Anurag Mairal, director of technology solutions at PATH Health Technologies, says that it's time to start looking at low-cost innovations in healthcare differently. What should the road map be for an innovation? Should the product debut in a developing country first and then, evolve for the developed market or vice versa?
"We're at a point now, that companies cannot just keep adding bells and whistles to the same product to garner sales," Mairal told me.
So, given the increasing costs of healthcare in the U.S. and in Europe, companies are looking increasingly at simpler solutions that have the capacity to criss-cross border with a few tweaks.
PATH is a Seattle-based non-profit. But it's working with the commercial sector to scale, distribute, and market its innovations. That's Mairal's task. He's a new addition to the PATH team, after a noted career with Johnson & Johnson companies. He is symbolic of this merger between social impact and commercial viability.
His approach includes disruptive innovation (disrupt the global health system by changing the cost equation, moving away from a grants-based approach to a commercial-approach) and developing a market for said innovations. It's not enough to innovate. Must build a system to introduce these innovations to the market, advertise them, create distribution chains, and get them to the end-user.
PATH was started in the 1970s by three researchers: Gordon Duncan, Rich Mahoney, and Gordon Perkin. Their aim was quite the same: bring together public health and the private sector. Their focus, though, was slightly different: population control. So, their first innovations addressed population overload -- interventions to curb birth rates -- and were focused on Asia.
Since then, they've expanded their focus, looking at nutrition, water, sanitation, vaccinations, and reproductive health. Here are some of the innovations that PATH has piloted:
River blindness tests
It looks like a pregnancy test but it's designed to identify river blindness (or a tropical disease, "onchocerciasis"), which is a preventable condition that has affected 37 million people globally, many in poor, rural communities situated near a water source. With a grant from the Gates Foundation for $1.8 million, PATH created this device. Traditionally, a health worker would have have to draw a vial blood, take it to a clinic where it can be processed, and then report the results several days later. The later strip, however, requires just one drop of blood from a finger prick and results are available in 20 minutes. Ideal for rural health workers.
Rice is a popular grain, eaten by half the world's population. Fortified rice includes micronutrients such as iron, thiamin, zinc, vitamin A, and folic acid. PATH partnered with food purveyors in India, Brazil, and Colombia to produce the fortified grains to combat iron deficiencies, malnourishment, and anemia. Now, the grains are being coupled with school meal programs, such as in Burundi, to ensure that they reach school kids in low-income communities.
Mobile-phone milk pasteurization
Still in the works, FoneAstra is a system that uses mobile phones to monitor flash-heat pasteurization of donor breast milk. When a mother's milk is not safe to consume or is simply not available, human milk banks (HMB) fill the need; WHO supports the use of HMBs to address malnourished infants. However, the pasteurization process is tricky and healthcare facilities are hesitant to use this donor milk, unsure of its safety. By having a cell phone attached to the pasteurization device, FoneAstra enables these health clinics to monitor data on pasteurization, assuring them that the milk is safe to use. A pilot is under way in South Africa with the Human Milk Banking Association.
PATH created this design after consulting with women globally (in the US, South Africa, Thailand, and Dominican Republic) to ensure that they had single-size solution. It's more "discreet" than the condom, is easier to use than hormonal contraception, and enables women to protect themselves from unwanted pregnancy and some sexually-transmitted diseases. Now, PATH is commercializing this for sale with Germany-based health company, Kessel. But, it's also trying to figure out how the diaphragm could be integrated into family planning programs, given that it's a reusable product and would eliminate trips to a local health clinic. Those projects are under way in Uganda, India, and South Africa.
Vaccine vial monitors
Vaccine temperatures are critical - if too hot, they lose their potency. One of PATH's earliest innovations (1996) included the vaccine vial monitor- a square indicator on the label that lets health workers know if the vaccine is still safe to use. Modeled after a technology used in the food industry, it prevented WHO from dumping massive quantities of vaccines whose potency would be "unknown" after a day in the sun or in the hands of a health worker. UNICEF and WHO claim that this innovation saves the global health community $5 million every year.
The opposite problem of vaccines getting too hot -- they freeze in the carriers. Coupled with ice packs, the vaccines can be at the risk of freezing which diminish their potency as well. Solution? PATH discovered a new way to use nontoxic, biodegradable phase-change material with ice packs to prevent freezing.
Here's a product that debuted in the developed world but is being refined, and considered for the developing world as well. While you can find a female condom in drug stores, Mairal explains that they're not popular. Why? They're not always easy to use and can be uncomfortable. A more refined version, developed by PATH, has higher quality materials (i.e. 0.03 mm thin polyurathane film that allows for heat transfer), claims to be easier to use and feels more natural.
Rather than showcasing pre-made videos on maternal and neonatal health, PATH's Digital Public Health Platform -- basically, video and projector equipment- is enabling rural women in Rajasthan, India to create videos, showcase their films, and answer questions. The community-driven approach includes teams of health workers for local solutions and storytelling.
Trump’s attacks on the free press don’t just threaten the media—they undermine the public’s capacity to think, act, and defend democracy.
Are Donald Trump’s latest attacks on the press really that bad? Are they that out-of-the-ordinary, given the famous record of complaints nearly all his predecessors have lodged? (Even George Washington had a hostile-press problem.)
Are the bellows of protest from reporters, editors, and others of my press colleagues justified? Or just another sign that the press is nearly as thin-skinned as Trump himself, along with being even less popular?
I could prolong the buildup, but here is the case I’m going to make: Yes, they’re that bad, and worse.
I think Trump’s first month in office, capped by his “enemy of the people” announcement about the press, has been even more ominous and destructive than the Trump of the campaign trail would have prepared us for, which is of course saying something. And his “lying media” campaign matters not only in itself, which it does, but also because it is part of what is effectively an assault by Trump on the fundamentals of democratic governance.
Plagues, revolutions, massive wars, collapsed states—these are what reliably reduce economic disparities.
Calls to make America great again hark back to a time when income inequality receded even as the economy boomed and the middle class expanded. Yet it is all too easy to forget just how deeply this newfound equality was rooted in the cataclysm of the world wars.
The pressures of total war became a uniquely powerful catalyst of equalizing reform, spurring unionization, extensions of voting rights, and the creation of the welfare state. During and after wartime, aggressive government intervention in the private sector and disruptions to capital holdings wiped out upper-class wealth and funneled resources to workers; even in countries that escaped physical devastation and crippling inflation, marginal tax rates surged upward. Concentrated for the most part between 1914 and 1945, this “Great Compression” (as economists call it) of inequality took several more decades to fully run its course across the developed world until the 1970s and 1980s, when it stalled and began to go into reverse.
The journalist’s comments suggest gay men enjoy sex with children—an idea that has been widely debunked.
In the comment that cost him his book deal and speaker slot at the Conservative Political Action Conference, the Breitbart journalist and right-wing provocateur Milo Yiannopoulos defended “relationships in which those older men help those young boys to discover who they are.”
In the video, a clip of an old podcast episode that was tweeted this weekend by the group Reagan Battalion, Yiannopoulos says he isn’t defending pedophilia, before adding that “in the gay world, some of the most enriching ... relationships between younger boys and older men can be hugely positive experiences.” (Yiannopoulos later blamed “sloppy phrasing," saying when he was 17 he was in a relationship with a 29-year-old man. The age of consent in the U.K. is 16.)
Neither truck drivers nor bankers would put up with a system like the one that influences medical residents’ schedules.
The path to becoming a doctor is notoriously difficult. Following pre-med studies and four years of medical school, freshly minted M.D.s must spend anywhere from three to seven years (depending on their chosen specialty) training as “residents” at an established teaching hospital. Medical residencies are institutional apprenticeships—and are therefore structured to serve the dual, often dueling, aims of training the profession’s next generation and minding the hospital’s labor needs.
How to manage this tension between “education and service” is a perennial question of residency training, according to Janis Orlowski, the chief health-care officer of the Association of American Medical Colleges (AAMC). Orlowski says that the amount of menial labor residents are required to perform, known in the profession as “scut work,” has decreased "tremendously" since she was a resident in the 1980s. But she acknowledges that even "institutions that are committed to education … constantly struggle with this,” trying to stay on the right side of the boundary between training and taking advantage of residents.
Megaprojects are rarely, if ever, completed on schedule.
The construction of a massive wall along the border of the United States and Mexico is one of President Donald Trump’s central campaign promises. And it’s a promise he intends to keep.
Within days of taking the oath of office in January, Trump began laying the groundwork for the construction of a series of walls and fences that would span some 1,250 miles along the border. On Monday, the Department of Homeland Security issued a memo outlining its commitment to “begin planning, design, construction and maintenance of a wall” to deter and prevent illegal entry into the United States. The memo follows an executive order in which Trump called for the wall’s “immediate construction.”
Joe Moran’s book Shrinking Violets is a sweeping history that doubles as a (quiet) defense of timidity.
The Heimlich maneuver, in the nearly 50 years since Dr. Henry Heimlich established its protocol, has been credited with saving many lives. But not, perhaps, as many as it might have. The maneuver, otherwise so wonderfully simple to execute, has a marked flaw: It requires that choking victims, before anything can be done to help them, first alert other people to the fact that they are choking. And some people, it turns out, are extremely reluctant to do so. “Sometimes,” Dr. Heimlich noted, bemoaning how easily human nature can become a threat to human life, “a victim of choking becomes embarrassed by his predicament and succeeds in getting up and leaving the area unnoticed.” If no one happens upon him, “he will die or suffer permanent brain damage within seconds.”
The preconditions are present in the U.S. today. Here’s the playbook Donald Trump could use to set the country down a path toward illiberalism.
It’s 2021, and President Donald Trump will shortly be sworn in for his second term. The 45th president has visibly aged over the past four years. He rests heavily on his daughter Ivanka’s arm during his infrequent public appearances.
Fortunately for him, he did not need to campaign hard for reelection. His has been a popular presidency: Big tax cuts, big spending, and big deficits have worked their familiar expansive magic. Wages have grown strongly in the Trump years, especially for men without a college degree, even if rising inflation is beginning to bite into the gains. The president’s supporters credit his restrictive immigration policies and his TrumpWorks infrastructure program.
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The Border Adjustment Tax, a proposal favored by House Speaker Paul Ryan, has aroused serious opposition from Republican senators.
Donald Trump is feeling good about taxes. In his gonzo press conference last Thursday, he assured Americans that “very historic tax reform” is absolutely on track and is going to be—wait for it!—“big league.” The week before, he told a bunch of airline CEOs that “big league” reform was “way head of schedule” and that his people would be announcing something “phenomenal” in “two or three weeks.” And at his Orlando pep rally this past weekend, he gushed about his idea for a punitive 35 percent border tax on products manufactured overseas. The magic is happening, people. And soon America’s tax code will be the best, most beautiful in the world.
But here’s the thing. What Trump doesn’t know about the legislative process could overflow the pool at Mar-a Lago. And when it comes to tax reform, even minor changes make Congress lose its mind. Weird fault lines appear, and the next thing you know, warring factions have painted their faces blue and vowed to die on the blood-soaked battlefield before allowing this marginal rate to change or that loophole to close.
A senator has joined human-rights groups in opposing warrantless scans of travelers' digital devices.
For years, travelers entering into the U.S.—whether they’re citizens or not—have been pulled aside at the border and pressured into giving up passwords to their phones and other electronic devices. Customs agents have claimed the authority for these searches under the auspices of a broad exception to Fourth Amendment rights that applies at the border.
But Senator Ron Wyden, a Democrat from Oregon, has a few questions about that legal authority. He sent a letter to the secretary of the Department of Homeland Security on Monday, expressing dismay at reports that people were being asked to unlock and hand over their smartphones at the border. He also said he’s planning on introducing a bill to require agents to get a warrant before searching a device, and to prevent DHS from implementing a new policy that would require foreign visitors to turn over their online passcodes before visiting the U.S.