5:03
  Do you want to just explain what's driving those 50 ,000 deaths a year?
• 5:08
  Because it's an extraordinary figure.
• 5:10
  And sometimes it's more.
• 5:11
  That's a conservative number.
• 5:12
  It's like more.
• 5:13
  More people die of that than died in the Vietnam War.
• 5:17
  I mean, it's that's annually every year.
• 5:20
  Yeah, every year, every year.
• 5:21
  And that's why, you know, the great work Walgreens does and other people do it.
• 5:24
  But what occurred to us is nobody was doing it as their main gig.
• 5:29
  I mean, I, you know, everybody who was doing adult vaccination.
• 5:34
  It was a side hustle.
• 5:36
  You know, they were doing urgent care.
• 5:37
  They were doing primary care.
• 5:40
  They were selling diapers and Frito -Lays.
• 5:42
  Nobody was doing it as their main hustle.
• 5:46
  And we thought, you know what?
• 5:47
  If only one company would say, that's all we're going to do.
• 5:51
  You know, somebody comes in with a sore throat, we're not going to see them.
• 5:54
  We're going to refer them to our primary care.
• 5:56
  Somebody comes in with a tummy ache, we're not going to see them.
• 5:59
  We're just going to f - And then what we realized is there was seven books of business that adult vaccinations were involved in.
• 6:06
  But before you go there, just people, people are going to, I think, be struck by that number.
• 6:13
  What's killing people like what are they doing?
• 6:16
  Yeah, I can vaccinate against.
• 6:18
  Look, look, look at the flu.
• 6:19
  I mean, how many annual deaths are from from the seasonal flu pneumonia?
• 6:24
  You know, we have we have an excellent, excellent, you know, vaccines for especially in people with underlying conditions, elderly.
• 6:34
  And then you even look at travel medicine.
• 6:36
  You know, we have vaccines now for cholera, yellow fever, we have for Japanese encephalitis, rabies, the typhoid, hep A is a big cause of morbidity during travel.
• 6:49
  And as the world becomes more interconnected, travel medicine, which is really the medicine related to the things you can get when you travel to.
• 6:57
  from one country to another, particularly areas that may not where you get exposed to stuff you wouldn't necessarily have immunity against, we actually have very effective, safe vaccines for those diseases.
• 7:11
  And I have to tell you, when I talk to primary care doctors, and I mentioned, let's say in a conversation, yellow fever vaccine, most primary care doctors don't even know that exists.
• 7:20
  They don't even know there's a vaccine for Japanese encephalitis.
• 7:23
  So I think it's a part of partly education.
• 7:25
  We talk about the...
• 7:26
  the lay people, but even the medical community could use education on that.
• 7:31
  So, but it's not just travel.
• 7:33
  You know, what we found is that people were not getting their tetanus boosters.
• 7:37
  They would just forget about him.
• 7:39
  And, you know, prior to COVID, the idea that adult vaccinations would even be important.
• 7:44
  It wasn't even a consideration.
• 7:46
  I tease a lot of people that we were a COVID company before COVID hit, right?
• 7:51
  I mean, a lot of people had to...
• 7:53
  A lot of people had to pivot to COVID.
• 7:55
  We were like that.
• 7:56
  All our software, our technology was written to manage titers and vaccinations and, you know, managing it, keeping track of it.
• 8:04
  You know, we, we connected with the state databases and we did a lot of things technology wise in preparation for COVID.
• 8:12
  Part of the challenge in vaccinations, just so folks can track is.
• 8:16
  you're supposed to get them on a particular schedule.
• 8:19
  You've got to make sure that the titers, the amount of vaccine that you're getting is appropriate to where you are in your course of health.
• 8:27
  And it's an interesting problem you're trying, because again, you're right.
• 8:31
  It's not even embedded in a lot of folks' medical records necessarily consistently.
• 8:38
  And primary care doctors wouldn't even ask about it.
• 8:40
  So you'd show up with a knee problem or a back problem or a...
• 8:44
  you know, you have a flu or cold.
• 8:45
  But what was also interesting is that we realized over the last 20 years, primary care doctors had stopped carrying any vaccines at all before they might have carried maybe hep B or something.
• 8:58
  So what happened, partly because the reimbursements went down, partly because it was such a chore to have your staff understand vaccine medicines.
• 9:06
  You know, they expire very quickly.
• 9:09
  Some of them you have to dilute a certain way and their staff.
• 9:12
  And some of you have to refrigerate some you have to put in a freezer.
• 9:15
  You actually have to buy a vaccine refrigerator.
• 9:18
  And most doctors were using, you know, refrigerators that were meant for a kitchen.
• 9:22
  And so this whole idea of really doing adult vaccinations properly, to be very frank with you, when we audit other offices that still do vaccines, half the time, the vaccines that are supposed to be in the refrigerator and the freezer and vice versa, and their staff has to get have to have to keep up on whether they expired or not.
• 9:45
  So it just seemed like vaccine medicine was the Wild West and we wanted to bring some structure to that.
• 9:52
  We wanted to raise the ante and see if we could make a dent in those 50 ,000 at the exclusion.
• 10:00
  And we realized we had to do it at the exclusion of everything else.
• 10:03
  It's very tempting.
• 10:04
  So if somebody comes in and you have a sore throat, you already have a nurse practitioner or a PA there.
• 10:09
  Well, what the heck?
• 10:10
  Let's just see them.
• 10:11
  We said no.
• 10:12
  We're not going to do that because our staff are going to be world -class expert on adult vaccinations.
• 10:19
  So Jonathan, I'm fascinated by this notion of employee health relative to student health and, you know, and, you know, hospital departments or the military that are managing this more effectively.
• 10:32
  What happens to employees in this context?
• 10:36
  No, here's the problem.
• 10:37
  No, there is when you look at student health, employee health and defense firms.
• 10:42
  I would say that only 5 % of them are big enough to have their Student Health, Employee Health Department internally.
• 10:51
  The rest have to outsource it.
• 10:53
  And currently, it's outsourced through a potpourri of different things.
• 10:58
  They send their drug testing somewhere.
• 11:00
  Maybe sometimes they send their vaccines to the county health department.
• 11:05
  Their physicals is done by Submergent Care.
• 11:08
  And there's no technology solution for these people.
• 11:11
  Remember, for every one Stanford hospital or UCLA hospital, there is 20 nursing homes that don't have an employee health department, memory centers and Alzheimer's centers and wound care centers and surgery centers.
• 11:27
  All of these need employee health departments and they're not big enough to have it internal.
• 11:34
  So they have to outsource this.
• 11:35
  And this is where E7 Health comes in.
• 11:37
  We become their outsource.
• 11:40
  employee health department.
• 11:41
  So in fact, theoretically, we could, if we, once we grow big enough, every hospital, instead of hiring a nurse to sit in a 20 by 20 office with a refrigerator full of vaccines, which they're not really necessarily skilled to take care of, should theoretically outsource it to a company that that's all they does.
• 12:01
  And so what we decided to do is write technology for it, because the idea itself is meaningless.
• 12:08
  If you have, we...
• 12:09
  have world -class proprietary technology that can manage somebody's employee health department.
• 12:15
  So let's say you were a chain of hospitals and you decide to outsource your employee health to us.
• 12:21
  You would not even need a database to keep track of everything.
• 12:28
  What you would do is you would just log on to our E7 Health portal.
• 12:33
  And if Jayco shows up in your hospital and says, give me all the TB skin tests, for the radiology department last year at this hospital, you would just go on our system and pull it up.
• 12:45
  So can your system aggregate information from different places?
• 12:49
  Because what I think people, like I served six years in the military, in the military, all of your records are in one place.
• 12:56
  They actually look at your vaccines very carefully because they want to be able to move you around to all kinds of parts of the world.
• 13:02
  And they make sure that you're up to date, but it's in, because all the data is in one place.
• 13:06
  For most employees, Even those long -term employees at one hospital, typically they're getting their care all over the place, not even necessarily in that hospital system.
• 13:16
  You're saying that you've developed a tech platform that can aggregate that information.
• 13:21
  It gets even better than what you're thinking.
• 13:23
  It's actually a CRM.
• 13:24
  So we can tailor make your access to that CRM based on your needs.
• 13:29
  So if you come to us and say, look, I'm going to need results based on states or based on location.
• 13:36
  or based on departments or based on year, this is how I would like the data served up to us.
• 13:41
  So because basically our medical records is actually a glorified CRM with HIPAA compliance and what have you.
• 13:48
  So when an employee comes in, they sign a waiver that their employer has access to their records.
• 13:53
  So we can then serve up the data in a meaningful way for that client if they're big enough.
• 13:59
  This is really exciting, but a lot of employers get hit with a lot of different things that you're really talking about, not just a traditional customer relationship management serum.
• 14:08
  This is really a health relationship management system that you've built.
• 14:13
  How do you get employers' attention to actually buy this, what could be a critical function?
• 14:20
  And certainly during COVID, people realized it is a critical function.
• 14:24
  Well, right now, the amazing thing is if you come on as a corporate client, we don't even charge you for this.
• 14:30
  You just have to get all your services from us and then all the data stored in our system.
• 14:35
  So, so far, we haven't even tried to sort of monetize the technology other than I think when we rarely to ever lose a corporate client only because, you know, they've got, first of all, we're amazing with 10 ,000 positive reviews on our website in the last three years.
• 14:50
  I mean, you wouldn't believe it, but.
• 14:52
  My because you know, they can't believe it.
• 14:54
  We've got to get them to start reviewing our this care talk podcast.
• 14:56
  That's amazing.
• 14:57
  Yeah, I know right.
• 14:58
  No, but what I'm trying to tell you is when people become our corporate clients, they can't imagine leaving because where would they go?
• 15:05
  And is the reason they sign up for you because they really get the fact that the vaccines are so under managed in their population?
• 15:12
  Is that how people typically buy?
• 15:15
  No, no.
• 15:15
  Well, we're talking about now other books of business, but the corporate employee health, they just have to do it.
• 15:22
  In other words, if you're running a surgery center or you have a chain of radiology centers, you have to get pre-employment vaccines and physicals and titers.
• 15:33
  And so I don't think they know they need it.
• 15:37
  They just have been going to five places to get it.
• 15:40
  They find us.
• 15:42
  And so that group is a captured audience in the sense that they're going to have to get it somewhere.
• 15:48
  But yes, we have other books of business like travel medicine and general health.
• 15:53
  You know, a lot of people like, you know, I need a tetanus booster.
• 15:58
  I, you know, I can't get in to see my doctor.
• 16:00
  I've got a deductible anyway.
• 16:01
  And literally one of the things, one of the things we've done to come to our clinics is Amazon S.
• 16:08
  Within three clicks, you have an appointment for the same day.
• 16:12
  You walk in the average wait time is five minutes.
• 16:14
  Oh, that's that's that's amazing.
• 16:16
  So where can people as are you limited by geography?
• 16:18
  Because obviously you have to physically deliver the vaccine.
• 16:21
  Right.
• 16:22
  So that that business is brick and mortar.
• 16:24
  So we basically covered the Las Vegas area with our two locations.
• 16:28
  We're just finishing up the last round of technology changes and then we're going to look for expansion first.
• 16:34
  Regional.
• 16:35
  and then hopefully national.
• 16:37
  So that's the long -term plan.
• 16:38
  And I think you're gonna, you said you're gonna make this technology available to others.
• 16:42
  Why would you do that?
• 16:44
  No, no, that was the drug testing side there.
• 16:46
  I apologize.
• 16:47
  But the drug testing platforms.
• 16:49
  Yeah, that platform that we've written.
• 16:51
  So one of the books of business that a lot of people with vaccines need is drug testing.
• 16:55
  So they come in, they're applying to nursing school, they need vaccines, but then they'll say, okay, as part of my nursing school application, I also need to get a drug test or employers.
• 17:04
  Many employers who need vaccinations also need their employees drug tests.
• 17:08
  Honestly, Dr.
• 17:09
  Bhaktori, I think people don't realize how common drug testing is just as a matter of sort of being employed across the country.
• 17:17
  I mean, it's a massive need.
• 17:20
  Huge.
• 17:21
  And about half of it is regulated with the Department of Transportation, FAA, pipeline.
• 17:28
  And so...
• 17:30
  They they there's no choice for that.
• 17:33
  And then there's another half that needs to get drug tested because their safety sensitive positions, they're going to be operating certain things or they're going to have access to certain things.
• 17:42
  So yes, it's a multi billion billion dollar industry as well as well.
• 17:47
  By the way, it's employee health.
• 17:48
  I was just to get back to that.
• 17:50
  Employee health is probably the largest, you know, 20 billion dollar industry that nobody is focusing on as their sole thing.
• 17:58
  So E7 Health is the derivative of the vaccine company and eNational testing is your drug testing business?
• 18:08
  No, U .S.
• 18:09
  Drug Test Centers is our drug testing business.
• 18:11
  eNational is now our newest venture where we do online laboratory testing, meaning cholesterol, anything nationwide.
• 18:19
  So in other words...
• 18:20
  You've got a lot of things going on, Dr.
• 18:22
  Vector.
• 18:22
  Well, they're all derivative of E7 Health.
• 18:25
  So E7, we basically looked at what E7 Health does using brick and mortar.
• 18:30
  And then we said, what can we do nationally that would involve partnering with collection centers like LabCorp and Quest?
• 18:37
  So I know it sounds different, but if you look at E7 Health's book of business, the seven E7 stands for seven books of business, drug testing and laboratory testing are two pillars of E7 Health.
• 18:50
  And then we took those and we took them national using partnerships, if that makes sense, if you really want to know.
• 18:58
  And leveraging technology as well.
• 19:01
  Do you want to?
• 19:02
  I'd love you to I'd love you to comment.
• 19:03
  I mean, every there's drug testing for for employment is pretty common.
• 19:11
  I don't think people think about AI as having anything to do with it.
• 19:17
  Can you talk a little bit about as AI attaches itself to everything probably sensible and insensible as we're trying to get our head around it, should employee potential employees be worried or happy about AI and drug testing and what's the imp?
• 19:33
  What does it actually mean?
• 19:35
  Well, you know, AI is certainly at its infancy in most of the industries.
• 19:39
  We're currently using AI technology to help manage drug testing programs for companies.
• 19:46
  Because I think people don't understand what drug testing programs are.
• 19:50
  They think drug testing programs for companies is simply the drug testing.
• 19:54
  There's the educational component.
• 19:55
  There's the policy component.
• 19:57
  There is the, you know, the whole managing random testing versus, you know, and being not being biased.
• 20:05
  There's the idea of how do you get the information to the people who need it to supervisors and people?
• 20:12
  How do you do training for the?
• 20:15
  designated employee reps at all these companies.
• 20:17
  So the whole idea of managing a drug testing program is multifaceted and it's not simply getting the drug test done.
• 20:26
  That's sort of the simplest core thing, but managing a massive corporations drug testing program is a 10, 20 faceted process that involves a lot of moving pieces.
• 20:40
  And that's really where we're leveraging our platform and our technology.
• 20:44
  to help employers, help even the government who is regulating them have access to what they need to make sure everybody's in compliance.
• 20:54
  And the compliance component is another huge component.
• 20:57
  But how much of that is prone to artificial intelligence?
• 21:01
  And should employees be worried about the algorithm being wrong and then being clean as opposed to a user?
• 21:10
  Yeah, I mean, theoretically, yes, but there's so much government regulation.
• 21:14
  that limits and puts guardrails and backup audits.
• 21:20
  And you have to statistically be in line with government regulations that I think there's so many guardrails.
• 21:27
  I think AI is limited by government compliance too, because you think other industries have a lot of government regulation.
• 21:35
  The drug testing industry is, especially on the DOT and the regulated side, is just 100 % government regulated.
• 21:43
  So people, employers and employees can feel like it's safe that technology is taking over.
• 21:50
  It's totally safe because of, I think a lot of the technology, even the AI, we spent in getting, in making sure things are compliant.
• 21:59
  Because at the end of the day, whether you do drug testing or not, if you're not compliant, it's like you didn't do drug testing.
• 22:06
  I mean, from an employer's point of view, you get dinged, not whether you did drug testing or didn't do it, you get dinged.
• 22:13
  Well, if you don't do it, you're in trouble.
• 22:15
  But you get most of the time you get dinged because you weren't in compliance.
• 22:18
  Yeah.
• 22:18
  And I think we help.
• 22:20
  We use artificial intelligence and our technology to focus on making sure the right thing happens at the right time and the right data is available to the right people.
• 22:30
  So for you, the art, the algorithms, the leveraging automated algorithms, learning algorithms, which is really the essence of AI, is actually helping you just optimize your current workflow.
• 22:42
  It's not about some novel gremlin making its own decisions on how the test results should be interpreted.
• 22:54
  You know, other industries, I would say yes, but I think you're also in the kind of business where there's a lot of government regulation.
• 23:00
  And I think, you know, You know when it comes to HIPAA or anything staying HIPAA compliant.
• 23:06
  It's very structured I mean it's ordered there's an ordered structure to that you can you can you can paint between the lines but nothing outside the lines so I think I think you're simpatico on this with me that I think we are using our technology to optimize and and Reduce friction to get to where you want to be anyway So what we do is we take we use artificial intelligence and technology to?
• 23:32
  to take out the friction in the system, if that makes sense.
• 23:36
  No, it does.
• 23:37
  It does.
• 23:37
  Although it's interesting, digital health in general was, I think, overrated during the pandemic and is almost going through a period of being underrated.
• 23:47
  Do you have any perspective on that?
• 23:49
  Because you've obviously leveraged technology across your seven different businesses.
• 23:54
  This is one of the most common questions I get.
• 23:57
  And when I give the answer, everyone's so surprised by this.
• 24:00
  because nobody thinks of it this way.
• 24:02
  I actually think the main reason healthcare technology in general is behind the times is not because we don't have smart programmers or smart ideas.
• 24:15
  I think it's the fact that we have to make more than the consumer happy.
• 24:23
  There's always a third party.
• 24:24
  The example I give is imagine if you went to a restaurant and you're trying to have a romantic dinner with your wife.
• 24:31
  but then the chef sits down at the table and wants to be part of the conversation.
• 24:36
  I think when you try to write technology that reduces friction for the provider or the patient, but then you have Medicare, Medicaid, government regulations, HIPAA, and you have to make all those happy.
• 24:50
  So when you go to your programmer, maybe this analogy will hit home.
• 24:55
  If I called you guys and said, listen, I have a new electronic health records that you can throw in all your clinics and it will reduce the work of your staff by 50 % and it will improve access for the patients by 50%.
• 25:12
  I mean, everything will be at their fingertips.
• 25:14
  The only problem is your Medicare reimbursements will go down 10%.
• 25:18
  Who's signing up for that?
• 25:20
  Don't answer that question.
• 25:22
  My point is, my point is, Healthcare technology is governed by how well it does reimbursements and then secondarily everything else.
• 25:34
  That's why you can three clicks and you can order a hammer on Amazon and it's in your doorstep next day.
• 25:41
  Three clicks on your healthcare system doesn't get you a cholesterol test the next day.
• 25:46
  And the reason for that...
• 25:47
  You're still signing HIPAA permissions.
• 25:50
  You're right.
• 25:51
  Exactly.
• 25:53
  So it's not as people always say, why is healthcare technology?
• 25:56
  You know, why didn't the promise ever come?
• 25:59
  It's not that we don't have.
• 26:01
  Look, if Uber can do it, if Amazon can do it, you know, literally, you should right now be able to go online and get every cholesterol test you've ever had on your cell phone.
• 26:11
  But you can't.
• 26:12
  But don't you think it's getting better, though?
• 26:14
  I mean, is it is it really a problem of consumer expectations are ahead of?
• 26:20
  Are health care is the ability to deliver or do you think health care will always be more complicated digitally?
• 26:25
  Look, I mean, I don't know when the last time somebody went to a doctor's office, their primary care, I would venture to bet that 50, 75 % of people still get a clipboard with 10 pages of paper.
• 26:40
  You know, so who are we kidding?
• 26:44
  Like you're you're you're getting a clipboard with paper.
• 26:48
  And so.
• 26:49
  That tells you that I don't think it's our our our our our you know, we're thinking that we should be further ahead.
• 26:56
  It should be further ahead because it doesn't happen.
• 26:59
  You know, when you go, you can book a restaurant on your phone.
• 27:02
  You can do everything.
• 27:03
  I think trying to make a third party happy is going to limit the coders ability to write a frictionless system.
• 27:12
  So that's but that's your see, I'm I'm along the lines of a moron lines of.
• 27:18
  I think the smartest people try to solve the smartest problems and are uninterested in the dumb problems like how to make the clipboard go away, which I think actually is an interest.
• 27:27
  When you talk about friction, it's taking out unnecessary steps.
• 27:32
  A lot of the smartest people in healthcare are much more focused on curing cancer than ending paper.
• 27:37
  And I think that's probably one of our challenges.
• 27:41
  But come on, these Fortune 500 companies and Epic, they could throw all the money in the world at this and then...
• 27:46
  But they can't because their hands are tied.
• 27:50
  Because they're also, yeah, they're trying to make government regulators happy and HIPAA happy.
• 27:57
  I've got a couple of other critical questions for you.
• 27:59
  As a leader of one of the most interesting vaccine companies in America, if we get another pandemic, are we in better shape now than we were the last time to actually protect the population?
• 28:13
  Wow.
• 28:14
  That's a loaded question.
• 28:17
  That is a loaded question.
• 28:21
  From where I sit from my purview, I don't see any better access, any better mechanism to distribute vaccine.
• 28:29
  I suppose the one guiding one happy light of all this is mRNA technology, which I'm sure would still be sitting on a shelf somewhere because of the stigma.
• 28:40
  I had to reach it just so folks that that is the technology where you can program the vaccine against the virus.
• 28:47
  which was really the great breakthrough of the vaccines.
• 28:51
  That breakthrough is what's been sitting on the shelf for 10 years.
• 28:54
  I think there was a stigma to using genetic code.
• 28:58
  I'm going to make an argument.
• 29:00
  I'm going to make it up.
• 29:01
  It would have never seen the light of day were it not an emergency because imagine telling people in normal times that we're going to inject genetic code into you, which will then create a protein, which then your body will develop antibodies to it.
• 29:16
  So I, I, If there's a silver lining in all those unfortunate millions of people that died by forcing mRNA technology, it may save hundreds of millions of lives in the future if the promise of mRNA technology comes to fruition, both cancer and other viruses.
• 29:32
  So if there's a silver lining in all that.
• 29:36
  Yes, that is.
• 29:38
  So I'm going to jump around one more time because you've written some very provocative things about.
• 29:44
  DNRs or do not resuscitate orders.
• 29:46
  You know, the conventional wisdom is that everybody should have advanced directives.
• 29:51
  Those plans for if you were a relative are deathly ill.
• 29:56
  And, you know, we've heard many warnings against too much medicine being delivered too late for too little benefit.
• 30:04
  And the conventional idea as well, since people are going to pass anyways, a do not recessed or DNR order is sort of a conventional thing.
• 30:14
  So with the expectation that everything that you could have gotten access to in health care, you have gotten access.
• 30:20
  I've got a 90 year old mother.
• 30:21
  This is very personal to me, as it is to so many other Americans.
• 30:25
  Yet you've published some really provocative things on the DNR.
• 30:30
  If you have a do not recessed state order, I mean, how do you think about that?
• 30:34
  Are you more or less likely to get the care you need with a do not resuscitate order.
• 30:41
  Well, I think we've got to get away from opinion.
• 30:44
  It's not my opinion.
• 30:47
  There's now over 20, maybe 30 peer-reviewed journal articles in the most respected journals you can imagine that has answered that question.
• 30:58
  It's not up for discussion.
• 31:01
  If you become DNR, make your loved ones DNR, they're statistically, without doubt, more likely to die sooner.
• 31:09
  not get the care they need.
• 31:11
  Now, the flip side of that is, yes, DNR does prevent pain and suffering, you know, and maybe in the late stages, right before death, and it has a place.
• 31:22
  But the problem with it is, even though it does good for those people, for a bunch of other people, it actually ends their life sooner.
• 31:32
  And the irony of it is, look, if we had a vaccine, that saved 95 % of people who got it, it would save them, but 5 % would die, we'd take it off the market.
• 31:47
  Because if DNR was a drug, the FDA would pull it.
• 31:54
  Because it causes so much harm that you can't say we're going to do it because it helps.
• 32:04
  Because you think of a surgery.
• 32:05
  If there was a surgery, that saved 75 % of people that had the surgery, but killed 25 % of it.
• 32:12
  The surgery that would not be good.
• 32:15
  No, it's an incredibly powerful point, Dr.
• 32:19
  Bhaktari, that I don't think we paid enough attention to because like much of healthcare and medicine of all parts, like, you know, sort of a cultural norm can take over and then it can become sort of the rule as opposed to the standard.
• 32:34
  Dr.
• 32:34
  Bhaktari, thank you so much for joining.
• 32:36
  me and the Care Talk community today.
• 32:39
  You really are a beacon of hope for many doctors who want to become entrepreneurs.
• 32:44
  You've got a very interesting vaccine company, an employee health company, and that encompasses so much more of physical health and digital health.
• 32:53
  And you provided us some provocative and really well -informed challenges to healthcare today.
• 33:01
  And I think, sadly, a little bit of a pessimistic view on digital health.
• 33:07
  But thank you for joining us this morning.
• 33:11
  And let me just finish with, if you liked what you heard or you didn't, we'd love to have you subscribe on your favorite service.
• 33:18
  And please leave us a...