The opioid crisis is profitable. Blockchain tech can end that.
A tech-minded approach to drug fraud could squash those who enable the deadly opioid crisis.
BRIAN BEHLENDORF: So there's a tremendous amount of fraud in the prescription drug marketplace. And just like with provenance tracking of diamonds or the food supply chain, you can have provenance tracking for pharmaceuticals. You can have a system whereby the drugs — from the time they're manufactured and the batch that they were made in and in the factory they were made in — were tracked in some way that maybe parts of that were public, maybe parts of it were private, but were tracked through the distribution process to the end recipient. Now obviously when we're talking about individual patients and the prescriptions that they get, that is highly sensitive data. That's data that you wouldn't ever store directly in a chain — what your prescription is, what my prescriptions are, that sort of thing — but tracking these objects, tracking these individual vials of a drug or bottles of a drug as they get down to the pharmacy level is something that we can do to try to see: where are there pharmacies that seem to be dispensing a lot more than they should be based on the prescriptions that they're receiving?
Furthermore, finding ways to actually measure, so maybe separate from the opioid crisis but we actually have a challenge of adherence in the drug industry of understanding, for a given prescription drug, who is actually taking that at the times they should be taking it and continuing to take the full regiment rather than stopping halfway through because they felt okay. And so you could see IoT sensor data from the dispenser devices themselves, weaving together a picture that allows us to see all the way from the batch the drug was made in to the people who were prescribed it, and who took it if there is a problem out there, if there is a quality control issue where did that come from, and who might be responsible for that? And correspondingly the patients who do adhere well, are they benefiting from the use of those drugs? Or the ones who are having poor reactions are the ones who are only taking half their prescription? That sort of thing.
Bringing it back to the opioid crisis, I think tracking prescriptions in a system like this, if we can find ways to do it that respect patient confidentiality — because I'm a huge believer in the importance of keeping the patient at the center of who their information is being shared with and on what basis — but if we can build kind of an airtight system for tracking all that and understanding where these prescriptions are going, we'll have a much better basis for discovering fraud, discovering places where there might be fraud, and it's worth deeper investigation, and trying to understand how do we get to — I tend not to blame the drug taker because I think they're just medicating to meet their needs, it's really the distributors and those writing fake prescriptions and others who are enabling a lot of this crisis, and I think distributed ledger technology can help us understand where there might be abuses in that system.
So we have a number of healthcare organizations in our community. We have a company called Kaiser, really big on the West Coast, and I think out here they're known as well. Change Healthcare, which is a part of McKesson, and lot of startups. And they're looking at a number of different use cases in the healthcare sector from supply chain provenance in pharmaceuticals to provider directories, which are basically these directories of doctors and the certifications that they've been awarded and are they keeping up with their yearly ten hours of education, those types of things, to prescriptions, and then really the big kind of Holy Grail is medical records. Can we make medical records more portable? Not by publishing them into a distributed ledger because, again, the whole point of a distributed ledger is 'push this data out widely', but instead by creating wallets of health information for individuals that keep track of your records, that operate somewhat like a Bitcoin wallet where you know you have these assets and you can decide to share these records. You receive them from one doctor you can decide to share them with another doctor. If you moved and you had to change doctors, change healthcare providers, you can bring that data with you. And what would be tracked on ledger is a pointer to your wallet and a signature for each of the records you have that attest to the actual data. So if I get a prescription, I can't change that entry from 10 pills to 100 pills because that would change the signature, and the signature is what would be recorded in the ledger. So all of these kinds of questions about trust and provenance and discovery, understanding "where is all my data?" and being able to bring that together and view the patient as the center of health information exchange is a problem that we haven't been able to solve when we approached health IT as a point-to-point integration challenge or left it up to the patient to cart around the big boxes of paper records or CD-ROMs, but I think we can really make a dent in it with distributed ledger technology, and many of our companies are working on that very challenge.
- The same way blockchain technology could end the blood diamond trade, it could also stop those profiting from the opioid crisis by removing the traditional opportunities for drug fraud, explains Hyperledger's Brian Behlendorf.
- "I tend not to blame the drug taker because I think they're just medicating to meet their needs, it's really the distributors and those writing fake prescriptions and others who are enabling a lot of this crisis, and I think distributed ledger technology can help us understand where there might be abuses in that system."
- Blockchain technology could also revolutionize health information systems — from harnessing the IoT to ensure patients take their medication at the right time and often enough (drug adherence is a big problem), to checking the credibility of doctors, and not having to cart around a small filing cabinet of your life's medical records every time you change doctors or providers.
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The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
MRI scans show that hunger and loneliness cause cravings in the same area, which suggests socialization is a need.
- A new study demonstrates that our brains crave social interaction with the same areas used to crave food.
- Hungry test subjects also reported a lack of desire to socialize, proving the existence of "hanger."
- Other studies have suggested that failure to socialize can lead to stress eating in rodents.
People sometimes crave socialization, literally.<p> Forty participants underwent 10 hours of either social isolation or fasting before being placed in an MRI machine. Those who fasted had their brains imaged while viewing pictures of food; those emerging from isolation viewed photos of socializing people. <strong><br> <br> </strong>The areas of the brain related to hunger pains, reward, and movements, the substantia nigra pars compacta and ventral tegmental area (SN/VTA), are also associated with cravings for food or addictive substances. When those who fasted viewed images of food, these regions of their brains lit up. Most interestingly, the same brain regions lit up when those who had been isolated for 10 hours saw pictures of other people socializing. <br> <br> Test subjects also filled out questionnaires during and after the fasting and isolation periods. Not only did this confirm that people felt cravings for what they had missed, but that the effect was similar in both cases. </p><p>They also showed that very hungry people were less responsive to images of socializing, suggesting that "hanger," the state of being irritable as a result of hunger, is a demonstrable <a href="https://www.insider.com/loneliness-and-hunger-have-similar-effects-on-the-brain-study-2020-11" target="_blank" rel="noopener noreferrer">state</a>. </p>
How can I use this information? I’m asking for a friend.<p> The obvious takeaway is that it is perfectly normal to feel a need for interaction with others after an extended bout of isolation. Our brains treat some form of interaction as a basic need that must be met. While not shown as clearly in humans, not getting these needs often drives mice to <a href="https://pubmed.ncbi.nlm.nih.gov/29334694/" target="_blank" rel="noopener noreferrer">stress ea</a><a href="https://pubmed.ncbi.nlm.nih.gov/29334694/" target="_blank" rel="noopener noreferrer">t</a>, a finding that makes a great deal of sense in light of these new findings. <br> </p><p>Exactly how we can meet the need for socialization outside of just meeting up with people (a tricky proposition at the time of writing) remains up for debate. Anybody who has tried a Zoom party during the pandemic can attest to it just not being as nice as seeing friends in person. <br> <br> The study's authors are aware of this issue and note that:<br> <br> "A vital question is how much, and what kinds of, positive social interaction is sufficient to fulfill our social needs and thus eliminate the neural craving response. Technological advances offer incessant opportunities to be virtually connected with others, despite physical separations. Yet, some have argued that using social media only exacerbates subjective feelings of isolation.<sup>"</sup><br> </p><p>Unfortunately, the study cannot offer us an answer to this question just yet. </p>
Like always, there are limitations to this study.<iframe width="730" height="430" src="https://www.youtube.com/embed/sgxMsgDWnAU" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> This study involved 40 participants. While its essential finding is likely to be generally applicable, exactly how applicable it is to the broader population cannot be known with certainty from such a small group. The participants were also healthy, well-connected young adults who might react to various problems differently than other demographic groups. </p><p>Their tendency to do so while being the focus of endless studies on psychology is a well-recorded problem. <br> <br> Likewise, the fact that the participants knew they would only be isolated for 10 hours may have impacted how they reacted to the isolation—it is often easier to endure something when you know precisely when it will end. </p><p>Getting around that in future experiments may prove impossible. From an ethical standpoint, it would be difficult to structure an experiment on humans predicated on the idea that they will be kept isolated from all social interaction indefinitely. <br> <br> Lastly, while all of the participants were quite hungry after 10 hours, there were enough variations in how lonely people felt after isolation to suggest a more significant variance in need for socialization than in demand for food. While this seems obvious, we all know both introverts and extroverts; it does make it more challenging to determine how much social interaction counts as a "need" that the brain craves just as it craves food. </p><p>As usual, more research is needed.</p><p> The idea that humans are social animals existed long before modern neuroscience was possible. Now, we can see exactly what happens in the brain when we can't socialize. While the final word on the subject is still to be said, it might be time to give a friend a call. </p>
Researchers document the first example of evolutionary changes in a plant in response to humans.
- A plant coveted in China for its medicinal properties has developed camouflage that makes it less likely to be spotted and pulled up from the ground.
- In areas where the plant isn't often picked, it's bright green. In harvested areas, it's now a gray that blends into its rocky surroundings.
- Herbalists in China have been picking the Fritillaria dealvayi plant for 2,000 years.
Fritillaria dealvayi<p>The plant is <em> </em><a href="http://www.efloras.org/florataxon.aspx?flora_id=2&taxon_id=200027633" target="_blank"><em>Fritillaria dealvayi</em></a><em>,</em> and its bulbs are harvested by Chinese herbalists, who grind it into a powder that treats coughs. The cough powder sells for the equivalent of $480 per kilogram, with a kilogram requiring the grinding up of about 3,500 bulbs. The plant is found in the loose rock fields lining the slopes of the Himalayan and Hengduan mountains in southwestern China.</p><p>As a perennial that produces just a single flower each year after its fifth season, it seems <em>Fritillaria</em> used to be easier to find. In some places its presence is betrayed by bright green leaves that stand out against the rocks among which which it grows. In other places, however, its leaves and stems are gray and blend in with the rocks. What's fascinating is that the bright green leaves are visible in areas in which Fritillaria is relatively undisturbed by humans while the gray leaves are (just barely) visible in heavily harvested areas. Same plant, two different appearances.</p><div id="19cbf" class="rm-shortcode" data-rm-shortcode-id="c68d3086f5411ffd951edaad1cb811b9"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1329832938985435138" data-partner="rebelmouse"><div style="margin:1em 0">2/2: The picture on the left shows a Fritillaria delavayi in populations with high harvest pressure, and the one on… https://t.co/oriBNZGcsV</div> — University of Exeter News (@University of Exeter News)<a href="https://twitter.com/UniofExeterNews/statuses/1329832938985435138">1605891854.0</a></blockquote></div>
How we know we're the cause<p>There are other camouflaging plants, but the manner in which <em>Fritillaria</em> has developed this trait strongly suggests that it's a defensive response to being picked. "Many plants seem to use camouflage to hide from herbivores that may eat them — but here we see camouflage evolving in response to human collectors."</p><p>"Like other camouflaged plants we have studied," Niu says, " we thought the evolution of camouflage of this fritillary had been driven by herbivores, but we didn't find such animals." His close examination of Fritillaria leaves revealed no bite marks or other signs of non-human predation. "Then we realized humans could be the reason."</p><p>In any event, says Professor Hang Sun the Kunming Institute, "Commercial harvesting is a much stronger selection pressure than many pressures in nature."</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDgyNzM0My9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYzMDc3NDQwMn0.lXwsG0ShcnMcVLl06APdEeEOY5_WOs4UfN8oVCKsgtc/img.png?width=980" id="ccc8e" class="rm-shortcode" data-rm-shortcode-id="907e152dd5ad0429aa6350c53f5a85aa" data-rm-shortcode-name="rebelmouse-image" alt="herb shop" />
Credit: maron/Adobe Stock
The study<p>Since herbalists have been plucking <em>Fritillaria</em> from the rocks for 2,000 years, one might hope a record would exist that could allow researchers to identify areas in which the plant has been most thoroughly picked. There is no such documentation, but Liu and Stevens were able to acquire this type of information for five years (2014–2019), tracking the harvests at seven <em>Fritillaria</em> study sites. This allowed them to identify those areas in which the plant was most heavily harvested. These also turned out to be the locations with the gray-leaf variant of <em>Fritillaria</em>.</p><p>Further supporting the scientists' conclusion that gray <em>Fritillaria</em> was more likely to evade human hands and live long enough to reproduce was that participants in virtual plant-identification tests confirmed the species was hard to spot in the wild.</p><p>"It's possible that humans have driven evolution of defensive strategies in other plant species, but surprisingly little research has examined this," Stevens notes.</p><p>Hang Sun says such studies make clear that humans have become drivers of evolution on our planet: "The current biodiversity status on the earth is shaped by both nature and by ourselves."</p>
What’s Eminem doing in Missouri? Kanye West in Georgia? And Wiz Khalifa in, of all places, North Dakota?
This is a mysterious map. Obviously about music, or more precisely musicians. But what’s Eminem doing in Missouri? Kanye West in Georgia? And Wiz Khalifa in, of all places, North Dakota? None of these musicians are from those states! Everyone knows that! Is this map that stupid, or just looking for a fight? Let’s pause a moment and consider our attention spans, shrinking faster than polar ice caps.
Researchers make the case for "deep evidential regression."
- MIT researchers claim that deep learning neural networks need better uncertainty analysis to reduce errors.
- "Deep evidential regression" reduces uncertainty after only one pass on a network, greatly reducing time and memory.
- This could help mitigate problems in medical diagnoses, autonomous driving, and much more.
Credit: scharsfinn86 / Adobe Stock<p>On the road, 1 percent could be the difference between stopping at an intersection or rushing through just as another car runs a stop sign. Amini and colleagues wanted to produce a model that could better detect patterns in giant data sets. They named their solution "deep evidential regression."</p><p>Sorting through billions of parameters is no easy task. Amini's model utilizes uncertainly analysis—learning how much error exists within a model and supplying missing data. This approach in deep learning isn't novel, though it often takes a lot of time and memory. Deep evidential regression estimates uncertainty after only one run of the neural network. According to the team, they can assess uncertainty in both input data <em>and</em> the final decision, after which they can either address the neural network or recognize noise in the input data.</p><p>In real-world terms, this is the difference between trusting an initial medical diagnosis or seeking a second opinion. By arming AI with a built-in detection system for uncertainty, a new level of honesty with data is reached—in this model, with pixels. During a test run, the neural network was given novel images; it was able to detect changes imperceptible to the human eye. Ramini believes this technology can also be used to pinpoint <a href="https://www.theguardian.com/technology/2020/jan/13/what-are-deepfakes-and-how-can-you-spot-them" target="_blank">deepfakes</a>, a serious problem we must begin to grapple with.</p><p>Any field that uses machine learning will have to factor in uncertainty awareness, be it medicine, cars, or otherwise. As Amini says, </p><p style="margin-left: 20px;">"Any user of the method, whether it's a doctor or a person in the passenger seat of a vehicle, needs to be aware of any risk or uncertainty associated with that decision."</p><p>We might not have to worry about alien robots turning on us (yet), but we should be concerned with that new feature we just downloaded into our electric car. There will be many other issues to face with the emergence of AI in our world—and workforce. The safer we can make the transition, the better. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His new book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>