10 Healthcare Questions for Watson


This week Charlie Rose interviewed the robot Sophia for CBS.  We've come up with the following questions for the famous computer, Watson.  

1.  What is health?  For years, the medical philosophers have said it's the absence of disease.  But is health a negative quality, a lack? The World Health Organization has a positive definition:  “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”  But this doesn’t work for those of us with a chronic disease who have learned to have some happiness.  Machteld Huber from the Institute for Positive Health says health is the “ability to adapt and self manage in the face of social, physical, and emotional challenges.”  Health is an ability?  So can babies be healthy?  Please help us Watson!  We won't be good at healthcare if we can't even agree on what health is in the first place.

2.  Are you healthy, Watson?  

3.  Why do drugs cost so much?  This question continues to elude the best minds of our generation.  Perhaps with all your processing power you can come up with a complex answer.  For certainly, the obvious answer can't be right.

4.  Why does the $1,000 genome cost $2,000?  

5.  If a diagnosis is 50% of solving a health issue, then why don’t we pay 50% of healthcare dollars for the diagnostic testing?

6.  Are there enough government funds going into the war on death?

7.  Who would you say was better at health:  Christopher Hitchens, who died at sixty-two but went out swinging, or Mbah Gotho from Java who is 145 and desperate to die because he has outlived all 10 of his siblings, four wives, and also all of his children?  

8.  Is medicine just a good excuse to do more fun biology?  Or is biology, and the naming every letter of our genome, just a distraction from health?  In other words (and we mean no offense by this) is science really the blackbox of health?

9.  If we can prevent disease through gene editing or mitochondrial transfer, should we?  Why wait til our kids are 6 years old and sick with a rare disease to lobby the FDA for drugs?  Why not get a mitochondrial transfer of healthy genes before birth?

10.  Doctors are calling him a textbook narcissist, a sociopath, a psychopath.  Please, Watson, give us the definitive diagnosis for Donald Trump!!!

Editorial: Four Ways to Improve Your Academic Career (And Avoid the Call of Industry)

The Editors

A career path in academia should not be seen as one of compromise. 

Several recent articles, such as this editorial from Nature, suggest that defecting from academia to industry isn't all that bad.  We feel quite the opposite:  the soiled life of business should be avoided at all costs.   We must continue to fight against the stigma that has long been associated with the academic career.   Staying on in the school room for one's whole life is a noble calling.   

Surely the biggest reason for this awful stigma comes from the fearful and debilitating condition known as being "granted tenure."    But tenure doesn’t have to be dreaded.  Yes, there are some frightful times leading up to full professorship, i.e, those years spent as a slave, excuse me, postdoc, or writing that first of several books that no one will ever read.  We encourage our readers to remember there were some good reasons you decided to don those silly looking robes and avoid any exploration of the business world.   Here are some suggestions for transcending the academic stigma and turning your career around:

1.  Think of tenure as a good thing.  It doesn’t have to be all doom and gloom.  It doesn’t have to strip you of all your values.  Just because you got called before the regents and vice regents and assistant vice regents and the assistants to the assistants of the vice regents one day and awarded tenure, does not mean your life is over.  Plenty of people have found reasons to live after they no longer had to really work anymore.  Look at all those people who retire from industry and find a life in golf.    Campuses are often beautiful places.  They have museums and elegant fountains.  Consider tenure another kind of retirement.  A good self help book on this subject:  Life after Tenure by W. E. Prozac.

2.  Allow that title after your name to lead to a positive self image.  Just because everyone rolls their eyes whenever you say you have a PhD, doesn’t mean you have to let it get you down.  Embrace this archaic tradition.  Meditation can be a great help here.       Next time you’re alone in your office, imagine yourself in a special bubble, the PhD bubble.  Imagine this bubble is full of light that no one can darken with their smiles.  After you have mastered this alone in your office, give it a try out in the hallway.   Soon you’ll be able to feel good about that title when you’re standing in front of all those young people with their whole lives ahead of them.  It even works when you’re off campus and out in the "wild"-- for example, in the line at the grocery store.  Just because you don’t have to work hard for money anymore, doesn’t mean you can’t work hard at that self image.

3.  Embrace Twitter.  It’s a great place to feel like your mind is active without the danger of accomplishing something.  You shouldn’t have to accomplish anymore.  You have tenure.  Let go of that protestant work ethic your parents worked so hard to install in your operating system.  The academic life was meant to be one of purity--unsoiled by sweat and struggle.  Let go of work and embrace Twitter.  It’s helping so many others in your shoes.

4.  Stop competing.  Competition is for losers.  And winners.  But you are better than both.  It’s a hard concept to grasp, but you no longer need to win or lose: you’ve already won and are now beyond winning and losing.  You already know everything.  It’s time to spread your great wisdom to the rest of the world as you see fit.  Book some conference talks.  Tweet a lot.  Whenever you are with someone, do all the talking.  This is your time, your day.  You’re the gold medalist.  The rest of the world has been put there to fight amongst each other and praise you.  And whatever you do, always keep in mind:  that Nobel is on it’s way.

It’s time to normalize life in the academy.  For too long academics have dealt with a low self image, have been marginalized by those in industry.   Which is no doubt why there are so many defections.   You may be an academic because you never dared try anything else.  But try to be more active in your passivity.  It will do your career wonders.



CEO of ABC Diagnostics Takes a Hint from Allergan's Saunders

Theral Timpson

We found the following wadded up next to a trash can:

CEO Blog: Another Social Contract with Patients

Lately, there has been zero focus on the price of diagnostics.  Damnit.  Drug companies get all the attention.   And the profits.  I’m writing out a new social contract for diagnostics companies. 

It’s often said that 50% of solving a problem is in first of all defining the problem.   This holds true for medicine as well.  If a patient pays $100,000 for a medication, we should get paid $100,000 for the correct diagnosis.  Period.

According to a recent study, 12 million Americans are misdiagnosed each year.  This is water off the drug companies’ backs.  Their drugs will be prescribed anyway.

Unfortunately no one in the diagnostics industry has taken any aggressive, let alone predatory approach to pricing.  Therefore, we will.

There are four principles to the social contract:

1.  Invest and Innovate

As an industry, we risk billions of dollars to develop life saving and life enhancing diagnostics.  Yet we can’t pay our lighting bill.   For similar innovation, our counterparts at drug companies get paid hundreds of millions in salary and bonuses.  I hope I can work there someday.

2.  Access and Pricing

You want access?  Then it’s time we joined the American economy and got some self respect.  We must raise prices.  

Obviously we have approached CMS in the wrong way all these years.

Rather than pulling our pants down and waiting each year to see how much lower they will drop our pricing, we commit to being much more proactive.  As of today, we commit to raising our prices considerably, multiple times per year, and at the least by 100% each time.  These pants are not coming down until I get home to a good glass of wine.

In other words, we will engage in price gouging actions and predatory pricing.

I commit to ending up in a congressional hearing.  With my pants up.

3.  Quality and Safety

It has been said that the diagnostics industry’s low pricing plight is a result of their lack of quality products.   We commit to stop sneaking around the FDA and to stop going direct to the consumer with half baked products all at the price of a bake sale.  Yes we can.

4.  Education

We are committed to educating physicians.   The use of a diagnostic test might result in a drug company selling a single medication to a single patient for hundreds of thousands of dollars a year.  We commit to getting in bed with these drug companies.

There is such unbridled joy in my heart when a Dx company finds itself in the spotlight.  A joy I never experience.  

--John Smith, ABC Diagnostics, Inc.

Five Reasons France Has Become the Number One Anti-Vaccination Nation

Theral Timpson

A recent study shows that the French are, to an alarming degree, against vaccinating.  Huh?  The ultra secular and increasingly atheist, nuclear power dominated, science loving, Voltaire producing French?  It doesn’t make any sense.  According to this study a whopping 41% of the French are holding out against vaccines.  Compare that to just 14% in the U.S.  Which nations are best about their vaccinations?  Those in Southeast Asia and Africa.  They still remember what it’s like to not like polio.

Stunned by this number, we wrote to several people in France asking why almost half the country is against vaccinations.  They offered these five reasons:  

1.  No bonbon, no buy buy.  Michel Macaroon of Aix en Provence told us that any product that doesn’t make it ultimately into a bakery or restaurant is going to do very poorly with the French.

2.  The power not to shower.  According to Helene Sale of Paris, the French are very happy to see that other people around the world finally understand why they do not shower or bathe.  “Our bodies have these amazing natural bugs called bacteria.  They protect us.  When one does not--how do I say--wash them off everyday, like in America, then one is naturally protected from these diseases.  Oui?”

3.  The power that is France.  Jacques Guerre is a capitaine in the French military.  “Are we not known for our Resistance?” he asked.

4.  Le Grande Tragedie.  Audrey Appris, a professor at l’Universite Paris-Sorbonne, wrote in, “Why should we limit the tragically beautiful diverse ways of dying?”

5.  Yes, yes . . . and all that.  The well known chef, Alain Passard had his secretary write back.  “Yes, yes, we’re the country of Pasteur and Voltaire and all of that.  Please don’t bore me.  Really, I ask, what cannot be cured with the finest Chateauneuf de Pape?”

Oui, oui, indeed. 

The All American EpiPen Timeline

Theral Timpson

Millions of years ago - Bees sting humans.  Certain humans eat nuts.  Anaphylactic shock happens.

1973 - Some All American humans are increasingly afraid that other humans will attack on them with chemicals.  The Pentagon asks scientists at a company called Survival Technology, Inc. to develop a quick treatment for when humans are fried by nerve gas.

1977 - All American Shel Kaplan invents the CombiPen.

1998 - All American Heather Bresch claims to receive an All American MBA from West Virginia University.

2004 - Shel Kaplan improves the CombiPen into the EpiPen.  He doesn’t know that Heather Bresch will make millions of dollars from his invention. 

2007 - Mylan Pharmaceuticals buys EpiPen product from Merck.  The All American EpiPen is selling for $57.  It injects a dollar’s worth of the generic hormone epinephrine to treat anaphylactic shock.  

2007 - Heather Bresch is Mylan’s COO.  She makes $2.5 million a year.  The All American light goes off in Heather Bresch’s head regarding the EpiPen.  

2007 - After a newspaper calls, All American West Virginia University quickly grants Heather Bresch an MBA degree.  It wasn't granted in 1998 because Heather Bresch completed only half the coursework.   In her All American way, Heather Bresch thanks the newspaper for investigating her,  “I owe you a thank you for pointing out the administrative nightmare around my MBA.”

2007 - Mylan Pharmaceuticals is a major donor to West Virginia University.

2007 - Heather Bresch’s dad is an All American governor of the state of West Virginia.  West Virginia University is one of the state’s largest employers.

2009 - Shel Kaplan, inventor of the EpiPen, dies in obscurity, having made no money in All American royalties.  

2011 - Mylan raises the price of the EpiPen to $198.64.  Heather Bresch is named “Patriot of the Year” by the All American Esquire magazine.

2013 - Congress passes the School Access to Emergency Epinephrine Act.  Mylan raises the price of the EpiPen to $264.50.

2015 - In their All American way, Mylan moves their headquarters to the Netherlands to avoid paying the United States taxes.  Heather Bresch is named one of Fortune Magazine’s “50 Most Powerful Women in Business.”  Her income is $19 million a year.

May, 2016 - Mylan raises the price of EpiPen to $608.61.  Yearly sales of EpiPens are over $1billion.  EpiPens bring in 40% of the company's profits.  Newspapers around the country blow the All American whistle.

August, 2016 - Senators knock on Mylan’s door.  Heather Bresch's dad is now a senator.

August, 2016 - Heather Bresch answers, “Hello Senators. Hello Dad.  Would you like a champagne-bourbon cocktail?  As dad knows, In West Virginia, we call this drink the All American Persephone. . . . Now senators, no one’s more frustrated than me.”   

August, 2016 - Hillary Clinton tweets an All American tweet.  Biotech stock indexes drop sharply.   Mylan says price of EpiPen will remain the same.  Offers some patients some All American assistance.

August, 2016 - Mylan’s stock value drops $3 billion in 5 days as All American investors panic.

August, 2016 - If Heather Bresch gets fired, her All American golden parachute is worth $61.5 million.

10 Genomics Questions for the Presidential Candidates

Theral Timpson has just released 20 science questions for the presidential contenders.  We thought we'd send in our own list of 10 genomics related questions.  Here they are:


1.  Will you get your genome sequenced, and 

   A.  Donald, will you show us what percentage of Neanderthal you have?

   B.  Hillary, will you show us the variants you keep on your private home server?


2.  If Obama could be cloned, should his clone be able to run for another term?


3.  Which of the following would make the best Moonshot:

   A.  A regular genetic screen for all members of congress for 20 intelligence variants 

   B.  Making sure all firewood around the country is non-GMO and gluten free

   C.  Installation of a pipeline from Canada to the US, but for prescription drugs, not oil

   D.  Enable school kids everywhere to sequence their own genomes on the MiniSeq


4.  What is the microbiome? 

   A.  Donald’s private parts

   B.  The chance of Gary Johnson getting into the debates

   C.  Another word for Hillary’s idealism

   D.  Jill Stein’s favorite strain of non-GMO pot 


5.  What’s your position on LDTs?  (Hint, it’s not a drug or a religion or a sexual identity.)


6.  How are you going to one up Obama’s Precision Medicine Initiative?  (Hint:  Put in some actual money.)


7.  What is an exome?

   A.  The genome of one of Trump’s ex-wives 

   B.  The portion of the genome that appears on an X-ray

   C.  The only portion of the genome that Gary Johnson thinks the government should be interested in

   D.  The genome of a voter turned away from the polling station


8.  During the next 4 years a trove of genetic information will come in.  To deal with this onslaught, how important is it that a National Genetic Counselor be the next new cabinet position? 


9.  What is CRISPR?

   A.  GMO bacon

   B.  Part of the refrigerator

   C.  Part of the future

   D.  A national council in favor of stiffer hundred dollar bills

   E.  The New York City dry cleaner where Trump gets his shirts done


10.  If it turns out that we can’t cure cancer in the next four years, how will you break this to the people?

Gene and Tonic, July 8, 2016: 49ers Going into Genetic Testing

Theral Timpson

Just two years at their new home in Silicon Valley and not far down the road from 23andMe, the San Francisco 49ers are offering their fans genetic testing and the chance to donate blood to advance human genome research.

Announcing a partnership with the company ORIG3N, the 49er Chief Operating Officer, Ethan Casson, says that “this is the first agreement of its kind where a major sports organization can give back to the human genome some of what the genome has given to professional football players.”

ORIG3N CEO said, “it’s an incredible opportunity to show 49er fans just how bad their own sports genes are compared to an average NFL player, to say nothing of warning them of cancer, Alzheimer’s, Parkinson's and anything else that could some day kill them.”

He also said his company name was so bad that they needed a major deal like this to go anywhere.

Scientists who weighed in on the announcement praised the 49ers for their progressive attitude to health, saying that if the 49ers can’t end all the concussions, perhaps they can help out in this other way.

George Church, who has spent years trying to go about collecting DNA samples in the right way, said, “screw it,” and volunteered to be an usher at the games and give tests to the fans.

“We always hear that we are ‘ushering’ in a new era of medicine,” he reminded.

Luke Timmerman reported on his Report that he just got back from the White House where he overheard the Veep expressing some envy of the 49ers deal.

“We have to use this one press room at the White House to get people participating in the President’s Initiative and my Cancer Moonshot,” said Biden. “And they have a stadium!”

There was one lone editor at the San Francisco Chronicle who chimed in with skepticism of the 49ers getting into genetic testing (moving south): “Do we need any more proof to know that there is something wrong with the Silicon Valley water? Whoever drinks it always comes up more thirsty . . . for data."

Gene and Tonic, July 7, 2016: Not the Scientific Method

Theral Timpson

On Monday the New York Times published an OpEd for a guy who wants to take the scientific method away from scientists.

There was immediate outrage from Scientific American. Their executive editor wrote, “I am shocked that in a liberal society such as those who read the New York Times and drive Priuses, a society which prizes itself for valuing the uniqueness of others, that scientists are now being singled out and persecuted in this manner. The next thing you know, scientists won’t be able to use either bathroom. After all we gave you--the moon and Silicon Valley and glowing plants for your cubicles--and we get repaid like this?”

The author of the Times piece tells scientists that they can’t have their method because they can’t use it on themselves. And furthermore, just because poets and philosophers aren't as precise as scientists, reads the article, doesn’t mean they can’t use the method.

Many were in disbelief that the New York Times would run such a piece. In fact new scientific theories were springing up hourly, such as the Subway Theory based on the likelihood of New York Times journalists riding the subway with journalists from The Onion and accidentally dropping and picking up the others’ stories.

The Times spokesperson denies this saying, “anyone who bothers to stay apprised of the media business would known why it’s not true. The numbers just don’t work out. The Onion is down to a staff of two sitting at the table: the editor and the onion. At the Times, those of us left can’t even cook with onions."

Another theory is that a Times journalist and an Onion journalist walk into a bar together. After getting drunk they decide to swap stories and see what happens.

Proponents of this theory think it’s happened many times before.

Update: It’s rumored that the story intended for the Times that went instead to The Onion was a piece by Carl Zimmer saying he was the first journalist to have his genome sequenced. Zimmer denies this, insisting the story was intended for STAT News.

Gene and Tonic, July 7, 2016: Vermont's New Law and the Nobel Laureates

Theral Timpson

On July 1st, Vermont’s GMO labeling law went into effect. All food sold in the state that has been genetically modified has to say so on the label.

While some geneticists are throwing their hands up in the air in total exasperation, others are consulting big food.

“It’s all been genetically modified at some point. So put GM on every piece of food,” reads one consultant’s email. “They’re Vermonters. While you’re changing the labels--which I do understand isn’t cheap--you might as well put, ‘Have a beautiful and pleasant day, Vermont!’”

Still other geneticists are more optimistic, such as Nathan Pearson here on Mendelspod. Put GM on the label, he suggests. The next thing you know, the average shopper will be requesting GM products at their local market.

There was one group of scientists that has been very upset. They all won the Nobel prize, and so they sent Greenpeace a letter accusing them of “a crime against humanity.”

Greenpeace is the leader of the anti-GMO crowd, making them basically the Vermont of non-profits.

A spokesperson for Greenpeace said that the Nobel winners could “go f*** themselves, and gene drive their a**holes out of existence."

Oh, no, we got that wrong.  That wasn’t a spokesperson.   The spokesperson said, “We don’t get spanked by just anyone. Just because these people have a Nobel doesn’t mean they’re qualified to spank Greenpeace like this. How would you feel if you got spanked by over a hundred Nobel prize winners?”

A journalist familiar with the non-profit and wished to remain anonymous did say that Greenpeace had a tendency towards S & M.

“It’s part of the gig, right? Part of the act is to resist. They’re not the worse S & M pair in the world. In fact, I think they rather do quite well together,” said the journalist.

Gene and Tonic, June 24, 2016: "Best of" . . . this Week

Theral Timpson

Other than sitting by as Great Britain became Petite Britain, how did you enjoy the week? If anyone shares an office--like I do--with someone from the European Union (Austria), then you were allowed to focus on little else. But there were some fun items this week, which I’ve turned into a short “Best of” list.


Best Ad Campaign of the Week

This category has to go to STAT news. Just when they are running out of major stories to cover after six months in publication, they start coming out with some cool social media ads.



Best Ome of the Week

"Thanatotranscriptome: genes actively expressed after organismal death"

“It’s alive! It’s alive!” Scientists at University of Washington, Seattle found that some fish genes remain active up to four days after death. It turns out that death reverts us to a kind of embryonic state where some of our genes get upregulated.   In other words, our genes get the final say.

Think of it as a postscript to our lives:

“PS.  Boy, glad that’s over.” 

“PS.  No, no, no, no!!!”

How about, “PS.  Should have gone to Illumina for that whole genome sequence."

Or probably, “PS.  I lived to see Great Britain fall apart.”


Best Podcast Name of the Week

“Before you pop that Tylenol, tune into this podcast”

Is it just me, or did anyone else find this week’s Signal Podcast with Luke Timmerman and Meg Tirrell to be brilliantly named? It’s all happening at STAT News these days. I only wish I’d come up with this title for one of the Mendelspod shows.

It does inspire some alternate versions:

“If you think you have a headache now, just listen to our show.”

“Podcast, then Tylenol. Podcast, then Tylenol.”

Let's try some other medications:

“Before you pop that laxative, give our podcast a chance.”

“Wait. Do you really need that sleeping pill, when you can listen to our podcast for free from your iPad?”

“Listen to Mendelspod. Take an anti-diarroeahl.  And call me in the morning.”

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