Ambrosia, a Silicon Valley start-up run by the enigmatic Jesse Karmazin and funded in-part by the notorious Peter Thiel, claimed that transfusions of plasma from young donors could offer some serious health benefits. For the cool price of 8,000 USD for 1 litre or 12,000 USD for 2 litres, customers at its clinics in 6 cities across the US were promised rejuvenation. In various interviews, Karmazin stated that this treatment offered recipients “improvements in illnesses such as Alzheimer’s and other age-related disorders, as well as other things associated with aging, like energy, muscle strength, memory, skin quality, joint pain, etc.”
And so, with such bold claims, we took it upon ourselves to see what was really going on. We analyzed the science. We evaluated the ethics. We even talked to Karmazin himself. Our conclusion? With dubious scientific claims, an unpublished and not peer-reviewed clinical trial, an uncomfortable ethical basis, and a leader unwilling to see right from wrong, Ambrosia posed a clear and very real threat its patients, itself, and society as a whole.
As it turns out, our assessment was correct. In February 2019, concerns from the FDA prompted Ambrosia to shutter its clinics across the US. A firestorm of negative publicity proceeded, leading Ambrosia’s founder, Karmazin, to announce his plan to dissolve the company.
There was one problem with this, however: He didn’t.
Now in November 2019, Ivy Plasma itself is no more, having been replaced with Ambrosia 2.0 and links to its website (Ivy Plasma) redirecting to the new Ambrosia webpage. When asked about the rationale for Ivy Plasma, Karmazin stated: “Ivy Plasma was a short-lived rebranding effort to test customer interest in other products.” And when pressed about the transition back to Ambrosia, Karmazin said: “People really like the Ambrosia name and brand, so Ambrosia is going to continue. The resounding response from people wanting to sign up was, ‘keep things the same.’ So that’s what we’re going to do.”
So, given all these developments, where does this leave us?
First, Ambrosia is indeed back to offering customers “young blood” transfusions at its one “clinic” in San Francisco. Second, according to its shiny, new website, Ambrosia is also offering to sell its blood supplies to interested doctors and their patients for transfusions. And Jesse Karmazin? He’s up to even wackier antics, recently claiming that a now-deceased former Ambrosia customer faked his own death. When challenged on this claim, Jesse was adamant in this conspiracy right up until he was shown the man’s death certificate. And of course, Ambrosia still falsely claims to have scientific backing for these procedures in humans, despite still not yet publishing the results of its much-maligned clinical trial. The worse part? Ambrosia can do all of these things legally, in part because of the lax regulatory environment for off-label products in the USA. And until this changes, Ambrosia and its founder Jesse Karmazin don’t appear to be going anywhere.
So while “young blood” transfusions may not be the secret to eternal life, Ambrosia and its founder Jesse Karmazin seem to have found immortality on their own.
It’s August 24th, 2013, and Matt Harvey is having an off night.
Over the 2013 season, Harvey has distinguished himself as one of the best pitchers in baseball. Amid an otherwise dismal season for the New York Mets, the 24 year-old has become the brightest young hope for the team. He will finish the season with the 3rd lowest earned run average (a rough measurement of the number of runs a pitcher allows his opponents to score) in the majors. Less than three weeks ago, he pitched a “complete game shutout”–throwing an entire 9-inning game without allowing the opposing team to score a single run. Mets fans eagerly look to him as a key prospect for their team’s future. Today though, he struggles, giving up 13 hits in a 3-0 loss to the Detroit Tigers. At first, nothing seems too concerning. Interviewed after the game, he reports that he feels “pretty tired”–understandable going into the final month of Major League Baseball’s 6 month-long, 162 game season.
The next day, Harvey reports having some tightness in his forearm. A seemingly innocuous complaint on the surface, it is recognized for its seriousness by the Mets medical team. Harvey is sent for an MRI, which comes back with devastating news: his ulnar collateral ligament (UCL), a triangular bundle of connective tissue fastening the medial epicondyle of the humerus to the proximal end of the ulna, is ruptured. He will not pitch again for 18 months.
There are risks involved in taking the body to its physiological limits, though. Soft tissue is only so strong, and the elbow undergoes tremendous stress during the act of throwing. The violent and repetitive act of pitching often ends up exceeding the limits of the elbow. In pre-adolescent players, the stress can cause the end of the humerus to fracture. In older players, the breaking point shifts from bone to ligament: specifically, the UCL.
A few weeks after his diagnosis, Harvey underwent one of the most well known procedures in professional sports: ulnar collateral ligament reconstruction. Most know it as “Tommy John surgery”.
In response to John’s injury, however, one of the Dodgers’ team physicians, orthopedic surgeon Frank Jobe, proposed a new procedure to recreate the damaged ligament. Jobe would take the tendon of the palmaris longus from John’s right wrist and thread it through holes drilled into John’s left humerus and ulna into a figure-8 pattern. John agreed to the procedure. He spent the entire 1975 season rehabilitating his repaired elbow, and returned to the Dodgers in 1976.
Jobe was cautious, wanting to make sure that the surgery provided long term benefit before attempting it again. After successful surgeries on several more baseball players, as well as a javelin thrower, he became confident in the procedure, publishing his results in the Journal of Bone and Joint Surgery in 1986. Three years later, Tommy John retired after a career spanning 26 seasons. 14 of those seasons came after his UCL reconstruction. The procedure that saved his career would come to be known by his name.
In 2014, Frank Jobe passed away at 88 years old. He left behind a remarkable legacy. In World War II, he served as a medical supply sergeant and participated in the Battle of the Bulge. He was a clinical professor of orthopedics at University of Southern California School of Medicine and founded the Biomechanics Laboratory in Los Angeles. And of course, he innovated a medical procedure that revolutionized baseball and continues to rescue the careers of pitchers, like Matt Harvey, to this day. On his medical accomplishments, Jobe mused, “Sometimes it just makes you want to cry watching those guys go on to great things. It really does.”
Today, Tommy John surgery poses a new problem. With baseball becoming increasingly competitive, rates of UCL reconstruction rose 343% from 2003 to 2014, with the highest increase in the 15-19 year old age group. All of which begs the question: could baseball, from little league through to the majors, be doing more to prevent these injuries rather than relying on an invasive reconstructive surgery that requires over a year of recovery time? While major league pitchers often have tightly controlled pitch counts (not exceeding a certain number of pitches in a game) and rest days, youth baseball leagues often do not have nearly the same restrictions, and often any rules that may be in place are ignored. Little league pitchers are pushed to pitch for longer and more frequently than is safe, and managers can be ignorant of the risks or warning signs of arm injury.
Increasingly, sports medicine researchers are encouraging unstructured play and participation in a variety of sports to reduce overuse injury. Unfortunately, opportunities for multisport participation appear to be decreasing. Local sports leagues are being displaced by travel teams, which typically involve more specialized players, greater time commitment, and increased financial burden. The displacement of local leagues not only decreases opportunities for youth to participate in multiple sports, but also reduces the options available to families who cannot afford a travel league. Additionally, many school districts in the United States have decreased the time dedicated toward physical education and recess, in favour of increased time in the classroom. These cuts reduce the opportunities for children to diversify their physical activity and try different sports, especially those from lower income households. In order to reverse this trend, youth sports needs a fundamental realignment of ideals, moving away from producing elite athletes for families that can afford the price, and toward creating equitable opportunities that allow children to engage with multiple different sports, regardless of financial status. Until these changes occur, though, Tommy John surgery will continue to be a familiar phrase for baseball players and fans alike.
Author: James Colapinto
James Colapinto completed his B.Sc. in Developmental Biology and M.Sc. in Plant Development at the University of Toronto. He is interested in sports medicine, addiction and mental health advocacy, and classical music. He is an avid Blue Jays fan and mediocre right fielder.
October 6-12, 2019, is the Canadian Alliance on Mental Illness’s Mental Illness Awareness Week (MIAW). This week-long campaign is dedicated to raising awareness and fostering discussion around the topic of mental health. In the spirit of this initiative, it is imperative that we as medical students educate ourselves on this issue that affects our health, as well as the well-being of our friends, families, and future patients. Written by our very own Hasan Hawilo, here is an article that highlights some ideas about mental health and illness care in Ontario.
Lastly, when it comes to medical professionals, things aren’t any better. Medical students are at an increased risk of being diagnosed with mental illness. Up to two-thirds of physicians may rely on self-treatment as the only form of care for their mental disorder. All of these statistics, taken together, emphasize that mental illness is becoming increasingly prevalent. If you’re dealing, coping, or struggling with mental health challenges, you are not alone. Consider, as an analogy, that your brain and body operate under the same fundamental principles as an engine. When something goes wrong with your car, you don’t second-guess making an appointment with an expert in the field of automotive repairs. If you’re struggling with mental health, it only makes sense to see an expert in the field of mental health.
This is all to say that if you think you need help, give thought to reaching out to health services in the London and Windsor communities.
New Healthcare Infrastructure
Put simply, mental health in Canada is expensive and under-resourced. According to a 2013 report by the Mental Health Commission of Canada (MHCC), the direct annual costs of mental illness (including treatment and support services) across the country are $50 billion. Soon after the 2018 provincial elections, the Ford government announced a $1.9 billion investment in mental health funding over the next 10 years. Though this investment represents a $330-million-a-year cut from the previous government’s budget and has been criticized by health advocates in Thunder Bay as disingenuous, funding ultimately represents a step in the right direction. In January 2019, the Ford government announced $633 million in funding dedicated to the development of two new Center for Addiction and Mental Health (CAMH) buildings in Ontario, thereby introducing 235 new inpatient beds. These two additions to the Queen Street West Complex in Toronto are expected to open in 2020.
Bell Let’s Talk: Breaking Down the Stigma?
It is encouraging to note that the social perception of mental illness is not what it once was. Today, 96% of Canadians consider their mental health to be at least as important as their physical health, and 42% of Canadians have discussed mental health concerns with others. These data optimistically suggest that awareness initiatives such as American rapper Logic’s suicide hotline song are having a positive impact on people’s willingness to have frank discussions about their well-being and to seek help. However, social stigma continues to have a profound effect on the experience of mental illness in Canada; the Canadian Association of Mental Health reports that social stigma prevents 40% of Canadians affected by depression and anxiety from pursuing professional help.
So, what impact do awareness campaigns have on the average consumer? Bell Let’s Talk Day, arguably one of thelargest and most well-known mental health awareness campaigns in the world, has been criticized for its lack of inclusive campaign advertising, lack of substantive discussion around mental health problems, and potential conflicts of interest. University of Windsor’s Jasmine Vido does an excellent job of highlighting the public’s ambivalent reaction to the campaign. Unfortunately, there is a lack of rigorous studies evaluating the effects of mental literacy campaigns on the public. Though promising research from other mental health initiatives, both in Canada and abroad, suggests that these mental health awareness strategies encourage patients to reach out for help, it is ultimately difficult to make meaningful and generalizable conclusions about individual campaigns. From a fiscal standpoint, since 2010, Bell’s initiativehas raised over $100 million in new funding for mental health. Bell’s intentions are unquestionably profit-oriented, and its mental health campaign doubles as a spectacular marketing tactic – but so what? There are few players in the field of mental health investment. Shouldn’t a for-profit company that represents its shareholders benefit from their social good? Unlike Netflix’s original series 13 Reasons Why, which has been criticized by the Canadian Mental Health Association (CMHA) as a potentially harmful depiction of suicide, Bell Let’s Talk has garnered support from the MHCC. Until we can identify sustainable solutions that better address the complex issue of mental health stigma, Bell Let’s Talk may serve a valuable purpose.
Author: Hasan Hawilo
Hasan Hawilo completed his B.Sc. at McMaster University. He is passionate about grassroots volunteer organizations that address the social determinants of health and excited to learn more about how politics interacts with stakeholder interests to inform healthcare policy.
There is significant controversy when it comes to physicians commenting on their patients’ weight and lifestyle choices. Not only is weight loss especially difficult to achieve, and even more difficult to sustain; repeatedly telling patients to loose weight often hinders weight loss. Existing in a society that constantly shames and vilifies fatness, and often treats fat people as second-class citizens, fat patients become hypersensitive about their weight and any comments about it. In this context, a physician telling a fat patient to lose weight, when done without nuance and as a cursory addition to management plans, can have a very negative impact on the patient.
The Body Positivity Movement and Physicians
Cue the body positivity movement. Body positivity is essential for the society we live in: it represents and advocates for the idea that our worth is not determined by our size or our health status, and that to discriminate, shame, and vilify people based on their size, is unacceptable. Where body positivity loses its focus, however, is if it suggests that physicians should not tell their patients to lose weight ever.
While I agree that health cannot be defined
and constrained to something as simple as body size alone, and that each
individual has a right to define health for themselves, I think that physicians
still have a right to encourage, motivate, and influence their patients toward
healthier habits. HIV patients are stigmatized, but doctors don’t stop
encouraging healthy sexual practices to HIV patients. Similarly, fat stigma
does not mean that excess weight does not have a correlation with bad health
outcomes. Excess weight complicates pregnancies, deliveries, and surgeries in
general, making them riskier, and has been linked to many conditions such as
metabolic syndrome, sleep apnea, and osteoarthritis of the knees. Thus, to
suggest that a physician never comment on weight as a relevant factor in
causing or exacerbating a patient’s condition is too simplistic and does fat
patients a disservice.
It is however, important to accept that
physicians are in a unique place to comment on the lifestyle choices of an
individual. As a society, we don’t comment on people who choose to smoke, but
as physicians(-to-be), it is our role to influence and motivate our patients
toward healthier habits. Similarly, physicians have a responsibility toward
their fat patients to talk about healthier life choices if they, in their
clinical judgement, think that a patient’s weight or health is being affected
by their lifestyle choices.
These factors significantly complicate the
discussion surrounding weight loss reduction. However, these are not reasons to
justify that discussing weight reduction is always detrimental. Instead, they
are reasons to introduce the idea of discretion and nuance in handling
sensitive conversations such as those surrounding weight reduction.
In caring so deeply about our patients’
physical health, we cannot forget about their mental well-being and sanity,
especially because the two are so interconnected and intertwined. For patients’
that live in a society that constantly reminds them that their weight makes
them inadequate, physicians reiterating that only reinforces a vicious cycle of
self-loathing, fuelling feelings of worthlessness. In patients that are
battling mental health issues such as depression, anxiety, eating disorders,
and substance abuse disorders, feelings of worthlessness and self-loathing can
fuel into and exacerbate their mental health conditions. Perhaps
most disturbing is that it discourages patients from seeking health care
services at all.
Moving Forward Together
Weight loss discussions are discussions
that need to happen in the context of a longitudinal relationship, or in the
context where the support of a longitudinal relationship is possible. As well,
these discussions require participation from the patient, and should empower
and give control back to patients who likely feel disenfranchised by their
inability to lose weight. There needs to be discretion as to when and how to
approach the subject. This means that if a lot of times you have to ignore your
patient’s weight problem because it’s not the right time or setting, then so be
it. Finally, these discussions must take into account that simply prescribing
patients with lifestyle changes often underestimates the influence of other
contextual factors that can impact weight loss.
Part of the challenge of being an effective physician is the art of difficult conversations. Running away from a conversation because it is difficult is neither productive nor useful to our patients. But by finding ways to have important conversations in a productive manner, we are able to better serve our (future) patients and be better physicians.
It sounds like such a silly statement. Breathing is something that we are innately
programmed to do. But when I was asked to describe my experience with
depression and generalized anxiety disorder, this was the only phrase that
began to describe it. It is like learning to breathe over and over again.
My struggles with mental health have been present for
most of my life. However, it wasn’t until three years ago that I could put a
name to what I was experiencing – when I was diagnosed with both generalized
anxiety and major depressive disorders. I had experienced many of the symptoms
encompassed in these two conditions since I was a child. But because there was
nothing medically “wrong” with me, I was labelled as moody, overly emotional,
or disruptive. For the next several years of my life, I internalized the
thoughts and feelings that I was experiencing as myself just overreacting or
getting worked up over nothing. I placed an inordinate amount of blame on
myself and resolved to move past these scenarios and just “be better”.
Throughout high school and university, the anxiety and
emptiness that I experienced were magnified. The funny thing was, if you asked
anyone in my life from my close friends to casual acquaintances, they would
describe me as being incredibly happy all of the time. Sure, I knew that away
from the gaze of others I would have bad days or weeks, but I would also have
periods of unequivocal happiness where I couldn’t wait to see what the future
would hold for me, so how could I possibly be depressed? Over time, the periods
of depression and crushing anxiety began to grow longer and the moments of happiness
became increasingly less frequent. Even when you need it the most, reaching out
for help is an incredibly difficult feat. I found this to be especially true
because I didn’t know how to define what I was experiencing yet. Was I
over-reacting? Was this something that everyone goes through in university? How
could I ask for help when I didn’t even know what I needed help with? With
time, I finally made the decision to reach out to my doctor. Being formally
diagnosed gave me a strange sense of closure. I could finally put a name to my
illness. A name that made me feel even the slightest bit that my struggles were
validated. I felt excited and hopeful about my future. I knew what was wrong
with me and now I could go out and fix it. Like I have found time and time
again, life just isn’t that simple.
When I started medical school, it was meant to be the
happiest time in my life. I had worked for it for years and dreamed of it for
even longer. I had always believed that my depression and anxiety were centered
around my unhappiness with where I was at in life. If I could accomplish more,
do better, be better then I wouldn’t have this weight hanging over me. In a
one-year period I married my high school boyfriend, completed my master’s
degree, and was accepted into medical school- everything I had dreamed of was
finally at my fingertips. At this time, I thought that I would finally be free
of the depression and anxiety that had haunted me since I was a child. I was
exactly where I wanted to be in life. But as I sat there during my medical
school orientation, I felt the familiar pain of not being able to breathe.
From that moment on, I fell into a depression deeper
than I had ever experienced. Depression and anxiety have become colloquial
terms that are thrown around to superficially talk about mental health but
being suicidal isn’t something that is often spoken of. Suicide is an
uncomfortable topic that is often shied away from in conversations about mental
illness, but it is a very real and prevalent issue, especially within the
medical community. Because of the prevalent stigma that comes along with
speaking of being suicidal, I was afraid to reach out and ask for the supports
that I needed. How could the girl who was always smiling and supportive, the
person that classmates would go to for advice, the student body president be
suicidal or suffering from depression? How could I ever be the doctor when I
was also the patient?
In starting medical school, I had endeavored to keep
my illness a secret. I believed that if my new peers discovered what I was
hiding, the imposter syndrome that I so often experienced would be validated by
all of those around me. I began to worry about how dealing with mental illness
would affect my future career as a physician. But I have decided that I refuse
to be part of a healthcare system where I will be stigmatized for being both a
physician and patient.
My story is not special, and it is not unique. There
are an endless number of people like me, who have experienced this kind of
hardship and still persevere every single day. I’m still sick, and I believe
that these are issues that I will continue to manage for the rest of my life.
But my perspective on my illness has changed. I’ve started talking more openly
about my mental health with those in my life. Normalizing my illness has given
me the strength that I need to learn how to breathe again one day at a time.
I’m slowly learning to trust others and that I don’t need to carry the weight
of my illness all on my own. I have built the most incredible support system,
and I could not be more thankful for the endless number of people that have
demonstrated kindness and compassion and friendship throughout my journey. I
take the medications that I need to allow my brain to function normally, and I
continue to work on myself every day with the help of an incredible
psychiatrist who is well-versed in physician and trainee mental health. I’m not
okay today, but I know that I will be one day. I know that I have a future with
love and hope and happiness. I know that my experiences with depression and
anxiety will help me to be a more compassionate and empathetic doctor. I know
that one day I will breathe freely again.
As I continue to move forward in my journey, there are
a number of realizations that I’ve made that have contributed to my recovery. First,
I have spent most of my life searching for my purpose; seeking out greater
meaning in the world and the one ultimate source of happiness to light a spark
inside me and show me why I’m here. This is something that I have spent years
searching for but have never found because life is just not that simple. One of
my closest friends has helped me to realize that life is not black or white.
Good or bad. Pure or evil. Just as happiness isn’t one grand event or nothing
at all. She has shown me that happiness isn’t a destination or one occurrence
in life that we get to experience. Happiness, as cliché as it may sound, is a
collection of tiny moments in everyday life than can bring joy and appreciation
and love. These moments can be as simple as having coffee with a friend in the
middle of a hectic day, spending an hour at the park with my dog, sleeping in
without an alarm, or hearing the purest and most magnificent belly-laugh of my
husband. Any of these moments alone are not momentous or overly significant, but
together they form a life filled with purpose and meaning and value and hope.
Now, during difficult days, there is a quote that I
like to remind myself of by one of my favourite authors Jamie Tworkowski:
“Your questions deserve
answers, but just as much, you deserve people who will meet you in your
questions. Some answers will take years. Some answers will take a lifetime. The
questions often weigh so much. The good news is you don’t have to carry them on
your own. This life, our healing, our recovery, it is certainly a journey. What
a miracle that we don’t have to do it alone.”
Despite the difficulties and uphill battles that I still continue to face. Despite the struggle of facing a world that continues to stigmatize and cower away from my illness. Despite the beautiful and wonderful days that can be interrupted unexpectedly by a familiar sense of being unable to breathe, I am not alone. What a miracle that I don’t have to do this alone.
Author: Jessica Garabon
This post was inspired by Proaction Mental Health, a new social movement created by Schulich medical students to tackle the stigma of mental health, and to provide a strong supportive community among future healthcare professionals. Follow them at @proactiononmh on Instagram and Twitter!
In my previous posts, I have been trying to share some
interesting facts from medical history, and have been trying to describe why
studying the history of medicine is meaningful for those of us entering this
this post, Dr. Adam Rodman, the creator of one of my favourite medical podcasts
joins me for an interview.
Dr. Adam Rodman is an internal medicine physician at Hospitalist at Beth Israel Deaconess Medical Center, and an Instructor at Harvard Medical School. He runs the podcast Bedside Rounds, which is chock full of fascinating narratives from the history of medicine.
Could you tell us about yourself? What does a typical work day look like for you?
Thank you for having me! I’m a hospitalist now, though
initially I was a global health physician through the amazing Beth Israel
Deaconess Medical Center Global Health Fellowship program, where I worked at
Scottish Livingstone Hospital in Molepolole, Botswana. I was the physician on
the medical and tuberculosis wards; physician there means, as it still does in
much of the world, an internal medicine-trained doctor. My life is a little
less exciting now that I’m permanently in Boston, but I still have a great job.
It’s actually not that different than Botswana, though the pathology is
different, of course. I care for medically-complex patients in the hospital,
with either myself as their sole doctor, or as part of a larger team of
residents and students.
In a typical day, I get to the hospital around 8 and start to “bedside discovery round” with my team — that is, we go and see each of our patients together, and along with the patient we review their data and discuss their plan for the day. In the afternoon, I’ll either help my team by seeing patients, teach the students and residents, precept in a student-run clinic, or even just work on my academic research, including my podcast Bedside Rounds, which I make in partnership with the American College of Physicians.
At what point in your medical career did you become interested in the history of medicine?
Oh, that’s a great question! I’ve always been interested in history, unsurprisingly — I was a history major in college. But I don’t think my interest in the history of medicine came until well after medical school. As I’m sure you know, medicine is presented very ahistorically — you drink from a firehose of information, with very little context or background for why or how things developed. Like most students, I just accepted this. This is how medicine was:MONABASH* after MI, a fever is 38 centigrade, make sure you pre-round on all your patients or the attending will be mad. When I was a resident, though, I became more and more curious about WHY we do the things that we do. There are lots of ways to address the question “why”. A lot of basic science research seeks to answer these questions, as does the evidence-based medicine project at large. For me, medical history was my outlet for curiosity. So, to answer your question, I’d say the second year of residency was when I really started getting comfortable enough with my own medical practice to start questioning things.
Do you feel that studying the history of medicine changes how you practice medicine? If so, can you share an example?
Yes, yes, and yes! Studying history has changed my
entire approach to practicing medicine. So first, at a concrete level, it helps
me question dogma. So, like I was mentioning before, the study of medical
history will quickly reveal that so much of what we’re taught in medical school
stands on shaky foundations.
One of the classic examples is the definition of a “fever”.
We’re all taught that a fever is 100.4 or 38 degrees Celsius. It’s scientific
simplicity. You’ll even see some of our colleagues confidently announce, “it’s
either a fever or it’s not!” and make fun of patients who say, “I run low, so
99.7 is a fever for me.” But even a cursory examination of history will show
that this was based on mid-19th century data from Wunderlich, using an esoteric
thermometer, axillary temperatures, unclear data analysis, and a, let’s just
say… an imprecise method of measuring data. Moreover, numerous studies have
shown that body temperatures are not only lower, but vary throughout the day —
and in fact, the most important thing appears to be variation from the
patient’s own baseline. It turns out, in this case, that taking an historical
approach is, in fact, taking the scientific approach, critically appraising
data that has real clinical impact. And while we’re at that, taking an
historical approach also shows that our patients’ own experiences are probably
accurate — they probably do “run low” because 98.6 F is high! **
And once you start to realize this with one subject,
you realize that a whole spate of medical knowledge is equally shaky or
contingent. You’ll discover arbitrary drug dosing and durations, very real
epistemological concerns about our ability to know what causes disease, and
even reason to doubt some randomized controlled trials — I don’t want to turn
this interview into a lecture about skepticism, but I’ll add that the more you
read about the fragility index, the more you’ll see that the basis of our
knowledge is often far shakier than we’d like to admit.
I don’t want to say that a study of history has made me cynical — it hasn’t; if anything, I’m far more aware of how much good we can do now compared to past eras. But it’s made me very humble about the limits of our knowledge. And it’s made me focus on many of the older qualities of being a physician — compassion, good communication skills, and being at the bedside.
In your episode “The Cursed” you describe the outlandish autopsy findings of King Charles II of Spain as an example of how a different system of medical knowledge can produce a difference medical gaze. Can you talk about how being aware of your own gaze changes how you approach medicine, if at all?
I was hoping you’d ask this question!
So as a brief explanation to your readers, the clinical gaze refers to the
postmodern concept first stated by Michel Foucault in the Birth of the Clinic
that our scientific and epistemologic structures fundamentally shape how we
approach the patient. Listen to the episode if you want more! Or even better,
read the Birth of the Clinic!
As medical students, you are all
becoming acculturated in a very specific gaze. It’s not necessarily a bad
thing, I should add — my clinical gaze allows me to suspect, say, pericardial
tamponade within minutes of talking to a sick patient (as happened in the past
few weeks). But being aware of my own gaze has made me realize that many of the
things I do are for my gaze, rather than for my patient. Examples abound, but
generally we want data at the expense of our patient’s experiences; we have
elderly patients who are woken up every 4 hours overnight for vitals checks. We
draw “daily” labs at 4 AM on patients who have long since showed clinical
stability; if a patient is getting better, you do not need to “trend” their
leukocytosis resolving; if they are stably anemic you do not need to “continue
to monitor” their hemogram. That only satisfies our gaze. We forget that the
patient is in front of us, and not in the computer (another postmodern concept
— the EHR as simulation).
It’s also made me re-prioritize how I spend my limited time during my day. Often one of the least useful things to a modern clinical gaze is the thing that patients most appreciate — sitting at their bedside and chatting with them about their lives. I think we all know we need to spend more time with our patients — but being aware of my gaze has really made me understand why.
Is there anything else you would like to add or talk about?
Yeah, one final thing — a plug for students. You do
not need to be really into medical history to be a good doctor. But the impulse
that is behind it — curiosity — is essential, and often squelched in medical
education. We have an amazing field that privileges such an important position
in our patients’ lives. What differentiates the great doctors from the merely
good is a deep, abiding curiosity — about science, about our patients, about
why we do the things the way we do. Make sure to cultivate your curiosity and
creativity throughout medical school, and not just in medicine. Keep playing
your instruments, keep producing art, keep reading for fun. The curious mind
makes a wonderful physician!
If you are looking for a podcast to listen to in between your studying sessions, I highly recommend Bedside rounds (http://bedside-rounds.org). Dr. Rodman is starting a medical podcasting clinical elective in Boston later this year. Follow him @adamrodmanMD (https://twitter.com/adamrodmanmd )
Disclaimer: We started writing this post back in January, right around when Ambrosia officially began operating in the US. Since then, Ambrosia has suspended its work following concerns from the FDA. Its former website domain, ambrosiaplasma.com, is no longer live. Simply put, Ambrosia seems to have disappeared. And though Ambrosia may be out of the picture, if we’ve learned anything whilst writing this piece, the quest for immortality has a long history. Ambrosia and its founder Jesse Karmazin are not the first and certainly won’t be the last to tout the transfusion of “young blood” to combat disease and aging. And with the scientific jury still out on whether or not this is even possible–let alone safe–the importance of this piece cannot be overstated. As a result, we have therefore decided to leave this piece in its original narrative form. We hope you enjoy reading.
Humanity has been fantasizing about an elixir of youth since the Mesopotamian Epic of Gilgamesh. Have we finally found it in an obscure blood transfusion startup? Ambrosia, a company run by the Stanford-trained Jesse Karmazin, claims to have begun operations in 6 US cities. Its mission? To provide customers with the blood of young people. Its claims? To rejuvenate its customers through the use of this “blood drug.”
This, for the cool price of 8,000 USD for 1 litre or
12,000 USD for 2 litres. And while the word “ambrosia” may have its roots in
the food or drink of the Greek gods conferring longevity and immortality,
Ambrosia, LLC, is anything but.
What is Ambrosia?
Taking a tour of Ambrosia’s recently updated website, one is immediately reminded of other similar, Silicon Valley-esque sites. It’s aesthetically pleasing. It has pictures of hikers, lush fields, and tastefully decorated shelves–all of the things you want your company to stand for. What Ambrosia’s site doesn’t have is information. The entire site has just 160 words, including the “science” used to back up this treatment modality (more on that later). Towards the end of the site, visitors are directed to a PayPal payment menu with two options: 1 L or 2 L of young people’s blood. Even in our minimalist culture, this website seems to be a little bit sparse.
So, to learn more about what Ambrosia is, what it does, and how it started, we went straight to the source: Jesse Karmazin, a Stanford Medical School graduate (but, still without a medical license), founded Ambrosia in 2016. Since then, he’s kept a relatively sparse presence on the internet while building his company. Other than attracting the attention of the notorious Silicon Valley investor Peter Thiel, basic Google searches of Karmazin yield nothing more than articles about Ambrosia and his LinkedIn profile--which is where we chose to reach out to him. He answered, and kindly agreed to let us cite him here.
To gain a better
understanding of where the blood for these transfusions is obtained, we first
asked Mr. Karmazin what controls and definitions they used for these
transfusions. Said Jesse, “the blood is obtained from blood banks in the US,
and is tested according to FDA requirements,” going on to later describe that
“[we] define young blood as 16-25… blood banks do keep track of donor ages.”
When asked about that science behind what Ambrosia does, things got a little
more abstract. While Jesse did say they would be publishing the results of
their clinical trial later this year, he did not give us any more specifics
about the outcomes of the study. He did, however, mention that “we’re seeing
improvements in illnesses such as Alzheimer’s and other age-related disorders,
as well as other things associated with aging, like energy, muscle strength,
memory, skin quality, joint pain, etc.” In addition, much of the existing
literature Jesse shared with us as the basis of Ambrosia’s work has only been
done on mouse “parabiosis” models and rather than with transfusions (an
important distinction we’ll get into later) which has only further clouded the
legitimacy of this science. This brings us to the centre of the debate about
Ambrosia: is there any science to back this up?
What’s the science?
The use of younger people’s blood to improve one’s well-being and prolong life is not a new idea. In fact, history is littered with tales of larger-than-life figures seeking mortality in the blood of the young. Pope Innocent VIII (ironic, we know), who claimed the Holy Chair in 1484, quickly saw his health deteriorate. Following a stroke in 1488, Pope Innocent VIII was desperate and barely clinging to life. So, in attempt to thwart death, Pope Innocent VIII looked to the youth:
And while this experiment with the use of young blood to cure his ailments ultimately failed, the dream of such a therapy has lived on.
Enter Jesse Karmazin.
Jesse Karmazin, the CEO and Founder of Ambrosia, stated his interest in the field of parabiosis started back in 2013, from a study in mice that suggested that some aspects of aging could be reversed when older mice are transfused with younger mouse blood. In this study, researchers identified a compound in blood, GDF11 (a member of the TGF-B family), that declines with age, and suggested that restoration of this compound could reverse age-related cardiac hypertrophy. Though interesting, these results were obtained through a less-than-ideal procedure for humans called parabiosis, which involves literally sewing older mice to their younger counterparts to connect their vasculatures for up to 4 weeks. I don’t know about you, but spending 4 weeks sewn to someone else seems like a high price to pay for restored youth.
The problems with Ambrosia and parabiosis don’t stop there. Ambrosia’s now-complete clinical trial, as registered at ClinicalTrials.gov, yields some serious red flags. Despite still not publishing any results from the trial, the description of the trial states an actual enrolment of 200 participants above the age of 35 that received infusions of plasma derived from young donors between the age of 16-26. In order to assess “spectrum of physiologic pathways with evidence-based connections to aging,” Ambrosia’s trial description also sets out primary outcomes to track a panel of age-associated biomarkers before and after treatment. Such biomarkers include various immunoglobulins, chemokines, cytokines, and lipoproteins that are linked to “specific disease states”. Throughout the trial, participants were also said to have had their “organ function [which will be] specifically measured includes the liver, bone marrow, kidneys, pancreas, muscles, cardiovasculature, cerebrovasculature, and the thyroid. All of this, without any data to show or science to back up their claims.
are the ethics?
First and foremost, Ambrosia’s commodification
of blood undermines the altruism-based framework of both clinical research and
blood donation. In its previously-discussed clinical trial, Ambrosia was
charging individuals 8000 USD just to participate in a research study with no scientific merit in humans.
As they exist today, blood donation and clinical research both tend to rely on volunteers. Some donors in the U.S. are compensated, however, with donors receiving up to $50 per donation, and some research participants also being compensated for their time. The rationale for compensating volunteers for their time and donation exist in some jurisdictions to avoid coercing volunteers into participation, while alleviating the sometimes-significant barriers to participation.
In either case, by selling blood plasma
that has been collected either from volunteers or compensated participants for
a staggering $8000 per litre, Ambrosia has commoditized this precious resource
in a way that does not reflect how the medical community has chosen to encourage
blood collection. Allowing participants to participate in a clinical trial by
paying to do so subverts the prevailing framework for medical research where
participants are encouraged to participate out of good will. How this trial was
approved by a research ethics board remains unclear to us.
In the realm of ethics, a secondary concern also comes to mind: blood is a scarce resource. By diverting blood that would otherwise go to saving lives towards an unproven intervention, people who have proven medical need for blood transfusions may be disadvantaged. Furthermore, should this treatment option become more mainstream and cheaper, already low stockpiles of blood for donation will become even more strained.
The Epic of Gilgamesh is an ancient Mesopotamian odyssey written in the Akkadian language, and chronicles the adventures of Gilgamesh, the king of the city state of Uruk. While the details of the story are not pertinent to this piece, the ending most certainly is. Upon meeting Utnapishtim, the survivor of the Babylonian flood, he is told the story of the flood and is shown where to find a plant that is capable of everlasting life. Upon finding the plant, Gilgamesh lets his hubris get the best of him, letting his guard down only to have it seized and eaten by a serpent. Gilgamesh never succeeds in his quest for immortality, and returns to Uruk dismayed and defeated.
This story is not unlike that of Jesse
Karmazin and all of the other men and women before him who have dreamed of
youth and immortality. Indeed, it is a quest that has lasted for all of time,
and seems poised to last for the foreseeable future. And like all those who
ventured on this quest before it, Ambrosia, LLC, will hopefully be no exception
to the trend: a victim to its own hubris. With dubious scientific claims, an
uncomfortable ethic basis, and leader unwilling to see right from wrong, it is
clear that Ambrosia poses a clear and very real threat to society and itself.
Only time will tell how far it goes; and, without serpents to steal its
stockpiles of donor blood, what it will take to stop it.
In my previous blog post, I started to describe how Marcus Aurelius thought that we should face all our struggles without complaint. But where does the strength to do this come from? Let’s continue with what Marcus thought the answer to that question was:
You have power over your mind-not outside events. Realize this, and you will find strength.
A strong person, according to Marcus, recognizes that strength comes from within. It’s in our thoughts and in how we choose to perceive the world around us. The Stoic philosophy that Marcus learned as a young adult taught him that no events which happen are in themselves evil, it’s only our perception of them that is evil. If we have the inner fortitude and belief that we will overcome whatever hardship we are facing, then that is the source of true strength. Marcus explains this well and takes it a step further when he says:
Apply this principle: not that this is a misfortune, but that to bear it nobly is good fortune.
Again, it all comes down to perception. Question yourself: Is this
difficult task or unfortunate event really a bad thing, or is it simply an
opportunity to make myself better? If we begin to face our problems with this
in mind (which I understand is no easy feat), then we will be facing it with
all the strength we can muster, and we can’t ask for much more than that.
One last passage on this topic that I found particularly powerful is the following:
Thou sufferest this justly: for thou choosest rather to become good tomorrow than to be good today.
Medical school and being a doctor isn’t going to be easy, it was never going to be. But all the exams we write, the facts we memorize, the patients we will see and inevitably, the mistakes we will make along the way, are simply necessary steps to make us better people, and doctors of tomorrow.
What Motivates Us
In his Meditations, Marcus spends much time
discussing the purpose of his life. As he mentions over and over again, he
finds the praise of others (remember that he was considered a god), the pursuit
of fame, glory and wealth all as hollow things. His line of thinking is, if
everything including yourself is transient, then what is the point of achieving
fame and glory when people are bound to forget you eventually? As Marcus says:
What is even an eternal remembrance? A mere nothing. What then is that about which we ought to employ our serious pains? This one thing, thoughts just, and acts social, and words which never lie, and a disposition which gladly accepts all that happens
This was not meant to be some doom and gloom statement about how we are all going to die and nothing matters. Instead, by constantly repeating statements like the ones above, Marcus was attempting to keep himself well-grounded and not to get caught up in all the extravagances that many prior, and certainly many later emperors did. He was reminding himself then, and us now, what the truly important things in life are: acting justly and for the common good, and being thankful for what life has given you. Marcus then goes a step further and says:
Have I done something for the general interest? Well then I have had my reward. Let this always be present to thy mind, and never stop doing such good.
Here again, Marcus is reiterating the fact that
acting for the common good is the highest reward one can receive, even if its
not appreciated at the time. Indeed, it is the very act of working for the
common good that should serve as our motivation for everything we do. In other
words, the most important thing is being able to go to bed each night with the
satisfaction of knowing that we helped someone that day, and that that act in
and of itself should be all we need to keep us satisfied and motivated.
I couldn’t help but wonder what Marcus would say if now, almost 2000 years later, I were to ask him for one piece of advice about how to be a good person and leader. But then I came across this passage in Meditations that I think answers that question pretty clearly.
Waste no more time arguing what a good man should be. Be one.
Alright then Marcus, point taken. I guess he would
say that we all already have it in our hearts what it takes to be a good person
and doctor, we just have to have the strength and dedication to do it.
note on translations:
Since the Meditations are essentially Marcus’s reflections on the philosophical school of thought called Stoicism, and the vast majority of philosophical teachings at the time were written in Greek, Meditations too was written in Greek (even though Latin is the language most commonly associated with Ancient Rome). As in any work of literature originally written in ancient Greek, there are various different translations which all have the same essence, but with slightly different wording. Therefore, if you look up these quotes online or have heard/read a slightly different quote than one I have used here, note that it is simply a different translation of the same piece of work, and hopefully you can see that it captures the same meaning.
Quotes from Meditations:
“And though wilt give thyself relief, if thou doest every act of thy life as if it were the last, laying aside…discontent with the portion which has been given to thee.”
“Short then is the time which every man lives, and small the nook of earth where he lives; and short too the longest posthumous fame”.
“Which of these things is beautiful because it is praised, or spoiled because it is blamed? Is such a thing as an emerald made worse than it was, if it is not praised?”
“The best way of avenging thyself is not to become like the wrongdoer.”
“Let not future things disturb thee, for thou wilt come to them, if it shall be necessary, having with thee the same reason which now thou usest for present things.”
“No man can escape his destiny, the next inquiry being how he may best live the time that he has to live.”
“Look within. Within is the fountain of good, and it will ever bubble up, if thou wilt ever dig.”
“Neither in thy actions be sluggish nor in thy conversation without method, nor wandering in thy thoughts…nor in life be so busy as to have no leisure.”
“This too is a property of the rational soul, love of one’s neighbour, and truth and modesty.”
“If it is not right, do not do it: if it is not true, do not say it.”
I have always considered myself a history buff. I will admit, I
still pride myself on my collection of books accumulated from childhood that
fill my room. While history has always been a hobby of mine, as I got older, I found
myself finding inspiration in the lives and exploits of men and women
throughout history; from ancient Mesopotamia to the global conflicts that shook
our world in the 20th century. Since starting medical school, I now
find myself reflecting on what it means to be a ‘good doctor’ and have begun to
see the stories of these same men and women in that new light. Recently, I have
been on a bit of an ancient Rome/Greece binge and in doing so have come across
(again) the writings of the Roman Emperor Marcus Aurelius (yes, the old emperor
in Gladiator). For reasons I will endeavour to share with you, I think that we
have much to learn from this once beloved emperor about how to be a good person
and by extension, good doctors. But first, let us start with some background.
Importance of the Roman Empire
Ask someone to blurt out the first thing that they think of when you
say “Roman Empire” and chances are it will be the Coliseum, gladiators, togas
or Julius Caesar. But the Roman Empire has given us so much more than a trendy
tourist hotspot, movies with Russel Crowe fighting sadistic emperors, toga
parties or Caesar salad (spoiler alert, Caesar salad has nothing to do with
Julius Caesar). Rome is everywhere, from the ruins left behind to the borders
of our modern-day countries, even to the organization of our governments. But what
can we learn from the people, places and history of 2000 years ago? While that
is a question that countless classical historians have spent their lives trying
to answer, what I add is this: the world of the ancient Romans that Marcus
Aurelius knew was not so different from ours. Just like us today, the ancients
worried about the economy, national security, religion, politics, healthcare
and countless other existential crises.
Who was Marcus Aurelius?
Born in 121 AD in Spain, Marcus Aurelius was adopted by his uncle
and future Roman Emperor Antoninus Pius as his son and heir to the throne. Upon
becoming emperor after the death of Antoninus, Marcus devoted much time to
reforming the law to be fairer for the poor and powerless, promoting free
speech, stabilizing the armies and boosting the economy. For this and for his
famously humble and simple personal life, Marcus is known as the last of the
five “Good Emperors” and the last emperor of the “Pax Romana (Roman Peace),”
stretching from the first emperor Augustus all the way to Marcus, a period of
about 207 years. While there has certainly been some romanticising of this era in
Roman history, there is no doubt that these years saw Rome at the height of its
power in terms of economic wealth, territorial extent, military success and
relative peace within its borders. After the death of Marcus, the Roman empire
fell under increasingly more despotic emperors, witnessed decades of civil war
and economic recession, and never truly regained the same power, influence and
wealth that it had enjoyed previously.
Marcus’ biggest claim to fame however remains his Meditations. While by day Marcus was fending
off the invasion of the Germanic “barbarians” into the Roman empire, by night
he was writing in a personal diary his daily thoughts and feelings. Never
intended for the public eye, Meditations
reflect the inner thoughts of Marcus at his most vulnerable and dark times
while he reflects back on the teachings of the Stoic school of philosophy that
he had learned as a young man. Preserved after the death of Marcus, this diary allows
us a glimpse into the thoughts of one of the most humble and down-to-earth people
to ever live, let alone be an emperor. Reading his work, you get no hint that
this was written by one of the most powerful men, in one of the most powerful
empires ever to set foot on the world (considering that Roman emperors were
basically treated as gods on Earth). Just like many people before me, I too
have found inspiration in the words of Marcus and think that there is something
in them that can give us some insight into how to be good people, and by
extension, good doctors.
is a collection of some of the lessons I believe we all can learn from Marcus.
On Handling the Tough Times
Even though he was an emperor, Marcus was no stranger to struggle.
Death loomed heavy over his head as he witnessed both the death of many of his
children, and also the eventual death of his wife. Even Marcus himself was a
sickly man, (although we don’t know his exact ailment today) his seemingly
impending death seemed often to be on his mind throughout Meditations. Apart from personal struggles, Marcus also had an entire
empire to worry about. Early in his reign, he was fending off invasions from
the Parthian Empire in his Eastern provinces. Even after a Roman victory, there
was no time for rest, as very soon after there was a plague (likely smallpox)
that ravaged the empire, closely followed by an invasion of Germanic
“barbarians” along the northern border… and it keeps going.
The biggest lesson I think we can learn from Marcus in this regard
is best summarized by this passage in Meditations:
‘A cucumber is bitter.’ Throw it away. ‘There are briars in the road.’ Turn aside from them. This is enough. Do not add, ‘And why were such things made in the world?’
The lesson that Marcus has captured
in this passage is the fact that hardships will happen to everyone and there is
no use thinking “why me?”. Marcus would say that instead of becoming upset that
such things have happened, we should focus our energies on solving them and
moving forward. Thoughts of “why me” or “this is such a waste of time, why do I
have to do this” are in themselves “wastes of time” and don’t help solve the
problem or complete the task at hand.
But where does the strength to do this come from? Check out my next blog post to learn where Marcus thought the answer to this question laid.
Since the Progressive-Conservative (PC) Party of Ontario won the majority government in June 2018, Ontario physicians have been surprised with several healthcare developments. The day after assuming power, the new government announced budget cuts to OHIP+. In October 2018, frustrations with the government’s new Physician Services Agreement (PSA) proposal led the Ontario Medical Association (OMA) to engage in a two-phase binding arbitration process (yes, the same process whose updates have flooded our inboxes). The PSA is a contract negotiated by the OMA on behalf of Ontario physicians regarding compensation and funding for professional activities. However, the most recent and substantial healthcare change proposed by Ford’s government pertains to a large-scale reform. By “committing to new models of collaboration and patient care,” Premier Ford has promised to deal with hospital overcrowding and improve healthcare navigation for patients. But what can we expect of the new healthcare plan announced by the Ford Government?
No More LHINs?
A significant transformation proposed by the Ford government is the dissolution of the province’s 14 Local Health Integration Networks (LHINs). Since April 2007, Ontario’s LHINs have been responsible for allocating and monitoring approximately $30 billionfrom Ontario’s Ministry of Health and Long-Term Care (MOHLTC) to fund the province’s 14 health regions. While the LHINs have promoted a community- and patient-centered approach to healthcare, they have not been without criticism. For instance, the LHINs’s $90 million annual budget has been disapproved as expensive, and their allocation process as overly-bureaucratic. Furthermore, a 2015 provincial auditor general report suggested that on average, the LHINs had successfully reached only 6 of the MOHLTC’s 15 performance targets. Perhaps more concerning is that discrepancy between the various LHINs’ performance standards could be as large as seven-fold. This concern was echoed by OMA president Dr. Nadia Alam, who expressed that the LHINs possess an “unfairness in the level of service.”
In late January, a leaked draft bill of the PC government’s Health System Efficiency Act revealed that the PC government planned to replace the LHINs, The Ontario Health Quality Council, HealthForce Ontario Marketing & Recruitment, Cancer Care Ontario, eHealth Ontario, and Trillium Gift of Life Network with a single “superagency.” Critics of the draft bill, such as former surgical oncologist and University Health Network CEO Dr. Bob Bell, argued that consolidation of these diverse organizations poses a risk to vulnerable patients whose care may no longer be prioritized. Rather than relieve concerns about the LHINs complex processes, the superagency could turn into an even bigger bureaucratic headache. Others similarly, like former Champlain LHIN director Dr. Rob Cushman, were concerned that a superagency could diminish local and regional control over healthcare.
This significant overhaul of existing healthcare systems was confirmed by Health Minister Christine Elliott on February 26th, when she also announced that Health Shared Services Ontario and Health Quality Ontario would be joining the organizations amalgamated into the superagency. Some healthcare members such as Dr. Nadia Alam, Dr. Doris Grispud, CEO of the Registered Nurses Association of Ontario, and Anthony Dale, CEO of the Ontario Health Association, expressed optimism regarding this proposal. However, New Democratic Party (NDP) Leader Andrea Horwath has cautioned that privatization could be next. Furthermore, Ontario Health Coalition (OHC) executive director, Natalie Mehra, is urgently warning that the bill will not defend the public interest in healthcare. The OHC is organizing town halls across the province to protect existing healthcare and is planning a rally at Queen’s Park on April 30th.
Another of Ford’s major campaign promises involved a significant
reduction in hallway medicine, a
phrase he’s used extensively since election time last year. While this “emerging subspecialty of medicine” has provided a temporary answer
to hospital overcrowding, Ontario’s ageing population and healthcare
infrastructure shortages are contributing to capacity challenges requiring long-term
solutions. Indeed, as of October 2018, alternate level of care (ALC)
patients (those that no longer need hospital care, but are awaiting long-term
care) accounted for approximately 16% of acute care beds. ALC has been
suggested to pose
challenges to both patients and hospitals. Moreover, compared
to other provinces and most other developed countries, Ontario has the lowest
number of acute care beds per capita, with 10% of Ontarians waiting 41 hours to
be admitted to the emergency department.
Home Care Ontario (HCO), a group representing for- and non-profit home
care provider agencies, looks forward
to Ford’s superagency model as a welcomed opportunity to expand home-care
funding. They believe homecare aligns nicely with the new budget vision and a recent government report appears to
support this claim. However, given that HCO
represents many for-profit companies, they also have the opportunity to
capitalize on this healthcare alliance. The PC government has already provided an
additional $90 million to address hallway medicine;
suggest that increased integration of home care with other medical sectors will
do more to improve outcomes than more bed space or increased home care funding.
solutions, such as transitional spaces to address patients
waiting for a new home after being discharged, and reactivation care centers
to assist with patient recovery following prolonged bed rest, are areas that
physicians suggest would serve as a valuable focus.
In theory, a transformation of this magnitude could integrate care delivery, address hallway medicine, and provide sustainable home care solutions to improve patient-centered healthcare experience. Whether the new provincial healthcare plan will live up to its promises and address current healthcare limitations is something that only time will tell.