Posts Tagged China

Lessons from Shanghai, China: Strategy for containment & care during Covid-19 


Recently, CABS, the Chinese American Biopharmaceutical Society hosted a webinar on the topic,  “COVID-19 Clinical Treatment and Research Experiences from China”, with Dr. Wenhong Zhang. Dr. Zhang is Director of the Department of Infectious Diseases in Shanghai and leader of Anti-Covid-19 team. He is also on Chinese Society of Infectious Disease and with Chinese Association of Internal Medicine. During the fight against Covid-19, Dr. Zhang led the Shanghai team to formulate a clinical treatment and containment plan.

 

Night, City, Shanghai, Asia, East, Architecture, Urban

An article in scientific publication Lancet predicted in late January that after Wuhan, Shanghai can be the epicenter of the virus with as many as 800,000 cases. However, with very early focus on containment and reasonable social distancing (even without complete lockdown measures), Shanghai managed to restrict the spread to about 4,000 cases. The key was that the healthcare system went on full alert when they had their very first case of a person traveling from Wuhan.

 

Dr. Zhang shared many details of their process for containing the spread and answered questions sent by the audience members. I have captured a few of the nuggets from his talk and I am sharing them below.


Diagnosis: Immediately they optimized diagnostics and did all needed tests for suspected patients. Shanghai made separate fever clinics and all patients who met 1 epidemiology criteria plus one clinical criteria were encouraged to go to these clinics. Suspected Covid-19 patients were sent to separate quarantine wards for full testing, and while they awaited results.  If the results came back positive, they were sent to separate hospitals for quarantine stay and were tested again, before release.

 

Further, while in the US some hospitals first tested for flu and other viruses and if the patient tested positive for any of them then they were not tested for coronavirus, Shanghai tested all suspect cases for coronavirus. Dr. Zhang said that they have found that there are a lot of co-infections so a person can have regular flu virus plus coronavirus. Additionally, they found a high negative rate in PCR testing, while a positive rate was around 70%. Therefore, despite negative test results, if the patient was highly suspect than they did more testing. They did not rely on CT scans because they found that a chest CT cannot precisely confirm Covid and all cases needed molecular diagnosis.

 

Detailed process in place: Shanghai had a very detailed process in place for the steps to be taken for patients in the first screen, then first test, then when tested positive, if tested negative, and for followup.  Timely diagnosis and timely distancing and quarantine is very important, said Dr. Zhang. Immediate separation and early control of local transmission is the key to stop the Covid-19 disease spread, said Dr. Zhang.  This is something that did not happen in Italy. Almost all of their early cases were of foreigners. Eventually all of their cases and high death toll has been among the local population.

 

Treatment Options: Dr. Zhang shared that over 95% of the patients recovered and eventually were released. One patient died. There has been debate around anti-viral treatments. Dr. Zhang said, these treatments don’t seem to be effective. China also used hydroxychloroquine (widely touted malaria drug) to treat Covid patients and did not find it to be effective. However, it can have compassionate use since it shows little lasting side effects, said Dr. Zhang. Although he did not observe clinical evidence of anticoagulants, he said, it is possible that early anticoagulation may block clotting and eventually reduce the risk of major organ damage.

 

Respiratory Treatment: Dr. Zhang shared that the most fundamental treatment in keeping patients alive is respiratory treatment. We have a narrow window to stop progression from mild symptoms to severe symptoms, said Dr. Zhang. Low and short duration corticosteroids may stop progression and we need more studies to find that out. Life support for critically ill patients is crucial. Timely intervention with mask oxygen inhalation, nasal cannula oxygen therapy, mechanical ventilation etc. can prolong life until the body’s immune system gets critical time to fight off the virus.

 

Medical Personnel: In Shanghai, strict following of protocol, translated into not a single infection spreading into the healthcare professionals. Highly qualified and standardized process included appropriate PPE (personal protective equipment) with gowns, goggles, masks, double layer gloves and shoe covers. Healthcare professionals were asked to never share a meal with others at home, during the time this contagion was active. As far as possible, the patients were kept in negative pressure wards and surfaces were cleaned with disinfectants every 4 hours.

My Comments
Stay tuned for my next article on how China effectively used high tech, specifically big data and coupled it with public awareness and public participation to contain the virus. Please note: I am not a fan of, or in any way endorsing communism or authoritarianism. And yet, perhaps there are lessons even for Western democracies, to pay heed to early signs and implement containment strategies. And that is exactly what Bill Gates was referring in 2015, when he spoke at TedTalks and warned us about a virus pandemic that can possibly kill millions. That is what various scientists have been warning of, for years.

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RIP John McCain & RIP Atal Bihari Vajpaiee


World lost two leaders this month, in world’s two greatest democracies, India and the USA, and were fondly remembered in many tributes. RIP #JohnMcCain & RIP #AtalBihariVajpaiee . Regardless of the party and ideology, these conservative career politicians remind us that democracy rests on the shoulders of men and women who dedicate their lives for making a case for their principles and then accepting the verdict that comes from people and serving with grace, regardless of the outcome. These men sought to unite the people under their leadership, served with integrity, and chose to be guided by their conscience and tried to build bridges, when they could. Some highlights from the lives of these two men – specifically their centrist moves — something that is inevitable in a democracy and something we need an ardent reminder of, in these polarizing times.

Image result for atal bihariAtal Bihari Vajpaiee: Under ABV, BJP moderated its extreme conservative Hindu nationalism. India conducted 5 nuclear tests during his time in office but Vajpaiee simultaneously softened hard stance towards Pakistan, inaugurated Delhi-Lahore bus service and in fact traveled to Lahore by bus and made a push for full scale diplomatic peace process. Unfortunately Pakistan’s incursion into India’s borders, into LOC (line of control), led to bloody Kargil war during his time. Pakistan was forced to withdraw, after suffering heavy losses. ABV took oath for the office of Prime Minister of India 3 times and served thrice in that capacity for varying lengths. Indian airlines flight was hijacked when he was PM. But the biggest political disaster hit his government in 2001 when there was destruction of Babri Mosque & VHP wanted to lay foundation for a temple at the site. Thousands gathered but it ended peacefully. In 2002 however, when Hindu pilgrims were killed in a train returning from protests in Ayodhya, the resulting anti-Muslim sentiments led to intense violence and deaths of thousands of Muslims and destruction of their homes and property, in the state of Gujarat.  In his last years in the parliament, ABV made last efforts to achieve peace with Pakistan, he also visited China and China-India relations improved greatly. ABV’s government introduced many domestic and economic and infrastructural reforms to encourage foreign investments, reduce governmental waste and encourage R&D and privatization of government owned corporations and introduced efforts to improve quality of education. ABV was recipient of Bharat Ratna, India’s highest award for exceptional service.

Beverly HIlls, California, USA; May 28, 2008; Republican Presidential Candidate John McCain speaks during a press conference at the Beverly Hilton.John McCain: Although generally a conservative, McCain disagreed with his party, when guided by his conscience to do so. Most recent example was when he voted against the repeal of #Obamacare. He was a member of bipartisan “Gang of 14”. McCain made campaign finance reform one of his signature concerns that eventually led to passing of the McCain–Feingold Act. McCain also chaired the Senate Commerce Committee and opposed pork barrel spending. McCain lost his party’s nomination for president once to George W. Bush and once he lost his bid for the highest office to Barack Obama. McCain invited both his previous opponents Bush and Obama to give eulogies at his funeral. That is a mark of a man who does not hold grudges and seeks to build bridges. When McCain served in the Vietnam war, he endured fractures and almost drowned and was then captured by the enemy in 1967. He was held by the enemy forces for over 5 years. When his father became commander of US forces, the enemy offered to release him but McCain refused saying “I will accept neither parole nor special favors from the enemy”. As a prisoner, he endured severe solitary confinement, had dysentery, was repeatedly tortured, severely beaten (once on a schedule of every 2 hours), and planned to commit suicide when he reached his breaking point. McCain survived, became a vocal opponent of extreme torture, and later joined politics. McCain married his first wife Carol, adopted her two children and had a daughter. But after his return from Vietnam, both had changed, he had extra marital affairs for which he took full responsibility and later he and his wife amicably divorced and he married his second wife Cindy in 1981. Cindy and John had three children and later adopted a girl from Bangladesh and named her Bridget. McCain was recipient of several awards. McCain’s many contributions and his often choosing to be guided by his conscience rather than by party and politics were mentioned and remembered today by his many friends, as he was laid to rest.

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Life Science and Investment Partnership Opportunities with China – 2015 OneMed Forum & OneMed China Forum


Opportunities and challenges for life science companies, in working with China, was a big focus of OneMed Forum, 2015.  OneMed Forum 2015, took place at the same time JP Morgan event was happening in San Francisco.

USS San Francisco (CA-38) entering San Francis...

USS San Francisco (CA-38) entering San Francisco Bay under the Golden Gate Bridge, December 1942. The structure on the lower left is Fort Point. This picture was taken December 11, 1942, as the USS San Francisco, severely damaged in the Naval Battle of Guadalcanal the previous month, returns to her namesake city. The ship was en route to the Mare Island Navy Yard for repairs. (Photo credit: Wikipedia)

The OneMed Forum conference with a mission to bring healthcare companies and investors together, opened on January 12, 2015 with a panel that discussed Opportunities in China.  China has seen a very rapid economic growth that has spurred tremendous interest in investing in promising products and technologies, particularly in the healthcare arena.  This panel explored strategies to access the Chinese market.  There was a lot of stress on getting local partners early on.  The panel also discussed deal structure alternatives for companies looking to secure capital, as well as licensing and distribution opportunities in China.  (PS – please see link  http://bit.ly/Zcwxqi  for Life Science job opportunities in China)

After OneMed Conference ended on January, 13th, OneMedChina conference occurred at the same venue.  After the opening remarks by Tony Chu, Founder and Partner with The Pharma Partners, a panel discussed a topic of great general interest “Investing in America”.  It is no more that American companies are chasing Chinese investors, but also many Chinese investors are actively seeking investment opportunities in North America and Europe, particularly in the healthcare arena.  There is a great deal of interest among Chinese investors in technologies that would address Chinese and global markets.  The panel of experts included, Mr. Kevin Chen, Partner and Head of Healthcare Investment, Sequoia Capital China, Mr. Xiangyu Ouyang, Partner & Head of Healthcare Investment, Legend Capital, Dr. David Wang, Partner, OrbiMed China and Mr. Edward Zhou, Partner and Head of Healthcare Investment, New Horizon Capital.  The panel shared insights on investment strategy to follow and shared their current global investment focus.

Next panel on “How to build a successful partnership with a Chinese company” was represented by Dr. Sanuj Ravindran, Global Head of Business Ventures, The Medicine Company and Mr. Andrew Wong, VP of Business Development at SciClone Corporation.  Both panelists stressed the need for local partners.  Wong said that hiring a local advisor will help bridge the culture gap.  Ravindran stressed the need to get on the ground and spend some time to get business and cultural understanding for such partnership to get off to a good start.

These panels were followed by lunch with extended networking time.  Rooms for one on one discussions between investors and companies were also available.

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JPM 2014: Keynote by General Michael Hayden, Former Director, NSA & CIA


Three days before President Mr. Obama announced changes in NSA and limitations to Government access to phone data, participants at 32nd Annual J. P. Morgan Healthcare Conference in SF, had an opportunity to listen to the luncheon keynote address given by General Michael Hayden, former director of National Security Agency and Central Intelligence Agency. See below some highlights from the talk.

Traditionally lunch keynotes at JPM conference have been given by conservative political figures. Hayden is known to have headed the super secret agency from 1995 to 2005 and oversaw some of the controversial programs that followed 9/11.  He has always defended them as effective and proper.  At JPM keynote however, Hayden did not give his opinions but mostly discuss the increasing complexity in the world, where the choices are limited and equally complex, with varying ramifications.

Hayden painted a realistic, complex, and scary picture of the world.  In the new hyper connected world, the boundaries are less defined, said Hayden.  Previously, it was easy to classify the world into domestic and foreign; intelligence and law enforcement.  However, geographical and other boundaries are not that well marked, in this new world.  Today, a security establishment tries to defend the nation against threats that do not neatly fit into domestic or foreign, said Hayden.  To bolster his argument, he quoted the example of Edward Snowden’s actions and its wide ranging implications.

Hayden also said that US has parted ways with its allies a while back.  For instance, while US believes in the use of force, our allies believe that its usefulness is limited.  In the US, law is not concerned with privacy issues of an individual who is not a US citizen.  Whereas in Europe, there is a broader sense of expectation of privacy as a sacred human right, said Hayden.  “Values matter and we have fundamental value differences with our allies”, said Hayden.

Speaking of China, he said, China does not present any major threat to the us because our economies are deeply integrated, with the Chinese economy more dependent on the US than the other way around.  In the coming years, China will face huge labor shortages, due to its one child policy.

Speaking about Al Qaeda, Hayden said, it is not a group, but a movement, focused on scaling “a leaderless jihad”.  Al Qaeda represents some of the toughest choices.  If the US is too tough, too soon then it may be able to squash trouble, before it becomes bigger, but on the other hand, an early use of force can turn people against the US, said Hayden.  In some regions, Al Qaeda only focuses on local grievances and not on the US.  If the US goes there to squash the group in its infancy then it can snuff out the trouble before it begins or it might end up focusing the groups efforts on the US as its new enemy.  Also how the US defines a problem can affect the adoption of the strategy.

Hayden also gave his opinions on his former boss, President Mr. Bush as well as on President Obama.  President Bush’s style was Wilsonian and Jacksonian, said Hayden.  When it came to dealing with external threats, President Bush was an idealist and aggressive and he tended to be rhetorical.  President Obama is also Wilsonian, in that he is idealist and rhetorical.  But additionally, he is Jeffersonian, a thinker, said Hayden.  Hayden is believed to have said before that it is important to understand the scary world we live in and keep a focus on safety, while also protecting civil liberties.  I would have loved to hear his perspectives on how these competing issues would be balanced.   Instead, Hayden focused on sharing his thoughts on the complex set of challenges that the government or the government security agencies like the NSA and the CIA face on a daily basis and discussing how any choice they make could put them on a path of novel set of choices and challenges.

Michael Hayden, director of the CIA.

Michael Hayden, director of the CIA. (Photo credit: Wikipedia)

The seal of the U.S. National Security Agency....

The seal of the U.S. National Security Agency. The first use was in September 1966, replacing an older seal which was used briefly. For more information, see here and here. (Photo credit: Wikipedia)

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Xi’an – Terracotta Warriors & Ancient City Wall


Xi’an is capital of Shaanxi province in Western China. It has more than 3000 year history. At one time, most important connection between the East and the West was through China’s Silk Road, where goods (which included a lot of silk) traveled from East to West. A great deal of cultural exchange occurred through the Silk Road. Xi’an is the starting point of the Silk Road. And now it has become more famous after the discovery of the Terracotta Army of Emperor Qin Shi Huang.

IMG_1479Our cultural knowledge also was enhanced in Xi’an. On the first day, we visited the ancient wall that surrounds the city. It is absolutely beautiful. We also visited the Great Wild Goose Pagoda. In the evening, we went to a show that depicted emperor Huang’s dynasty. My friend and I decided to walk back to the hotel instead of riding back with the tour. At several places, people were doing Tai Chi or were dancing and at couple of places, I joined in the fun and found the people to be very welcoming.

Next day, we visited the Terra Cotta Warriors. Emperor Qin’s Terracotta pits are located 1.5 kilometers from the emperor’s mausoleum. The pits were never mentioned in the historical records and at one time pillaged and wrecked and then remained buried until 1974. In 1974, a farmer was drilling a well and happened to come upon them. When President Clinton visited China, he wanted to meet this farmer and the farmer was apparently taught some English and some easy answers – like how are you, I am fine, me too etc. When Mr. Clinton shook his hand and told him “I am Bill Clinton”, the poor farmer replied “me too”.

Many people consider the Terracotta pits to be the Eighth Wonder of the World. And they are truly amazing. The largest pit measures 230 meters in length and 63 meters in width. The works is endless and still ongoing to excavate and restore the warriors. It is assumed that 6,000 warriors and horses will be unearthed from this pit alone. All the statues are life size and exquisitely made. About 40,000 bronze weapons have been unearthed from the pits. They are exquisitely made and coated with chrome-saline oxide coating, which protected the sharpness of the weapons and retained their shinyness.

The emperor has to be a complete megalomaniac to have built such an huge army to be buried, when he died. Obviously it makes something quite uncomprehendingly amazing for future generations.
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2013 Year-in-Review – Year about expanding perspectives & moving out of comfort zones


Previous years’ turmoil continued in 2013 with debates around healthcare, privacy, race, gun control, weather and more, coming to a boiling point.  Everyone was persuaded to move out of their comfort zones, from Paula Dean (on race remarks) to those shocked by Sandy Hook shooting and Boston bombings (would gun control have an impact on curbing mass violent acts) to Obamacare (so many mishaps and jury is still out in terms of long term impact) to Pope St. Francis of Assisi (if Pope is sounding more like Jesus and embracing humanity, how are those entrenched in the church’s doctrine and dogma to make sense with any of it) to archaic “stand your ground” laws.  World events also compelled national leaders to expand their perspectives and confront moral issues around Syria (as the world sits by helplessly, a country of 21M has created 2M refugees and 120,000+ have died), China (flush with economic power, flexing its muscle), enormous legacy and impact of Nelson Mandela (lesson to insist on justice and then follow it with compassion and forgiveness).  And Mr. Obama has communicated that US delegation for upcoming Winter Olympics in Russia will include America’s openly gay athletes.  If storms and typhoons are any indication of winds of change, they were blowing stronger than ever, towards the year’s end.  Nearly 4000 people lost their lives and 4.4M people were displaced by super typhoon Haiyan, in Philippines.  In the US, tornados, thunder storms, black ice, freezing rain, and power outages, briefly turned the concern over from global warming to global freezing.  Winds of change are felt by many, as the job market has gotten stronger, housing market has markedly improved, stock market has rallied, hiring has continued to pick up pace and unemployment has fallen to 7%.  Yeaaaaaa!!!!

As the year draws to a close, as a recruiter (focused on life science, biotech, and medical device companies that were lagging behind in the recovery), the pace of hiring is making me very busy and quite happy.  Please see my opportunities in JOBS category of my blog www.darshanavnadkarni.wordpress.com and send resume to wd_darshana at hot mail dot com.  The year was anything but uneventful, for me.  I saw nearly two dozen plays (check out my reviews in the Play category), countless movies, read many books, attended book clubs, attended many conferences and talks (many of which I have written about on my blog), and attended many wonderful Gujarati music events (on which I have written in Gujarati). As a certified blogger, as member of the “press”, with my complementary tickets to live theater, conferences, and other events, it has been a great pleasure to spread the love and introduce many friends to the joys of quality entertainment and other events and I have interacted or have gotten mentioned by actors, directors, authors, and got mentioned in ads.  It’s been a fun ride.

Both of us, my daughter, Neesha and I traveled.  Neesha completed the last semester of this year, in a study abroad program, at Glasgow, Scotland.  California girl absolutely loved Scotland, despite the weather!  She also traveled to London and met the huge Kothari clan and many cousins (my mom’s side of the family), and traveled to Ireland (also loved it) and greatly enjoyed learning Scottish dancing.  Neil is busy and IT is his life, so he says.  My mom is doing well and I am grateful to the angels watching over her.  I took absolutely delightful Mediterranean cruise and visited gorgeous islands of Greece (Athens, Mytilini, Mykonos, Heraklion) and mystical Turkey (Istanbul and Kusadasi).  And then I went on yet another fantastic tour and visited amazing China!  While the Mediterranean cruise tickled the senses, the trip to China, at the year’s end, expanded the senses.  (Do check out my travel writeups on my blog, – a new category that I started this year).

Wish you a wonderful holiday season at the year’s end, and an absolutely fabulous journey and many blessings in 2014.
Darshana
SANYO DIGITAL CAMERAIn Turkey, 2013

Glasgow bid logo

Neesha was in Scotland Glasgow bid logo (Photo credit: Wikipedia)

Neesha was in Scoland and D in Forbidden City, Beijing, China
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China Tour – The Great Wall


China Tour was truly an amazing, inspiring, awesome experience. Majority of my travels take me to ruins and old civilizations. In China, even the ruins (the Great Wall, Terracotta Warriors) are not totally in ruins or are in various stages of restoration. That progress is everywhere. Skyscrappers doting the skylines in major cities point to architectural beauty and something fundamentally progressive. China has literally taken its billion people and housed them. Compared to India (I hate to say this but without acknowledging, how is India going to progress, where there are indeed huge pockets of progress), China has made huge progress in infrastructure and in improving the standard of living. In India, many of its billion people are sitting, squatting, living on the streets. Indeed in China, there are the “ghost cities” (fully constructed empty cities indicative of a housing bubble). But apart from that, people are in homes. You rarely see crowds or trash (with the exception of roads clogged with auto traffic). And with the exception of shoving (which seems to be culturally ingrained), people are disciplined and follow rules and put trash in trash cans. Compared to India, China is squeaky clean, and it is addressing the smog problem. What amazing progress!

Just to be fair, let me mention that India is perhaps the only country in the world that has maintained a lively, engaging democracy, throughout all the ups and downs, after the colonial powers left, in 1947.  As one of the four SICK (Syria, Iran, China, N. Korea) countries, China on the other hand, blocks Facebook and curtails freedoms of social expression.   I will discuss in another blog some thoughts on democracy, socialism, ability to vote versus having a roof over the head, what truly may define progress and give a nation competitive leverage.  But for now, I am sharing below, a little about the incredible Great Wall of China.

The Great Wall

Climbing the Great Wall of China is a great experience :). The Great Wall built from east to west across the northern border of China was meant to protect the Chinese empire against intrusions by hostile military or nomadic groups or to keep track on transportation of goods and for collection of taxes for goods traveling along the Silk Road, and to keep track of immigration and emigration. Several walls were built and later joined together and made bigger and stronger. Most famous one was built between 220-206 BC by the first emperor of China, Qin Shi Huang who united China. Most of existing wall was reconstructed during the Ming Dynasty. According to one estimate, the entire wall measures up to 21,196 km or 13,171 miles.

The day we toured this site, it was incredibly cold. I climbed half way past post 9 (it goes to no. 13). The climb is arduous, steep and when there are steps, they are high. Besides being so cold, the wind was so ferocious, you almost fear that it will pick you up from the climb and throw you down into the valley. I decided (very wisely) to not push it and to turn around at that point. At the base there are curio shops, coffee shops, and a little museum like place, or one can walk to the other side of the wall, where there is Lop lake. The Great Wall was a major highlight of the tour. It is enormous, gigantic, well maintained, and beautiful vistas all around are breathtaking.  

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The Piano Teacher by Janice Y. K. Lee – Book Review


The Piano Teacher is a story of British, American and other expats in Hong Kong and the local wealthy Chinese who were all caught in a tremendous struggle for survival, during the Japanese occupation in the early 1940s.

Historical Background
In March 1939, Japan dropped bombs on Hong Kong territory, destroying a bridge and a train station.  Japanese occupation of Hong Kong began in December, 1941, after 18 days of fierce fighting against imposing Japanese forces who invaded the territory.  The occupation lasted for 3 years and 8 months, when Japan surrendered at the end of the Second World War.

All the characters are caught in a complicated struggle for survival during extremely brutal Japanese administration during the occupation.  There is a constant tug between integrity and submission, for the sake of survival.  The story is interesting and is placed in a historical context that is important and yet not a lot is written about it.  There are times when the author gives interesting insights into the characters.

Some aspects of the story emerge with clarity and are interesting.  For instance, during 1940s and 1950s, the extent to which stereotypes and prejudices played a role, in an outwardly diverse place like Hong Kong, is interesting.  “The Indians had been brought over by the British, of course.  Pakistanis ran carpet stores, Portuguese were doctors, and Jews ran the dairy farms and other large businesses.  There were English businessmen and American bankers.  White Russian Aristocrats, and Peruvian entrepreneurs – all peculiarly well traveled and sophisticated – and of course, there were the Chinese, quite different in Hong Kong from the ones in China”.  Similarly when occupiers came, they divided the immigrant population by race and accordingly assigned living quarters and other privileges.  Author has done good research to convey the brutality of the occupiers and their impact on innocent people.

But unfortunately, there are many limitations.  The book meanders and the real plot begins only after a reader sticks through slow moving and boring beginning.  There is too much of vague dialogue that seems to be going nowhere, there are portions of the book that do not flow well.  The characters are not well developed and they lack depth.  There isn’t a single character that a reader can identify with, root for, and turn the pages to see the character survive the occupation.  This is a huge limitation in the book.  The occupiers are clearly bad, brutal, and loose in the end.  That part of the story is very clear and well developed.  Almost any reasonably well told story would have had survivors that a reader is rooting for and is eager to see them come through this horrific ordeal.   Character’s humanness and limitations would only make them more real, not distant.  But characters in the book feel too distant.  As a reader, you feel no empathy, no dislike, no hope, nothing for them.  Then there is the piano teacher.  The book has her title but she has no role whatsoever.  The story could have been told without her presence.

The story just does not grip you in anyway whatsoever.  You flip the pages and it matters little how it will end.  It is extremely disappointing.  This is a story with an exciting plot and tremendous promise that simply failed to live up to its potential.        

Japanese soldiers arrested the western bankers...

Japanese soldiers arrested the western bankers and kept them in a Chinese hostel. (Photo credit: Wikipedia)

   

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Syria Conundrum and the US response


Syria has presented an interesting conundrum for the US.  For over 2 years, charming Syrian dictator who is also a ruthless murderer, Bashar al Assad has laid siege upon his own people and has systematically massacred over 100,000 civilians, and millions have become refuges.  World watches helplessly.  What is a US president to do?  Welcome to the 21st century, where American mindset will prove lacking, unless we embrace complexity and uncertainty.

We in the US, like clear problems that have clear solutions.  We do not like shades of gray.  We like our leaders to be decisive, not reflective.  And we just do not understand the complexities that exist in many parts of the world, except in a perfunctory manner.  For instance, we can rattle off statistics about how many languages are spoken in certain parts of the world; we can talk about gender differences in parts of the world; we can speak about class dynamics.  What we do not understand are the underlying reasons that make it so; the stakeholders who want to preserve the status quo and why; those who clamor for change and how they are in no way different from any of us in the US, in terms of their tech savvyness, their English speaking skills, and who may be more savvy in terms of their cultural insights.  

President Obama has been criticized for the “zig-zag” nature of his policy, in response to Syria.  I will however, go out on a limb, and say that this is exactly what we need from our leader in the new, global, multicultural world fraught with enormous complexities and serious challenges; a world that does not present clear problems and one that is much less ready for clear, decisive solutions.  This is not a world where one sentence rhetoric that says, let us capture Bin Laden “dead or alive” will work.

In fact just to make my point with clarity that the Americans so love, I am going to quote some Bushisms below.
“Removing Saddam Hussein was the right decision early in my presidency, it is the right decision now, and it will be the right decision ever.” –George W. Bush, Washington, D.C., March 12, 2008
“Wait a minute. What did you just say? You’re predicting $4-a-gallon gas? … That’s interesting. I hadn’t heard that.” –George W. Bush, Washington, D.C., Feb. 28, 2008
“Let’s make sure that there is certainty during uncertain times in our economy.” — George W. Bush, Washington, D.C., June 2, 2008
“Oftentimes people ask me, ‘Why is it that you’re so focused on helping the hungry and diseased in strange parts of the world?'” –George W. Bush, Washington, D.C., April 18, 2008

The thing is that world is not so strange to a lot of people who not only have stepped out of their homes and their comfort zones and traveled places and mingled with people vastly different from them.  Additionally, with technology people can make little google guy on street view walk and go places for them and people do research on wikipedia and they use skype, telepresene, go to meeting, webex and other technologies to bring the world closer and there are no far-away, “strange” places.  The thing is that removing any dictator or an abuser of human rights is neither a fully right decision and nor is it a completely wrong one.                                                                                                             

Consider the competing priorities that the President of the US must manage.  In this new world, the US cannot act as a cop and neither can the US remain a helpless bystander.  The US President, commander-in-chief of the armed forces cannot simply ignore Assad’s blatant refusal to follow the rules previously agreed upon by 190 odd countries, regarding the ban of chemical weapons.  But neither can the President of the US ignore the fact that Americans are tired with war and they do not want their leader calling them to make sacrifices, especially in the face of so much uncertainty.  The US cannot ignore the moral imperative to intervene; if the US does not escort the moderates now than it is less likely we will find them later.  Nor can the US ignore the national interest argument of Assad gone mad and his people pouring into the neighboring regions; more countries and groups may stockpile such weapons and use them and someday they could be used against the US.

President Obama’s considered response – actually responses, his willingness to come forth and present the argument to the American people, his reluctance to jump into war, his willingness to get support from the Congress, his flexibility to change the course of military action, all this is precisely what we need in a leader who must weigh the competing complexities, not just once, but on a daily and hourly basis.  And despite this, the President is neither waffling, nor has run out of options. 

President Obama has warned the Syrian dictator, over and over that the world is watching and keeping track of his human rights abuses.  Assad was warned regarding the use of chemical weapons.  The president has gone and discussed with the world leaders; though the countries do not want to intervene, there is tremendous tacit support in the world, and huge disapproval of Assad’s actions.  The president has gotten solid evidence of use of chemical weapons by Assad, has sought approval from the Congress for military strike, and the president has explained to American people and ensured us that there will be no boots on the ground, that we will not be called upon to make significant sacrifices, when we have our own priorities and challenges to deal with.  And now, another dictator, Vladimir Putin has come forth, to help the process of negotiation and Mr. Obama has also entertained that.  At this point Mr. Obama has built the most solid case that if he uses military might, it will only be after he has tried every other option and the objective will be to strike strategically Assad’s control and command posts, with an objective to weaken him, without putting boots on the ground.

Now let us also answer those who say that military strike to weaken Assad is an action that is too little, too late.  Middle East is a complex region.  There are many voices, many stakeholders; there are many who suffer deeply and there are many who bestow deep suffering onto others.  Going into that region with an idea to fix something, to take a dictator out, to support a friend, to hurt a foe, to broker a peace, will never have intended consequence because every action from outside, generates equal and opposite reaction from inside.  However, what we can do is to give a blow to anyone flaunting violating an agreed upon treaty, a few precise air strikes that send a strong message that you can get away with only so much before the world will take notice of your actions and send a punishing message.  This action, while conveying a message to Assad, also would convey a message to the rebels that if they stay focused and disciplined than the world will not completely forget them and they have friends outside who are committed to seeing the atrocities stopped.  It is nice to have moderate friends in that region.  It would give a psychological boost to the rebels and we would hope that some of them are moderate.  Strategically, it would keep the situation from spiraling completely out of balance, a situation where Assad’s side could get so powerful that they may completely wipe out the other side from every raising its head.

We know what happens in situations that spiral out of balance.  The examples are many and they are heartbreaking – Armenian genocide by the Ottoman Turks, after World War I; rape of Nanking, China, by the Japanese in 1937; atrocities against the Jews in Nazi Germany, before the end of world war II; civil war that wiped out its entire educated population, in Cambodia, in 1970s by Pol Pot led Khmer Rouge; Muslim genocide in Kosovo in 1990s, under the leadership of all too powerful Slobodan Milosevic; genocide and slaughter of the Tutsis by the powerful Hutus in Rawanda, in mid-1990s.  Atrocities committed by Assad regime are nearing that kind of epic proportions.  And he has one chance now to deliver and destroy his chemical weapons.

Vladimir Putin has also made a mockery of human rights in Russia.  And now he has an opportunity to emerge as a politician of some stature, not just by sending in an op-ed piece, obviously written by someone else; but by bringing value to the table in getting Syria to hand over its chemical weapons stockpiles over to the international community.  Syria, better pay heed, that the country that cherishes democracy, seeks to stop human rights abuses, embraces the weak, and the children, is not soft at its core; it has mettle and is committed to its principles and it will not sit idly watching this ruthless man massacre innocent children.  And as for us, to operate more effectively in the complex, smaller, new world, we better learn to become comfortable with lack of certainty, fuzziness and shades of gray; we’d better learn some flexibility and adaptability; and we’d better understand that we live in a global community.  If TB and Bird Flu can travel across countries with great speed, so can chemical and biological weapons, and there is a reason that most of the world has made a pact to banish such weapons of mass destruction. 

An enlargeable map of the Syrian Arab Republic

An enlargeable map of the Syrian Arab Republic (Photo credit: Wikipedia)

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Impact of Emerging Healthcare Changes on Medical Device Industry


Hospital

Hospital (Photo credit: José Goulão)

Reenita Das, Partner, Healthcare and Life Sciences at Frost and Sullivan, talked about worldwide transformation that is happening in healthcare, and its impact on medical device industry, at www.bio2devicegroup.org event.

What is taking place right now is a massive global remix, with merging of disciplines, cross pollination of ideas, technology, and applications.  With the shifting of the boundaries, a new world is emerging, said Das.  The business model is shifting from one size fits all, provider centric, procedure based, capitated model to personalized, patient centric, bundled, value based approach to healthcare.  Unlike previously fragmented approach, hospitals and payors will increasingly look at more decentralized, community based, integrated approach to treating diseases where the focus will be on preventing diseases, not on treatment of diseases, said Das.  This is a new reality where hospital will not be the first, but the last option, in disease management.

Currently, 80% of dollars are going into treating 20% of the population, over the age of 65.  There is a shift under way to move cost of dollars from end stage to “at risk” patients and that will be a bitter pill to digest for companies that are reaping profits from treatment of chronic diseases.  As the focus grows on moving away from treatment, after the disease progression, to moving towards earlier prediction with an aim to improve the quality of life, the medical device industry will be impacted with shift in dollars.  In order to improve the quality of life, it is important to have earlier screening with better prediction of susceptibility to certain diseases, so as to begin preventive treatment earlier.  Dollars will move away from medical devices that focus on treatment to those that focus on monitoring, diagnosis, and prediction.  In 2012, 60% of healthcare dollars were spent on treatment of diseases and only 19% went into diagnosis.  Das said, in 2025, only 35% of the dollars are expected to go towards treatment, while 27% will go towards diagnosis, 22% towards prediction, and 16% in monitoring of disease progression.  Das’s advice, “don’t compete in the treatment space, it is becoming smaller.”                   

As Asia emerges as a major focus for healthcare spending, there will also be a greater focus on holistic way of treating diseases.  Between 2010 and 2020, healthcare expenses in the US will be $3922 billion.  But spending more money does not translate into better healthcare and there will be increasing pressure to spend less.  Simultaneously, there will be growth in healthcare spending in Asia, with $1446 billion of healthcare expenses in China, $331 billion in India, $31 billion in Vietnam and so on.  Asian hospital brands will become global brands, in the next ten years and emerging markets will also become very competitive, with increasing interest in “reverse innovation”, where cutting edge cost effective innovations in developing countries, will be then brought to US and other Western markets.  Between 2010 and 2020, Asia is likely to grow 150%, said Das.

Developing countries are emerging as meccas for cost effective healthcare.  Additionally, they are making better and more widespread care available to indigenous populations.  China, for instance, has eliminated the definition of poverty, as it has eliminated poverty.  By 2020, China expects 100% healthcare coverage for all Chinese people.  BRIC represents 2.9% or 40% of world’s population.  These and other emerging group of nations will likely influence innovation, choice, and spending on healthcare.

Business process change will emerge as one of the biggest challenges in healthcare.  What was once a payment is now a cost, what was once a cost is now a potential savings.  Data will emerge as the holy grail, as everything becomes data driven.  There will be focus on data integration and democratization of data.  There will be an emphasis on risk sharing and focus on mobility and security of informationPatient engagement is a challenge that will have to be addressed, to close the integration gap.  Currently, majority of the patient portals provide secure access to medical records, and ability to schedule appointments, refill prescriptions, and so on.  However, there has been little success in achieving behavior modification, individualized outreach, efficient platforms to enable search and access of relevant information, efficient platforms for social media interactions, efficient platforms for mHealth applications and so on.  So lot of work needs to be done.

How will the changes impact how medical technologies are evaluated and purchased?  With increasing cost pressures, there will be a shift in payments based on quality plus cost and focus on value over volume and procedure based reimbursement.  This will bring new challenges with respect to new pricing models, cost of adoption, impact on workflow, integration of information, and slower adoption of new technologies.  Decisions will be increasingly made by committees of finance people, in addition to the clinicians.  As purchase decisions move away from clinicians to hospital administrators and products increasingly become commoditized, US will shift from being exporter to importer of medical technologies.  The new realities will make it imperative that companies fail fast.

Where are IT solutions are failing to reach the holy grail, in the realm of data?  There is lot of data being generated and there are also predictive analytics.  However, data integration is lagging behind.  Currently, data is provided in separate solutions.  Additionally, the predictive analytics are not translating into action.  So although the technology has arrived and applications are available, solutions are not there.  There will also likely be fewer employer contracted health plans as more employers like Sears and Olive Garden choose to offer cash for plans or money to pay for healthcare.  This trend goes along with the fact that one size does not fit all and there has to be personalization of healthcare coverage.

There is also more cross industry convergence between healthcare and other industries like automotive, information technology, energy and so on.  The top five technology trends are 1) Interoperability that can bring new technologies capable of integrating medical devices into a connected platform to enhance functionality and minimize errors; 2) Multifunctional; 3) Capable of Big Data integration to enhance functionality for diagnostic and treatment devices; 4) Low-Cost; and 5) Nanotechnology that provides benefits biocompatibility, and functionally at an unparalleled scale and is better able to influence diseases at a cellular level.  Das predicted, there will be growth in the areas of structural heart, robot assisted technologies, infection control, home health care, and neurological devices.

Finally, just as you accumulate miles for travel, customers will accumulate miles for better health.  As healthcare become increasing data driven and there is increased use of analytics to define care pathways, there will be incentives for patient engagement, greater use of remote health monitoring and mobile apps, and new care models will emerge based on collaboration, information exchange, awareness, and achieving health outcomes, particularly in case of chronic diseases.

Das’s comprehensive informative presentations generated many questions and was followed by Q&A.

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